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Chew Bonilla A, Bueno Zarazúa P, Rosales Padron J, Fulda Graue E, Graue Wiechers F. Delayed manifestation of proliferative retinopathy associated with chronic myeloid leukemia. Am J Ophthalmol Case Rep 2024; 36:102132. [PMID: 39161376 PMCID: PMC11332797 DOI: 10.1016/j.ajoc.2024.102132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 08/21/2024] Open
Abstract
Purpose This report highlights a rare case of delayed manifestation of proliferative retinopathy associated with chronic myeloid leukemia (CML) during remission. Observations Case report and review of the literature; In this case report, we outline the delayed manifestation and clinical progression of proliferative retinopathy in a 52-year-old male patient with a history of CML diagnosed in 2001. Initially, the patient presented with a white blood cell count (WBC) of 402,200/μl, and the leukocytosis persisted until 2005. Thereafter, the patient remained in remission for over 15 years without any visual complaints until 2022. At that time, the patient sought medical attention due to a ten-day history of left eye visual impairment, leading to the discovery of peripheral neovascularization in both eyes and vitreous hemorrhage in the left eye during fundus examination. The WBC count at the time of presentation to the Emergency Department was 10,460/μl. The patient was treated with fluorescein angiography guided panretinal photocoagulation to the areas of ischemic retina. Subsequent follow-up after eight months demonstrated regression of neovascularization. Conclusions and Importance Our findings highlight the occurrence of proliferative retinopathy in the context of CML, uniquely manifesting during remission. This case emphasizes the importance of ophthalmological assessments not only at the time of CML diagnosis but also during subsequent follow-ups, recognizing the potential for delayed presentation of ocular complications.
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Affiliation(s)
- Alan Chew Bonilla
- Retina Department, Institute of Ophthalmology Fundación Conde de Valenciana, Chimalpopoca 14, Colonia Obrera, Mexico City, 06800, Mexico
| | - Paulina Bueno Zarazúa
- Retina Department, Institute of Ophthalmology Fundación Conde de Valenciana, Chimalpopoca 14, Colonia Obrera, Mexico City, 06800, Mexico
| | - Jaime Rosales Padron
- Retina Department, Institute of Ophthalmology Fundación Conde de Valenciana, Chimalpopoca 14, Colonia Obrera, Mexico City, 06800, Mexico
| | - Emiliano Fulda Graue
- Retina Department, Institute of Ophthalmology Fundación Conde de Valenciana, Chimalpopoca 14, Colonia Obrera, Mexico City, 06800, Mexico
| | - Federico Graue Wiechers
- Retina Department, Institute of Ophthalmology Fundación Conde de Valenciana, Chimalpopoca 14, Colonia Obrera, Mexico City, 06800, Mexico
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2
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Bhattacharjee R, Mishra A, Mishra C, Bhawsinka Y. Chronic myeloid leukemia diagnosed from the course of diabetic retinopathy. Med J Armed Forces India 2024; 80:599-603. [PMID: 39309576 PMCID: PMC11411308 DOI: 10.1016/j.mjafi.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/10/2022] [Indexed: 01/31/2023] Open
Abstract
We report a case of chronic myeloid leukemia (CML), which was diagnosed during the management of proliferative retinopathy (PR) in a patient with type I diabetes mellitus due to the fulminant nature of the PR. This case highlights the importance of vigilance on the part of the ophthalmologist in the diagnosis of co-existing systemic disorders, notably hematological malignancy, which aggravates the posterior segment vasculopathy of the eye and the management of which is crucial for the patient. We also describe a short literature review on the clinical features, mechanism of the posterior segment vasculopathy of the eye, and management of PR co-existing in a patient with CML.
