Purtscher-like Retinopathy in a Patient with Acute Alcoholic Pancreatitis and a Literature Review.

Abstract

Background and Clinical Significance: Purtscher-like retinopathy is a rare occlusive microangiopathy that causes sudden vision loss of varying severity. It presents with diverse retinal findings, such as cotton-wool spots, haemorrhages, and optic disc and macular edema, among others. A key characteristic is the absence of trauma. This condition has been observed in patients with acute pancreatitis, renal failure, preeclampsia, HELLP syndrome, childbirth, and other systemic disorders. Case Presentation: A 35-year-old male presented with complaints of seeing spots in front of both eyes, with a duration of ten days following the initiation of treatment for acute alcoholic pancreatitis. On examination, best-corrected visual acuity (BCVA) in both eyes was 5/6. Fundus examination revealed multiple cotton-wool spots and haemorrhages located in the posterior pole and around the optic disc, more pronounced in the left eye, where the optic disc had blurred margins and the macular reflex was absent. Perimetry showed paracentral scotomas, and optical coherence tomography (OCT) revealed thickening and disruption of the inner retinal layers in the papillomacular region of both eyes. Fundus fluorescein angiography demonstrated adequate perfusion of the vascular network, with hypofluorescent areas in the arteriovenous phase, peripapillary and in the papillomacular zone, due to masking by cotton-wool spots and haemorrhages. Treatment included systemic antiplatelet agents, anticoagulants, and vitamins, along with topical non-steroidal anti-inflammatory drugs. Two months after the initial presentation visual acuity improved to 6/6 in both eyes. Follow-up OCT scans showed atrophy of the inner retinal layers corresponding to the previous cotton-wool spot and the areas of reduced light sensitivity on perimetry had decreased in size. Conclusions: Acute pancreatitis is the most common systemic condition associated with the development of Purtscher-like retinopathy. Timely diagnosis and management of the underlying systemic disease are essential for preventing ocular complications. Ophthalmological evaluation is necessary in patients with acute pancreatitis who present with visual symptoms in order to detect this often-overlooked rare condition.