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LETTER TO THE EDITOR
Year : 2019  |  Volume : 67  |  Issue : 2  |  Page : 312-313

Comment on: Bilateral combined central retinal artery and vein occlusion in a 3-year-old child with nephrotic syndrome


Department of Ophthalmolgy, S.S. Medical College, Rewa, Madhya Pradesh, India

Date of Web Publication23-Jan-2019

Correspondence Address:
Dr. Anamika Dwivedi
D2-8, Doctors Colony, Rewa - 486 001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1633_18

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How to cite this article:
Dwivedi A, Lakhtakia S. Comment on: Bilateral combined central retinal artery and vein occlusion in a 3-year-old child with nephrotic syndrome. Indian J Ophthalmol 2019;67:312-3

How to cite this URL:
Dwivedi A, Lakhtakia S. Comment on: Bilateral combined central retinal artery and vein occlusion in a 3-year-old child with nephrotic syndrome. Indian J Ophthalmol [serial online] 2019 [cited 2019 Nov 21];67:312-3. Available from: http://www.ijo.in/text.asp?2019/67/2/312/250667



Dear Sir,

We read the article 'Bilateral combined central retinal artery and vein occlusion in a 3-year-old child with nephrotic syndrome' by Sinha et al.[1] with deep interest and would like to congratulate the team for an excellent documentation of fundus, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) in a 3-year-old child.

However, we wish to point out certain points which we thought were important for diagnosis.

  1. The fundus picture shows areas of retinal opacification in the posterior pole which are well demarcated and bounded by arterioles and not diffuse as seen in central retinal artery occlusion (CRAO). These areas appear to be discrete with clear demarcation between affected retina and the contiguous retinal vessels, suggestive of Purtscher flecken.[2] This sparing of perivascular retina from whitening is obviously evident in extramacular areas of retinal whitening in fundus photographs.
  2. A cherry red spot can be seen in Purtscher's retinopathy when the retinal whitening surrounds the fovea and does not necessarily confirm the diagnosis of CRAO.
  3. Retinal haemorrhages which are characteristically seen in all four quadrants in central retinal vein occlusion (CRVO) are very few and seen isolated in this case and this is common in Purtscher's retinopathy.
  4. We could not find any evidence of delayed filling in the FFA pictures presented and as mentioned in the article, though we understand the technical difficulties involved in a 3-year-old child.
  5. Authors have reported arteriolar attenuation at 3 weeks but there seems to be no evidence of arteriolar attenuation in the fundus images of BE presented alongside the spectral domain optical coherence tomography (SDOCT) images.[1]


In view of the above-mentioned characteristics, the diagnosis of Purtscher's-like retinopathy is more appropriate instead of combined CRAO and CRVO. There are reports in the literature describing Purtscher's-like retinopathy in children with nephrotic syndrome with similar severity.[3],[4],[5]

Declaration

The manuscript has been read and approved by all the authors and each author believes that manuscript represent honest work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sinha S, Rau AT, Kumar RV, Jayadev C, Vinekar A. Bilateral combined central retinal artery and vein occlusion in a 3-year-old child with nephrotic syndrome. Indian J Ophthalmol 2018;66:1498-501.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Miguel AI, Henriques F, Azevedo LF, Loureiro AJ, Maberley DA. Systematic review of Purtscher's and Purtscher-like retinopathies. Eye (Lond) 2013;27:1-13.  Back to cited text no. 2
    
3.
Zwolinska D, Medynska A, Galar A, Turno A. Purtscher-like retinopathy in nephrotic syndrome associated with mild chronic renal failure. Pediatr Nephrol 2000;15:82-4.  Back to cited text no. 3
    
4.
Viola F, Vezzola D, Villani E, Mapelli C, Barteselli G, Ratiglia R. Purtscher-like retinopathy in septicemic disseminated intravascular coagulation associated with nephrotic syndrome. Eur J Ophthalmol 2013;23:601-3.  Back to cited text no. 4
    
5.
Dwivedi A, Dwivedi D, Chalisgaonkar C, Lakhtakia S. Purtscher-like retinopathy: A rare ocular finding in nephrotic syndrome. Oman J Ophthalmol 2018;11:42-5.  Back to cited text no. 5
[PUBMED]  [Full text]  




 

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