Sudden unilateral visual loss as an initial presentation of chronic myelogenous leukemia

Abstract

Leukemia is a cancer of the white blood cells. Many patients with leukemia are unaware of their disease until routine blood work up for other conditions reveals incidental findings leading to a diagnosis of leukemia. Up to 50% of patients with leukemia have ocular manifestations. In fact, floaters or decreased vision may be the initial symptom of leukemia. Case study: A 51-year-old Caucasian female patient with sudden unilateral visual loss in the left eye was found to have bilateral retinal neovascularization and Roth spot hemorrhages. Blood work up and cytological analyses confirmed the Philadelphia chromosome, which has been implicated in the development of chronic myelogenous leukemia (CML). Further testing confirmed a diagnosis of chronic phase CML. After a two-month course of imatinib and close monitoring by a hematological oncologist, her vision has improved and the retinal vascularization has significantly resolved. Conclusions: Eye care professionals are in a unique position to identify this devastating disease early on. A delay in diagnosis of the disease may lead to conversion into the acute phase, which has a poor prognosis for survival. A prompt referral to internal medicine and oncology for co-management is crucial.

Ophthalmologic manifestations as the initial presentation of chronic myeloid leukemia: A review

“…The median age was 37.05 years (range 27.5-49), and 67.5 % of patients were male. Most of the cases were initial presentations of CML (33 cases), and only five of them were in relapses 4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][25][26][27][28][29][30][31][32][35][36][37][39][40][41][42][43][44][45][46][47] . The retina was most often involved, with retinal hemorrhages as the most common finding.…”

“…12,17,20,22,27,32,33,39,42 Eight of these had unilaterallydecreased of vision, and 1 had normal vision. 12 Thirty-one patients presented with bilateral ophthalmic findings 4,[8][9][10][11][13][14][15][16]18,19,[23][24][25][26][28][29][30][31][32][34][35][36][37][38][40][41][42]44,46 . Four of these patients had normal vision upon presentation 9,13,24,34 , while 11 patients had unilateral decrease of vision 10,14,16,17,25,26,32,…”

“…12 Thirty-one patients presented with bilateral ophthalmic findings 4,[8][9][10][11][13][14][15][16]18,19,[23][24][25][26][28][29][30][31][32][34][35][36][37][38][40][41][42]44,46 . Four of these patients had normal vision upon presentation 9,13,24,34 , while 11 patients had unilateral decrease of vision 10,14,16,17,25,26,32,36,38,44,46 . The rest had bilaterally decreased vision.…”

“…In the posterior segment vasculopathy secondary to CML is more common than direct leukemic infiltration (Table 1). The most common findings are leukemic retinopathy (Roth spots, cotton wool spots, leukemic infiltrates, preretinal hemorrhage, intraretinal hemorrhage, subretinal hemorrhage, dilated tortuous vessels, optic disc hyperemia, and retinal vascular sheathing 9,10,15,20,22,[24][25][26]28,31,32,34,[37][38][39][40]42,44,46 .…”

A case of leukemic retinopathy mimicking common ischemic retinopathies

“…Although allogeneic HCT remains the sole curative therapy, initial treatment with imatinib has been suggested . In most cases, initial imatinib treatment for chronic phase chronic myeloid leukemia halts the disease progression .…”