Chronic Myeloid Leukemia Diagnosed in a Patient With Uncontrolled Proliferative Diabetic Retinopathy

Figueiredo, Lígia; Rothwell, Renata; Meira, Dália; Fonseca, Sofia

doi:10.1097/icb.0000000000000140

Cited by 11 publications

(24 citation statements)

References 7 publications

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“…Schmid et al 7 have reported a case of transient severe non-proliferative DR in an adolescent with type 1 diabetes and CML, which regressed later with the treatment of CML alone. Raynor et al 6 and Figueiredo et al 8 reported cases of type 2 diabetes with sudden worsening of DR to proliferative stages, which was consistent with the development of CML in these cases. The factors which may contribute to the development and rapid worsening of DR include enhanced endothelial dysfunction, vascular stasis, and retinal ischaemia due to associated anaemia.…”

Section: Discussionsupporting

confidence: 66%

“…Only a few case reports exist on proliferative retinopathy in patients with diabetes and CML. 6–8 , 16 A summary of cases of proliferative retinopathy in patients of CML with or without diabetes is provided in Table 2. Schmid et al 7 have reported a case of transient severe non-proliferative DR in an adolescent with type 1 diabetes and CML, which regressed later with the treatment of CML alone.…”

Section: Discussionmentioning

confidence: 99%

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Chronic myeloid leukaemia accelerates proliferative retinopathy in patients with co-existent diabetes: A risk factor not to be ignored

Chawla

Kumar

Kumawat

et al. 2019

European Journal of Ophthalmology

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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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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Chronic myeloid leukaemia accelerates proliferative retinopathy in patients with co-existent diabetes: A risk factor not to be ignored

Chawla

Kumar

Kumawat

et al. 2019

European Journal of Ophthalmology

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“…The review of the literature revealed few case reports and articles addressing effects of leukemia and imatinib that can result in glaucoma. [234567] Sharma et al attributed the leukemic infiltration and blockage of the trabecular meshwork, leading to the raised IOP. [2] Figueiredo et al attributed hyperviscosity syndrome associated with CML resulting in retinal ischemia leading to upregulation of vasoproliferative factors including vascular endothelial growth factor (VEGF) and hence, rapid progression in diabetic retinopathy (DR) and NVG.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Figueiredo et al attributed hyperviscosity syndrome associated with CML resulting in retinal ischemia leading to upregulation of vasoproliferative factors including vascular endothelial growth factor (VEGF) and hence, rapid progression in diabetic retinopathy (DR) and NVG. [5] Gulati and Saif reported a non-diabetic 62-year-old male, on imatinib (400 mg OD) for gastrointestinal stromal tumor, developed retinal neovascularization, and hemorrhage after 7 months of initiation of treatment. [6] A dose reduction to 200 mg OD resulted in resolution of hemorrhages without affecting efficacy of drug.…”

Section: Discussionmentioning

confidence: 99%

Uncontrolled neovascular glaucoma – an alarming manifestation of chronic myeloid leukemia on imatinib therapy – a case report and review of literature

Roop

Angmo

Kamble

et al. 2019

Indian J Ophthalmol

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A 45-year-old diabetic male, with diabetic retinopathy and medically uncontrolled neovascular glaucoma (NVG) underwent intracameral bevacizumab followed by trabeculectomy, with controlled intraocular pressures (IOP) post-operatively, OD: 12 mmHg; OS: 14 mmHg. Patient was referred to hematology, where he was diagnosed as chronic myeloid leukemia (CML) and started on imatinib mesylate. Thereafter, he presented with recurrence of neovascularization and vascularization of the bleb along with OS vitreous hemorrhage at 6 weeks follow-up. While he was planned for OS vitreo-retinal surgery, he presented with OD spontaneous hyphema with raised IOP (OD: 38 mmHg, OS: 16 mmHg). He had maintained a tight glycemic control. Following imatinib therapy, there was a rapid progression and recurrence of neovascularization, eventually leading to failure of trabeculectomy OD and bilateral severe loss of vision. Imatinib may be implicated in the worsening of NVG in CML patients, especially with co-existing diabetes and thus, such patients should receive regular thorough ophthalmic evaluation as long as imatinib continues.

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“…These potentially blinding complications are most commonly associated with chronic myeloid leukemia (CML). [6][7][8][9][10][11][12][13] It is thought that chronic leukocytosis in CML can lead to an increase in blood viscosity and retinal capillary closure, and widespread, chronic capillary closure can in turn lead to neovascularization.…”

Section: Introductionmentioning

confidence: 99%

Retinal Vascular Changes on Optical Coherence Tomography Angiography and Ultra-widefield Fluorescein Angiography in Patients With Chronic Leukemia

Liu

Smith

Mackey

et al. 2019

Journal of VitreoRetinal Diseases

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Purpose: This article describes pathological retinal vascular changes on multimodal imaging in patients with chronic leukemia. Methods: A prospective, observational study was conducted. Patients with chronic leukemia and concurrent leukocytosis were recruited from a tertiary-referral, academic medical center. Eligible patients received complete ophthalmic examinations and multimodal retinal imaging: spectral-domain optical coherence tomography (SD-OCT), optical coherence tomography angiography (OCTA), and ultra-widefield fluorescein angiography (UWF FA). Results: Six patients (11 eyes) were consecutively enrolled. At presentation, mean age was 56.9 years, median visual acuity was Snellen 20/20, and median leukocyte count was 114.5 K/mm3 (upper limit of normal: 11.00). Three of 11 eyes had SD-OCT abnormalities, including focal retinal thinning and hyperreflective material at the level of the retinal pigment epithelium. Five of 11 eyes showed OCTA abnormalities, including focal vascular flow loss and a diffuse decrease in vascular density. Four of 11 eyes had peripheral retinal abnormalities on UWF FA, including microaneurysms and nonperfusion. Five of 11 eyes showed pathological vascular changes on retinal imaging, and of these 5 eyes, 3 had unremarkable retinal examinations. Conclusions: Retinal vascular pathologies are frequently seen in patients with chronic leukemia and concurrent leukocytosis, though these patients are rarely symptomatic. Multimodal imaging allows for more sensitive detection of these pathologies compared with clinical examination alone. On OCTA, pathological vascular flow loss is more evident in the superficial capillary plexus. There may be a correlation between pathologies seen in the central and peripheral retina, but this observation will need to be confirmed by a future study with a larger cohort.

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Chronic Myeloid Leukemia Diagnosed in a Patient With Uncontrolled Proliferative Diabetic Retinopathy

Abstract: Other pathologies should be excluded in diabetic patients with a rapid and severe progression in their retinopathy despite adequate metabolic control. These patients should be treated promptly and aggressively until systemic disease is stable.

Cited by 11 publications

References 7 publications

Chronic myeloid leukaemia accelerates proliferative retinopathy in patients with co-existent diabetes: A risk factor not to be ignored

Chronic myeloid leukaemia accelerates proliferative retinopathy in patients with co-existent diabetes: A risk factor not to be ignored

Uncontrolled neovascular glaucoma – an alarming manifestation of chronic myeloid leukemia on imatinib therapy – a case report and review of literature

Retinal Vascular Changes on Optical Coherence Tomography Angiography and Ultra-widefield Fluorescein Angiography in Patients With Chronic Leukemia

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