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    General

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    Grand Rounds

    A patient with a medical history of type II diabetes mellitus (most recent HbA1c: 5.2%, no prior diabetic retinopathy), well-controlled hypertension, hyperlipidemia, and stage IV uterine leiomyosarcoma undergoing the third cycle of gemcitabine/docetaxel chemotherapy presented with a two-week history of bilateral blurry vision. The patient denied ocular trauma. Visual acuity was 20/25 in both eyes, with normal intraocular pressure and unremarkable anterior segment examination. Dilated fundus examination revealed bilateral peripapillary cotton wool spots and scant intraretinal hemorrhages. Optical coherence tomography (OCT) demonstrated inner retinal hyperreflectivity corresponding to the cotton wool spots, while fluorescein angiography revealed normal choroidal perfusion without evidence of vasculitis, but with peripapillary filling defects and blockage due to intraretinal hemorrhages. A limited workup for infectious and inflammatory causes was negative. In the context of the patient’s vascular comorbidities and temporal association with chemotherapy, a presumptive diagnosis of gemcitabine-induced Purtscher-like retinopathy was made. Gemcitabine was discontinued, and the patient was observed. At two-month follow-up, the retinopathy had resolved completely. She continues to be managed by oncology and primary care for her underlying conditions.

    Presentation Date: 10/23/2025
    Issue Date: 07/03/2026

    • Presenter: Fernando Pellerano-Sosa, MD URL
    • Faculty Discussant: Jaclyn Lekse Kovach, MD URL

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