A Case of Purtscher's Retinopathy Responsive to High-dose Steroid Therapy

PURPOSE: To report a case of high dose steroid-responsive Purtscher's retinopathy which was developed after operation for diaphragmatic laceration sustained in motorcycle accident. CASE SUMMARY: A 68-year-old man came to our hospital with complaining of decreased visual acuity in the right eye after diaphragmatic laceration operation. Best corrected visual acuity was 0.1 in the right eye. Anterior segment was nonspecific. However, afferent pupillary defect was observed. Superficial intraretinal hemorrhage, numerous cotton-wool spots, peripapillary hemorrhage, and macular edema were detected on fundus examination. Fluorescein angiography revealed capillary nonperfusion and fluorescein filling defect due to retinal hemorrhage in arteriovenous phase and fluorescein leakage from the macula and capillary nonperfusion area in the late venous phase. Accordingly, Purtscher's retinopathy was diagnosed and the patient was observed without specific treatment. After 2 weeks of observation, symptoms and fundus findings were not changed. High-dose steroid therapy was begun with injection of one gram of methylprednisone for three days, switched to oral prednisolone, and then slowly tapered in period of 3 weeks. 7 days after the treatment, visual acuity was improved to 0.2 in the right eye but afferent pupillary defect was still observed. Cotton-wool spots slightly decreased, peripapillary hemorrhage was absorbed but macular edema was remained. 14 days after the treatment, visual acuity greatly improved to 0.63 and afferent pupillary defect was not observed. Cotton-wool spots and macular edema were decreased but fluoroscein leakage from capillary nonperfusion area was remained. CONCLUSIONS: In the case of Purtscher's retinopathy, high-dose steroid therapy can be a useful management method for the improvement of visual acuity and other symptoms.

A Case of Flavobacterium Indologenes Keratitis

PURPOSE: Flavobacterium indologenes is known to cause keratitis very rarely. Authors have experienced 1 case of keratitis from Flavobacterium indologenes with history of diabetes mellitus, thereby reporting it. METHODS: History taking, slit lamp examination, staining and culture, sensitivity test about antibiotics were performed on 1 case of keratitis. RESULTS: Flavobacterium indologenes was detected in staining and culture that was performed on the first visit. Piperacillin was used based on the sensitivity test about antibiotics. Improvement of corneal lesion and symptom was observed with the use of piperacillin. CONCLUSIONS: Flavobacterium indologenes can be considered as a casual pathogen in keratitis with condition susceptible to opportunistic infection such as systemic illness or abnormal ocular immunity.

Comparison of Sugical Outcome between Early and Delayed Repair of Orbital Wall Fracture

PURPOSE: We analyzed the preoperative and postoperative clinical findings of orbital wall fracture patients between the group operated within 2 weeks (early group) and the group operated 3 weeks or later (delayed group). METHODS: Eighty three patients who had been operated from January 1997 to December 2001 were included, 68 patients were early group and 15 patients were delayed group. We analyzed retrospectively the degree of diplopia, limitation of extraocular motility and enophthalmos for more than 6 months following surgery. RESULTS: Orbital wall fracture predominantly occurred in male than in female (p>0.05), and mostly between 21 and 40 years old. The main cause was from violence and traffic accidents. The major coexisting diseases were head trauma and fractures of low extremities, especially in the group of delayed operation. The common locations of fracture were either inferior wall or combined inferior and medial walls. The early group showed less severe preoperative clinical states and better outcomes of postoperative improvement than the delayed group. However, there was no statistically significant difference between two groups in the degree of postoperative limitation of extraocular motility and enophthalmos. CONCLUSIONS: The early group tended to be less severe preoperatively and showed better postoperative outcome than the delayed group. However, the repair of orbital wall fracture was be indicated to improve clinical states even after 3 weeks following injury.