Mitkova-Hristova Vesela Todorova, Atanassov Marin Anguelov, Idriz Yumyut Remzi, Hristova Steffanie Hristova
Department of Ophthalmology, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria.
Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria.
Diagnostics (Basel). 2025 Sep 12;15(18):2317. doi: 10.3390/diagnostics15182317.
: Purtscher-like retinopathy is a rare occlusive microangiopathy that causes sudden vision loss of varying severity. It presents with diverse retinal findings, such as cotton-wool spots, haemorrhages, and optic disc and macular edema, among others. A key characteristic is the absence of trauma. This condition has been observed in patients with acute pancreatitis, renal failure, preeclampsia, HELLP syndrome, childbirth, and other systemic disorders. : A 35-year-old male presented with complaints of seeing spots in front of both eyes, with a duration of ten days following the initiation of treatment for acute alcoholic pancreatitis. On examination, best-corrected visual acuity (BCVA) in both eyes was 5/6. Fundus examination revealed multiple cotton-wool spots and haemorrhages located in the posterior pole and around the optic disc, more pronounced in the left eye, where the optic disc had blurred margins and the macular reflex was absent. Perimetry showed paracentral scotomas, and optical coherence tomography (OCT) revealed thickening and disruption of the inner retinal layers in the papillomacular region of both eyes. Fundus fluorescein angiography demonstrated adequate perfusion of the vascular network, with hypofluorescent areas in the arteriovenous phase, peripapillary and in the papillomacular zone, due to masking by cotton-wool spots and haemorrhages. Treatment included systemic antiplatelet agents, anticoagulants, and vitamins, along with topical non-steroidal anti-inflammatory drugs. Two months after the initial presentation visual acuity improved to 6/6 in both eyes. Follow-up OCT scans showed atrophy of the inner retinal layers corresponding to the previous cotton-wool spot and the areas of reduced light sensitivity on perimetry had decreased in size. : Acute pancreatitis is the most common systemic condition associated with the development of Purtscher-like retinopathy. Timely diagnosis and management of the underlying systemic disease are essential for preventing ocular complications. Ophthalmological evaluation is necessary in patients with acute pancreatitis who present with visual symptoms in order to detect this often-overlooked rare condition.
类Purtscher视网膜病变是一种罕见的闭塞性微血管病，可导致程度不一的突然视力丧失。其眼底表现多样，如棉絮斑、出血、视盘及黄斑水肿等。一个关键特征是无外伤史。这种情况在急性胰腺炎、肾衰竭、先兆子痫、HELLP综合征、分娩及其他全身性疾病患者中均有观察到。：一名35岁男性，在开始治疗急性酒精性胰腺炎十天后，出现双眼眼前有黑影的症状。检查发现，双眼最佳矫正视力（BCVA）为5/6。眼底检查显示，后极部及视盘周围有多个棉絮斑和出血，左眼更为明显，左眼视盘边界模糊，黄斑反射消失。视野检查显示旁中心暗点，光学相干断层扫描（OCT）显示双眼乳头黄斑区视网膜内层增厚及中断。眼底荧光血管造影显示血管网络灌注正常，动静脉期、视盘周围及乳头黄斑区有低荧光区，系棉絮斑和出血遮挡所致。治疗包括全身应用抗血小板药物、抗凝剂及维生素，同时局部应用非甾体类抗炎药。初诊两个月后，双眼视力提高至6/6。随访OCT扫描显示，与之前棉絮斑对应的视网膜内层萎缩，视野检查中光敏感度降低区域的大小减小。：急性胰腺炎是与类Purtscher视网膜病变发生相关的最常见全身性疾病。及时诊断和处理潜在的全身性疾病对于预防眼部并发症至关重要。急性胰腺炎患者出现视觉症状时，有必要进行眼科评估，以发现这种常被忽视的罕见疾病。
