Introduction
Ophthalmologic manifestations associated with chronic myeloid leukemia are rare, but few prospective studies have shown that they are prevalent in 35-50% of all leukemic patients1. They are most common in blast phase leukemias and less typically seen in chronic phase. Ocular involvement may precede the diagnosis or develop throughout the course of the disease. The exact mechanism of the involvement is unknown but may be due to the result of either primary infiltration of malignant cells or secondary to hematological changes and hemostasis from leukemia.
The most common manifestations of leukemic retinopathy include venous dilation and tortuosity. Retinal hemorrhages can also be seen during the development of this disease and are usually present in the posterior pole and accompanied by a white center with leukemic cells, platelet-fibrin aggregates, or septic embolic. Cotton wool spots can also be seen. Hyperviscosity can also present as a bilateral central retinal vein occlusion2. In cases of extreme leukocytosis (WBC >200,000 mm3), peripheral ischemia and neovascularization can be seen1. This last symptom is most notably seen in patients with chronic myeloid leukemia (CML). However, central retinal vein occlusions are rare symptomatic manifestations of CML. Patients may present with blurred vision or sudden, acute vision loss, even preceding typical symptoms of CML such as fever, weight loss, and fatigue.
The mainstay of treatment of leukemic retinopathy is chemotherapy targeted at the underlying disorder. However, leukapheresis is a treatment modality that has been shown in some case reports to have successfully reversed vision loss and ophthalmologic damage. Leukapheresis is emerging as an efficacious adjunct or initial treatment option for patients with severe retinopathy.
We present a case of severe leukemic retinopathy leading to acute unilateral vision loss that was successfully treated with leukapheresis along with hydroxyurea.