腹部挟圧外傷に合併したＰｕｒｔｓｃｈｅｒ網膜症の１例

Abstract

A 32-year-old man was compressed between two boards and suffered a pancreatic injury and acute blurring of vision. He was treated conservatively at a local hospital and transferred to our hospital on the 10th day following his injury. His corrected visual acuity was 0.08 for his right eye and 0.3 for his left. An ophthalmoscopy revealed multiple cotton-wool exudates and retinal hemorrhages, while a fluorescein angiography examination showed staining of the vessel walls and minor leakage along the vessels. We diagnosed the patient as having Purtscher's retinopathy and managed the patient by observation. Endoscopic retrograde pancreatography and computed tomography examinations revealed a disruption of the main pancreatic duct and a right renal infarction. A caudal pancreatectomy and a right nephrectomy were therefore performed on the 18th day after the injury. The visual acuity improved to 0.8 in the right eye and 1.0 in the left eye 5 months after the injury. Purtscher's retinopathy is characterized by a sudden loss of vision after a head, chest or abdominal injury and is associated with cotton-wool exudates and retinal hemorrhages in the posterior pole. No effective treatments have been reported, but the prognosis is typically considered to be good. Emergency doctors should be aware of this disease as a cause of blurred vision resulting from extraocular injury.