Preretinal Hemorrhage Research Articles

Ophthalmic manifestations of myelin oligodendrocyte glycoprotein-IgG-associated disorder other than optic neuritis: a systematic review

Background/AimsOptic neuritis (ON) is the primary ophthalmic manifestation of myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD), but numerous reports have expanded the visual manifestations of this condition. The goal of this study...

Bilateral iPhone Gorilla Glass Intraocular Foreign Bodies in a Pediatric Patient.

A 13-year old male presented with bilateral intraocular foreign bodies (IOFBs) after a bullet struck his iPhone. The right eye vision was 20/50 and examination disclosed a limbal entry wound at 6:00, dense traumatic cataract, and vitreous hemorrhage. The left eye was 20/40 and an entry wound located roughly 4mm posterior to the limbus was noted. Fundoscopy revealed multiple refractile particles with pre-retinal and vitreous hemorrhage. CT scan demonstrated hyperdensities in the vitreous cavity bilaterally. Globe closure, cataract removal, vitrectomy, and endolaser were undertaken in the right eye, while only globe closure was performed in the left eye. On latest follow-up, the patient had 20/20 corrected vision without inflammation bilaterally. This case highlights challenges associated with the management of IOFBs of unknown material in a pediatric patient. A conservative approach led to full visual recovery, despite retained intraocular smartphone Gorilla glass.

Roth spots as debut of multiple myeloma

A previously healthy 42-year-old man complained of sudden visual loss in the left eye 1 day before the consultation. Funduscopic examination showed the right eye with dilatation and tortuosity of the veins, multiple Roth spots, flame-shaped and dot-blot intraretinal hemorrhages. Optic nerve and foveola showed no alterations (Fig. 1.1). The left eye showed similar characteristics but with more abundant and confluent hemorrhages. A preretinal hemorrhage was present on the macula, which explains the sudden loss of vision (Fig.

Valsalva retinopathy: Long-term results and management strategies.

To investigate the long-term results and efficacy of the treatment modalities for preretinal hemorrhage due to valsalva retinopathy. Retrospective review was conducted on 24 eyes of 24 patients with valsalva retinopathy who were treated between 2004 and 2019. These patients were treated with Nd:YAG laser, argon laser and vitrectomy or were only observed. Nd:YAG laser hyaloidotomy was performed in 10 eyes, argon laser was applied to two of those following failed Nd:YAG laser, and vitrectomy was performed in one eye. A conservative approach was adopted in 13 eyes. There were 15 females and nine males with mean age of 41.08 ± 12.72 (21-65) years. Mean follow-up period was 42.83 ± 23.78 (range: 12-116) months. Patients with hemorrhage size smaller than or equal to 4-disc diameter were observed for spontaneous resorption and achieved 20/20 visual acuity within 6 months. Visual acuity of all patients treated with Nd:YAG and/or argon laser, increased within the first week after the treatment. Vitrectomy was performed in only one patient with hemorrhage located away from macula. The good visual outcomes were achieved in all treatment modalities. Observation, Nd:YAG laser and argon laser seem to be safe and effective approaches for eyes with valsalva retinopathy. The size, volume and duration of hemorrhage are the most crucial factors for treatment choice, success and complications.

"Arcus retinalis": A novel clinical marker of sub-internal limiting membrane hemorrhage.

Preretinal hemorrhages can be located in subhyaloid or sub-internal limiting membrane (ILM) space. Though optical coherence tomography (OCT) may help to distinguish the exact location of hemorrhage in selected cases, it is often difficult to discern clinically. The purpose is to describe a novel clinical sign named "arcus retinalis" as a clinical marker of sub-ILM hemorrhage. Retrospective observational case series. Ophthalmic records of 31 eyes with sub-ILM hemorrhage were analyzed. The sub-ILM nature of the hemorrhage was confirmed either by the presence of two distinct layers (ILM and posterior hyaloid) on OCT or on intraoperative sub-ILM localization of the hemorrhage during vitrectomy. 15 out of 31 eyes with sub-ILM hemorrhage demonstrated a retinal yellowish-white arc corresponding to the outer margin of the sub-ILM hemorrhage. A complete circle was not seen in most of the cases. This arc corresponded to a vertical peg-like structure in the outer retina on OCT and had a tendency to fade away over months. In 10 eyes, it was visible at presentation and in five eyes it could only be seen after clearing of the hemorrhage. Retinal yellowish-white arc ("arcus retinalis") is a useful clinical marker of sub-ILM hemorrhage with distinct OCT features that tends to disappear with time.

