Unlike acute lymphoblastic leukemia, central nervous system involvement in chronic myelogenous leukemia is rare, Citation3 and in the absence of headaches or other focal neurological findings, he did not undergo further analysis of his cerebrospinal fluid. Flow cytometry with CD34 staining showed <5% blasts. The myeloid series was increased and left shifted with full maturation. The patient was diagnosed with chronic phase chronic myelogenous leukemia (BCR-ABL-negative) by bone marrow aspiration and biopsy with an overall cellularity of 95%. There was no evidence of choroidal involvement or subretinal fluid. The left eye demonstrated a larger inner retinal lesion with smaller adjacent lesions, without an outer retinal component. OCT scans of the macula revealed hyperreflective lesions in the inner retina as well as a separate outer retinal lesion in the right eye ( Figure 2). Focal areas of leukemic infiltration were present in the fovea OU ( Figure 1) with larger leukemic lesions temporally in right eye and inferotemporally in the left eye. Scattered white-centered hemorrhages were present throughout the fundus. His cup-to-disk ratio was 0.85 with healthy rims and bilateral peripapillary atrophy. His dilated fundus exam revealed a posterior vitreous detachment in his right eye without vitreous hemorrhage. His external slit-lamp examination was remarkable only for nuclear sclerosis OU. His pupils were symmetric and reacted briskly to light without a relative afferent pupillary defect. His best corrected visual acuity was 20/80 oculus uterque (OU), and intraocular pressures were 13 and 14 mmHg, respectively. The clinical response was documented on serial spectral domain optical coherence tomography (OCT) imaging, with image registration.Ī 59-year-old man with a history of asthma, hypertension, and newly diagnosed atypical chronic myelogenous leukemia, which was BCR-ABL receptor-negative, presented to the eye clinic with a several-week history of decreased vision, floaters and photopsia, and central scotomas. In this case report, we present a rare scenario of bilateral, foveal leukemic infiltration, and vision loss in a patient with atypical chronic myelogenous leukemia who eventually had regression of these foveal lesions and recovered vision after chemotherapy. Citation1 While ocular involvement can range from 39% to 53% of cases in patients with acute leukemia, Citation1 only a small portion of these findings are a result of direct leukemic infiltration. These hemorrhages are typically found in the posterior pole and particularly in the inner layers with focal destruction. Citation1, Citation2 The most prevalent of such findings include intraretinal hemorrhages, cotton-wool spots, and white-centered hemorrhages. Leukemic retinopathy refers to numerous, abnormal fundoscopic findings that stem from complications of leukemia, such as anemia, thrombocytopenia, and hyperviscosity.
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