Miliary microaneurysms: An angiographic biomarker of leukemic retinopathy?

Kawali, Ankush; Mahendradas, Padmamalini; Sanjay, Srinivasan; Shetty, Rohit

doi:10.4103/ijo.ijo_2375_19

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…• Microaneurysms (MA) ○ Leukemic retinopathy may share common clinical features with diabetic retinopathy. MAs in leukemic retinopathy are smaller in size, clustered more closely to give a firecracker-appearance on FFA [29]. This picture of miliary MAs can differentiate leukemic retinopathy from a variety of ocular conditions such as Behcets retinal vasculitis, sarcoidosis where MA is not a typical feature.…”

Section: Ffa Features In Leukemic Retinopathymentioning

confidence: 89%

Clinical and Imaging Features of Leukemic Retinopathy

Hui¹,

Szeto²

2023

Leukemia - From Biology to Clinic

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Hematological malignancies may be associated with ocular manifestations in up to 50% of cases, and ocular symptoms can be the initial presentation. Retinal leukemic infiltrates may be observed in up to 3% of leukemia patients. Leukemic retinopathy may present more commonly in acute leukemias than chronic leukemias as Roth’s spot, multi-level retinal hemorrhages, cotton wool spots, or opportunistic infection secondary to pancytopenia. On the other hand, patients with chronic leukemias, such as chronic myeloid leukemia (CML), may present with leukemic retinal infiltrates and venous stasis secondary to hyperviscosity, which may lead to secondary peripheral microaneurysms and neovascularization. Vascular complication, such as central retinal vein occlusion, may also occur as a result of venous stasis. In addition, leukemic retinopathy is associated with poorer overall survival as pediatric CML patients without ocular manifestation may have twice as high 5-years survival rate compared with those with ocular manifestation. The presence of leukemic retinopathy is associated with more severe systemic disease and is correlated with hematological parameters such as white blood cells count (WBC). In addition, a positive correlation was found between ocular leukemic infiltration and agonal leukocyte count and the severity of systemic disease in an autopsy study. Therefore, the presence of retinal infiltrate may be associated with leukemia with extreme leukocytosis. Optical Coherence Tomography (OCT) is a noninvasive retinal imaging tool that can help diagnose leukemic retinopathy. Inner retina hyper-reflective lesions were observed in areas with intra-retinal hemorrhages or hemorrhagic lesions, while outer retina hyper-reflective lesions were observed in areas with whitish retinal infiltrates. In addition, the loss of the physiological hourglass appearance on cross-sectional OCT scan of retinal vessels may be seen in leukemic retinopathy. It is believed that intraluminal blood flow is responsible for the physiological hourglass appearance, consisting of two paired hyper-reflectivities inside vessel wall on OCT. In leukemic retinopathy, hyperviscosity may disrupt normal intraluminal blood flow, leading to the loss of this physiological appearance. In summary, leukemic retinopathy can be the first presentation of leukemia. Ophthalmologists can play an important role in the diagnosis of leukemia. Noninvasive retinal imaging could help us to monitor and understand the pathophysiology of leukemic retinal infiltrates. Prompt diagnosis and treatment of underlying leukemia may preserve vision and prolong survival rate.

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Section: Ffa Features In Leukemic Retinopathymentioning