Ocular manifestations of acute myeloid leukaemia

Each and every ocular tissue may be affected in leukemia and ocular involvement is a known entity since a long time . Prevalence of ocular involvement in leukemia ranges from 9% to 90% and can result from primary/direct infiltration of ocular tissues by leukemic cells or secondary/indirect involvement following systemic leukemic involvement.We present a case of a 30 years old female presented to emergency opd with history of epistaxis, low grade fever and headache from last 1 month and blurring of vision bilaterally from last 3-4 days. Examination reveals pallor, pedal edema, raised jugular venous pressure and hepatosplenomegaly. Hematology shows Hb - 4.1gm%,platelet count- 9000/mm, total leucocyte count - 11,000/mm ,international normalized ratio -2.02,elevated lymphocytes(82%) and deranged liver function tests. Peripheral smear shows microcytic hypochromic anaemia having metamyelocytes 3%, blast cells 71% with negative myeloperoxidase and periodic acid Schiff. Visual acuity was finger counting at one metres in both eyes. On slit lamp examination,there were bilateral diffuse subconjunctival hemorrhages, clear cornea, quite anterior chamber and anterior vitreous. Ocular movements were full and pupils were reactive bilaterally. Fundus examination in right eye shows dense intraretinal hemorrhages with central clearing in superior and inferior temporal arcade with macular hemorrhage and severe macular edema. In left eye, a large preretinal hemorrhage in superonasal and superotemporal arcade with vitreous hemorrhage was present along with multiple scattered intraretinal hemorrhages and severe macular hemorrhage with macular edema. Patient was diagnosed of having leukemic retinopathy with macular edema in a case of acute myeloid leukaemia.All leukemia patients should have an ocular acessment and examination at diagnosis and at least every 6 months . Ophthalmologist may have a secondary role in the treatment of leukemias but proper recognition of the ocular manifestations is crucial in the management of a case of leukemia.

Morphological Analysis of Retinal Microvasculature to Improve Understanding of Retinal Hemorrhage Mechanics in Infants.

PurposeIn this experimental study, we quantify retinal microvasculature morphological features with depth, region, and age in immature and mature ovine eyes. These data identify morphological vulnerabilities in young eyes to inform the mechanics of retinal hemorrhage in children.MethodsRetinal specimens from the equator and posterior pole of preterm (n = 4) and adult (n = 9) sheep were imaged using confocal microscopy. Vessel segment length, diameter, angular asymmetry, tortuosity, and branch points were quantified using a custom image segmentation code. Significant differences were identified through two-way ANOVAs and correlation analyses.ResultsVessel segment lengths were significantly shorter in immature eyes compared to adults (P < 0.003) and were significantly shorter at increasing depths in the immature retina (P < 0.04). Tortuosity significantly increased with depth, regardless of age (P < 0.05). These data suggest a potential vulnerability of vasculature in the deeper retinal layers, particularly in immature eyes. Preterm retina had significantly more branch points than adult retina in both the posterior pole and equator, and the number increased significantly with depth (P < 0.001).ConclusionsThe increased branch points and decreased segment lengths in immature microvasculature suggest that infants will experience greater stress and strain during traumatic loading compared to adults. The increased morphological vulnerability of the immature microvasculature in the deeper layers of the retina suggest that intraretinal hemorrhages have a greater likelihood of occurring from trauma compared to preretinal hemorrhages. The morphological features captured in this study lay the foundation to explore the mechanics of retinal hemorrhage in infants and identify vulnerabilities that explain patterns of retinal hemorrhage in infants.

Outcome of sutured scleral fixated intraocular lens in Marfan syndrome in pediatric eyes.

