Lee Debora H, Hwang Christopher K, Cukras Catherine A, Wiley Henry E, Malik Farhan F, Chew Emily Y, Keenan Tiarnan D
Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
Ophthalmology Department, Tysons Corner Medical Center, Kaiser Permanente, McLean, Virginia, USA.
Am J Ophthalmol Case Rep. 2020 Mar 12;18:100664. doi: 10.1016/j.ajoc.2020.100664. eCollection 2020 Jun.
To report the clinical course of two cases with Purtscher-like retinopathy (PLR), associated with peritoneal dialysis (PD), demonstrating disease recurrence and progression to neovascularization and vitreous hemorrhage.
Case 1 (45-year old woman) experienced acute bilateral vision loss. Medical history included hypertension, end-stage renal failure (ESRF), PD, and obstructive sleep apnea. Visual acuity (VA) was 20/100 OD, 20/80 OS. Fundus findings were pathognomonic for PLR and included white streaks within arterioles. Nine months later, repeat imaging demonstrated disease recurrence and progression, including increased ischemia and new retinal neovascularization. The patient was managed with pan-retinal photocoagulation, sleep apnea treatment, and oral corticosteroids. Four months later, VA remained stable without additional progression.Case 2 (74-year old woman) experienced acute bilateral vision loss. Medical history included hypertension, ESRF, and PD, complicated by peritonitis. VA was 20/25 OD, 20/32 OS. Fundus findings were pathognomonic for PLR and included white streaks within arterioles. Three months later, further acute vision loss occurred, coinciding with recurrent peritonitis. Repeat imaging revealed disease recurrence and progression, including severely increased retinal ischemia. The PD catether was removed and the patient converted to hemodialysis. Bilateral vitreous hemorrhage later complicated the course.
PLR can occur in association with PD, particularly in acute peritonitis. Contrary to classical descriptions, PLR may take a chronic and progressive course, with increasing ischemia and progression to neovascularization or vitreous hemorrhage. Increased surveillance for complications is recommended and treatment of neovascularization may be required.
报告两例与腹膜透析（PD）相关的类Purtscher视网膜病变（PLR）的临床病程，显示疾病复发并进展为新生血管形成和玻璃体积血。
病例1（45岁女性）经历急性双侧视力丧失。病史包括高血压、终末期肾衰竭（ESRF）、PD和阻塞性睡眠呼吸暂停。右眼视力（VA）为20/100，左眼为20/80。眼底检查结果为PLR的特征性表现，包括小动脉内的白色条纹。九个月后，重复成像显示疾病复发和进展，包括缺血增加和新的视网膜新生血管形成。患者接受了全视网膜光凝、睡眠呼吸暂停治疗和口服皮质类固醇治疗。四个月后，视力保持稳定，无进一步进展。病例2（74岁女性）经历急性双侧视力丧失。病史包括高血压、ESRF和PD，并伴有腹膜炎。右眼视力为20/25，左眼为20/32。眼底检查结果为PLR的特征性表现，包括小动脉内的白色条纹。三个月后，出现进一步的急性视力丧失，与复发性腹膜炎同时发生。重复成像显示疾病复发和进展，包括视网膜缺血严重增加。移除了PD导管，患者改为血液透析。双侧玻璃体积血后来使病程复杂化。
PLR可与PD相关发生，尤其是在急性腹膜炎时。与经典描述相反，PLR可能呈慢性进行性病程，缺血增加并进展为新生血管形成或玻璃体积血。建议加强对并发症的监测，可能需要对新生血管形成进行治疗。
