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Middle East Afr J Ophthalmol
2013 Jan 01;204:353-6. doi: 10.4103/0974-9233.120016.
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Bilateral proliferative retinopathy as the initial presentation of chronic myeloid leukemia.
Macedo MS
,
Figueiredo AR
,
Ferreira NN
,
Barbosa IM
,
Furtado MJ
,
Correia NF
,
Gomes MP
,
Lume MR
,
Menéres MJ
,
Santos MM
,
Meireles MA
.
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The authors report a rare case of a 48-year-old male with chronic myeloid leukemia (CML) who initially presented with a bilateral proliferative retinopathy. The patient complained of recent visual loss and floaters in both eyes (BE). Ophthalmologic evaluation revealed a best corrected visual acuity (BCVA) of 20/50 in the right eye and 20/200 in the left eye (LE). Fundoscopy showed the presence of bilateral peripheral capillary dropout with multiple retinal sea fan neovascularisations, which were confirmed on fluorescein angiography. Full blood count revealed hyperleukocytosis, thrombocytosis, anemia, and hyperuricemia. Bone marrow aspiration and biopsy showed the reciprocal chromosomal translocation t (9;22), diagnostic of CML. The patient was started on hydroxyurea, allopurinol and imatinib mesylate. He received bilateral panretinal laser photocoagulation and a vitrectomy was performed in the LE. The patient has been in complete hematologic, cytogenetic, and major molecular remission while on imatinib and his BCVA is 20/25 in BE.
Figure 1. Color fundus photographs of posterior pole of the right eye (a and b) and left eye (LE) (c-d) demonstrate dilated and tortuous veins, dot-blot and flame-shaped retinal hemorrhages and microaneurysms in both eyes, and also mild vitreous hemorrhage in the LE
Figure 2. (a-f): Fluorescein angiography of the right eye shows peripheral retinal non-perfusion with leaking peripheral neovascularisation
Figure 3. (a-f): Fluorescein angiography of the left eye shows some degree of blockage due to the vitreous hemorrhage; it also demonstrates multiple arteriovenous anastomosis with marked areas of capillary dropout and extensive leaking peripheral neovascularisations
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