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

Abstract

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.