Título / Title

PURTSCHER'S RETINOPATHY AFTER MOTORCYCLE ACCIDENT

Introdução / Purpose

Report of a patient with Purtscher's retinopathy (PR) after a motorcycle accident complicated by thoracic trauma treated with prednisone due to absence of spontaneous improvement after 30 days.

Material e Método / Methods

The follow-up lasted 6 months and included visual acuity (VA) measurement, retinography and optical coherence tomography.

Resultados / Results

The patient is a 36-year-old man, native of Manaus, who presented to the clinic 2 months after suffering thoracic trauma and sudden visual loss in the right eye (OD).
Best corrected VA in OD was 20/800 with no anterior segment findings. Fundus examination revealed cotton-wool spots, peripapillary hemorrhages and Purtscher flecken at the posterior pole. Left eye exam showed no abnormalities and 20/20 VA.
After 4 weeks, clinical findings persisted. We then prescribed oral prednisone (1 mg/kg) tapered over 7 weeks. After the treatment, the patient presented with 20/200 VA in the OD with improvement of the retinal lesions.

Discussão e Conclusões / Conclusion

Purtscher’s retinopathy is characterized by sudden and transient vision loss following trauma. It is a rare pathology, with an incidence of approximately 0.24 per million per year. Its causative factors are fat emboli that follow trauma, leading to pre-capillary arterial occlusion in the nerve fiber layer.
Fundoscopic signs most often observed include cotton wool spots, retinal hemorrhages and Purtscher flecken, pathognomonic findings that correspond to multiple areas of retinal whitening. When persistent, late signs such as optical atrophy are responsible for permanent vision loss.
Due to scant epidemiological data, case reports may help create the background needed for retrospective analysis. The disease’s initial course usually involves spontaneous improvement. In this case, improvement was associated with oral corticosteroid use. Further studies are needed to evaluate the efficacy and optimal route of application for treatment.

Palavras Chave

Purtscher; Purtscher's retinopathy; purtscher flecken; trauma; prednisone