Purtscher's Retinopathy After Cardiopulmonary Resuscitation: A Literature Review

Abstract

Purtscher's retinopathy is a rare angiopathy reported in patients with a history of severe trauma and other systemic diseases. The diagnosis is made on clinical grounds, and the severity varies. A 41-year-old gentleman with underlying poorly controlled diabetes mellitus and dyslipidemia was referred to the ophthalmology department for diabetic retinopathy screening. He denied visual complaints. Ocular examination revealed a negative relative afferent pupillary defect with a visual acuity of 6/6 bilaterally. The anterior segment examination was unremarkable. Both eye (oculus uterque, OU) fundus revealed a pink disc with a cup-to-disc ratio of 0.4 and peripapillary flame-shaped hemorrhages. Right eye (oculus dexter, OD) also showed multiple cotton wool spots along the superotemporal arcade involving zones 1 and 2 of the retina, while left eye (oculus sinister, OS) showed a single cotton wool spot along the superotemporal arcade at zone 1 of the retina. Otherwise, there were no visible retinal emboli, dot hemorrhages, or hard exudates, and the macula was normal. The retinal features were not characteristic of diabetic retinopathy. It mimicked hypertensive retinopathy, but the patient was normotensive. The absence of inner retinal thickening and hyperreflectivity on optical coherence tomography of the macula ruled out retinal vein occlusion. This prompted us to elicit further history, and the patient disclosed a recent admission for myocardial infarction in which he received cardiopulmonary resuscitation with chest compressions for seven minutes. Hence, the diagnosis of OU Purtscher's retinopathy was made, and the patient was monitored closely in the clinic. Purtscher's retinopathy remains a diagnostic dilemma and should not be neglected in complex clinical contexts.

Clinical features of retinopathy after cardiopulmonary resuscitation

“…However, according to results of these studies, when abusive head trauma was excluded, retinal hemorrhage associated with CPR was confirmed in 1 out of 43 children by Odom et al [ 5 ], 1 out of 22 children by Pham et al [ 6 ], and 1 out of 38 children by Binenbaum et al [ 7 ], and the average prevalence was approximately 3.3%. Retinal hemorrhage associated with CPR in adults has been reported in only a few cases [ 13 , 14 ], and its prevalence is unknown. As our study was retrospective and investigated patients who visited the ophthalmic clinic with various symptoms, it was not possible to confirm the exact prevalence.…”

“…The concerns about injuries or adverse effects caused by CPR have increased with the increase in successful CPR [ 4 ]. However, there are only few studies on ophthalmological changes after CPR [ 5 – 9 , 13 , 14 ].…”

“…Thus, it is necessary to study the clinical findings of the retina after CPR. However, there are only few case reports on retinopathy after CPR in adults [ 13 , 14 ], and no comparative study has been conducted on retinopathy in adult patients who survive after CPR.…”