Purtscher-Like Retinopathy and Associated Pathologies
Summary
Purtscher-like retinopathy is an uncommon occlusive microangiopathy of the retina characterised by sudden, painless vision loss and distinctive fundoscopy findings. Etiologically, it arises after severe chest compression, head injury or in association with systemic diseases such as acute pancreatitis, connective tissue disorders, thrombotic microangiopathies and pre-eclampsia. Pathophysiological mechanisms involve complement-mediated leukocyte aggregation, microembolisation of precapillary arterioles and ischaemic damage to the inner retinal layers. Typical fundal signs include cotton-wool spots, Purtscher flecken and intraretinal haemorrhages. Multimodal imaging with optical coherence tomography, fluorescein angiography and OCT-angiography has improved detection of subtle vascular compromise and guided timely intervention. While many patients experience spontaneous recovery, those with delayed diagnosis or additional risk factors may suffer permanent visual impairment. Management focuses on treating the underlying systemic condition, with emerging evidence for systemic steroids and complement inhibitors. Interdisciplinary collaboration between ophthalmology, rheumatology and critical care is vital to optimise patient outcomes and to establish evidence-based protocols for this rare but sight-threatening syndrome.
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Purtscher-Like Retinopathy and Associated Pathologies publication trend
The graph below shows the total number of articles in purtscher-like retinopathy and associated pathologies across all publications each year (not limited to Nature Index journals).
Technical terms
Microangiopathy: Pathological alteration of small blood vessels leading to occlusion and tissue ischaemia.
Purtscher flecken: Polygonal patches of retinal whitening around the optic disc characteristic of this condition.
Cotton-wool spots: Focal infarcts of the retinal nerve fibre layer appearing as fluffy white lesions on fundoscopic examination.
Optical coherence tomography (OCT): Non-invasive imaging modality providing high-resolution cross-sectional views of retinal architecture.
Complement cascade: Sequential activation of plasma proteins that promotes inflammation and thromboembolism in microvasculature.
References
- Purtscher Retinopathy Resulting from a Car Crash Accident—Multimodal Imaging Value. Diagnostics (2024).
- Purtscher's and Purtscher-like retinopathy etiology, features, management, and outcomes: A summative systematic review of 168 cases.. PLOS ONE (2024).
- Internal limiting membrane separation and posterior vitreous hyperreflective dots: novel OCT findings in Purtscher-like retinopathy. BMC Ophthalmology (2024).
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