Purtchers Retinopathy - Chest Compression - Bilateral CRAO
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50-year-old man that I saw in the office on December 1, 2008. He was doing fine until November 3rd, 2008. He was behind a truck. There was a loveseat that he was going to pick up with a friend and then the truck was backing up, the driver of the truck slipped his foot off the brake and on to the accelerator and threw Mr. Mercurio backwards into a home. The truck actually pinned him and went through the door of the house, then the truck driver went forward and Mr. Mercurio was stuck to the back of the truck and dragged him forward about twenty feet, at which point the truck driver stopped and the truck was resting on his thighs and it took four fire trucks and some time before they were able to jack the truck up off of his legs.
Most of the time he was pinned under the bumper. His vision unfortunately, has been poor since he was hospitalized for six days at Bayfront. I have two notes from Bayfront, one was an ophthalmologists consult dated November 2006, when the patient had a dilated examination, which showed many fatty deposits in the fundus in both eyes, in the left one he had a cherry red spot and at that point he diagnosed the patient with bilaterals Purtscher's retinopathy secondary to fat emboli. There is a Heidelberg photo and fluorescein, which I have copies of from November 13th, 2008, which on the OCT scan shows deposits under the retina. The pictures are not great quality because they are Xeroxes. The fluorescein shows reasonably good perfusion, however, there is in the left eye a large area which looks to be possibly subretinal and pre-retinal hemorrhage. The right eye has a patchy subretinal hemorrhage. I do not have any note from the November 13th examination. His vision is still poor in both eyes. His vision is a little better than it was a month ago.
VISUAL ACUITY: OD 1/200, OS 3/200. IOP: OD 16, OS 17. Visual fields are constricted.
SLIT EXAMINATION: The cornea is clear. The anterior chamber is quiet. The lens is clear.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is no posterior vitreous separation or patchy white cotton wool spots around the fovea. There is a little bit of a cherry red spot. There are also patchy retinal hemorrhages in the macula and around the optic nerve.
OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There is more prominent whitening of the parafoveal retina with patchy retinal hemorrhages. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAM: The fluorescein angiogram shows good filling of the central retinal artery starting on the left eye. The artery fills briskly at ten seconds and recirculation time is six seconds. We switched immediately to the right eye and it looks like both eyes have at this moment normal perfusion with no occlusion on either the retinal artery or retinal venous side. There is hypofluorescence were the hemorrhages are. I do not see any significant pigment epithelial damages or no leakage from the vessels in the late frames.
IMPRESSION:
1. BILATERAL PURTSCHER’S RETINOPATHY
2. POSSIBLE BILATERAL CENTRAL RETINAL ARTERY OCCLUSION
3. RETINAL HEMORRHAGES – BOTH EYES
4. TRAUMATIC MACULOPATHY
DISCUSSION: I explained to the patient unfortunately, it looks like he has developed severe ischemia in both eyes. The retina can only tolerate about forty five minutes to an hour with poor circulation and then even when the circulation is restored unfortunately, there sometimes remains permanent damage. I am hopeful over the next few months his vision will start to improve. The recovery from the subretinal hemorrhage and from the retinal artery occlusions can sometimes be surprisingly good in young patients.
At this point I do not think there is anything more to do or for his eyes.
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50-year-old man that I saw in the office on December 1, 2008. He was doing fine until November 3rd, 2008. He was behind a truck. There was a loveseat that he was going to pick up with a friend and then the truck was backing up, the driver of the truck slipped his foot off the brake and on to the accelerator and threw Mr. Mercurio backwards into a home. The truck actually pinned him and went through the door of the house, then the truck driver went forward and Mr. Mercurio was stuck to the back of the truck and dragged him forward about twenty feet, at which point the truck driver stopped and the truck was resting on his thighs and it took four fire trucks and some time before they were able to jack the truck up off of his legs.
Most of the time he was pinned under the bumper. His vision unfortunately, has been poor since he was hospitalized for six days at Bayfront. I have two notes from Bayfront, one was an ophthalmologists consult dated November 2006, when the patient had a dilated examination, which showed many fatty deposits in the fundus in both eyes, in the left one he had a cherry red spot and at that point he diagnosed the patient with bilaterals Purtscher's retinopathy secondary to fat emboli. There is a Heidelberg photo and fluorescein, which I have copies of from November 13th, 2008, which on the OCT scan shows deposits under the retina. The pictures are not great quality because they are Xeroxes. The fluorescein shows reasonably good perfusion, however, there is in the left eye a large area which looks to be possibly subretinal and pre-retinal hemorrhage. The right eye has a patchy subretinal hemorrhage. I do not have any note from the November 13th examination. His vision is still poor in both eyes. His vision is a little better than it was a month ago.
VISUAL ACUITY: OD 1/200, OS 3/200. IOP: OD 16, OS 17. Visual fields are constricted.
SLIT EXAMINATION: The cornea is clear. The anterior chamber is quiet. The lens is clear.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is no posterior vitreous separation or patchy white cotton wool spots around the fovea. There is a little bit of a cherry red spot. There are also patchy retinal hemorrhages in the macula and around the optic nerve.
OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There is more prominent whitening of the parafoveal retina with patchy retinal hemorrhages. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAM: The fluorescein angiogram shows good filling of the central retinal artery starting on the left eye. The artery fills briskly at ten seconds and recirculation time is six seconds. We switched immediately to the right eye and it looks like both eyes have at this moment normal perfusion with no occlusion on either the retinal artery or retinal venous side. There is hypofluorescence were the hemorrhages are. I do not see any significant pigment epithelial damages or no leakage from the vessels in the late frames.
IMPRESSION:
1. BILATERAL PURTSCHER’S RETINOPATHY
2. POSSIBLE BILATERAL CENTRAL RETINAL ARTERY OCCLUSION
3. RETINAL HEMORRHAGES – BOTH EYES
4. TRAUMATIC MACULOPATHY
DISCUSSION: I explained to the patient unfortunately, it looks like he has developed severe ischemia in both eyes. The retina can only tolerate about forty five minutes to an hour with poor circulation and then even when the circulation is restored unfortunately, there sometimes remains permanent damage. I am hopeful over the next few months his vision will start to improve. The recovery from the subretinal hemorrhage and from the retinal artery occlusions can sometimes be surprisingly good in young patients.
At this point I do not think there is anything more to do or for his eyes.
