Purtscher-like retinopathy presented a honeycomb-like pattern in optical coherence topography angiography

BACKGROUND: To report a case of Purtscher-like retinopathy (PUR) and the optical coherence tomography (OCT) and OCT angiography (OCT-A) findings before and after treatment. CASE PRESENTATION: A 65-year-old male presented with acute onset of vision loss for 2 weeks. Fundus examination revealed cotton-wool spots, retinal haemorrhage, and Purtscher flecken spread around the optic disc in the right eye. He was diagnosed with Purtscher-like retinopathy because he lacked any traumatic medical history. OCT presented some band-like hyperreflective lesions at the inner nuclear layer, which are indicative of paracentral acute middle maculopathy (PAMM). OCT-A revealed apparent reduction in blood flow signal at the deep retina and choriocapillaris layers with a honeycomb-like hypointense signal pattern. After 3 months of follow-up, OCT revealed resolution of retinal oedema, but PAMM lesions remained visible. Based on OCT-A, the honeycomb-like pattern turned into a homogeneous reduction in blood flow with small patches of hypointense signal areas in the choriocapillaris. CONCLUSION: This case presented a new OCT-A sign in PUR with a honeycomb-like hypointense signal at the choriocapillaris layer, indicating the involvement and ischaemia of the choroid during the pathological process.