Bilateral retinal artery occlusions as the first manifestation of extramedullary central nervous system involvement in relapsed acute myeloid leukaemia

Sequential Bilateral Paracentral Acute Middle Maculopathy in a Middle-Aged Woman

Purpose: To present a case of sequential paracentral acute middle maculopathy (PAMM) in a middle-aged woman with no cardiovascular risk factors. Methods: A single case was evaluated. Results: A 53-year-old woman with a history of PAMM resulting from perfused central retinal artery occlusion in the left eye presented with PAMM in the right eye 3 years later. The patient had a medical history of treated anemia, stress disorder, and insomnia. Examination of the right eye showed a superior parafoveal crescent of translucent retina without associated edema or hemorrhage. Optical coherence tomography (OCT) showed hyperreflective band-like areas in the superior parafoveal and perifoveal regions. Fluorescein angiography revealed normal arterial filling. OCT angiography showed patchy filling of the middle capillary plexus with normal perfusion of the superficial capillary plexus in the right eye. Conclusions: Although bilateral sequential PAMM is rare, close monitoring in a case of PAMM in 1 eye should be considered.

Early Ophthalmological Manifestations of Acute Myeloid Leukemia: Current Perspectives

Acute myeloid leukemia (AML) is a hematological malignancy affecting different organ systems including the eye. The purpose of this review is to present and evaluate the medical literature regarding the early ophthalmological manifestations of acute myeloid leukemia. AML affects the ocular system through direct infiltration of tissues, secondary to hematological abnormalities, or in the form of chloroma or myeloid sarcoma in the brain or orbit consequently leading to a variety of manifestations depending on the ocular tissue involved. It is imperative for ophthalmologists to be aware of the early ophthalmological manifestations of AML which will allow for earlier diagnosis and treatment of this life-threatening disease.

Unilateral isolated optic nerve infiltration combined with central retinal artery occlusion in a patient with acute myeloid leukemia

Purpose

To report a case of unilateral isolated optic nerve infiltration combined with central retinal artery occlusion in a patient with acute myeloid leukemia.

Observations

A 28-year-old acute myeloid leukemia patient with systemic remission after hematopoietic stem cell transplantation presented with optic nerve infiltration combined with central retinal artery occlusion. Fundus examination showed diffuse papillary swelling with blurred margins and whitening macular with cherry-red spot. CBFβ-MYH11 fusion transcript analysis revealed central nervous system relapse of acute myeloid leukemia and optic nerve infiltration.

Conclusions and importance

Isolated optic nerve infiltration combined with central retinal artery occlusion is an extremely rare presentation in acute myeloid leukemia. Even in the absence of cytological and radiographic evidence from cerebrospinal fluid, optic nerve infiltration should not be ignored.