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Two Case Reports of a Purtscher-like Retinopathy Occurring after Retrobulbar
구후마취 후 발생한 푸르처유사망막병증 2예
JKOS 2019 Aug;60(8):802-7
Published online August 15, 2019;  https://doi.org/10.3341/jkos.2019.60.8.802
Copyright © 2019 The Korean Ophthalmological Society.
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Il Won Jeong, MD1,2, Chang Wook Choi, MD1,2, Sang Jun Ko, MD1,2
정일원1,2 · 최창욱1,2 · 고상준1,2

Department of Ophthalmology, Wonkwang University College of Medicine1, Iksan, Korea
Institute of Wonkwang Medical Science, Wonkwang University2, Iksan, Korea
원광대학교 의과대학 안과학교실1, 원광대학교 원광의과학연구소2
Received October 25, 2018; Revised January 9, 2019; Accepted July 18, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: Although there are significant risks, retrobulbar anesthesia is commonly used for eye surgery. We report two cases of Purtscher-like retinopathy, a rare complication.
Case summary: (Case 1) A 76-year-old female visited our hospital because of decreased vision. She underwent right cataract surgery with retrobulbar anesthesia. After 7 days, she had decreased visual acuity (VA) and a constricted visual field. Multiple white spots and cotton wool spots around the optic nerve and post pole, macular edema (ME), and subretinal fluid (SRF) were found using a fundus examination. A non-perfusion area and staining of the vascular wall were seen using fluorescence angiography. Although carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were performed, the ME and SRF persisted. After intravitreal aflibercept was injected twice (2-month interval), the ME and SRF decreased and remained stable. (Case 2) A 61-year-old male underwent left cataract surgery with retrobulbar anesthesia. After anesthesia, the VA of the left eye was 10 cm finger count. The fundus examination showed multiple hemorrhage blots and retinal hemorrhages, and hyperfluorescence around the optic nerve and post pole; vascular wall staining revealed a Purtscher-like retinopathy. Left carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were then performed. After treatment, the VA of the left eye, ME, and SRF were improved at the 4-month follow-up.
Conclusions: We report rare complications of retrobulbar anesthesia, with active and timely treatment having a positive impact on the visual prognosis.
Keywords : Purtscher-like retinopathy, Retrobulbar anesthesia

 

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