Purtscher and Purtscher-Like Retinopathies: What Do We Know?

Purtscher and Purtscher-like retinopathies are rare but important to recognize. Its diagnosis is clinical, in which at least 3 of the following diagnostic criteria should be present: 1) Purtscher-flecken (visible in the fundoscopy, they are intra-retinal whitening areas with a clear zone on either side of the vessels), 2) intra-retinal hemorrhages, 3) cotton wool spots (these are located superficially to the vessels and have ill-defined edges), 4) plausible etiology, 5) compatible complementary examination (such as angiography and Optical Coherence Tomography). Purtscher's retinopathy is traumatic (usually head trauma, chest compression or long bone fracture) and the term Purtscher-like retinopathy is reserved for non-traumatic causes (acute pancreatitis, HELLP syndrome, carcinoma, among many others). Supportive treatment should be performed as well as treatment of the underlying etiology. Other treatments, such as corticosteroids, intra-vitreal injection of anti-VEGT or intra-vitreal injection of tissue plasminogen activator, are theoretically logical but it is unknown whether they are beneficial compared to observation. The prognosis is variable and depends on the severity of retinal alterations at presentation, as well as the underlying cause. Further evidence regarding treatment and prognosis is necessary, but difficult to conduct considering this is an uncommon disease.