Changes in retinal circulation and choroidal thickness in patients with acute myeloid leukemia detected by optical coherence tomography angiography

Abstract

PurposeTo investigate changes in retinal circulation and the choroid in patients with acute myeloid leukemia (AML) in the acute and remission stages, to analyze the correlation between retinal circulation and laboratory parameters, and to assess risk factors associated with leukemic retinopathy.MethodsForty-eight patients (93 eyes) with AML were enrolled and divided into two groups according to fundus examination findings: the retinopathy and no retinopathy groups. Patients underwent eye measurements before treatment and after remission. Macular vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ), and choroidal thickness (ChT) were measured using optical coherence tomography angiography. Patients with healthy eyes were recruited as control participants.ResultsPatients with leukemic retinopathy had higher measurements of white blood cells (WBCs), circulating blasts, fibrin degradation products, and cross-linked fibrin degradation products (D-dimer) and a lower hemoglobin (HB) count (p < 0.05). In the acute phase of the disease, the VD and PD were lower and the ChT was thicker in patients with AML than in controls (p < 0.05), irrespective of the presence of leukemic retinopathy; however, the patients were partially recovered in the remission stage. The VD was lower in patients with higher WBC (r = −0.217, p = 0.036), D-dimer (r = −0.279, p = 0.001), fasting blood glucose (FBG) (r = −0.298, p = 0.004) and triglyceride (r = −0.336, p = 0.001) levels. The FAZ area was negatively correlated with HB (r = −0.258, p = 0.012).ConclusionPatients with AML appear to have subclinical retinal perfusion loss and choroidal thickening in the acute phase of the disease, but this is reversible. Injury to bone marrow function may cause a decrease in retinal perfusion. Leukemic retinopathy is associated with abnormal hematologic parameters and coagulopathy.

Retinal Changes in Patients With Covid-19 and Different Expressiveness of Metabolic Changes

“…Analyzing the general connection of D-dimer level with ophthalmic pathology in general, we can note the following correlations: the level of D-dimer is statistically significantly higher in patients with proliferative diabetic retinopathy than in patients with non-proliferative diabetic retinopathy [38,39]. Also, a statistically higher level of D-dimer was found in patients with leukemic retinopathy compared to the control group [40].…”

Bilateral optic nerve infiltration and leukemic retinopathy as initial signs of leukemia relapse with central nervous system involvement in an adult: A case report

“…Leukemic retinopathy is the term most often used to denote the fundus manifestations of anaemia, thrombocytopenia and hyperviscosity observed in patients with leukaemia [12] . Experts believe that leukemic retinopathy is associated with abnormal hematologic parameters and coagulopathy [13,14] . Our patient presented with bilateral retinal vein dilatation and tortuosity, blot and ame-shaped retinal hemorrhages, and serous retinal detachment, features that were the result of both direct retinal leukemic in ltration and leukostasis secondary to hyperleukocytosis [15] .…”

Ocular pharmacological and biochemical profiles of 6-thioguanine: a drug repurposing study

“…In particular, 5 µM 6TG significantly increased the cell viability of HUVECs exposed to high glucose and also reduced their vasculogenic activity, confirming its anti-angiogenic effects previously reported in endothelial cells or the chick embryo chorioallantoic membrane, as well as in AML patients showing a reduced bone marrow microvessel density when treated with 6TG ( Padró et al, 2000 ; Presta et al, 2002 ; Dean, 2012 ). It is worth noting that AML is frequently associated with severe retinal alterations characterized by retinal microvascular involvement, such as choroidal thickness and abnormalities in retinal circulation, known as leukemic retinopathy ( Yang et al, 2023 ). The anti-angiogenic effects of 6TG (1 and 2.5 mg/kg) were also shown in a DR mouse model by FA analysis, evidencing a reduction in retinal vascular alterations present in diabetic mice, such as irregular vessel caliber, vessel tortuosity and thinning, microaneurysm, or arteriovenous nicking.…”