To report the clinical outcomes and complications in eyes with Marfan syndrome with subluxated/dislocated lens undergoing sutured scleral fixated intraocular lens (SSFIOL) implantation. A retrospective review was done for a consecutive series of 73 eyes of 43 patients with Marfan syndrome, with age less than 18years who underwent SSFIOL from July 2000 to June 2017. Postoperative best corrected visual acuity, intraocular pressure and refractive error, intraoperative and postoperative complications and time for the development of these complications were analyzed. Visual acuity improved significantly to 0.43 ± 0.30 (p = 0.01), 0.40 ± 0.3 (p = 0.00) and 0.39 ± 0.3 (p = 0.00) logMAR units at 6weeks, 1year and at last follow-up, respectively. The refractive error reduced significantly (p = 0.056, 0.039 and 0.031) at 6weeks, 1year and final follow-up following surgery. Intraoperative complications included iatrogenicretinal break (n = 3) and surgical trauma to the iris (n = 1). Postoperative complications included increased intraocular pressure in 3 eyes (4.1%), intraocular lens dislocation/subluxation in 5 eyes (6.8%), retinal detachment in 3 eyes (4.1%), choroidal detachment in 1 eye (1.3%), pupillary capture in 15 eyes (20.5%), vitreous hemorrhage in 1 eye (1.3%), pre-retinal hemorrhage in 1 eye (1.3%) and hyphema in 1 eye (1.3%). SSFIOL provides good visual outcomes in eyes with ectopia lentis associated with Marfan syndrome. Complications can be seen in some cases, and the parents need to be counseled regarding the same before surgical intervention.

Retinal tear formation after whole-body vibration training exercise

BackgroundThe purpose of this report is to describe the occurrence of a retinal tear, pre-retinal and vitreous hemorrhages after completing a session of whole-body vibration training. Though our patient is the third documented case of vitreous hemorrhage following whole-body vibration training, he is the first to show a close association of a retinal tear and vitreous hemorrhage with whole-body vibration training.Case presentationThis case report describes a 59-year-old male who had acute onset of floaters and shadows in the left eye. The results of the examination revealed a temporal retinal tear, inferior pre-retinal hemorrhage, and mild vitreous hemorrhage. He was successfully treated using laser photocoagulation with resolution of vitreous and pre-retinal hemorrhages on 4-month follow up.ConclusionsWith the rise in popularity of whole-body vibration training exercise, it is important for the medical and athletic community to be aware of possible associated ocular complications. We believe that high-force vibration training may cause retinal tears in susceptible persons.

Preventive laser treatment of tractional symptomatic retinal flap tears: long-term outcomes

Case monitoring of tractional symptomatic flap tears after laser treatment. From 2014 to 2019 we observed 119 patients (130 eyes) with peripheral flap (horseshoe) retinal tears in acute posterior vitreous detachment. Laser coagulation of the retina was performed using Navilas 577s (577 nm), OcuLight GL (532 nm). Laser retinotomy of horseshoe tear flap and dissection of overhanging vessels were performed using Nd:YAG-ultra Q Reflex laser (1064 nm) and controlled with RTVue XR Avanti. At the initial examination before the preventive laser coagulation, the following conditions were found: regmatogenous retinal detachment (RRD) - 8 eyes (6.2%), partial hemophthalmus - 29 (22.3%), preretinal hemorrhage - 15 (11.5%), epiretinal membrane - 9 (6.9%), non-full-thickness macular retinal breaks - 6 (4.6%), peripheral changes: retinal holes - 16 (12.3%), tears with operculum - 5 (3.8%), retinal degenerations - 40 eyes (30.8%). Observation for 5 years after laser retinopexy revealed new pathological changes: flap tears - 13 (10.6%); holes - 9 (7.4%); tears with operculum - 5 (4.1%); vitreoretinal tuft - 6 (4.9%); RRD - 3 cases (2.5%). In 16 patients (16 eyes) with horseshoe tear and pronounced vitreoretinal traction, the flap retinotomy was performed, which eliminated the traction component and prevented the development of RRD. Follow-up of tractional symptomatic flap tears for 5 years after preventive laser retinopexy revealed the appearance of retinal detachment in 2.5% of cases. Laser retinotomy of horseshoe tear after barrier retinopexy eliminated the traction component and helped prevent the development of RRD.

Preretinal hemorrhages after accidental exposure to a laser pointer: Two case reports

We report here cases of subhyaloid premacular haemorrhage and vitreous haemorrhage in two young patients after accidental exposure to a laser pointer.

