Purtscher-like retinopathy in patients with exacerbation of chronic pancreatitis: case report

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Purtscher retinopathy is a rare retinal disease, which is typically associated with severe injuries (head contusion, chest compression, pelvic bone fractures, etc.) and manifested by severe vision loss, multiple light lesions, and intraretinal hemorrhages. Purtscher-like retinopathy is (a type of Purtscher retinopathy) a rare and therefore poorly understood condition. Its most common cause is severe systemic conditions of solid organs. The pathophysiology of Purtscher-like retinopathy includes retinal vasculature microembolization resulting in arteriolar and precapillary occlusion. This leads to infarcts in the retinal nerve fiber layer and cotton-wool spots. Compression traumas cause an acute increase in venous pressure, leading to angiospasm and vascular endothelial damage, followed by vascular occlusion. Currently, there is neither a single diagnostic algorithm nor a unified treatment for this condition, which makes it an urgent issue. The article presents clinical observations and treatment outcomes in two patients with Purtscher-like retinopathy secondary to exacerbation of chronic pancreatitis.

作者简介

Dmitrii Belov

City Multifield Hospital No. 2, Saint Petersburg; Saint Petersburg State University

编辑信件的主要联系方式.
Email: belovd1990@gmail.com
ORCID iD: 0000-0003-0776-4065
SPIN 代码: 2380-2273

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Natalia Zumbulidze

North-Western State Medical University named after I.I. Mechnikov

Email: guramovna@gmail.com
ORCID iD: 0000-0002-7729-097X
SPIN 代码: 4439-8855

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Vladimir Petukhov

City Multifield Hospital No. 2, Saint Petersburg

Email: v.p.petukhov@gmail.com
ORCID iD: 0000-0003-4973-3937
SPIN 代码: 2879-9313

MD

俄罗斯联邦, Saint Petersburg

Ilia Vakhranev

North-Western State Medical University named after I.I. Mechnikov

Email: visiondoctor1@gmail.com
ORCID iD: 0009-0005-8370-6571

MD

俄罗斯联邦, Saint Petersburg

Yury Gnatyuk

City Multifield Hospital No. 2, Saint Petersburg

Email: yuragnatyuk@yandex.ru
ORCID iD: 0009-0001-2061-0805

MD

俄罗斯联邦, Saint Petersburg

参考

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  3. Kupriyanova IN, Orlova OL, Flyagina VI. Purtscher’s retinopathy in acute pancreatitis and newly diagnosed diabetes. RMJ. Clinical ophthalmology. 2016;(4):232–236. doi: 10.21689/2311-7729-2016-16-4-232-236 EDN: ZNOGHJ
  4. Kincaid MC, Green WR, Knox DL, Mohler C. A clinicopathological case report of retinopathy of pancreatitis. Br J Ophthalmol. 1982;66(4):219–226. doi: 10.1136/bjo.66.4.219
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  6. Blodi BA, Johnson MW, Gass JD, et al. Purtscher’s-like retinopathy after childbirth. Ophthalmology. 1990;97(12):1654–1659. doi: 10.1016/s0161-6420(90)32365-5.
  7. Miguel AI, Henriques F, Azevedo LF, et al. Systematic review of Purtscher’s and Purtscher-like retinopathies. Eye (Lond). 2013;27(1):1–13. doi: 10.1038/eye.2012.222
  8. Sadda SR, Schachat AP, Wilkinson CP, et al. Ryan’s retina. 7th edit. Vol. 2. Elseiver: 2023; P. 1877–1878.
  9. Nesmith BLW, Bitar MS, Schaal S. The anatomical and functional benefit of bevacizumab in the treatment of macular edema associated with Purtscher-like retinopathy. Eye (Lond). 2014;28(8):1038–1040. doi: 10.1038/eye.2014.85

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1. JATS XML
2. Fig. 1. Ophthalmoscopic examination and optical coherence tomography of the macular zone one month after treatment (top) and before treatment (bottom). According to optical coherence tomography, macular thickness has normalized due to complete fluid resorption.

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3. Fig. 2. Ophthalmoscopic image of the patient’s fundus: a – right eye; b – left eye.

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4. Fig. 3. Ophthalmoscopic image and optical coherence tomography of the fundus of the right eye one month after treatment (top) and before treatment (bottom).

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5. Fig. 4. Ophthalmoscopic image and optical coherence tomography of the fundus of the left eye one month after treatment (top) and before treatment (bottom).

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