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Affiliation(s)
| | - Avinash Mishra
- Professor & Head (Ophthalmology), Military Hospital Jalandhar, India
| | - Chitaranjan Mishra
- Ophthalmologist, VR Specialist, Trilochan Netralaya, Sambal Pur, Odisha, India
| | - Yoshita Bhawsinka
- Ophthalmologist, VR Specialist, Trilochan Netralaya, Sambal Pur, Odisha, India
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3
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Balamurugan S, Kaur K, Gurnani B, Agrawal A. Bilateral acute vision loss as the initial presentation of chronic myeloid leukemia in a young female. Indian J Cancer 2023; 60:578-582. [PMID: 38206079 DOI: 10.4103/ijc.ijc_573_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/16/2021] [Indexed: 01/12/2024]
Abstract
Chronic myeloid leukemia (CML) is a hematological malignancy characterized by structural/functional changes and increased neutrophils. Rarely, ophthalmic manifestations are the first clue toward underlying pathology. We report a case of a 34-year-old woman who presented with sudden-onset diminution of vision in both eyes. On examination, she was diagnosed with panuveitis in the right eye and choroiditis in the left eye. Further investigations revealed an underlying CML in the accelerated phase. The patient was managed with systemic immunomodulators along with topical and periocular steroids. Prompt diagnosis and management in collaboration with an oncologist and hematologist helped us achieve a good outcome.
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Affiliation(s)
- Sivaraman Balamurugan
- Department of Uvea Services, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
| | - Kirandeep Kaur
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
| | - Bharat Gurnani
- Department of Cornea and Refractive Services, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
| | - Anushri Agrawal
- Department of General Ophthalmology, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
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4
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Naeem U, Alkhateeb A, Nashwan AJ, Yassin MA. Proliferative Retinopathy in Chronic Myeloid Leukemia & Diabetes: A "double whammy". Surv Ophthalmol 2022; 67:1731-1732. [PMID: 35872011 DOI: 10.1016/j.survophthal.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Usman Naeem
- Ophthalmology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ameen Alkhateeb
- Ophthalmology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdulqadir J Nashwan
- Hematology Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Mohamed A Yassin
- Hematology Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar
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5
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Yassin MA, Ata F, Mohamed SF, Alkhateeb A, Naeem U, Al-Qatami AI, Nashwan AJ, Fernyhough LJ. Ophthalmologic manifestations as the initial presentation of chronic myeloid leukemia: A review. Surv Ophthalmol 2022; 67:530-543. [DOI: https:/doi.org/10.1016/j.survophthal.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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6
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Yassin MA, Ata F, Mohamed SF, Alkhateeb A, Naeem U, Al-Qatami AI, Nashwan AJ, Fernyhough LJ. Ophthalmologic manifestations as the initial presentation of chronic myeloid leukemia: A review. Surv Ophthalmol 2021; 67:530-543. [PMID: 34252423 DOI: 10.1016/j.survophthal.2021.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/26/2022]
Abstract
The presentation of chronic myeloid leukemia (CML) can be variable and related to the phase of the disease. It can manifest a wide range of symptoms and signs; ocular involvement is reported in patients with leukemia at the time of diagnosis. We describe ophthalmic manifestations as an initial presentation in patients with CML. We identified 38 publications between 1971 and 2020 describing ocular manifestations in CML. Ophthalmic problems occur either from direct or indirect infiltration of neoplastic cells or from secondary causes. Although nearly all ocular structures may be affected, leukemic retinopathy is the most frequent clinical manifestation. Others include iris infiltration, anterior uveitis, hypopyon, exudative/serous retinal detachment, and optic nerve infiltration.
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Affiliation(s)
- Mohamed A Yassin
- Hematology Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Fateen Ata
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Shehab F Mohamed
- Hematology Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ameen Alkhateeb
- Ophthalmology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Usman Naeem
- Ophthalmology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ahmed I Al-Qatami
- Ophthalmology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdulqadir J Nashwan
- Hematology Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar.
