Multimodal imaging findings in Purtscher-like retinopathy after retrobulbar anesthesia

Abstract

Introduction: This is a case of Purtscher-like retinopathy with an unusual etiology of retrobulbar anesthesia, evidenced by optical coherence tomography-angiography (OCT-A) images. Patient and Clinical Findings: After cataract surgery with a retrobulbar block, a 65-year-old woman experienced sudden dramatic visual reduction with superficial white retinal patches on fundus examination and corresponding capillary bed infarcts on fluorescein angiography and OCT-A. Diagnosis, Intervention, and Outcomes: Using advanced OCT-A, fluorescein angiography imaging, and fundus photography, the patient was diagnosed with Purtscher-like retinopathy. The patient was treated with topical steroids, nonsteroidal anti-inflammatory drops, and antibiotic drops, with gradual and nearly complete resolution of visual acuity. Conclusions: This case represents a rare but possible complication of retrobulbar anesthesia associated with cataract surgery. Despite dramatic changes on OCT-A, and in contrast to other reports with similar characteristic findings, our patient regained significant vision.