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Purtscher-like retinopathy following valsalva maneuver effect: case report
Saidin Nor-Masniwati1, Yaakub Azhany, Embong Zunaina
1Department of Ophthalmology, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. zunaina@kb.usm.my.
Introduction:
Purtscher's retinopathy is a rare condition that is noted in cases related to various types of trauma. The characteristic finding in the fundus is the presence of multiple Purtscher flecken. Purtscher-like retinopathy has a similar presentation in the fundus, but without an association with trauma.
Case Presentation:
A 43-year old Malay man presented with a sudden onset of central foggy vision in the left eye after holding his breath for two minutes while catching a falling object. It was not associated with floaters, flashes of light, or head trauma. His vision in the right eye was 6/6, and in his left eye it was finger counting. He had bilateral temporal sub-conjunctival hemorrhages. An examination of his left fundus revealed multiple white cotton wool spots and dot-blot retinal hemorrhages with diffuse retinal edema at the posterior pole. His right fundus was noted to have only mild temporal peri-papillary edema associated with a few dot-blot hemorrhages. Fundus fluorescein angiography showed good arterial perfusion and no evidence of leaking or neo-vascularization. A diagnosis of Purtscher-like retinopathy was made, and the patient was treated with indomethacin tablets for six weeks. At his six-week follow-up examination, his left eye visual acuity had improved to 6/12. His bilateral sub-conjunctival hemorrhage had resolved. His left fundus showed residual multiple cotton wool spots and reduced retinal edema.
Conclusions:
Treatment with non-steroidal anti-inflammatory drugs seems to be effective in reducing edema in patients with Purtscher-like retinopathy.
Insights
Purtscher-like retinopathy, a condition mimicking Purtscher's retinopathy but without trauma, can cause vision loss. Treatment with non-steroidal anti-inflammatory drugs effectively reduced retinal edema in a case study.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Medical Case Reports
Background:
- Purtscher's retinopathy is a rare condition linked to trauma, characterized by Purtscher flecken in the fundus.
- Purtscher-like retinopathy presents similarly but lacks a traumatic association.
Purpose of the Study:
- To report a case of Purtscher-like retinopathy following Valsalva maneuver.
- To evaluate the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in managing Purtscher-like retinopathy.
Main Methods:
- A case study of a 43-year-old man with sudden vision loss after breath-holding.
- Ophthalmic examination, funduscopy, and fluorescein angiography were performed.
- Treatment with oral indomethacin for six weeks.
Main Results:
- The patient presented with bilateral sub-conjunctival hemorrhages and unilateral vision impairment.
- Fundus examination revealed retinal edema, cotton wool spots, and hemorrhages.
- Visual acuity improved to 6/12 in the affected eye after treatment, with reduced edema.
Conclusions:
- Non-steroidal anti-inflammatory drugs appear effective in managing edema associated with Purtscher-like retinopathy.
- Prompt diagnosis and treatment can lead to visual recovery.
