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Unilateral Central Microembolic Retinopathy following Chest Compression in Car Accident

Reichelt J. A., Horstmann C., Grütters G.,
Christian-Albrechts-Universität Kiel, Klinik für Ophthalmologie (Kiel)

Background: Microembolic retinopathy has been reported on after sudden chest compression (Purtscher´s disease). Retinopathy regularly occurs bilaterally. We would like to present the case of unilateral and circumscribed Purtscher´s disease with macular hole formation and nearly complete restitution.
Case report: A 19-year-old female patient was concerned about immediate blurred vision in her right eye after a car accident. Beside moderate myopia no further ophthalmological diseases were known. Bruises on chest and right shoulder impressed as sequel of the accident due to contusion by safety-belt. Visual acuity was 20/1000 on the right eye and 20/20 on the left eye. Fundoscopy revealed multiple circumscribed edema of the posterior pole. Anterior segment, optic disc and peripheral retina were regular. 60°-perimetry was unconspicuous on both eyes. In the early arteriovenous phase fluoresceine angiography showed multiple dotted circumscribed lesions with late discrete leakage. It could be interpreted as multifocal microembolic angiopathy. One week after treatment with prednisolone (initially 60 mg/die, slow reduction in two months) VA improved to 20/200. Nevertheless, macular hole formation stage 1 to 2 according to Gass with positive Watzke-Allen-sign occurred. Posterior vitreous detachment was absent. Three weeks further on, the hole closed spontaneously. Two months after the accident best corrected VA was 20/25 in the right eye, the fundus was regular. Vitreous body was detached centrally but still adherent to optic disc and periphery.
Conclusions: Coincidence of circumscribed, unilateral Purtscher´s disease and macular hole means an exceptional case of microembolic retinopathy. Improvement of VA confirms our conservative therapeutic scheme. Incidence of posterior vitreous detachment and macular hole closure indicates causal relationship. Expectant attitude in indirect trauma in young patients may avoid or facilitate pars-plana vitrectomy due to spontaneous vitreous detachment.