Purtscher-like retinopathy associated with acute pancreatitis at Vilnius University Hospital Santariskiu Klinikos

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Abstract

Purpose

To report two cases of Purtscher-like retinopathy associated with acute pancreatitis.

Methods

Retrospective analysis of two cases of Purtscher-like retinopathy associated with acute pancreatitis. Fluorescein angiography (FAG), retinal photography, laboratory tests, computer tomography (CT) were analyzed.

Results

2 cases were identified in a period from 2007 to 2013. The first, 57 y.o patient with a history of recently treated acute pancreatitis, was referred to clinic 2 weeks after visual impairment. Visual acuity (VA) was 0,3 in the right eye and 0,25 in the left eye. FAG revealed prolonged arterio-venous passage time, enlarged foveal avascular zone (FAZ), fluorescein blockage temporal to optic nerve disc due to soft exudates. Patient was treated with systemic steroids intravenously. VA improved to 1,0 after 9 days of treatment. The second, 39 years old patient was referred to our clinic 3 days after visual impairment. At the time of hospitalization despite patients normal vital signs, laboratory tests and CT revealed acute pancreatitis and reactive hepatitis. VA was hand motion in the right eye and 0,01 in the left eye. FAG showed large FAZ and evidence of leakage from vessels in the late phase. After treatment with intravenous steroids, VA improved to counting fingers at 30 cm in the right eye and 0,03 in the left eye.

Conclusion

Prognosis of Purtscher-like retinopathy may depend on systemic disease severity, VA in early stages and the presence of macular ischemia. Pancreatitis-associated retinopathy is rare and there are no evidence-based therapeutic recommendations.

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