Presentation of Chronic Myeloid Leukaemia in Accelerated Phase Presenting with Bilateral Leukemic Retinopathy - A Case Report

Abstract

The leukemias are malignant neoplasms of the hematopoietic stem cells, characterized by diffuse replacement of the bone marrow by neoplastic cells. There are 3 stages in Chronic Myeloid Leukemia-chronic phase, accelerated phase and blast phase.Ophthalmic manifestation can be classified into two categories: primary or direct leukemic infiltration and secondary or indirect involvement. Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. The prevalence of ocular involvement in leukemic patients has been reported to be 9% to 90% in various studies. To highlight the important ophthalmic manifestation in patients of leukemias we are presenting a case report on chronic myeloid leukemia in accelerated phase of a young male patient referred from medicine OPD with chief complaints of blurring of vision in both eyes since 2 days.

Ophthalmologic manifestations as the initial presentation of chronic myeloid leukemia: A review

“…The median age was 37.05 years (range 27.5-49), and 67.5 % of patients were male. Most of the cases were initial presentations of CML (33 cases), and only five of them were in relapses 4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][25][26][27][28][29][30][31][32][35][36][37][39][40][41][42][43][44][45][46][47] . The retina was most often involved, with retinal hemorrhages as the most common finding.…”

“…12,17,20,22,27,32,33,39,42 Eight of these had unilaterallydecreased of vision, and 1 had normal vision. 12 Thirty-one patients presented with bilateral ophthalmic findings 4,[8][9][10][11][13][14][15][16]18,19,[23][24][25][26][28][29][30][31][32][34][35][36][37][38][40][41][42]44,46 . Four of these patients had normal vision upon presentation 9,13,24,34 , while 11 patients had unilateral decrease of vision 10,14,16,17,25,26,32,…”

“…In the posterior segment vasculopathy secondary to CML is more common than direct leukemic infiltration (Table 1). The most common findings are leukemic retinopathy (Roth spots, cotton wool spots, leukemic infiltrates, preretinal hemorrhage, intraretinal hemorrhage, subretinal hemorrhage, dilated tortuous vessels, optic disc hyperemia, and retinal vascular sheathing 9,10,15,20,22,[24][25][26]28,31,32,34,[37][38][39][40]42,44,46 .…”

“…Proliferative retinopathy may result in vitreomacular traction 10 , vitreous hemorrhage 8,11,15,18,23 , and tractional retinal detachment 8,29 . Macular and foveal involvement have been reported multiple times and can cause profound visual loss 10,13,19,20,22,26,28,32,35,37,38,44 . Rarely, leukemic cells invade the vitreous cavity and cause vitritis.…”

“…Other findings like optic nerve swelling and infiltration may cause severe visual loss 12,13,[15][16][17]28,30,40 .…”