Abstract
Abstract: :
Purpose: To describe the occurrence of severe intraocular hemorrhage in a patient treated for sepsis with Recombinant Human Activated Protein C (RH–APC). Methods: Retrospective chart review, and review of the literature regarding clinical experience with RH–APC. Results:The majority of patients with severe sepsis demonstrate markedly diminished levels of APC, a key regulator of clotting homeostasis. In vitro data have demonstrated that APC inhibits thrombosis, promotes fibrinolysis, downregulates inflammation, and inhibits endothelial cell apoptosis. In severe sepsis, the factors responsible for activating Protein C are rapidly consumed resulting in disseminated thrombosis and multi–organ system failure. RH–APC has recently been shown in a randomized, double–blind, placebo controlled trial, to significantly reduce mortality from severe sepsis, and is finding a more prominent role in critical care medicine. The reported incidence of serious bleeding while being treated with RH–APC was slightly higher in the treatment group (3.5 percent vs. 2.0 percent, P=0.06). We describe a patient who survived sepsis and disseminated intravascular coagulation, but developed bilateral vitreous hemorrhages and a hemorrhagic retinal detachment while being treated with RH–APC. Conclusions: The medical treatment of sepsis associated with acute organ dysfunction remains one of the most difficult challenges in critical care medicine. Despite marked advances in technology, the rate of death from severe sepsis remains 30 to 50 percent. RH–APC has been recently introduced as a novel treatment modality. Bilateral vitreous and subretinal hemorrhages have not been previously described as a complication of this therapy. RH–APC is being used more frequently to combat mortality in sepsis, and we would like to alert the ophthalmic community regarding a blinding side effect of this medication.
Keywords: retinal detachment • pharmacology • vitreous