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7
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Goel S, Saroya A, Agrawal BK, Gogia K. Leukaemic retinopathy in a patient with chronic myeloid leukaemia. Clin Exp Optom 2021; 104:809-810. [PMID: 33689573 DOI: 10.1080/08164622.2021.1878858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Affiliation(s)
- Sugandha Goel
- Department of Ophthalmology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, India
| | - Arnav Saroya
- Department of Ophthalmology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, India
| | - Bimal K Agrawal
- Department of Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, India
| | - Kritika Gogia
- Department of Ophthalmology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, India
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8
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Priya BV, Jain K, Mahendradas P, Shetty BK. "String of beads" appearance on fundus fluorescein angiography as a clinical clue for leukemia-related proliferative retinopathy. Indian J Ophthalmol 2020; 67:2049-2051. [PMID: 31755450 PMCID: PMC6896570 DOI: 10.4103/ijo.ijo_233_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- B V Priya
- Department of Vitreo-Retina, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Kushagra Jain
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Bhujang K Shetty
- Department of Cararact and Refractive Lens Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
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9
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Hsia NY, Lin CJ, Lin HJ, Wu KH. Foveal photoreceptors loss and then recovery after treatment in a chronic myelogenous leukemia patient. Pediatr Hematol Oncol 2020; 37:545-548. [PMID: 32364423 DOI: 10.1080/08880018.2020.1760408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a 10-year-old boy with chronic myelogenous leukemia (CML)-related retinopathy of the eyes. Foveal photoreceptors loss was noted in the right eye, but it was restored with a continued ellipsoid zone after systemic 6-week imatinib mesylate and hydroxyurea treatment. Spectral-domain optical coherence tomography images of the foveal photoreceptors change in the right eye were taken. His best-corrected visual acuity of the right eye recovered from 20/100 to 20/20. Prompt treatment of the underlying CML could result in improvement or resolution of the ocular findings, and even foveal photoreceptors loss might be reversible with good visual acuity recovery.
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Affiliation(s)
- Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hui-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Kang-Hsi Wu
- Department of Hematology, China Medical University Hospital, Taichung, Taiwan
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10
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Pour EK, Bazvand F, Mehrabi Bahar MR, Abadi MD, Faghihi H. Unilateral Macular Choroidal Neovascularization; a Rare Manifestation in Chronic Myelogenous Leukemia. J Curr Ophthalmol 2020; 32:103-106. [PMID: 32510022 PMCID: PMC7265268 DOI: 10.1016/j.joco.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/04/2019] [Accepted: 09/18/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose: To report a case of chronic myelogenous leukemia (CML) treatment with imatinib mesylate in the remission phase who developed unilateral macular choroidal neovascularization (CNV). Methods: A 45-year-old male marketer with a 5-year history of CML treated with imatinib mesylate presented with 2 months history of progressive vision loss and metamorphopsia in the right eye. Results: Fundus examination of the right eye revealed grey-white elevated retinal lesion with indistinct borders in the macula and retinal telangiectasia in the temporal macula. Fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) confirmed the presence of CNV in the right eye. After treatment with anti-vascular endothelial growth factor (anti-VEGF), macular CNV regressed significantly. Conclusion: Macular CNV must be kept in mind as a rare ophthalmic manifestation of patients with CML under treatment with imatinib even in the remission phase.
