Purtscher's-Like Retinopathy in Alcoholic Pancreatitis: A Case Report Describing Vision Recovery and Residual Deficits

Purtscher's retinopathy (PR) is a rare ischaemic retinopathy associated with systemic disorders and trauma. Few cases have been reported, and prognosis remains unclear. We present a case of Purtscher's-like retinopathy (PLR) secondary to alcoholic pancreatitis and document visual acuity improvement but persistent visual field deficits. A man in his 50s presented to the hospital with vomiting, seizures and severe abdominal pain on the background of alcohol excess. One day after symptom onset, he developed a sudden, painless loss of vision bilaterally. He was diagnosed with acute alcoholic pancreatitis and alcohol withdrawal and treated accordingly; however, his visual symptoms did not resolve. On assessment, his ocular movements were preserved, but he had significantly reduced visual acuity in both eyes. On fundoscopy, he had widespread retinal ischaemia with blot haemorrhages, and a diagnosis of Purtscher's retinopathy was made. Optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) showed retinal oedema and ischaemic patches, consistent with the diagnosis. In the absence of evidence-based treatment options, he was managed conservatively, without treatment. At 12 weeks, his visual acuity had significantly improved, and he reports almost complete resolution of symptoms. At nine months, he remained asymptomatic; however, he had significantly reduced visual fields bilaterally and an increased cup-to-disc ratio. In the literature, there is a lack of high-quality data on prognosis for Purtscher's retinopathy, as well as poorly documented response to treatment, including oral glucocorticoids, as compared to conservative management. This case illustrates spontaneous visual acuity recovery within 12 weeks but persistent visual field deficits and provides valuable data on progression, imaging findings and outcomes for this rare retinopathy.