PMU-Autor/inn/en
Arlt Eva MariaAbstract
BACKGROUND
Purtscher"s retinopathy is a sight threatening, occlusive microvasculopathy associated with trauma, it is rarely reported after long bone fractures.
A 20-year-old female sustained a femoral shaft fracture (AO 32-A2.3) in a ski accident colliding with a snowgun and was treated with intramedullary nailing one hour after the accident. 14 hours after surgery the patient complained of loss of vision in both eyes and was therefore referred to a neurologist, furthermore an MRI scan of the brain was performed. Neither showed any pathological findings. The patient was finally transferred to an ophthalmology department. After slit lamp examination and funduscopy Purtscher"s retinopathy was diagnosed. Treatment was started right after diagnosis and 5 days after the onset of symptoms. The patient was administered intravenous haemo-rheologic therapy for five days as well as low molecular heparine in therapeutic dose and Vasonit® 400 mg bid orally.At follow-up 4 weeks and 6 months later visual acuity had improved after 4 weeks before that exam. At final follow-up the symptoms had almost resolved completely and uncorrected visual acuity (UCVA) and best corrected visual acuity had improved from originally 0.25 decimal in both eyes to 0.8 decimal UCVA and BCVA in both eyes.
Patients suffering from perioperative loss of vision have to be referred for ophthalmological and neurological assessment as soon as possible. History of trauma and visual loss can point to the diagnosis of Purtscher"s retinopathy.
Useful keywords (using NLM MeSH Indexing)
Adrenergic alpha-Agonists/therapeutic use
Anticoagulants/therapeutic use
Blindness/etiology
Bone Nails
Drug Therapy, Combination
Female
Femoral Fractures/diagnosis
Femoral Fractures/surgery*
Fracture Fixation, Intramedullary/adverse effects*
Fracture Fixation, Intramedullary/instrumentation
Heparin, Low-Molecular-Weight/therapeutic use
Humans
Magnetic Resonance Imaging
Naphazoline/therapeutic use
Pentoxifylline/therapeutic use
Recovery of Function
Retinal Diseases/diagnosis
Retinal Diseases/etiology*
Retinal Diseases/physiopathology
Retinal Diseases/therapy
Retinal Hemorrhage/etiology
Skiing/injuries
Time Factors
Treatment Outcome
Visual Acuity
Young Adult