With evolving diagnostic and therapeutic advances, the survival of patients with acute leukaemia has considerably improved. This has led to an increase in the variability of ocular presentations in the form of side effects of the treatment and the ways leukaemic relapses are being first identified as an ocular presentation. Leukaemia may involve many ocular tissues either by direct infiltration, haemorrhage, ischaemia, or toxicity due to various chemotherapeutic agents. Ocular involvement may also be seen in graft-versushost reaction in patients undergoing allogeneic bone marrow transplantation, or simply as increased susceptibility to infections as a result of immunosuppression that these patients undergo. This can range from simple bacterial conjunctivitis to an endophthalmitis. Leukaemia can present as pathology in the adnexae, conjunctiva, sclera, cornea, anterior chamber, iris, lens, vitreous, retina, choroid, and optic nerve. Recognition of the varied ocular presentations is also important in assessing the course and prognosis of leukaemia. We have presented a systematic approach taking each part of the eye in turn and outlining how leukaemia has been shown to affect it.

SummaryA 53-year-old man with hypopharyngeal stenosis following curative chemoradiotherapy for a tongue base tumour presented three years later for an attempt at pharyngeal dilatation. The first attempt 6 months previously was abandoned when awake fibreoptic intubation failed due to partial airway obstruction and desaturation when the fibrescope was advanced. As mask ventilation was anticipated to be possible, a further attempt at intubation after induction of anaesthesia was judged appropriate. The backup plan was jet ventilation via a cricothyroid cannula sited pre-induction. However, neither mask nor jet ventilation proved possible after the induction of anaesthesia and neuromuscular blockade with rocuronium. Swift administration of sugammadex on a background of thorough pre-oxygenation allowed return of spontaneous breathing before the development of hypoxia and so avoided the need for surgical airway rescue. This case demonstrates the utility of sugammadex in restoring spontaneous respiration in a 'can't ventilate' scenario, provided that the airway has not been traumatised by instrumentation. Impossible mask ventilation is an anaesthetic emergency requiring swift, decisive and coordinated management to prevent hypoxia and harm. It is defined as lack of chest wall movement or end-tidal CO 2 measurement during positive pressure ventilation despite airway adjuncts and additional personnel [1]. The incidence in the general population has been estimated at 0.2%, but may be as high as 15% in patients whose tracheas are known to be difficult to intubate [2]. In this cohort, impossible mask ventilation assumes greater significance and may result in a 'cannot intubate-cannot ventilate' (CICV) scenario. Guidelines advise how to maintain oxygenation in such scenarios of unpredicted difficult or failed intubation [3]. They do not necessarily apply to situations of predicted difficult intubation and they predate the widespread introduction of sugammadex, which may have a role to play in restoring spontaneous ventilation [4]. Case ReportA 53-year-old man (69 kg) presented with persistent dysphagia due to hypopharyngeal stenosis following chemoradiotherapy three years previously for squamous cell carcinoma (T1N2c) [5] of the tongue base. He was scheduled for a second attempt at elective examination under anaesthesia and dilatation of the stenosis. The first attempt 6 months previously was abandoned when awake fibreoptic intubation by a consultant anaesthetist experienced in this technique failed. An enlarged epiglottis and small anterior laryngeal inlet were seen, but advancing the fibreoptic scope caused partial airway obstruction and desaturation.

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PurposeTo report a case of unilateral leukemic retinopathy secondary to chronic myeloid leukemia (CML).ObservationsPatient presented to clinic with a visual acuity (VA) of 20/200 in the right eye (OD) after several months of progressive monocular vision loss and was found to have dense pre-retinal hemorrhage. Patient underwent 23-gauge pars plana vitrectomy to clear the preretinal hemorrhage along with a complex macula-off retinal detachment repair to address retinal tear and multilayer retinal hemorrhage. The patient was subsequently diagnosed with CML as she was found to be positive for the fusion protein of break point cluster gene (BCR) with Abelson tyrosine kinase (ABL1), BCR-ABL1, upon systemic work-up. Imatinib therapy resulted in complete hematologic and cytogenetic resolution after one month, however, the patient's vision remained unchanged six months after surgery.Conclusion and importanceTo the authors' knowledge, this is the first reported case of unilateral leukemic retinopathy secondary to low risk CML, as determined by the Sokal and Hasford prognostic scoring systems. CML should be included in the differential diagnosis of patients with progressive monocular vision loss with suspicious multi-layer retinal compromise.