The early diagnosis of congenital neuroinfections during ophthalmologic examination in children of the first months of life

To characterize the possibilities of early diagnosis of congenital neuroinfections during an ophthalmological examination in children in the first months of life. Five children with congenital neuroinfection, including 2 children with congenital toxoplasmosis and 3 children with congenital cytomegalovirus infection (CMVI), were studied. All babies were born prematurely (25 to 31 weeks of gestation (27.2±0.94)), with birth weight from 680 to 1610 g (1120±110.1). During the examination, binocular ophthalmoscopy and examination on a wide-field retinal pediatric camera were used. A blood testing for immunoglobulins and a polymerase chain reaction of blood were performed. To assess the state of the brain, neurosonography and magnetic resonance imaging were used. Ophthalmic signs of intrauterine infection appeared at the age of 4-5 months (at 47-51 weeks of postmenstrual age). In all children (in 4 in one eye, in 1 in both eyes), apparent exudative-proliferative changes in the retina and vitreous body appeared on the periphery with the formation of epiretinal membranes that exert a traction effect on the retina. In two children with CMVI, multiple preretinal hemorrhages in different parts of the retina in both eyes were revealed. Central chorioretinal foci in the fundus were detected in children with toxoplasmosis. A positive dynamics, such as a decrease of exudative phenomena, a partial fit of the retina, complete resorption of hemorrhages, was noted in children during treatment. It has been concluded that signs of intrauterine neuroinfection can appear delayed, only by the development of chorioretinitis, 4-5 months after birth and manifest with severe exudative-proliferative changes in the retina and vitreous body.

Nutritional anemia as a cause of reversible blindness

We report a case of 42-year-old male presented with acute onset breathlessness and blurring of vision in both eyes. Upon evaluation, the patient is found to have vitamin B12 and iron deficiency anemia; ophthalmoscopic examination revealed bilateral preretinal hemorrhages and Roth spots. This case documents the occurrence of retinopathy in nutritional dimorphic anemia causing blindness which is reversible after correction of anemia.

Acquired unilateral visual deterioration: More to ischemia than meets the eye

A 56-year-old woman presented with visual loss in the right eye with best-corrected visual acuity of 20/40. Funduscopic examination revealed neovascularization of the disk with peripapillary preretinal hemorrhages and leakage on fluorescein angiography. Cerebral arteriography demonstrated stenosis of the major cerebral vessels with classic collaterals configuring as “puff of smoke.” A diagnosis of moyamoya-related ocular ischemic syndrome manifesting with optic disk neovascularization was made.

LIGHTNING STRIKE: RECOGNITION AND MANAGEMENT

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: While lightning strike injuries are uncommon in clinical practice, these cause approximately 100 deaths and 300 injuries a year. Though 66% of the fatalities occur in the first hour due to arrhythmia or respiratory failure, substantial organ dysfunction can occur afterward. These include severe burn complications, deep tissue injury, rhabdomyolysis, seizures, cognitive impairment, otic abnormalities and ophthalmologic injury. Furthermore, 74% of survivors from strikes have permanent disabilities with a wide range of manifestations (1). CASE PRESENTATION: A 21-year-old man working on water hoses near a fire station had a witnessed collapse with prompt initiation of resuscitative efforts. En route to the emergency room and subsequently to the ICU, four tonic-clonic seizures were witnessed. Initial physical examination showed elevated temperature and blood pressure with a normal heart rate, an erythematous serpiginous rash from left head to the opposite foot where it ended in a caustic open wound, unilateral tympanic membrane rupture and pre-retinal macular hemorrhage. Labs demonstrated a leukocytosis, elevated liver enzymes, creatinine, creatinine kinase, and troponin. Electrocardiogram showed sinus arrhythmia without ischemia. Given the constellation of findings, a diagnosis of lightning strike was made. The patient was treated with fluid resuscitation, targeted temperature management and anti-seizure medications. He had numerous early sub-specialty consultations including trauma surgery, neurology, ophthalmology, otolaryngology, and dermatology. He was extubated on hospital day 9 and discharged on hospital day 18 neurologically intact. DISCUSSION: Cardiopulmonary stability is critical to prevent early mortality. The electrical impulse causes synchronous myocardial contraction followed by a variable period of asystole, causing ischemia and arrhythmias. Respiratory arrest is presumed to be a consequence of inhibition of the medullary respiratory center (2). Patients can have extensive, high degree burns that require specialist care. Interventions include aggressive fluid hydration, debridement and topical wound care. Muscle necrosis can lead to compartment syndrome, rhabdomyolysis and kidney injury. The central nervous system effects include autonomic instability, impaired consciousness, amnesia, seizures, tympanic membrane rupture, and ocular hemorrhage. Lasting ocular effects are common as 6% develop cataracts in the first year and a smaller population developing them within 3 years (3). CONCLUSIONS: The chances of a lightning strike are 1 in 500,000, conferring significant morbidity and mortality (1). Most practitioners have minimal experience with these injuries, affecting diagnosis and management. The effect of a lightning strike can damage numerous organ systems making it imperative to recognize different types of dysfunction for treatment of immediate injuries and long-term sequelae. Reference #1: “Lightning | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/disasters/lightning/index.html. Reference #2: Hiestand D, Colice GL. Lightning-strike injury. Journal of Intensive Care Medicine. 1988 Nov;3(6):303-14. Reference #3: Wesner ML, Hickie J. Long-term sequelae of electrical injury. Canadian family physician. 2013 Sep 1;59(9):935-9. DISCLOSURES: No relevant relationships by James Bardwell, source=Web Response No relevant relationships by Bhupinder Natt, source=Web Response No relevant relationships by Alan Nyquist, source=Web Response

