Retinal infiltration in a case of chronic myeloid leukemia.

Abstract

To describe a case of chronic myelogenous leukemia (CML) with retinal leukemic infiltration identified by optical coherence tomography (OCT) and OCT angiography (OCTA). Case report. A 64-year-old man presented with bilateral painless blurred vision as well as three weeks of fatigue, unintentional weight loss, and complete hearing loss. Dilated fundus exam of both eyes showed peripheral intraretinal hemorrhages with white centers, vascular tortuosity, and peripheral non-perfusion. No macular lesions were identified by slit lamp exam, fundus photography, fundus autofluorescence, or fluorescein angiography. OCT through the macula revealed multiple hyperreflective lesions throughout the inner retinal layers. Some of these lesions showed intrinsic flow by OCTA, but many lesions did not. The bone marrow biopsy confirmed CML, and these intraretinal lesions were deemed to be leukemic infiltrates. The patient regained vision after systemic chemotherapy with resolution of the retinal infiltrates over time. Primary leukemic retinal involvement can be challenging to diagnose, especially when the macula appears normal clinically. OCT and OCTA are useful imaging modalities for the detection of retinal leukemic infiltration. Completing a thorough review of systems and initiating an urgent, systemic work-up are warranted in cases of retinal infiltration.