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.

Pattern of anesthetic diffusion during peribulbar infiltration: a CT evaluation.

PURPOSE: The aim of this study was to evaluate the changes undergone by orbital structures during peribulbar anesthesia. METHODS: CT-thin slices were acquired and 8-9 ml of anesthetic, with a small part of low-density non-ionic water-soluble contrast medium were injected under CT guide once to follow extraconal spreading and diffusion to intraconal structures and above all, the surgically important structures such as recti muscles, orbicular and optic nerve sheath. Conjunctival sack involvement was assessed and conjunctival chemosis was rated. Induced ptosis was evaluated, verifying change before and after eyepressure. RESULTS: The results help in optimizing anesthetic technique, above all concerning the site, materials and quantity, and suggest the amount of anesthesia could be reduced. CONCLUSIONS: The peribulbar anesthetic technique proved effective and safe for patients.

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.