Purtscher-like retinopathy presented a honeycomb-like pattern in optical coherence topography angiography

Abstract

Background: To report a case of Purtscher-like retinopathy (PUR) and the optical coherence tomography (OCT) and OCT angiography (OCT-A) findings before and after treatment. Case presentation: A 65-year-old male presented with acute onset of vision loss for 2 weeks. Fundus examination revealed cotton-wool spots, retinal haemorrhage, and Purtscher flecken spread around the optic disc in the right eye. He was diagnosed with Purtscher-like retinopathy because he lacked any traumatic medical history. OCT presented some band-like hyperreflective lesions at the inner nuclear layer, which are indicative of paracentral acute middle maculopathy (PAMM). OCT-A revealed apparent reduction in blood flow signal at the deep retina and choriocapillaris layers with a honeycomb-like hypointense signal pattern. After 3 months of follow-up, OCT revealed resolution of retinal oedema, but PAMM lesions remained visible. Based on OCT-A, the honeycomb-like pattern turned into a homogeneous reduction in blood flow with small patches of hypointense signal areas in the choriocapillaris. Conclusion: This case presented a new OCT-A sign in PUR with a honeycomb-like hypointense signal at the choriocapillaris layer, indicating the involvement and ischaemia of the choroid during the pathological process.

Multimodal imaging findings in Purtscher-like retinopathy after retrobulbar anesthesia

“…2,[6][7][8] There are few case reports of Purtscher-like retinopathy accompanied by OCT-A images, but, to our knowledge, none in association with retrobulbar anesthesia. 4,9,10 Similar to the imaging in the study by Li et al, our OCT-A showed poor perfusion of the inner retinal vascular plexuses and a honeycomb-like hypointensity in outer retina/choriocapillaris layers. 4 These ischemic areas corresponded to the Purtscher flecken noted in the inner retina.…”

“…4,9,10 Similar to the imaging in the study by Li et al, our OCT-A showed poor perfusion of the inner retinal vascular plexuses and a honeycomb-like hypointensity in outer retina/choriocapillaris layers. 4 These ischemic areas corresponded to the Purtscher flecken noted in the inner retina. Li et al conjectured that this choroidal lobular infarction was the causative pathogenesis for lack of visual recovery in their patient.…”

“…2,6–8 There are few case reports of Purtscher-like retinopathy accompanied by OCT-A images, but, to our knowledge, none in association with retrobulbar anesthesia. 4,9,10…”

“…OCT-A showed inner retinal capillary bed ischemia and outer retina/choriocapillaris hypointensity in a honeycomb-like pattern (Figure 2, A–C), similar to a case in the literature. 4 A presumed diagnosis of Purtscher-like retinopathy was made, and the patient was given topical steroids, nonsteroidal anti-inflammatory drops, and antibiotic drops.…”

Purtscher-like Retinopathy in a Patient with Systemic Sclerosis: A Case Report and Narrative Review

“…Histopathology and electroretinography results and late changes at the RPE level visualized upon SD-OCT and described in the literature provide further evidence of choroidal involvement in PUR/PRL [ 6 ]. Other studies have suggested that a honeycomb-like hypointense signal from the choriocapillaris layer on OCT-A indicates the involvement of the choroid with ischemia [ 24 ]. A hypointense signal pattern in the choriocapillaris layer observed on OCT-A was also found with our patient, most likely as an artifact projection from the retinal layers.…”