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Affiliation(s)
- Elias Khalili Pour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bazvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmood Davood Abadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooshang Faghihi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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11
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Vicini G, Nicolosi C, Malandrino D, Tozzetti C, Rizzo S, Sodi A. Leukostasis retinopathy with leukemic infiltrates as onset manifestation of chronic myeloid leukemia: a case report. Eur J Ophthalmol 2020; 31:NP116-NP121. [PMID: 32476461 DOI: 10.1177/1120672120930679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a case of retinopathy as onset manifestation of chronic myeloid leukemia (CML), successfully treated with leukapheresis and medical therapy. METHODS A 28-year-old male patient presented complaining painless acute visual impairment in his right eye (RE). He reported moderate asthenia and episodes of night sweats during the previous month. His past medical history was unremarkable. BCVA at presentation was 20/80 in RE and 20/32 in left eye (LE). Fundus examination revealed venous congestion, diffuse Roth spots, and whitish macular infiltrates in both eyes. OCT showed hyperreflective foveal infiltrates, in both eyes. Blood test showed markedly elevated white blood cells (WBCs) count (430 × 103/mm3). Clinical-instrumental examination revealed hepatosplenomegaly. These features were consistent with CML. The patient was treated with leukapheresis and nilotinib. RESULTS After 2 weeks of treatment, the WBCs count dropped (71 × 103/mm3), and the patient reported subjective improvement of symptoms. At 1-month follow-up, BCVA and retinopathy signs were improved in both eyes. OCT showed the almost complete resolution of foveal infiltrates with ellipsoid zone focal defects. At 4-months follow-up, we observed complete resolution of retinopathy. BCVA was 20/32 in RE and 20/25 in LE. OCT showed the persistence of ellipsoid zone focal defects in RE and complete anatomical restoration in LE. At 6-months follow-up, the patient was clinically well and his WBCs count was normal. CONCLUSION In our case, the CML-related retinopathy represented the onset sign of the underlying systemic pathology, leading to proper management and treatment, with hematological normalization and resolution of the retinopathy.
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Affiliation(s)
- Giulio Vicini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, University of Florence, Florence, Italy
| | - Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, University of Florence, Florence, Italy
| | - Danilo Malandrino
- Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Camilla Tozzetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Andrea Sodi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, University of Florence, Florence, Italy
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12
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Mohamed SF, Qatami A, Nashwan A, Abdulla MA, Yassin MA. Ophthalmologic Manifestations as Initial Presentation of Patients with Chronic Myeloid Leukemia: Report of Two Cases. Case Rep Oncol 2020; 13:7-11. [PMID: 32110213 PMCID: PMC7036576 DOI: 10.1159/000504928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 12/02/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm, classically described as triphasic disease (chronic, accelerated, and blast). Despite the significant efforts made by different groups to optimize treatment and outcome, there are still unmet needs and unanswered questions. Ophthalmologic manifestations are among the therapeutic challenges. The best available therapy for patients presenting with ophthalmologic manifestations is still unclear. Here we present two cases of CML (chronic phase) with ophthalmologic manifestations as initial presentation, trying to shed light on this important type of presentation and proposing recommendations for hematologists in view of the current literature.
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Affiliation(s)
- Shehab F Mohamed
- Hematology, Medical Oncology Section, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ahmed Qatami
- Ophthalmology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdulqadir Nashwan
- Hematology, Medical Oncology Section, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohammad A Abdulla
- Hematology, Medical Oncology Section, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohamed A Yassin
- Hematology, Medical Oncology Section, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar
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13
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Christiansen JS, Gaddh M, Wells J. An uncommon presentation of chronic myeloid leukemia. Ann Hematol 2019; 99:357-358. [PMID: 31788723 DOI: 10.1007/s00277-019-03869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Manila Gaddh
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jill Wells
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
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14
