Visual disturbance as the first symptom of chronic myeloid leukemia

Abstract

Chronic myeloid leukemia (CML) is a well-studied entity and advances made in diagnosis and treatment have improved the disease outcome. Patients with ophthalmic manifestation of CML have been reported to have lower 5-year survival rates. Hence, recognizing the early fundus changes may improve outcome by allowing earlier diagnosis and treatment. We report a case of a previously healthy 30-year-old Myanmarese male, who presented with a minor visual disturbance, complaining of seeing a ‘black dot’ in his left visual field for the past 1 week. Fundoscopic examination revealed bilateral retinal blot hemorrhages, white-centered hemorrhage, and preretinal hemorrhage over the left fovea. The full blood count and peripheral blood film were abnormal, and bone marrow biopsy confirmed the diagnosis of CML. Cytoreduction therapy was promptly commenced and his symptoms resolved, with improvement in visual acuity. No complications were recorded at 1-year follow-up.

Ophthalmic Manifestations of Leukemia

“…В сетчатке по ходу сосудов видны беловатые полосы, представляющие собой пе-риваскулярную лейкемическую инфильтрацию. Могут наблюдаться преретинальные кровоизли-яния, интраретинальные кровоизлияния окру-глые и в форме пламени [14,18,19]. Нередко в цен-тре ретинального кровоизлияния можно видеть белый участок, вызванный аккумуляцией лейко-цитов.…”

“…Известны случаи, когда жалобы на ухудшение зрения, появление «пятна» перед глазом стано-вятся первой манифестацией заболевания у ра-нее «здоровых» людей [18,29,38]. Лейкоз может проявиться внезапным снижением зрения из-за экссудативной отслойки сетчатки, и офтальмолог будет первым врачом, проводящим обследова-ние такого больного.…”

Subjective intermittent colour vision loss as the initial presentation of chronic myeloid leukemia

“… 6 , 7 In CML, only 5–10% of patients present with ocular symptoms. 5 In his review of ocular manifestations of leukemia, Rosenthal included tortuous dilated retinal vessels, retinal vascular sheathing, hard exudates, cotton wools spots, retinal hemorrhages, microaneurysms, neovascularization, and lid, orbital, optic nerve, retinal and choroidal infiltration as possible signs. Indeed, several reports outlining these findings as the initial presenting symptoms of CML or symptoms in association with CML have been published.…”

“…Furthermore, patients who have ophthalmic manifestations of CML have been reported to have lower 5-year survival rates, underscoring the importance of prompt investigation and treatment in these patients. 5 Clinical signs include vascular changes, such as retinal vein tortuosity or obstruction, dot-blot hemorrhages, flame-shaped hemorrhages, and Roth spots. 5 We present, for the first time in the English literature, a case of a patient with undiagnosed CML who initially presented to the ophthalmology clinic with bilateral subjective intermittent loss of colour vision and episodic white-out vision.…”

A unique case of chronic myeloid leukemia presenting as monocular vision loss with unilateral retinopathy

“…To date, nine cases have been reported in which the ocular manifestations of CML were the only presenting signs of the disease, however, in all of these cases, ocular involvement was described bilaterally 7, 8, 9, 10, 11. In addition, the disease risk stratification of these patients with CML and symptomatic ocular presentations was not discussed.…”