{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T14:01:51Z","timestamp":1762783311456,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: 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. Case Presentation: 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. Conclusions: 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.<\/jats:p>","DOI":"10.3390\/diagnostics15182317","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T09:07:15Z","timestamp":1757668035000},"page":"2317","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Purtscher-like Retinopathy in a Patient with Acute Alcoholic Pancreatitis and a Literature Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5993-7143","authenticated-orcid":false,"given":"Vesela Todorova","family":"Mitkova-Hristova","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marin Anguelov","family":"Atanassov","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1636-468X","authenticated-orcid":false,"given":"Yumyut Remzi","family":"Idriz","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffanie Hristova","family":"Hristova","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.survophthal.2005.12.003","article-title":"Purtscher\u2019s and Purtscher-like retinopathies: A review","volume":"51","author":"Agrawal","year":"2006","journal-title":"Surv. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/0002-9394(75)90291-3","article-title":"Retinal Fat Emboli as A Sequela to Acute Pancreatitis","volume":"80","author":"Inkeles","year":"1975","journal-title":"Am. J. Ophthalmol."},{"key":"ref_3","first-page":"170","article-title":"Purtscher\u2019s-like retinopathy as a rare complication of acute alcoholic pancreatitis","volume":"16","author":"Wieczorek","year":"2021","journal-title":"Prz. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"bcr2016215485","DOI":"10.1136\/bcr-2016-215485","article-title":"Purtscher\u2019s-like retinopathy in acute alcoholic pancreatitis","volume":"2016","author":"Subudhi","year":"2016","journal-title":"BMJ Case Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1136\/bjo.2007.117408","article-title":"Purtscher\u2019s retinopathy: Epidemiology, clinical features and outcome","volume":"91","author":"Agrawal","year":"2007","journal-title":"Br. J. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2050313X241269565","DOI":"10.1177\/2050313X241269565","article-title":"Purtscher-like retinopathy: Case report of a rare complication of acute on chronic pancreatitis","volume":"12","author":"Bandara","year":"2024","journal-title":"SAGE Open Med. Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Serhan, H.A., Abuawwad, M.T., Taha, M.J.J., Hassan, A.K., Abu-Ismail, L., Delsoz, M., Alrawashdeh, H.M., Alkorbi, H.A., Moushmoush, O., and Elnahry, A.G. (2024). Purtscher\u2019s and Purtscher-like retinopathy etiology, features, management, and outcomes: A summative systematic review of 168 cases. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0306473"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2050313X231198367","DOI":"10.1177\/2050313X231198367","article-title":"Purtscher-like retinopathy with serous macular detachment in a case of acute pancreatitis: A case report","volume":"11","author":"Sharma","year":"2023","journal-title":"SAGE Open Med. Case Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1136\/pgmj.72.849.409","article-title":"Purtscher\u2019s retinopathy","volume":"72","author":"Buckley","year":"1996","journal-title":"Postgrad. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"110","DOI":"10.4103\/0974-620X.184531","article-title":"Purtscher-like retinopathy in acute alcoholic pancreatitis","volume":"9","author":"Nema","year":"2016","journal-title":"Oman J. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Prabhu, V., Joshi, A., Chitturi, S.P., Yadav, N.K., Chhablani, J., and Venkatesh, R. (2024). Internal limiting membrane separation and posterior vitreous hyperreflective dots: Novel OCT findings in Purtscher-like retinopathy. BMC Ophthalmol., 24.","DOI":"10.1186\/s12886-024-03413-w"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1590\/S1516-31802005000600008","article-title":"Purtscher-like retinopathy associated with acute pancreatitis","volume":"123","author":"Carrera","year":"2005","journal-title":"Sao Paulo Med. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/S1590-8658(00)80338-2","article-title":"Acute pancreatitis with Purtscher\u2019s retinopathy: Case report and review of the literature","volume":"32","author":"Campo","year":"2000","journal-title":"Dig. Liver Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1186\/s13256-016-1111-4","article-title":"Purtscher\u2019s retinopathy and renal cortical necrosis: Two rare vaso-occlusive complications in a patient with acute pancreatitis: A case report","volume":"10","author":"Haque","year":"2016","journal-title":"J. Med. Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"73885","DOI":"10.56305\/001c.73885","article-title":"Purtscher-like Retinopathy in a Patient with Acute Pancreatitis: A Case Report and Literature Review","volume":"2","author":"Almpani","year":"2023","journal-title":"J. Brown Hosp. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"bcr2013008607","DOI":"10.1136\/bcr-2013-008607","article-title":"Blind drunk","volume":"2013","author":"Dholakia","year":"2013","journal-title":"BMJ Case Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"100892","DOI":"10.1016\/j.ajoc.2020.100892","article-title":"Purtscher\u2019s-like retinopathy associated with acute pancreatitis","volume":"20","author":"Gahn","year":"2020","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.pan.2022.01.005","article-title":"Acute pancreatitis presenting as Purtscher-like retinopathy","volume":"22","author":"Narang","year":"2022","journal-title":"Pancreatology"},{"key":"ref_19","first-page":"345","article-title":"Purtscher\u2019s-like retinopathy\u2014A rare complication of acute pancreatitis","volume":"20","author":"Ciortescu","year":"2011","journal-title":"J. Gastrointest. Liver Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e00251","DOI":"10.14309\/crj.0000000000000251","article-title":"Blind After a Binge: Purtscher-like Retinopathy in Acute Alcoholic Pancreatitis","volume":"6","author":"Tariq","year":"2019","journal-title":"ACG Case Rep. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0002-9394(02)01474-5","article-title":"Sequential multifocal electroretinogram findings in a case of purtscher-like retinopathy","volume":"134","author":"Haq","year":"2002","journal-title":"Am. J. Ophthalmol."},{"key":"ref_22","first-page":"4318354","article-title":"Optical Coherence Tomography Angiography of Purtscher Retinopathy after Severe Traffic Accident in 16-Year-Old Boy","volume":"2018","author":"Hamoudi","year":"2018","journal-title":"Case Rep. Ophthalmol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1080\/09273948.2021.1906909","article-title":"Purtscher-Like Retinopathy Secondary to Medication Induced Calcium-Alkali Syndrome and Acute Pancreatitis in a Pregnant Female","volume":"30","author":"Alaei","year":"2022","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1038\/eye.2016.115","article-title":"Uveitic macular edema","volume":"30","author":"Fardeau","year":"2016","journal-title":"Eye"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ortmaier, R., Resch, H., Stieb\u00f6ck, C., Stundner, O., and Arlt, E.M. (2014). Purtscher\u2019s retinopathy after intramedullary nailing of a femoral shaft fracture in a 20-year old healthy female\u2014Report of a rare case and review of the literature. BMC Musculoskelet. Disord., 15.","DOI":"10.1186\/1471-2474-15-42"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2317\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:44:25Z","timestamp":1760035465000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":25,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15182317"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15182317","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,9,12]]}}}