Purtscher's-like retinopathy in acute alcoholic pancreatitis

Abstract

A 28-year-old man presented with a sudden onset of visual loss in both eyes (OU). He had a known history of acute pancreatitis and hepatitis following alcohol abuse. Examination of the anterior segment of the eye revealed non-sustained pupillary light reaction. The fundus showed typical Purtscher's flecken over the posterior pole with multiple cotton wool spots and retinal superficial haemorrhages in OU. Fundus fluorescein angiogram revealed abnormal hypofluorescence in both the posterior poles. Optical coherence tomography (OCT) for Purtscher's flecken showed abnormal retinal thickening with hyper-reflective areas in the inner neurosensory layers. The patient responded favourably to high-dose corticosteroid therapy (1.5 mg/kilogram per body weight) with a tapering dose. There was a mild reduction of the ischaemic areas with a corresponding improvement in visual acuity. This case has been presented owing to its rarity and under-reporting. Treatment with corticosteroids yielded favourable results.

An unusual association between pancreatic cancer and Purtscher-like retinopathy: Presentation of a unique case

“…Besides the classic Purtscher's retinopathy, a similar clinical retinopathy having non-traumatic etiology has also been described. This pathology, designated in the Literature as Purtscher's-like retinopathy [4] , is usually associated with acute pancreatitis [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , whose detection could be an indicator of multi-organ failure with a poor prognosis [14] . The possible pathophysiology lies in the pancreatic injury or inflammation that causes the release of activated proteases such as trypsin, which in turn activate the complement system.…”

Purtscher’s-Like Retinopathy Following Acute Pancreatitis

“…Purtscher's and Purtscher's-like retinopathies are rare, with an estimated incidence of 0.24 per million per year. 1,4 The actual incidence is suspected to be higher due to possible underreporting.…”

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

“…Furthermore, Purtscher’s-like retinopathy is rare with an incidence rate of less than 0.24 cases per million, and it is also a complication of AP [ 5 ]. 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, the incidence of sudden visual loss associated with changes in the retina ( inter alia retinal haemorrhages and oedema) in AP was found to be 2% [ 9 ]. Purtscher’s-like retinopathy represents one of the eye disorders in AAP [ 5 , 9 – 11 ] and only rarely acute non-alcoholic pancreatitis [ 14 ]. The exact mechanisms that lead to its occurrence are still undiscovered.…”

“…These changes cause blurred vision and the decrease of visual acuity. The criteria established by Agrawal and McKibbin are used to diagnose Purtscher’s-like retinopathy [ 9 , 16 ]. They include the presence of multiple Purtscher’s flecken and/or cotton-wool spots detected in funduscopic examination in one or both eyes, which occur in the course of an unassociated contributing illness [ 9 , 16 ].…”