Purtscher-like retinopathy caused by acute pancreatitis

Abstract

A 30-year-old woman with acute pancreatitis was referred to our eye clinic because of sudden blindness. Visual acuity was reduced to counting fingers in both eyes. Fundoscopy showed cotton-wool spots and intraretinal haemorrhages surrounding a normal optic disc bilaterally (figure A, B). At 3-month follow-up, the patient's retinal findings had much improved spontaneously. However, her visual acuity did not recover completely (right, 20/40, left, 20/25), although the underlying pancreatitis had been treated successfully. Purtscher retinopathy is caused by microembolisation of retinal and choroidal arterioles by fat emboli after severe trauma and is characterised by retinal ischaemia and haemorrhages. Purtscher-like retinopathy shows the same clinical findings but is associated with other diseases, including acute pancreatitis, systemic collagen vascular diseases, chronic renal failure, and thrombotic thrombocytopenic purpura. Enzymes from an inflamed pancreas seem to lead to complement activation, resulting in granulocyte aggregation and subsequent retinal microembolisation. There is no evidence-based treatment for this retinopathy. A 30-year-old woman with acute pancreatitis was referred to our eye clinic because of sudden blindness. Visual acuity was reduced to counting fingers in both eyes. Fundoscopy showed cotton-wool spots and intraretinal haemorrhages surrounding a normal optic disc bilaterally (figure A, B). At 3-month follow-up, the patient's retinal findings had much improved spontaneously. However, her visual acuity did not recover completely (right, 20/40, left, 20/25), although the underlying pancreatitis had been treated successfully. Purtscher retinopathy is caused by microembolisation of retinal and choroidal arterioles by fat emboli after severe trauma and is characterised by retinal ischaemia and haemorrhages. Purtscher-like retinopathy shows the same clinical findings but is associated with other diseases, including acute pancreatitis, systemic collagen vascular diseases, chronic renal failure, and thrombotic thrombocytopenic purpura. Enzymes from an inflamed pancreas seem to lead to complement activation, resulting in granulocyte aggregation and subsequent retinal microembolisation. There is no evidence-based treatment for this retinopathy.