Purtscher's-like Retinopathy in Chronic Renal Failure

Purpose: The authors describe the clinical findings of three young women with the previously unreported association of Purtscher's-like retinopathy and chronic renal failure. Methods: The authors reviewed the clinical records of three women with chronic renal failure who had been seen at the Oregon Health Sciences University with acute, profound visual loss associated with a severe vaso-occlusive Purtscher's-like retinopathy. Results: Two of the three patients previously had renal transplants, and both were experiencing allograft rejection. One of these two patients was undergoing hemodialysis. The retinopathy was bilateral in two patients, and unilateral in the third. Each of the 5 affected eyes had severe initial loss of vision to less than 20/400, and only one of these eyes had significant visual recovery. None of the patients had recent trauma, pancreatitis, autoimmune disease, or other condition known to be associated with Purtscher's-like retinopathy. Conclusion: A retinal vaso-occlusive disorder resembling Purtscher's retinopathy can occur in patients with chronic renal failure, even in the absence of trauma, pancreatitis, or known autoimmune disease. While the precipitating factor(s) remains unclear, it appears that the retinopathy in this setting may be more severe and associated with a poorer visual prognosis.