A CASE OF PURTSCHER’S RETINOPATHY SECONDARY TO ACUTE ALCOHOL INDUCED PANCREATITIS Ryley McPeters MD, Tyler Thorne MD, Tejas Joshi MD, Mathoula Bilalis MS-4, Lance Turkish MD, John Amoss, MD, Stephen Landreneau, MD Department of Medicine, LSU Health Sciences Center, New Orleans, LA INTRODUCTION: Purtscher’s retinopathy is a rare condition first described following intracranial trauma. This occlusive microvasculopathy is characterized by sudden visual loss with multiple areas of retinal whitening in the posterior pole of the eye. Similar findings have been seen in atraumatic patients termed Purtscher-like retinopathy (PuR). PuR has been described with acute pancreatitis and connective tissue diseases. PuR, associated with systemic disease, develops through the activation of the complement cascade which leads to leukoembolization of the retinal precapillary arterioles and cause the clinical appearance of Purtscher’s retinopathy. CASE: A 28 year-old woman with a history of alcohol abuse and multiple of admissions for acute pancreatitis presented with chief complaint of emesis and abdominal pain. Physical exam, initial blood tests and abdominal ultrasound were consistent with acute pancreatitis. The patient received appropriate fluid resuscitation and adequate pain control. During her hospital stay, the patient awoke from a nap, noted blurry vision, and saw “little dots floating around,” which almost completely resolved in the evening. The following morning, she had worsening blurry vision and floaters. Exam by Ophthalmology revealed cotton wool spots, macular edema and neurosensory detachment of the macula bilaterally secondary to PUR. Visual field testing showed loss of central field bilaterally with preserved peripheral vision. Visual acuity was 20/200 bilaterally with no improvement with pinhole. The patient received intraocular steroid injections with weekly follow up. Examination at 8 weeks demonstrated improvement of visual acuity to 20/40 bilaterally. DISCUSSION: The development of PuR is independent on the severity of pancreatitis and presents with a wide range of manifestations. The diagnosis is made clinically with sudden loss of visual acuity associated with optic nerve edema and visual field loss, along with retinal findings such as cotton-wool spots, retinal hemorrhage, artery attenuation, venous dilation, and Purtscher flecken. The treatment for the ocular complications of PuR have not been proven and prognosis depends on the areas of the retina that are affected.
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