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Chawla R, Kumar S, Kumawat D, Azad SV, Temkar S, Jain S. Chronic myeloid leukaemia accelerates proliferative retinopathy in patients with co-existent diabetes: A risk factor not to be ignored. Eur J Ophthalmol 2019; 31:226-233. [PMID: 31514533 DOI: 10.1177/1120672119875341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the retinal imaging characteristics, retinopathy management strategies and visual outcomes in cases of diabetes with chronic myeloid leukaemia. DESIGN Retrospective observational study. PARTICIPANTS Patients with diabetes and chronic myeloid leukaemia managed at our tertiary eye care centre from January 2015 to December 2017. METHODS Detailed ophthalmic and systemic evaluation, treatment and follow-up records were reviewed. The main measures studied were visual acuity, intra-ocular pressure, retinopathy severity, and surgical indications and techniques. RESULTS Of the six patients studied, three had diabetes and chronic myeloid leukaemia at presentation, while in three cases chronic myeloid leukaemia was diagnosed following evaluation for proliferative retinopathy. The visual acuity ranged from 20/20 to perception of light. All eyes had marked proliferative retinopathy out of proportion to the exudation. None of the eyes had significant macular oedema. Pan-retinal photocoagulation (10/12, 83.33%), intravitreal anti-vascular endothelial growth factor injection (8/12, 66.67%), vitrectomy (2/12, 16.67%), cataract surgery (2/12, 16.67%) and trabeculectomy followed by cryoablation (2/12, 16.67%) was performed for management of the ocular disease as indicated. Median follow-up was 16.5 months (range: 6-24 months). Final visual acuity ranged from PL to 20/20 with acuity ⩾ 20/100 in eight eyes. Four eyes had advanced optic neuropathy from neovascular glaucoma. CONCLUSION Accelerated proliferative retinopathy can be seen in cases of diabetes with chronic myeloid leukaemia at the very initial ophthalmic evaluation. Thus, there is a need to alter screening guidelines for retinopathy in cases of diabetes with chronic myeloid leukaemia. Early detection and aggressive management may help preserve visual acuity in such cases.
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Affiliation(s)
- Rohan Chawla
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suneel Kumar
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shorya Vardhan Azad
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shreyas Temkar
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shreyans Jain
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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15
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A unique case of chronic myeloid leukemia presenting as monocular vision loss with unilateral retinopathy. Am J Ophthalmol Case Rep 2019; 14:67-69. [PMID: 30911698 PMCID: PMC6416657 DOI: 10.1016/j.ajoc.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/08/2018] [Accepted: 02/06/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To report a case of unilateral leukemic retinopathy secondary to chronic myeloid leukemia (CML). Observations Patient presented to clinic with a visual acuity (VA) of 20/200 in the right eye (OD) after several months of progressive monocular vision loss and was found to have dense pre-retinal hemorrhage. Patient underwent 23-gauge pars plana vitrectomy to clear the preretinal hemorrhage along with a complex macula-off retinal detachment repair to address retinal tear and multilayer retinal hemorrhage. The patient was subsequently diagnosed with CML as she was found to be positive for the fusion protein of break point cluster gene (BCR) with Abelson tyrosine kinase (ABL1), BCR-ABL1, upon systemic work-up. Imatinib therapy resulted in complete hematologic and cytogenetic resolution after one month, however, the patient's vision remained unchanged six months after surgery. Conclusion and importance To the authors' knowledge, this is the first reported case of unilateral leukemic retinopathy secondary to low risk CML, as determined by the Sokal and Hasford prognostic scoring systems. CML should be included in the differential diagnosis of patients with progressive monocular vision loss with suspicious multi-layer retinal compromise.
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16
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Chen B, Yan X, Zhang X, Yang H. Leukostasis retinopathy: An uncommon visual threatening complication of chronic myeloid leukemia with severe hyperleukocytosis - A case report and review of the literature. Indian J Ophthalmol 2019; 66:1871-1874. [PMID: 30451209 PMCID: PMC6256890 DOI: 10.4103/ijo.ijo_627_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To describe a rare case of an unusual visual threatening complication of chronic myeloid leukemia (CML). A 21-year-old male visited the hospital complaining of 1-week painless binocular acute visual loss without any other symptoms. The patient was diagnosed with CML. He then received emergent leukapheresis with imatinib treatment, which achieved obvious hematological remission. However, the visual acuity did not recover along with the CML remission and ocular structure relief. CML-related leukostasis could induce severe leukostasis retinopathy. Hematologists and ophthalmologists should pay more attention to this relatively rare and severe complication of CML.
