Bu çalışmada kronik böbrek yetmezliği ile birlikte seröz retina dekolmanı olan nadir görülen bilateral Purtscher-like retinopatili bir olguyu sunmayı amaçladık.

We purposed to report an unusual case with Purtscher-like retinopathy with serous retinal detachment and chronic renal failure.

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Figure 1: Color fundus images of both eyes: Multiple cotton wool spots and multipl dot-blot-splinter retinal hemoorhages at peripapillary region and macula, and macular star in the left eye (A and B). Optical coherence tomography scans showed bilateral serous retinal detachment in macula, hyperreflective dots and thickening of retinal nerve fiber layer at the regions of cotton wool spots (C and D).

The fundus characteristics of disease are bilateral retinal signs include multiple white ischemic infarcts (cotton-wool spots in varying sizes or Purtscher-flecken) located around optic disk and at posterior pole and hemorrhages (dot and blot, pre-retinal, or flame) and sometimes optic disc swelling. The patients with PLR have similar fundus findings to PR, however PLR occurs in the patients with no relation to trauma. PLR is seen in patients with connective tissue disorder, HELLP syndrome, renal failure, long bone fracture, acute pancreatitis, pancreatic adenocarcinoma, the trombotic trombocytopenic purpura, preeclampsia eclampsia and amniotic fluid embolia In both PR and PLR, patients usually experience asymmetrical bilateral symptoms^1,2. Although, the pathogenesis of these diseases is still uncertain, the pathogenesis involves microembolic occlusion of the precapillary arterioles caused by fat, air, leucocytes, fibrin, platelets by emboli, complement activation, elevated intracranial or intrathoracic pressure and extravasation of lymph, vasculitis due to free fatty acids¹.

The diagnosis is made on clinical findings and supported by fundus fluorescein angiography. OCT can provide details about optic disk and posterior pole involvement. FFA can reveal the blockade of choroidal flourescence, retinal arteriolar occlusion, capillary non-perfusion areas and perivenous staining. OCT can show macular edema or optic disk edema^1,2. There are no specific the treatment of patients with Purtscher's retinopathy. The majority of patients with PR and PLR have some visual acuity without treatment. Application of hyperbaric oxygen and intravenous high-dose steroids may be useful for resisted and selected cases^1,8.

In conclusion, it should be considered that each case of Purtscher-like retinopathy could be a patient with renal failure.

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