Purtscher Disease

This is an acquired form of retinopathy associated with a variety of thromboembolic events. It is the consequence of hemorrhagic and vasoocclusive vasculopathy.

Purtscher Angiopathic Retinopathy.

First described in 1910 by O. Purtscher as a syndrome of sudden blindness associated with seveve head trauma. These patients presented with multiple white retinal patches and retinal hemorrhages associated with seveve vision loss.

There is no reported incidence. Variable depending on the underlying pathology. Acquired disease.

The clinical findings have traditionally been associated with severe crush injuries. However, Purtscher retinopathy has also been reported in association with pancreatitis, thrombocytopenic purpura, hemolytic uremic syndrome, systemic lupus erythematosus, dermatomyositis, scleroderma, and amniotic fluid embolism. The ophthalmoscopic findings associated with this syndrome are peripapillary cotton-wool spots, intraretinal hemorrhages, asymmetrical venous engorgement, and retinal whitening. Obviously, the circumstances in which Purtscher retinopathy develops determine the whole clinical picture.

The anesthetic management needs to take into consideration the different causes of the underlying pathology. To avoid sudden increases in intraocular pressure, medication susceptible to affect it such as succinylcholine and ketamine should be avoided if possible. Moderate hyperventilation can contribute to reduce intraocular pressure.