Optical Coherence Tomography Angiography Findings in Post-Traumatic Purtscher Retinopathy: A Case Report

BACKGROUND Purtscher retinopathy (PR) is a rare, vision-threatening retinal disorder that usually develops after trauma. It is characterized by retinal hemorrhages and areas of retinal whitening, which are thought to result from microvascular occlusion of precapillary retinal arterioles. Advances in imaging, particularly optical coherence tomography angiography (OCT-A), have provided valuable insights into the microvascular alterations associated with PR and offer strong evidence supporting its ischemic pathogenesis. We report a case demonstrating ischemic changes in retinal and choroidal circulation and discuss their prognostic significance. CASE REPORT A 63-year-old man with head neck trauma presented with acute, painless vision loss in the right eye. Initial ophthalmic examination revealed cotton-wool spots, retinal whitening, Purtscher flecken, and retinal hemorrhages. OCT showed hyperreflectivity of the inner retinal layers, subretinal fluid, and internal limiting membrane detachment. OCT-A demonstrated extensive capillary non-perfusion in both the superficial and deep retinal plexuses, as well as suspected ischemia at the level of the choriocapillaris. PR was diagnosed, and high-dose systemic corticosteroid therapy was initiated. At 3-month follow-up, retinal edema, cotton-wool spots, and Purtscher flecken had resolved; however, persistent non-perfusion of the retinal plexuses and subtle impairment of choriocapillaris perfusion were still evident. Final best-corrected visual acuity remained poor due to ischemic atrophy involving the retina, choroid, and optic nerve. CONCLUSIONS PR can involve both the retinal and choroidal circulation. OCT-A is a fast, safe, and non-invasive modality for identifying and monitoring these microvascular alterations. Combined retinal and choroidal ischemia in PR can be associated with poor visual outcomes.