Chemotherapy-Induced Retinopathy in a Diabetic and Hypertensive Patient With Stage 4 Metastatic Pancreatic Adenocarcinoma

Purpose: To describe a case of presumed Purtscher-like retinopathy in association with 2 chemotherapies. Methods: A retrospective chart review was performed. Results: A 40-year-old Black woman was diagnosed with pancreatic adenocarcinoma with metastasis to the liver. Cotton-wool spots and microaneurysms (dot/blot hemorrhages) were found on a routine examination 1 month after the patient started gemcitabine/paclitaxel. An increase in cotton-wool spots was noticed after she stopped gemcitabine/cisplatin therapy and started 5-fluorouracil/irinotecan/leucovorin therapy. These retinal changes were observed until the time of death. Conclusions: We believe that the Purtscher-like retinopathy began with gemcitabine toxicity but that the irreversible damage was the result of cisplatin chemotherapy. The patient’s uncontrolled hypertension and type II diabetes likely put her at greater risk for developing this retinopathy.