Neovascularization in Purtscher's retinopathy

Abstract

We report a case of neovascularization secondary to Purtscher's retinopathy that showed minimal improvement with photocoagulation treatment. A 14-year-old boy with a history of cerebellar medulloblastoma presented with blurry vision and floaters after being struck by a motor vehicle while riding his bike. At presentation, visual acuity was 20/400 in his right eye and counting fingers in his left eye. Fundus examination showed disk edema, retinal whitening, and retinal hemorrhages in both eyes. Optical coherence tomography demonstrated thinning of the temporal retina and disruption of the inner segment-outer segment junction of the photoreceptor layer in the right eye and thickening and edema of the nasal macula, as well as a central foveal hyper-reflectivity, in the left eye. At the initial visit, there was no ischemia or neovascularization (NV). One month later, the patient developed NV of the disk and ischemia in the mid-periphery of the left eye. The patient underwent treatment with pan-retinal photocoagulation. The NV regressed, but visual outcome remained poor at his 5-month follow-up visit.

Keywords: Purtscher’s retinopathy; disk edema; laser photocoagulation; neovascularization.

Figure 1

(A and B) Color fundus photograph montages showing disk edema, diffuse retinal whitening, and retinal hemorrhages more prominent in the left eye compared to the right eye. (C) Optical coherence tomography showing atrophy of the temporal retina and disruption of inner segment–outer segment junction of the photoreceptor in the right eye. (D) Optical coherence tomography revealing edema of the nasal macula and central foveal hyper-reflectivity consistent with a scar in the left eye. (E) Optical coherence tomography thickness map of the right eye demonstrating temporal thinning.

Figure 2

(A) Color photograph and (B) fluorescein angiogram of the right eye 1 month after presentation.

Figure 3

(A) Color photograph of the left eye 1 month after presentation revealing neovascularization of the disk. (B, C and D) Early, mid, and late fluorescein angiograms of the left eye at the same visit demonstrating leakage of the disk consistent with neovascularization. (E) Fluorescein angiogram of the mid-periphery revealing ischemia superonasal to the disk.

Figure 4

Color photographs of the right (A) and left (B) eyes 5 months after pan-retinal photocoagulation, demonstrating regression of neovascularization of the disk. Optic atrophy and pallor are present.