title: Purtscher-like retinopathy following valsalva maneuver effect: case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Ophthalmology, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. zunaina@kb.usm.my.
authors.forename: Saidin
authors.initials: S
authors.lastname: Nor-Masniwati
authors.forename: Yaakub
authors.initials: Y
authors.lastname: Azhany
authors.forename: Embong
authors.initials: E
authors.lastname: Zunaina