confidence: 89%

Clinical and Imaging Features of Leukemic Retinopathy

Hui¹,

Szeto²

2023

Leukemia - From Biology to Clinic

View full text Add to dashboard Cite

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“…Ultra-wide field fluorescein angiography has been reported to be able to identify peripheral miliary microaneurysms and peripheral non-perfusion in leukemic retinopathy. 12,13 The presence of miliary microaneurysms on angiography can be a useful sign to differentiate leukemic retinopathy from other differential diagnoses, such as retinal vasculitis, sarcoidosis, or post-fever retinitis. 12 Furthermore, OCT-angiography (OCTA) is a non-invasive imaging modality that may reveal pathological vascular flow loss in the superficial and deep capillary plexus in patients with leukemic retinopathy.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 The presence of miliary microaneurysms on angiography can be a useful sign to differentiate leukemic retinopathy from other differential diagnoses, such as retinal vasculitis, sarcoidosis, or post-fever retinitis. 12 Furthermore, OCT-angiography (OCTA) is a non-invasive imaging modality that may reveal pathological vascular flow loss in the superficial and deep capillary plexus in patients with leukemic retinopathy. 13 OCTA may allow more sensitive detection of leukemic retinopathy, as the pathological flow loss could be observed in asymptomatic patients with normal retinal appearance.…”

Section: Discussionmentioning

confidence: 99%

Massive retinal infiltrates as the presenting sign of chronic myeloid leukemia: Clinical and imaging features of leukemic retinopathy

Szeto

Mohamed

Tsang

et al. 2021

European Journal of Ophthalmology

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Purpose: To describe the clinical and optical coherence tomography (OCT) features of two cases with bilateral diffuse retinal infiltrates as the only presenting feature of chronic myeloid leukemia (CML) on initial diagnosis and upon relapse. Methods: We reported two patients with CML, one at initial diagnosis and one in remission who presented with bilateral subacute visual impairment. Fundal examination revealed bilateral symmetrical leukostatic appearance with increased vascular tortuosity, diffuse retinal infiltrates with size up to 6 disk diameters, retinal hemorrhages, and Roth’s spots. OCT showed multiple intra-retinal hyper-reflective foci corresponding to intra-retinal hemorrhages, and outer retinal hyper-reflective foci in area corresponding to retinal infiltrate. The different retinal layers were relatively preserved and distinguishable. Results: White cell count (WCC) were elevated in both patients ranging from 544 to 810 × 109/L. Bone marrow biopsy confirmed the diagnosis of CML in the patient without prior diagnosis and relapse of CML in another patient. Cytogenetic test detected Abelson murine leukemia (ABL) – breakpoint cluster region (BCR) fusion transcript in both cases. Both patients were started on oral imatinib, subsequently WCC returned to within normal values in both cases. Vision and OCT abnormalities improved and reduction in retinal hemorrhages and infiltrates were observed in follow up. Conclusion: This report highlights the important role of ophthalmologists and detailed fundus examination in making a prompt diagnosis of leukemia in patients with visual complaints. Appropriate systemic investigation and hematologist referrals for prompt treatment of CML may improve survival rate and preserve vision.

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Dense perivenular clustering of microaneurysms: A pointer of leukemic retinopathy?

Temkar,

Nair,

Ramachandar

et al. 2024

Indian Journal of Ophthalmology - Case Reports

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A boy in his late teens with a history of low-grade fever evaluated for a hematological malignancy was screened for ocular involvement. The fundus examination revealed a hyperemic disc with engorged tortuous retinal veins, pseudo sheathing of the peripheral retinal vasculature with surrounding retinal hemorrhages, and retinal infiltrates suggestive of leukemic retinopathy. Wide-field fundus fluorescein angiography showed areas of capillary non-perfusion along with characteristic dense segregation of multiple perivenular microaneurysms with sparing of the arterioles. The patient was diagnosed with chronic myeloid leukemia and treated with imatinib mesylate. No active ophthalmic treatment was carried out because there was no evidence of treatable retinal complications such as macular edema or retinal neovascularization. Clearance of leukemic infiltrates, along with complete regression of the microaneurysms, were observed 6 weeks after the treatment.

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Miliary microaneurysms: An angiographic biomarker of leukemic retinopathy?

Cited by 3 publications

References 6 publications

Clinical and Imaging Features of Leukemic Retinopathy

Clinical and Imaging Features of Leukemic Retinopathy

Massive retinal infiltrates as the presenting sign of chronic myeloid leukemia: Clinical and imaging features of leukemic retinopathy

Dense perivenular clustering of microaneurysms: A pointer of leukemic retinopathy?

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