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.