Sir,

We thank Nesmith et al1 for their interesting report of anatomical and functional benefit of intravitreal bevacizumab in the treatment of macular edema in a probable case of Purtscher-like retinopathy. The case reported respects the majority of the diagnostic criteria of Purtscher or Purtscher-like retinopathies suggested by Agrawal2 and adapted by us,3 namely:

  • Retinal hemorrhages, in the posterior pole, in small number (1–10).

  • Cotton wool spots restricted to the posterior pole.

  • Probable or plausible explanatory etiology (chronic pancreatitis, hepatitis C, cirrhosis, and typical presentation).

  • Compatible complementary investigation (characteristic fundoscopy, OCT revealing macular edema, and increased C5a).

  • The presence of Purtscher flecken4 is another diagnostic criterion (in this case there were none visible). Purtscher flecken are considered pathognomonic4 and occur in 63% of Purtscher and Purtscher-like retinopathies (PuR).3

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