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Fulltext Purtscher's Retinopathy After Cardiopulmonary Resuscitation: A Literature Review

Balasubaramaniam D, Lott PW, Iqbal T, Singh S

Cureus, 2023 Apr;15(4):e38033.
PMID: 37228527 DOI: 10.7759/cureus.38033

Purtscher's retinopathy is a rare angiopathy reported in patients with a history of severe trauma and other systemic diseases. The diagnosis is made on clinical grounds, and the severity varies. A 41-year-old gentleman with underlying poorly controlled diabetes mellitus and dyslipidemia was referred to the ophthalmology department for diabetic retinopathy screening. He denied visual complaints. Ocular examination revealed a negative relative afferent pupillary defect with a visual acuity of 6/6 bilaterally. The anterior segment examination was unremarkable. Both eye (oculus uterque, OU) fundus revealed a pink disc with a cup-to-disc ratio of 0.4 and peripapillary flame-shaped hemorrhages. Right eye (oculus dexter, OD) also showed multiple cotton wool spots along the superotemporal arcade involving zones 1 and 2 of the retina, while left eye (oculus sinister, OS) showed a single cotton wool spot along the superotemporal arcade at zone 1 of the retina. Otherwise, there were no visible retinal emboli, dot hemorrhages, or hard exudates, and the macula was normal. The retinal features were not characteristic of diabetic retinopathy. It mimicked hypertensive retinopathy, but the patient was normotensive. The absence of inner retinal thickening and hyperreflectivity on optical coherence tomography of the macula ruled out retinal vein occlusion. This prompted us to elicit further history, and the patient disclosed a recent admission for myocardial infarction in which he received cardiopulmonary resuscitation with chest compressions for seven minutes. Hence, the diagnosis of OU Purtscher's retinopathy was made, and the patient was monitored closely in the clinic. Purtscher's retinopathy remains a diagnostic dilemma and should not be neglected in complex clinical contexts.
The effects of electronic cigarette smoking on retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, and choroidal thickness

Balasubaramaniam D, Lim YW, Retnasabapathy S, A Qamarruddin F, Singh S

Cutan Ocul Toxicol, 2024 Nov 05.
PMID: 39498579 DOI: 10.1080/15569527.2024.2423265

PURPOSE: To compare the thickness of the retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and choroid in healthy electronic cigarette smokers and non-smokers using spectral domain optical coherence tomography (SD-OCT).
MATERIAL AND METHOD: 25 healthy electronic cigarette smokers and 25 age- and gender-matched healthy non-smokers were included in the study. RNFL, GCL, IPL and choroidal thickness were measured by SD-OCT using an automated programme. After normality tests, an independent sample t-test was used to analyse the differences in RNFL, GCL, IPL, and choroidal thickness values between the groups.
RESULTS: The mean age of electronic cigarette smokers and non-smokers was 33.68 and 33.64 years, respectively. The mean smoking history was 6.6 years (range 5-8 years). Most of the participants smoked 2-5 ml of e-liquid per day (52%), while 36% smoked more than 5 ml and 12% smoked less than 2 ml per day. The mean intraocular pressure in the electronic cigarette smoker group was 15.0 mmHg, while the non-smoker group was 15.32 mmHg. The mean axial length in the electronic cigarette smoker group and non-smoker group was 23.36 and 23.63 mm, respectively. No significant difference was observed regarding RNFL, GCL, IPL or choroidal thickness between both groups.
CONCLUSION: The thickness of the RNFL, GCL, IPL, and choroid was found to be similar in both the healthy electronic cigarette smokers and non-smokers groups.

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