Acute pancreatitis with Purtscher's retinopathy: case report and review of the literature.

The case is described of a 32-year-old man suffering from alcoholism who came to the Emergency Unit with vomiting, fever and sharp epigastric pain irradiating to the chest and upper abdomen. A diagnosis of acute pancreatitis was made after high amylase and lipase levels were observed and the results of computed tomography scan revealed images typical of acute pancreatitis. Findings upon admission and after the initial 48 hours did not correlate with a severe or complicated course according to Ranson's criteria. On the third day after admission he suddenly developed decreased vision. A fluorescein angiogram showed arteriolar occlusion, retinal and choriocapillary ischaemia. Purtscher's retinopathy was suspected. After 4 weeks, the patient had recovered from acute pancreatitis, ophthalmoscopic examination showed normal results, and visual acuity had almost returned to normal. Activation of complement in acute pancreatitis could account for many haematologic acute disorders due to leucocyte emboli or other complement-mediated aggregates. Coagulation abnormalities may range from isolated intravascular thrombosis to severe disseminated intravascular coagulation. Purtscher's retinopathy, due to microembolizations in the choroidal and retinal arterioles, should be included among the various systemic effects of acute pancreatitis. This visual disorder is a rare systemic manifestation of acute pancreatitis which was not correlated to a severe or complicated clinical course. Treatment of these ocular complications remains to be established and outcome, therefore, depends upon resolution of the pancreatic disease.

Markers of vascular injury in Behçet's disease associated with retinal vasculitis.

The pathogenesis of vascular damage in Behçet's disease (BD) is still unknown. We investigated anticardiolipin antibodies (AC) in a genetically homogeneous group of Italian patients with BD and retinal vasculitis. In a subset, we examined the level of factor VIII-related antigen and antiendothelial cell antibodies (AECA). We found a high prevalence of AC; AECA were not found in most of our patients. Only three patients had raised levels of factor VIII-related antigen, all of whom had systemic involvement. We believe BD may be considered as a vasculitis of unknown origin in which several and different pathogenetic factors may play a role.

Open noncontrolled multicenter long-term trial with ciclosporin in endogenous non-infectious uveitis.

The efficacy, tolerability and safety of low doses (5-7 mg/kg/day) of oral ciclosporin (CS) for treatment of endogenous uveitis resistant to conventional therapy were studied in an open, noncontrolled, multicenter long-term trial. CS was shown to be effective for patients with posterior or intermediate noninfectious uveitis; it limited the progression of the disease, decreased the number and severity of inflammatory relapses, and improved visual acuity while reducing signs of intraocular inflammation. Moreover, in corticodependent patients, a steroid-sparing effect was also obtained. At low doses and by means of the careful monitoring of safety parameters, the side effects (especially renal function impairment) were well controlled. Efficacy was maintained during long-term treatment.

Behcet's disease associated with HLA-B51 and DRw52 antigens in Italians.

Thirty-eight Italian patients with Behcet's disease, all with ocular involvement, (28 complete type and ten incomplete) were typed for HLA A,B,DR, and DQ antigens. A significant increase of HLA-B51 (p less than 0.00001) and DRw52 (p = 0.045) with no significant difference between complete and incomplete syndrome was found. The involvement of B51 antigen as the main immunogenetic factor in the disease is suggested by the high value of relative risk (RR = 16.03). However, the association with the II class antigen DRw52 (RR = 2.77) cannot be easily explained as a secondary association due to linkage disequilibria with B51.

Prognosis in Behcet's disease.

A retrospective clinical study made to determine the course and prognosis of the disease in 51 cases of Behçet's disease, with a follow-up of at least one year (average five years, range 1 to 15 years), showed that 45% of the eyes kept visual acuities of 1/10 or less, and 44% 8/10 or better, four years after the onset of the ocular symptoms. Ten years later, some 50% of the eyes had visual acuities of 1/10 or less and 32% had acuities of 8/10 or better. In the group of patients who were treated early with chlorambucil, the eye prognosis was significantly improved.