Recurrent pre-retinal haemorrhages associated with coagulation factor VII deficiency

Abstract The case concerns a 20 year-old woman with a sudden visual loss in her left eye. In the fundus examination, a focal pre-retinal haemorrhage was observed in the superior temporal vascular branch with accompanying vitreous haemorrhage. There was a favorable spontaneous outcome. Eighteen months later, she presented with a new visual loss in the same eye, showing a sub-hyaloid pre-macular haemorrhage that was satisfactorily drained by hyaloidotomy using a Nd-YAG laser. The patient had also presented with an upper digestive tract haemorrhage and menorrhagia. A haemostasis study was performed that showed a coagulation factor VII deficiency. This is a very uncommon disorder that has not been previously described in association with the appearance of pre-retinal haemorrhages.

Hemorragias prerretinianas de repetición asociadas a déficit del factor VII de la coagulación

The case concerns a 20 year-old woman with a sudden visual loss in her left eye. In the fundus examination, a focal pre-retinal haemorrhage was observed in the superior temporal vascular branch with accompanying vitreous haemorrhage. There was a favourable spontaneous outcome. Eighteen months later, she presented with a new visual loss in the same eye, showing a sub-hyaloid pre-macular haemorrhage that was satisfactorily drained by hyaloidotomy using a Nd-YAG laser. The patient had also presented with an upper digestive tract haemorrhage and menorrhagia. A haemostasis study was performed that showed a coagulation factor VII deficiency. This is a very uncommon disorder that has not been previously described in association with the appearance of pre-retinal haemorrhages.

Anti-Vascular Endothelial Growth Factor (Anti-VEGF) in Central Retinal Vein Occlusion : Are Loading Dose Necessary ?

&#x0D; &#x0D; &#x0D; Background : Ranibizumab (anti-VEGF) given monthly for six doses, is effective in central retinal vein occlusion (CRVO). However, the cost and adherence to complete Ranibizumab regiment is a burden for developing countries. Aim : To present two CRVO cases with satisfactory outcome after partial regiment of ranibizumab injections. &#x0D; Case presentation : A 52-year old male came with sudden, painless visual decline of the left eye (LE). Best corrected visual acuity (BCVA) was 0.4. Relative afferent pupillary defect (RAPD) was positive on LE. Anterior segment was normal. Fundus examination revealed a cup-disc ratio (CDR) of 0.4, macular edema (ME), scattered hemorrhages, dilated and tortuous retinal veins. Patient was diagnosed with CRVO and was given two monthly injections before stopping treatment. Patient came with worsened VA, was then given another injection. After 6 months, his BCVA was 0.8. Similarly, a 32- year old male came with sudden painless decline of vision of LE (BCVA 0.15). Anterior segment was normal. Fundus examination showed CDR of 0.3, ME, multiple scattered pre-retinal hemorrhages, dilated and tortuous retinal veins. Patient was similarly diagnosed with CRVO of LE and given two monthly injections. Final BCVA after six months follow-up was 0.9. &#x0D; Conclusion : Both cases showed improvement in VA despite having partial regiment of ranibizumab injections. &#x0D; &#x0D; &#x0D;

