Letter to the Editor
Reply: Ischemic central retinal venous occlusion as a possible differential diagnosis of Purtscher-like retinopathy
Respuesta: Oclusión venosa central de la retina isquémica como posible diagnóstico diferencial de la retinopatía Purtscher-like
G. Espinosa-Barberia,b,
Corresponding author
glenda_eb@hotmail.com
Corresponding author at: Glenda Espinosa-Barberi, Hospital Universitario de Gran, Canaria Doctor Negrín, Servicio de Oftalmología, Barranco la Ballena, s/n, 35010, Las Palmas, Spain.
Corresponding author at: Glenda Espinosa-Barberi, Hospital Universitario de Gran, Canaria Doctor Negrín, Servicio de Oftalmología, Barranco la Ballena, s/n, 35010, Las Palmas, Spain.
a Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
b Escuela de Doctorado y Postgrado, Universidad Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
C. Alba Linero
c HServicio de Oftalmología, Hospital Regional de Málaga, Málaga, Spain
V. Llorens Bellés, A. Adán Civera
d Institut Clínic d´Oftalmologia, Hospital Clínic de Barcelona, Barcelona, Spain
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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" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dear Editor:</p><p id="par0010" class="elsevierStylePara elsevierViewall">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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">1</span></a> This is the main difference with Purtscher retinopathy, since traumatic antecedents are present.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">3</span></a> which generates a retinal occlusion at the arteriolar level and microvascular infarction.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></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).</p><p id="par0025" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">6</span></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.</p><p id="par0035" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">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.</p><p id="par0045" class="elsevierStylePara elsevierViewall">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.</p><p id="par0050" class="elsevierStylePara elsevierViewall">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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">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. 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