Leukostatic retinopathy: a sight-threatening complication of chronic myeloid leukaemia with severe hyperleukocytosis

Abstract

Retinopathy secondary to chronic myeloid leukemia (CML) commonly manifests as venous dilation and tortuosity, retinal hemorrhages, microaneurysms, and cotton-wool spots which are similar to features of non-proliferative diabetic retinopathy or hypertensive retinopathy. However, massive vitreous hemorrhage is rarely encountered, especially among those treated with chemotherapy. We report a case of a young CML patient in accelerated phase, presenting with bilateral painless sudden visual loss. Fundus examination showed bilateral dense vitreous hemorrhage. Laboratory results showed thrombocytopenia with a very low platelet count. Magnetic resonance imaging (MRI) of the brain and orbit showed subacute intraparenchymal hemorrhages and bilateral intraocular hemorrhages. We performed pars plana vitrectomy (PPV) and endolaser on the left eye, which had more extensive vitreous hemorrhage. At one-week follow-up, the patient unfortunately developed a retinal detachment. The patient underwent a second PPV with endolaser and insertion of silicone oil. Despite the prompt surgical intervention, the patient developed an ischemic retina resulting in poor visual prognosis. One month later, we performed PPV and endolaser on the right eye. Postoperatively, her vision improved significantly from hand movement to pinhole vision 6/45. Dense vitreous hemorrhage is a rare complication of childhood leukemia. General physicians should refer leukemic patients for ophthalmic evaluation. Awareness of potentially blinding complications of CML and prompt referral upon diagnosis is warranted for early detection and treatment. Reduced awareness of this potentially blinding complication may result in poor visual outcome.