Treatment of retinopathy of incontinentia pigmenti by anti-vascular endothelial growth factor

Objective: To investigate the treatment of retinopathy of incontinentia pigmenti by anti-vascular endothelial growth factor. Methods: Retrospective study of 5 patients(8 eyes) diagnosed retinopathy of incontinentia pigmenti from 2005 to 2017, including 0 males and 5 females (8 eyes involved) with an average age of 2.4 months(range, 1-5 months). Medical history and family history were recorded in detail for all children. We did the examination of anterior segment of the eyeball, vitreous body,fundus and intraocular pressure for the 5 patients(8eyes).What's more,wo also took pictures for fundus with the machine of Retcam. Fundus fluorescence angiography (FFA) was performed in 2 patients(4 eyes). Different surgical methods were selected according to the specific conditions of the eye and postoperative were observed. Results: At the time of initial diagnosis, preretinal hemorrhage did not affect the macular region in 3 cases (5 eyes), pre retinal hemorrhage affected the macular region in 1 case(1 eye), the retinal neovascularization in 3 cases(5 eyes), the retinal detachment in 2 cases(2 eyes), and nonvascular zone of peripheral retinal in 5cases(8 eyes). Treatment and drug selection: 3 cases(5 eyes) were treated with injection anti-VEGF drug into vitreous body cavity, 1 case(1 eye) was treated with injection anti-VEGF drug into vitreous body cavity plus laser photocoagulation, 1 case(1 eye) was treated with anti-VEGF drugs plus vitrectomy. 1 case(1 eye) was treated with anti-VEGF drugs plus retinal cryotherapy and sclera bucking. In patients of injection anti-VEGF drug into vitreous body cavity, 2 cases(3 eyes) were given a single dose and 1 case (2 eyes) was given a repeated dose. Drug selection: 4 cases(6 eyes) ranibizumab injection (injection dose 0.025 ml), 1 case (2 eyes)conbercept injection (injection dose 0.025 ml). To follow-up date, etina was flat in 4 patients (7 eyes), epiretinal membrane in 2 patients(2 eyes), retinal detachment in 1 patient(1 eye). Conclusions: The efficacy of anti-vascular endothelial growth factor in the treatment of retinopathy of incontinentia pigmenti was prelininarily confimed.However,the optimal use timing,dosage,local and systemic safety issues were needed to be further studied. (Chin J Ophthalmol, 2019, 55:294-301).

FLORID NEOVASCULARIZATION OF THE RETINA IN A DIABETIC PATIENT UNDERGOING INDUCTION AND CONSOLIDATION THERAPY FOR ACUTE PROMYELOCYTIC LEUKEMIA

To report on a 39-year-old gentleman with a background of Type 2 diabetes mellitus who was diagnosed with acute promyelocytic leukemia (APL), which was treated by all-trans retinoic acid (ATRA), and subsequently developed bilateral neovascularization of the disk (NVD). Ophthalmic examination and investigation including fundus photography and fluorescein angiography. Three months after commencement of ATRA therapy, the patient was found to have florid bilateral NVD with adjacent preretinal and intraretinal hemorrhages. Fundus fluorescein angiography was undertaken and NVD was confirmed in both eyes, which was significantly greater than expected for the extent of disease secondary to diabetic retinopathy. As a result of the fluorescein angiography findings, we believe ATRA-mediated upregulation of vascular endothelial growth factor may be the etiology of the NVD. Literature review shows some in vitro studies, which describe ATRA-induced upregulation of vascular endothelial growth factor in ocular tissues. The patient was managed successfully by cessation of ATRA and a single intravitreal injection of bevacizumab in each eye. Acute promyelocytic leukemia treated with ATRA may result in upregulation of vascular endothelial growth factor in retinal tissues. Subsequent development of NVD may occur; however, this resolves well by cessation of ATRA and intravitreal injection of bevacizumab. We recommend that all patients undergoing treatment with ATRA for acute promyelocytic leukemia be monitored by an ophthalmologist.