Purtscher's retinopathy case report: short posterior ciliary arteries contribution to radial peripapillary capillary system observed with optical coherence tomography angiography

The authors report a case of Purtscher’s retinopathy whose optical coherence tomography angiography (OCT-A) analysis allows us to better understand the vascular network of the optic disk. Case report. A 75-year-old man presented with vision loss in his left eye (LE) after chest compression. The best-corrected visual acuity (BCVA) in the LE was 20/200, and the anterior segment showed a relative afferent pupillary defect. Dilated fundus examination revealed white peripapillary retinal patches and macular hemorrhage. The OCT scan showed edema and hyper-reflectivity of the inner retinal layers at macular level. In turn, OCTA evidenced capillary dropout in both macular retinal plexus, though with preservation of the radial peripapillary capillaries (RPC) and choriocapillary layer. At 9 months, BCVA was 20/20 associated with persistence macular ischemia but unaffected RPC. In conclusion, this case suggests that the RPC does not depend exclusively on retinal capillaries as there was a reversible damage after a microvascular retinal disorder such as Purtscher’s retinopathy. Possibly, the contribution from short posterior ciliary arteries ensures proper vascularization as choriocapillary layer also remained unaffected. Furthermore, OCTA is considered a useful tool that affords better assessment of RPC than FA.