Clinical Ophthalmology Open Access Full Text Article Dovepress open access to scientific and medical research C A S E R E P O R T Neovascularization in Purtscher’s retinopathy Annie Chan Douglas R Fredrick Theodore Leng Department of Ophthalmology, Byers Eye Institute at Stanford University, Stanford University School of Medicine, Stanford, CA, USA Correspondence: Theodore Leng Byers Eye Institute at Stanford University, Horngren Vitreoretinal Center, 2452 Watson Court, MC 5353, Palo Alto, CA 94303, USA Tel +1 650 498 4264 Fax +1 650 565 8297 Email tedleng@stanford.edu Abstract: We report a case of neovascularization secondary to Purtscher’s retinopathy that showed minimal improvement with photocoagulation treatment. A 14-year-old boy with a history of cerebellar medulloblastoma presented with blurry vision and floaters after being struck by a motor vehicle while riding his bike. At presentation, visual acuity was 20/400 in his right eye and counting fingers in his left eye. Fundus examination showed disk edema, retinal whitening, and retinal hemorrhages in both eyes. Optical coherence tomography demonstrated thinning of the temporal retina and disruption of the inner segment–outer segment junction of the photoreceptor layer in the right eye and thickening and edema of the nasal macula, as well as a central foveal hyper-reflectivity, in the left eye. At the initial visit, there was no ischemia or neovascularization (NV). One month later, the patient developed NV of the disk and ischemia in the mid-periphery of the left eye. The patient underwent treatment with pan-retinal photocoagulation. The NV regressed, but visual outcome remained poor at his 5-month follow-up visit. Keywords: Purtscher’s retinopathy, neovascularization, laser photocoagulation, disk edema Introduction Purtscher’s retinopathy was first described in 1910 by Otmar Purtscher in five patients who suffered acute blindness after sustaining severe trauma.1 The patients exhibited multiple areas of retinal whitening in the posterior pole which are now recognized as cotton wool spots. Papillitis, intraretinal hemorrhage, and preretinal hemorrhage were also seen. The severity of visual loss in Purtscher’s retinopathy is typically bilateral and variable. The onset of visual symptoms may be acute or delayed by up to 48 hours. Without treatment, vision usually recovers spontaneously within 1–3 months. The fundus examination may be characterized by mottling of the retinal pigment epithe- lium, temporal disk pallor, and attenuation or sheathing of the retinal vessels.2 Rarely, neovascularization can occur.3,4 Case report A 14-year-old boy was referred to the ophthalmology service for new blurry vision and floaters in both eyes. A few days earlier, he had suffered multiple fractures to his face and skull after being struck by a truck while riding his bike. He also had a lacerated liver and pancreas, a small pneumothorax, and a pelvic hematoma. He did not require any surgical intervention. His medical history was significant for cerebel- lar medulloblastoma that had been treated with surgery, radiation, and chemotherapy 6 years prior to presentation. submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/OPTH.S26076 Clinical Ophthalmology 2011:5 1585–1587 © 2011 Chan et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 1585