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Affiliation(s)
- Bo Chen
- Department of Ophthalmology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xiaoqin Yan
- Department of Ophthalmology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xian Zhang
- Department of Ophthalmology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Hong Yang
- Department of Ophthalmology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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17
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Kumawat D, Kumar V, Sahay P, Chandra P. Bilateral proliferative retinopathy in B-cell acute lymphoblastic leukemia. Indian J Ophthalmol 2018; 66:148-151. [PMID: 29283147 PMCID: PMC5778555 DOI: 10.4103/ijo.ijo_608_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 4-year-old child with B-cell acute lymphoblastic leukemia presented with vitreous hemorrhage due to proliferative retinopathy in both eyes. Pars plana vitrectomy was performed in both eyes to clear nonresolving vitreous hemorrhage after systemic stabilization. Visual recovery was limited by the disc drag in the right eye and subfoveal exudation in the left eye. Etiopathogenesis and management of proliferative retinopathy in acute leukemias are discussed.
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Affiliation(s)
- Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pranita Sahay
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Rane PR, Barot RK, Gohel DJ, Bhagat N. Chronic Myeloid Leukaemia Presenting as Bilateral Retinal Haemorrhages with Multiple Retinal Infiltrates. J Clin Diagn Res 2016; 10:ND04-5. [PMID: 27437258 DOI: 10.7860/jcdr/2016/18215.7822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
Chronic Myeloid Leukaemia (CML) causes retinopathy manifesting as venous dilation and tortuosity, perivascular sheathing, retinal haemorrhages, microaneurysms, cotton-wool spots and optic nerve infiltration. Retina is the most commonly involved intraocular structure in CML. However, retinal involvement is a rare form of presentation of CML and few cases have been reported. We report a case of CML presenting as unilateral sudden visual loss. Fundus showed multiple white centered retinal haemorrhages in both eyes with unilateral macular oedema. Blood work-up showed raised WBC count, high platelet count and low Haemoglobin. Cytological analysis of bone marrow biopsy confirmed Philadelphia chromosome. After a course of Imatinib, visual acuity improved and haemorrhages resolved with normalization of macular thickness. In our case, patient presented early, leading to early detection producing better visual prognosis. This highlights the importance of detailed hematological work up in patients with retinal involvement to rule out leukaemic retinopathy.
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Affiliation(s)
- Priyanka Ramkrishna Rane
- Registrar, Department of Ophthalmology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Hospital , Kalwa, India
| | - Rakesh K Barot
- Associate Professor and Head of Department, Department of Ophthalmology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Hospital , Kalwa, India
| | - Devadatta Jayantilal Gohel
- Professor and Head of Department, Department of Ophthalmology, Shri M.P. Shah Government College and Guru Gobind Singh Hospital , Jamnagar, India
| | - Nupur Bhagat
- Registrar, Department of Ophthalmology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Hospital , Kalwa, India
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Mohamed M, Oakley C, McEwen F, Connelley G. Leucapheresis for management of retinopathy in chronic myeloid leukaemia. BMJ Case Rep 2015; 2015:bcr-2015-212889. [PMID: 26628310 DOI: 10.1136/bcr-2015-212889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chronic myeloid leukaemia is a myeloproliferative neoplasm characterised by granulocytic hyperplasia in the bone marrow and the presence of a specific cytogenetic abnormality known as Philadelphia chromosome with fusion of breakpoint cluster region (BCR) and ableson (ABL) genes. Retinopathy is a rare sight-threatening complication of chronic myeloid leukaemia, which occurs due to leucostasis in retinal blood vessels. We report a case of a patient who presented with visual impairment due to leucostasis, who was successfully managed by leucapheresis along with BCR-ABL tyrosine kinase inhibitor.
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Affiliation(s)
- Muhajir Mohamed
- Department of Haematology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Carmen Oakley
- Department of Ophthalmology, Launceston Eye Institute, Launceston, Tasmania, Australia
| | - Fiona McEwen
- Department of Haematology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Georgina Connelley
- Department of Haematology, Launceston General Hospital, Launceston, Tasmania, Australia
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