Massive Subretinal and Vitreous Hemorrhages after Cardiopulmonary Resuscitation in a Patient with Septic Shock Caused by Acute Necrotizing Pancreatitis: Case Report

Abstract

Purpose: Cardiopulmonary resuscitation (CPR) is an emergency procedure that is performed to recover blood circulation through repeated chest compressions. We report a case of massive vitreous and subretinal hemorrhages of both eyes following CPR in a patient with septic shock. Case summary: A 46-year-old man without medical history presented with decreased vision in both eyes. Twenty days prior to presentation, he underwent CPR for cardiac arrest due to sepsis related to acute necrotizing pancreatitis. His initial best-corrected visual acuity (BCVA) was 20/200 in both eyes. Initial fundus photography revealed multiple dot intraretinal hemorrhages with cotton wool spots. Over two days, the retinal hemorrhages increased, and an ischemic sign was observed in both eyes on fundus fluorescein angiography. After three days, massive vitreous hemorrhages developed in both eyes, along with subretinal hemorrhage with retinal detachment (RD) in the right macular area. Laboratory tests revealed a coagulation profile abnormality. The BCVAs deteriorated to hand motion. Immediately, vitrectomy was performed, revealing vitreous hemorrhage and huge subretinal hemorrhages during the surgery. After one month, generalized retinal atrophy was evident in both eyes. Conclusions: This case describes massive vitreous and subretinal hemorrhages with RD following CPR that resulted in a poor visual outcome despite surgical intervention. Multiple factors may have contributed to the severe intraocular hemorrhage, including the physical nature of chest compressions during CPR, the acute pancreatitis with associated sepsis, ischemia due to microvascular damage, neovascularization, and coagulopathy. Therefore, meticulous fundus examination is required in patients undergo CPR and have a suspected coagulation profile abnormality.