first described in 1910 , purtscher s retinopathy is seen in severely traumatized patients and is characterized by sudden visual loss ( purtscher 1912 ) .
the characteristic ophthalmoscopic findings are multiple areas scattered throughout the posterior pole of superficial retinal whitening , which appear as focal areas of retinal arteriolar occlusion on fluoresceinangiography ( grass 1997 ) .
similar clinical findings have been reported in association with childbirth ( blodi et al 1990 ; shaikh et al 2003 ) , and have been termed purtschers - like retinopathy . the visual prognosis in purtschers - like retinopathy after childbirth is guarded , and to date , there is no definitive treatment .
however , there are encouraging reports of visual recovery in patients with purtscher s retinopathy receiving high dose intravenous corticosteroid therapy ( atabay et al 2003 ) .
we report a patient with purtschers - like retinopathy following childbirth who received a sub - tenon s capsule injection of triamcinolone with subsequent increase in visual acuity and decrease in retinal swelling .
ten days after an emergent caesarian section for severe preeclampsia , rh immunization , and fetal anemia , a 24 year - old primigravida primiparus patient presented with complaints of decreased vision in both eyes , right greater than left . there were no other systemic abnormalities such as elevated liver enzymes , low platelets or other hematologic abnormalities .
dilated fundus examination revealed bilateral purtschers - like retinopathy ( figures 1a , 1b ) , with widespread areas of macular ischemia and edema , as confirmed by optical coherence tomography ( figures 2a , 2b ) .
of note are the superficial areas of high intensity signal , indicative of retinal ischemia .
the central thickness in the right eye was 272 microns , and in the left 239 microns .
a sub - tenon s injection of 0.5 cc of triamcinolone ( 40 mg / cc ) was given in the right eye on day 15 after delivery .
at one week following the injection , her visual acuity was unchanged and her intraocular pressure was normal .
she noted a marked improvement in the vision in her right eye . on examination a her acuity
had improved to 20/60 in the right eye and 20/20 in the left , with normal intraocular pressures .
her fundus examination showed marked improvement , with most of the superficial ischemic areas resolving .
repeat optical coherence tomography in both eyes ( figures 3a , 3b ) demonstrated a reduction in the edema of the right eye by 30% from baseline , whereas the left , untreated eye showed a reduction in swelling of 14% .
her visual acuity remained 20/60 in the right eye and 20/20 in the left eye .
nearly a century ago otmar purtscher described a case of visual loss in a severely traumatized patient whose exam showed multiple superficial retinal hemorrhages and white patches throughout the posterior pole . since that time , similar findings have been associated with other conditions including compressive chest injuries , acute pancreatitis , fat embolism , retro - bulbar anesthesia , connective tissue diseases ( grass 1997 ) , and childbirth ( blodi et al 1990 ; shaikh et al 2003 ) .
the pathogenesis of purtschers - like retinopathy post - partum is unknown , but may be related to arteriolar obstruction by complement induced leukoemboli produced during parturition ( blodi et al 1990 ) .
similar clinical findings have been reported in the setting of amniotic fluid embolism . however , in the absence of a patent foramen ovale or pulmonary arteriovenous - shunts , it is unlikely that amniotic emboli are the direct cause of the observed retinal arteriolar obstructions .
other investigators have theorized that subclinical amniotic fluid emboli may activate complement and induce granulocyte microemboli , which could occur on both sides of the pulmonary capillary bed .
the visual recovery of postpartum patients with purtschers - like retinopathy is varied ( blodi et al 1990 ; shaikh et al 2003 ) . of the four patients described by blodi , three enjoyed significant improvement in central acuity ,
another case of purtscher - like retinopathy has been described in a patient with hellp syndrome during antepartum .
generally purtscher - like retinopathy has a favorable prognosis but this case resulted in permanent loss of vision ( stewart et al 2007 ) .
currently , there is no definitive treatment for postpartum purtschers - like retinopathy . in vivo
, corticosteroids have been shown efficacious in inhibiting complement - induced granulocyte aggregation ( hammerschimidt et al 1979 ) .
clinically , there are two reports of visual recovery after high dose , intravenous corticosteroid therapy in post - traumatic patients ( atabay et al 1993 ) .
the case presented here is unique in that the patient had bilateral , asymmetric purtschers - like retinopathy post - partum , with quantitative oct improvement following unilateral local steroid therapy .
 sub - tenon s injection of triamcinolone was performed in the right eye of a patient with bilateral purtschers - like retinopathy after childbirth . 
 the response of macular edema to local triamcinolone was investigated with optical coherence tomography . 
 five weeks following the injection , optical coherence tomography improvement was seen following unilateral sub - tenon s triamcinolone injection . 