engleski

Purtscher’s retinopathy associated with acute pancreatitis

A 27–year-old woman with a six-day history of fever, diffuse abdominal pain, nausea and vomiting was hospitalised because of loss of acuity in both eyes which developed three days previously. Clinical, laboratory and ultrasound findings confirmed acute pancreatitis. Colour fundus photography bilaterally revealed normal optic discs, cotton-wool exudates, flame and dot shaped retinal haemorrhages at both posterior poles. Intravenous fluorescein angiography showed multiple bilateral ischemic areas in the choroidal and retinal microcirculations with capillary dropout, and a clear diffusion of fluorescein from the perimacular vasculature in the posterior pole. Purtscher’s retinopathy was diagnosed. The patient was treated with analgesics, intravenous fluids, antibiotics and proton pump inhibitors. Three weeks later her vision had completely recovered. Ophthalmoscopy showed complete resolution of the retinal changes. Purtscher’s retinopathy is a rare condition, initially associated with severe head injury and blunt thoracic trauma, but subsequently seen also in patients with acute pancreatitis, fat embolism syndrome, renal failure, preeclampsia, and connective tissue disorders with vasculitis. It is attributed to the occlusion of retinal arterioles by aggregated granulocytes and/or platelets, following complement activation, or to fat microemboli or fibrin clots. This rare complication develops 24-48 hours after the inciting disease and in most cases resolves spontaneously 1-3 months after disease resolution. Visual prognosis is variable and is poor if central macular infarction has occurred. Treatment is usually expectant ; however, in some cases treatment with systemic steroids may be considered.

purtscher’s retinopathy; acute pancreatitis

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