Purtscher-like retinopathy caused by acute pancreatitis

• Verfasst von: Mayer, Christian [VerfasserIn]
• Verfasst von: Khoramnia, Ramin [VerfasserIn]
• Titel: Purtscher-like retinopathy caused by acute pancreatitis
• Verf.angabe: Christian Mayer, Ramin Khoramnia
• E-Jahr: 2011
• Jahr: September 23, 2011
• Umfang: 1 S.
• Fussnoten: Gesehen am 12.08.2022
• Titel Quelle: Enthalten in: The lancet <London>
• Ort Quelle: London [u.a.] : Elsevier, 1823
• Jahr Quelle: 2011
• Band/Heft Quelle: 378(2011), 9803, Seite 1653
• ISSN Quelle: 1474-547X
• DOI: doi:10.1016/S0140-6736(11)60474-1
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1814244883

Abstract

La retinopatía de Purtscher-like es una enfermedad ocular poco común que se manifiesta con pérdida súbita de la visión, asociada con una patología sistémica como lo es el lupus eritematoso sistémico. Se presenta el caso de un paciente masculino de 25 años, con retinopatía Purtscher-like como primera manifestación de lupus eritematoso sistémico, evaluado en un centro de alta complejidad de la ciudad de Medellín, Colombia. Se observa mejoría de signos y síntomas posteriormente al inicio de corticosteroides y terapia con ciclofosfamida intravenosa mensual. Se considera fundamental la valoración oftalmológica temprana en pacientes con sospecha de enfermedades autoinmunes, para realizar diagnósticos tempranos y mejorar el pronóstico de los pacientes. - Purtscher-like retinopathy is a rare ocular disease that manifests with sudden loss of vision, associated with a systemic pathology such as systemic lupus erythematosus. We present the case of a 25-year-old male patient with Purtscher-like retinopathy as the first manifestation of systemic lupus erythematosus, evaluated in a high-complexity centre in the city of Medellín, Colombia. Improvement of signs and symptoms was observed after the start of corticosteroids and monthly intravenous cyclophosphamide therapy. We consider prompt ophthalmological evaluation essential in patients with suspected autoimmune diseases, to make an early diagnosis and improve the prognosis. - There is paucity of data on ocular changes in acute Pancreatitis (AP). Moreover, subclinical alterations in retina & choroid have not been studied in AP. - To prospectively study retino-choroidal changes in AP. - Sixty patients (mean age 39.07 years; 41 males) with AP were followed up till recovery/death. Baseline slit-lamp examination, choroidal thickness (CT), retinal thickness (RT), choroidal vascularity index (CVI), retinal capillary density index (CDI) and arteriovenous ratio (AVR) were recorded. The patients were divided into two groups - mild (Group A; 5 patients) and moderately severe/severe (Group B; 55 patients) as per revised Atlanta classification. - Fundus examination showed mild optic disc edema with retinal hemorrhages in 6 (10%) patients in group B as compared to none in group A (p = 1.00). None of the patients had Purtscher retinopathy. Mean CT (317 ± 56.29 μm) was increased as compared to normal subjects (278.90 ± 57.84 μm, p = 0.003). The mean CVI (0.62 ± 0.04) was decreased as compared to normal (0.66 ± 0.01, p < 0.0001) as was the mean AVR (0.67 ± 0.03 vs. 0.7 ± 0.02, p < 0.0001). However, the mean RT of subjects with AP (239.68 ± 33.76 μm) was not significantly different compared to the normal subjects 253.17 ± 33.67 µm (p=NS). The mean CDI of superficial and deep plexus were comparable between normal and patients with AP. CT, RT, CVI, AVR and CDI were comparable between group A and group B as well as survivors and non-survivors. - Clinically significant ocular changes are seen infrequently in AP. However, subclinical changes in CT, CVI and AVR are observed in patients with AP compared to normal individuals. - Purtscher-like retinopathy is an uncommon condition with features similar to Purtscher retinopathy but have non-traumatic causes. Several pathogenic mechanisms have been put forth with differing views on treatment options. We describe for the first time, a case of Purtscher-like retinopathy which developed following a myocardial infarct and a transient ischemic attack. We present a review of the literature on this condition, describing the various clinical presentations, investigation findings, treatment options and prognosis.