Purtscher-like Retinopathy in Critically Ill Patients (Non-Traumatic Etiologies): A Systematic Review and Meta-analysis of Incidence, Associated Conditions, and Visual Outcomes
Bibliographic record
Abstract
Introduction: Purtscher-like retinopathy (PLR) is an occlusive microvasculopathy presenting with funduscopic findings similar to Purtscher's retinopathy but occurring in the absence of direct head or chest trauma. Its association with various systemic conditions, particularly those requiring intensive care unit (ICU) admission, is recognized, but comprehensive data on its incidence, spectrum of associated non-traumatic critical illnesses, and visual prognosis in this specific population remain sparse. This study aimed to systematically review the literature and perform a meta-analysis to estimate the incidence of PLR among critically ill patients with non-traumatic conditions, identify commonly associated systemic diseases, and quantify visual outcomes. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science databases were searched from January 1st, 2013, to December 31st, 2023, for studies reporting PLR in critically ill adult patients admitted for non-traumatic reasons. Studies included cohort studies, case-control studies, and sufficiently large case series (n≥5 with ICU context) reporting incidence or detailed clinical data. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale (NOS). Pooled incidence of PLR, associated conditions, and final visual acuity (logMAR) were synthesized. A random-effects model was used for meta-analysis due to anticipated heterogeneity. Results: 6 studies met the full eligibility criteria for quantitative synthesis, encompassing 960 critically ill patients from various ICU settings. The included studies were predominantly retrospective cohorts with moderate overall quality (median NOS score 7, range 6-8). The pooled estimated incidence of PLR in the evaluated non-traumatic critically ill populations was 3.4% (95% Confidence Interval [CI]: 2.1% - 5.5%), exhibiting substantial heterogeneity (I² = 80%, p < 0.001). The most frequently reported associated conditions were severe acute pancreatitis (reported in 4/6 studies) and sepsis/septic shock (4/6 studies). Other identified associations included acute kidney injury requiring renal replacement therapy, HELLP syndrome in post-partum patients admitted to ICU, and systemic lupus erythematosus/antiphospholipid syndrome flares requiring intensive care. Visual outcomes were generally poor; the pooled mean final best-corrected visual acuity (BCVA) was 0.85 logMAR (approx. Snellen 20/140; 95% CI: 0.65 - 1.05 logMAR), again with significant heterogeneity (I² = 75%). Approximately 45% of affected eyes had a final BCVA of less than 20/200. Conclusion: Purtscher-like retinopathy represented a notable, albeit relatively uncommon, complication among heterogeneous populations of critically ill patients admitted for non-traumatic conditions. It was most frequently associated with severe systemic inflammatory states such as acute pancreatitis and sepsis. Increased awareness and ophthalmoscopic screening in high-risk ICU patients may be warranted. The observed heterogeneity highlights the need for larger prospective studies with standardized diagnostic and reporting criteria.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.030 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.021 | 0.043 |
| Bibliometrics | 0.010 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".