Purtscher-Like Retinopathy

Abstract

Purtscher-like retinopathy is associated with retinal hemorrhages and ischaemia probably due to the complement-mediated leukoembolization. It is a rare and severe angiopathy found in conditions such as acute pancreatitis. Case. We present a case of a 53-year-old man who presented with a Purtscher-like retinopathy associated with the development of acute pancreatitis in the context of a Klatskin tumour (a hilar cholangiocarcinoma). The ophthalmologic evaluation revealed the best corrected visual acuity (BCVA) of 20/32 in the right eye (RE) and of 20/40 in the left eye (LE); biomicroscopy of anterior segment showed scleral icterus and fundoscopy revealed peripapillary cotton-wool spots, optic disc edema, and RPE hypo- and hyperpigmentation in the middle peripheral retina in both eyes with an intraretinal hemorrhage in the LE. 15 months after the initial presentation, without ophthalmological treatment, there was an improvement of BCVA to 20/20 in both eyes and optical coherence tomography (OCT) revealed areas of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots. Conclusion. Purtscher-like retinopathy should not be neglected in complex clinical contexts. Its unclear pathophysiology determines an uncertain treatment strategy, but a meticulous follow-up is compulsory in order to avoid its severe complications.

Bilateral whitish lesions in the fundus of a young male

“…Purtscher-like retinopathy is a rare vision-threatening microangiopathy secondary to complement-mediated leukoembolization and subsequent infarction of the retinal capillary bed. [ 3 ] History of trauma is typically absent, which differentiates it from a classical Purtscher retinopathy. Various causes include renal failure, pancreatitis, Valsalva maneuver, fat/air/amniotic embolism, connective tissue disorders, myocardial infarction, hematopoietic disorders, preeclampsia, HELLP syndrome, and post-viral and post-surgery illness.…”

Purtscher’s retinopathy and renal cortical necrosis: two rare vaso-occlusive complications in a patient with acute pancreatitis: a case report

“…2). The outcome of Purtscher’s retinopathy is uncertain; however, in most of the cases, visual acuity improves with time [33, 35]. Resolution of retinal lesions is expected within about 4 months.…”

Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis

“…So far, several such cases have been reported in the literature [ 5 , 9 – 11 ]. It must be emphasized that Purtscher’s-like retinopathy occurs primarily in acute alcoholic pancreatitis (AAP), and there are few case reports of this type of ocular disorder in acute non-alcoholic pancreatitis: in the context of a Klatskin tumour or an acute kidney injury [ 12 , 13 ]. Nevertheless, there is only 1 case report of this retinopathy in acute non-alcoholic pancreatitis without concomitant diseases [ 14 ].…”

“…On the other hand, alcohol abuse may contribute to the development of other retinal diseases among patients with diabetic retinopathy [ 15 ]. However, the most prevalent theory is that of retinal vessel occlusion by microemboli, which may originate from various kind of particles inter alia fat, fibrin clots, and leukocyte aggregates [ 12 ]. In the course of AP, the pancreatic damage contributes to exacerbated release of proteolytic enzymes into the circulation, which is responsible for the formation of C5a-induced leukocyte aggregate.…”

“…In the course of AP, the pancreatic damage contributes to exacerbated release of proteolytic enzymes into the circulation, which is responsible for the formation of C5a-induced leukocyte aggregate. As a consequence, retinal ischaemia occurs [ 12 ]. Furthermore, intraretinal haemorrhages, confluent cotton-wool spots, and Purtscher’s flecken are specific changes detected in the posterior pole of the eye [ 5 ].…”