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 his 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 hemorrhage, and purtscher flecken spreading around the optic disc in the right eye. He was diagnosed with Purtscher-like retinopathy because of the absent reports of any traumatic medical history. OCT presented some band-like hyperreflective lesions at the layer of inner nuclear layer known as paracentral acute middle maculopathy (PAMM). OCT-A revealed apparent reduction of blood flow signal at the layers of deep retina and choriocapillaris with a pattern of honeycomb-like hypointense signal. After 3-month follow-up, OCT scan showed a resolution of retinal edema, but the PAMM lesions were still visible. OCT-A presented the honeycomb-like pattern turned into a homogeneous reduction of blood flow with small patches of hypointense signal areas in choriocapillaris. Conclusion This case presented a new OCT-A sign in Purtscher-like retinopathy with a honeycomb-like hypointense signal at the layer of choriocapillaris indicates the involvement and the ischemia condition of the choroid in its 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.…”

“…Li et al conjectured that this choroidal lobular infarction was the causative pathogenesis for lack of visual recovery in their patient. 4 However, our patient's OCT-A showed reduced blood flow in a pattern that more closely resembled the infarction in corresponding superficial retinal layers. Our patient also showed significant ischemia on initial imaging but regained vision almost completely, thus misaligning any prognostic inferences that could be made from OCT-A.…”

“…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.…”