Unilateral macular choroidal neovascularization—a rare manifestation in acute myelocytic leukemia

Abstract

Rationale:Characteristic signs of leukemic retinopathy include bilateral intra-retinal hemorrhage, white-centred hemorrhage, macular hemorrhage and cotton-wool spots. Capillary closure, retinal microaneurysms and neovascularization following massive fundus hemorrhage could be involved in few of the above instances. However, single choroidal neovascularization (CNV) in macular has not been observed in acute myelocytic leukemia (AML).Patient concerns:A 22-year-old woman presented with a 7-day history of vision decline in the right eye (OD). The patient was diagnosed as M3 AML one month earlier. Chemotherapy was immediately administered, which led to temporary myelosuppression. Recent examination showed that best corrected visual acuity was 20/400 OD. Fundoscopy showed petechial and patchy intra-retinal hemorrhage in both eyes and grayish-white lesion in the right macular center, which was confirmed as macular CNV by OCT and OCTA.Diagnoses:The patient was diagnosed as macular CNV OD related to AML and chemotherapeutic regimens.Interventions:She received intravitreal ranibizumab injection 0.5 mg (10 mg/ml) in the right eye for once on January 3, 2017.Outcomes:CNV resolved three days after treatment with intravitreal ranibizumab injection 0.5 mg for once. No recurrence was observed after 10-month follow-up. Vision recovered to 20/40 at the last visit.Lessons:This is the first report demonstrating that macular CNV could be an ophthalmic side-effect secondary to initiated chemotherapeutic regimens in patients with M3 AML. Intravitreal injection of ranibizumab could be beneficial and safe in treating this CNV.

Rifabutin‐associated acute bilateral panuveitis mimicking endophthalmitis in an immunocompetent patient

“…Our results are comparable to the qualified tube surgery success rate of 63% reported by Gedde et al from the 1-year outcome data of the tube vs trabeculectomy study. 2 There was no significant difference between the two groups in both early and late complications as shown in Table 2. Our complication rates are consistent with…”

“…1,3 Patients usually present with bilateral anterior uveitis, with or without hypopyon, mimicking HLA-B27-associated uveitis. [1][2][3][4] They can also present with isolated posterior uveitis or panuveitis mimicking the appearance of endogenous endophthalmitis. 2 Two main hypotheses have been suggested for pathophysiology: an immune reaction to dead MAC cell wall proteins, which is supported by an experiment of producing uveitis in mice with Freund's adjuvant and bacterial cell wall proteins, or direct drug-toxicity reaction, which is supported by observing higher serum level when fluconazole or clarithromycin was administered concomitantly.…”

“…It can also be treated with topical corticosteroid only, even with posterior segment involvement. [1][2][3] In a small number of cases, the patients were successfully treated with topical corticosteroid treatment and rifabutin therapy was continued. 1 Our patient had multiple atypical features.…”

Choroidal neovascular membrane secondary to subfoveal leukemic infiltrate

“…There is only one case report of a secondary choroidal neovascular membrane (CNVM) reported in acute myeloid leukaemia (AML) . Yang et al described a 22‐year‐old woman with acute vision loss and CNVM confirmed by ocular coherence tomography‐angiography (OCTA) in the context of recent chemotherapy for AML . We report a patient with CNVM in acute lymphoblastic leukaemia (ALL), which was successfully treated with bevacizumab.…”

“…Direct infiltration cases are uncommon, including foveal infiltrates, macular lesions and retinal infiltrate . There is only one case report of a secondary choroidal neovascular membrane (CNVM) reported in acute myeloid leukaemia (AML) . Yang et al described a 22‐year‐old woman with acute vision loss and CNVM confirmed by ocular coherence tomography‐angiography (OCTA) in the context of recent chemotherapy for AML .…”