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Impressum
Purtscher-like Retinopathy with Bilateral Loss of Vision Following Acute Nonbiliary Pancreatitis
Ladewig M., Jandeck C., Bechrakis N. E., Foerster M. H.
Ophthalmology Department, Benjamin Franklin University Hospital, D-12200 Berlin, Germany
Background: Purtscher-like retinopathy with a bilateral loss of
vision is a rare and severe complication that may follow acute pancreatitis.
The prognosis ranges from complete recovery to total blindness. The final
stage may result in optic atrophy. The pathogenesis of Purtscher-like
retinopathy remains unknown.
Case report: A 43-year-old male patient with long-term alcohol
abuse was hospitalized because of acute, non-biliary pancreatitis. Following
onset of acute epigastric pain the patient noticed a bilateral loss of
vision. The major event triggering the pancreatitis was thought to be
related to an acute episode of excessive alcohol intake.
Results: Initially, visually acuity was severely reduced: the patient
could count fingers with both eyes. The anterior segment was unremarkable,
while the ophthalmoscopic examination revealed multiple cotton wool spots
surrounding the optic disc and small parts of hemorrhage at the vitreoretinal
interface. The angiography showed occlusion in the capillaries and decreased
perfusion in the posterior pole choroid. Additionally, we found a narrowing
of the 20° grades in the visual field. Multifocal ERG revealed a reduction
in amplitude in the central regions. In the subsequent course, retinal
edema diminished and optic atrophy developed.
Discussion: The pathogenesis of this form of retinopathy still
remains unknown. Fat embolism may result in ischemic retinal infarctions.
On the other hand, trypsin released during acute pancreatitis may cause
cleavage of C5a chemotactic fragments leading to an increase in leukocyte
aggregation with resultant production of oxygen free radicals. Several
case reports have been published that show a similar association of similarly
severe retinopathy with pancreatitis caused by excessive acute alcohol
consumption. Surprisingly, there is no correlation between the severity
of pancreatitis and that of retinopathy.