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. 2015:2015:421329.
doi: 10.1155/2015/421329. Epub 2015 Jan 6.

Purtscher-like retinopathy

Rita Massa  1 , Carolina Vale  1 , Mafalda Macedo  1 , Maria João Furtado  1 , Miguel Gomes  1 , Miguel Lume  1 , Angelina Meireles  1
Affiliations

Purtscher-like retinopathy

Rita Massa et al. Case Rep Ophthalmol Med. 2015.

Abstract

Purtscher-like retinopathy is associated with retinal hemorrhages and ischaemia probably due to the complement-mediated leukoembolization. It is a rare and severe angiopathy found in conditions such as acute pancreatitis. Case. We present a case of a 53-year-old man who presented with a Purtscher-like retinopathy associated with the development of acute pancreatitis in the context of a Klatskin tumour (a hilar cholangiocarcinoma). The ophthalmologic evaluation revealed the best corrected visual acuity (BCVA) of 20/32 in the right eye (RE) and of 20/40 in the left eye (LE); biomicroscopy of anterior segment showed scleral icterus and fundoscopy revealed peripapillary cotton-wool spots, optic disc edema, and RPE hypo- and hyperpigmentation in the middle peripheral retina in both eyes with an intraretinal hemorrhage in the LE. 15 months after the initial presentation, without ophthalmological treatment, there was an improvement of BCVA to 20/20 in both eyes and optical coherence tomography (OCT) revealed areas of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots. Conclusion. Purtscher-like retinopathy should not be neglected in complex clinical contexts. Its unclear pathophysiology determines an uncertain treatment strategy, but a meticulous follow-up is compulsory in order to avoid its severe complications.

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Figures

Figure 1
Figure 1
Retinography of the right eye at first ophthalmologic evaluation showing the presence of peripapillary cotton-wool spots and optic disc edema.
Figure 2
Figure 2
Retinography of the left eye at first ophthalmologic evaluation showing the presence of peripapillary cotton-wool spots, optic disc edema, and an intraretinal hemorrhage in the left inferior temporal arcade.
Figure 3
Figure 3
Retinography of the right and left eyes five months after presentation of the retinopathy revealing the presence of only peripapillary soft exudates in the right eye and no significant alterations in the left eye.
Figure 4
Figure 4
OCT of the right eye five months after presentation of the retinopathy. The red circle reveals the area of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots.
Figure 5
Figure 5
OCT of the left eye five months after presentation of the retinopathy. The red circle reveals the area of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots.
Figure 6
Figure 6
OCT of the right eye fifteen months after presentation of the retinopathy. The red circle reveals the area of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots.
Figure 7
Figure 7
OCT of the left eye fifteen months after presentation of the retinopathy. The red circle reveals the area of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots.
See this image and copyright information in PMC

References

    1. Purtscher O. Noch unbekannte befunde nach schadeltrauma. Ber Zusammenkunft Dtsch Ophthalmol Ges Journal. 1910;36:294–301.
    1. Agrawal A., McKibbin M. A. Purtscher's and Purtscher-like retinopathies: a review. Survey of Ophthalmology. 2006;51(2):129–136. doi: 10.1016/j.survophthal.2005.12.003. - DOI - PubMed
    1. de Medeiros H. A. G., de Medeiros J. E. G., Caliari L. C., da Silva J. F. Purtscher's and Purtscher-like retinopathies. Revista Brasileira de Oftalmologia. 2009;68(2):114–119. doi: 10.1590/s0034-72802009000200010. - DOI
    1. López-Tizón E., Reinoso-Montalvo C., Mencía-Gutiérrez E., Gutiérrez-Díaz E. Acute pancreatitis presenting as sudden blindness. Archivos de la Sociedad Espanola de Oftalmologia. 2006;81(3):161–164. - PubMed
    1. Agrawal A., McKibbin M. Purtscher's retinopathy: epidemiology, clinical features and outcome. British Journal of Ophthalmology. 2007;91(11):1456–1459. doi: 10.1136/bjo.2007.117408. - DOI - PMC - PubMed

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