Purtscher's retinopathy followed by neovascular glaucoma

Abstract

We report the case of a 66-year-old Japanese man who developed neovascular glaucoma secondary to Purtscher's retinopathy following a head injury. The patient presented at our hospital with blurred vision and a visual field abnormality in his left eye 1 month after suffering from a head injury. Upon initial presentation, his best-corrected visual acuity on a decimal chart was 1.5 oculus dexter and 0.6 oculus sinister. The intraocular pressure (IOP) was 12 mmHg in both eyes. Fundus examination of the left eye revealed multiple white lesions in the posterior pole. Optical coherence tomography demonstrated retinal edema, particularly in the inner retina. On the basis of these findings, a diagnosis of Purtscher's retinopathy was made. One month after the initial examination, the visual acuity in the left eye deteriorated to 0.01 in decimal chart, and the IOP increased to 37 mmHg. Gonioscopy showed angle neovascularization. The patient received an intravitreal bevacizumab injection and panretinal photocoagulation. Subsequently, the IOP normalized and the angle neovascularization regressed.

Keywords: blurred vision; head injury; head trauma; retinal edema; visual field.

Figure 1

Clinical findings at presentation. Notes: (A) A color photograph of the fundus of the left eye shows diffuse retinal whitening. (B) Goldmann kinetic perimetry of the left eye shows paracentral scotomas. (C and D) Optical coherence tomography of the left eye shows edema in the inner retinal layers.

Figure 2

Clinical findings at 1 month after presentation (2 months after the head injury). Notes: Fluorescein angiography of the left eye shows a mild leak from the peripheral vessels and from the nonperfusion areas in the peripheral retina; however, there is no retinal neovascularization. A delay in choroidal filling and arm-to-retina time was found.

Figure 3

Clinical findings at 4 months after the initial examination (5 months after the head injury). Notes: (A) A color photograph of the fundus of the left eye shows the regression of retinal white lesions. (B) Goldmann perimetry of the left eye shows the regression of the paracentral scotomas. (C and D) Optical coherence tomography of the left eye shows atrophy of the inner retinal layers.