title: Purtscher retinopathy: to treat or not to treat?
abstract: OBJECTIVE
  To report a case of Purtscher retinopathy and its therapeutic approach.
  
  
  METHODS
  In this observational case report, complete ophthalmologic examination was performed, including best-corrected visual acuity (BCVA) testing, slit-lamp biomicroscopy, dilated fundus examination, spectral-domain optical coherence tomography (OCT), fluorescein angiography (FA), and Humphrey 24-2 visual field testing.
  
  
  RESULTS
  The patient complained of right eye diminished visual acuity 48 hours after a car accident, with severe thoracic and abdominal blunt trauma but no direct ocular trauma. The BCVA was counting fingers at 1 meter, anterior segment examination was unremarkable, and the fundus showed cotton-wool spots and Purtscher flecken. Macular OCT revealed subretinal fluid with neurosensorial retinal detachment. The FA showed peripapillary and parafoveal leakage and visual field testing presented a central scotoma. We opted for an observation-only approach. Follow-up revealed a progressive reabsorption of the subretinal fluid with complete resolution of the macular neurosensorial retinal detachment after 2 weeks. After 2 months of follow-up, BCVA was 20/25 and the OCT revealed atrophic changes, with no subretinal fluid. The favorable outcome in terms of BCVA persisted at 4 and 6 months follow-up, although the central scotoma did not improve significantly.
  
  
  CONCLUSIONS
  The characterization of both acute and late-stage lesions provides a valuable insight to a better characterization of this rare disease. Despite a favorable response with a conservative therapeutic approach, structural and functional late stage sequelae influence the final visual outcome.
authors.affiliation: Centro Hospitalar Baixo Vouga, Aveiro - Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gil
authors.affiliation: Centro Hospitalar Baixo Vouga, Aveiro - Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Pires
authors.affiliation: Centro Hospitalar Universitário de Coimbra, Coimbra - Portugal.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Costa
authors.affiliation: Centro Hospitalar Baixo Vouga, Aveiro - Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Matos
authors.affiliation: Centro Hospitalar Baixo Vouga, Aveiro - Portugal.
authors.forename: Mariana Sá
authors.initials: MS
authors.lastname: Cardoso
authors.affiliation: Centro Hospitalar Baixo Vouga, Aveiro - Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Mariano
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D064887:Observational Studies as Topic; D012164:Retinal Diseases / Q000175:diagnosis* / Q000628:therapy*; D012607:Scotoma / Q000175:diagnosis / Q000209:etiology; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence / Q000379:methods; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology