Reply: Ischemic central retinal venous occlusion as a possible differential diagnosis of Purtscher-like retinopathy

Espinosa-Barberi, G.

doi:10.1016/j.oftale.2019.05.012

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Alba Linero" "autores" => array:1 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Alba Linero" ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "HServicio de Oftalmología, Hospital Regional de Málaga, Málaga, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "autoresLista" => "V. Llorens Bellés, A. Adán Civera" "autores" => array:2 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Llorens Bellés" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Adán Civera" ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Institut Clínic d´Oftalmologia, Hospital Clínic de Barcelona, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta: Oclusión venosa central de la retina isquémica como posible diagnóstico diferencial de la retinopatía Purtscher-like" ] ] "textoCompleto" => "Dear Editor:First of all I would like to thank the comment made and recently published about the work entitled "Multimodal image and treatment of Purtscher-like retinopathy". For us it is a pride that our work has been read and the time has been taken to make suggestions regarding it, which have been appreciated with respect.As has been mentioned, in the Purtscher-like retinopathy, multiple pathologies have been identified, among which are autoimmune diseases, renal failure, multiple organ failure, pancreatitis, et al.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> This is the main difference with Purtscher retinopathy, since traumatic antecedents are present.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The pathophysiology of retinopathy is controversial, due to the wide range of pathologies associated and described to date, but it is believed that the main mechanism is the thrombotic damage due to the abnormal activation of the complement,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> which generates a retinal occlusion at the arteriolar level and microvascular infarction.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> In our case, the backgrounds presented by the patient are compatible with this pathophysiology, since these are the main cardiovascular risk factors (hypertension, diabetes mellitus and hypercholesterolemia).The main signs that appear in this retinopathy are between the papilla and the posterior pole, since this is where the damage is located, findings compatible with those presented in the case. Severe macular edema is rare, although it has been reported in other cases, besides ours.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>It is true that 5 criteria have been identified, with the aim of being able to identify both the Purtscher-like retinopathy and the Purtscher retinopathy,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> of which at least 3 of them must be met in order to reach the diagnosis. In our case, 3 would be found, because it is believed that the cardiovascular risk factors presented by the patient can explain the etiopathogenesis of the disease.Although the Purtscher's fleckens, although they are a pathognomonic sign derived from the occlusion of the precapillary arterioles, are not found in half of the cases.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>As previously identified, the diagnosis is basically clinical and due to the clinical characteristics of our patients, the arteriolar congestive signs shown in the fundus as well as in the angiography and the evolution of the case described, was taken as main possible diagnosis the Purtscher-like retinopathy.However, we agree with the comment made in the letter to the editor, and it could also be a venous occlusion, since it has compatible antecedents and signs, which is why it was the main differential diagnosis taken into account, especially the ischemic subtype, due to the poor visual acuity with which the case was presented and the sudden onset of symptoms.We appreciate again the cordial suggestion and wish to thank for this valuable contribution to Purtscher-like retinopatrhy. We are willing to respond to any new concerns regarding this issue." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Espinosa-Barberi G, Alba Linero C, Llorens Bellés V, Adán Civera A. Respuesta: Oclusión venosa central de la retina isquémica como posible diagnóstico diferencial de la retinopatía Purtscher-like. Arch Soc Esp Oftalmol. 2019. https://doi.org/10.1016/j.oftal.2019.05.020" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "xxxx" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Massa" 1 => "C. Vale" 2 => "M. Macedo" 3 => "M.J. Furtado" 4 => "M. Gomes" 5 => "M. 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Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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