Unilateral Purtscher-Like Retinopathy Following Gemcitabine and Bevacizumab Therapy for Recurrent Cervical Carcinoma: A Case Report

Purtscher-like retinopathy (PLR) is a rare, vision-threatening occlusive microvasculopathy. We report a rare case of unilateral PLR following the initiation of chemotherapy for recurrent cervical carcinoma. A 54-year-old female with recurrent carcinoma of the cervical vault presented with sudden, painless diminution of vision in the left eye (visual acuity: 2/60), five days post-initiation of chemotherapy with gemcitabine and bevacizumab. Fundus examination revealed multiple superficial hemorrhages, cotton wool spots, and Purtscher flecken with macular edema, initially diagnosed elsewhere as a combined central retinal artery and vein occlusion. Systemic laboratory workup was unremarkable. A diagnosis of chemotherapy-induced PLR secondary to localized thrombotic microangiopathy was established. The patient was managed conservatively with close oncological follow-up. Gemcitabine and bevacizumab can precipitate localized thrombotic microangiopathy leading to PLR. Precise funduscopic evaluation is essential to distinguish PLR from combined retinal vascular occlusions to prevent unnecessary interventions and guide appropriate multidisciplinary management.