Adam Murtaza K, Pitcher John D, Shields Carol L, Maguire Joseph I
Retina Service, Wills Eye Hospital, Philadelphia, PA 19107, USA.
Oncology Service, Wills Eye Hospital, Philadelphia, PA 19107, USA.
Middle East Afr J Ophthalmol. 2015 Apr-Jun;22(2):249-52. doi: 10.4103/0974-9233.150630.
Serous retinal detachment (SRD) can be the initial manifestation of leukemia. Herein, we explore the retinal and choroidal features on enhanced depth imaging optical coherence tomography (EDI-OCT) of SRD in a patient with undiagnosed leukemia. A 23-year-old male developed blurred visual acuity of 20/200 in the right eye oculus dexter (OD) and 20/200 in the left eye oculus sinister (OS). Funduscopically, he manifested serous macular detachment in both eyes oculi uterque (OU) without hemorrhagic retinal abnormalities. EDI-OCT disclosed macular detachment OU and homogeneous, marked choroidal opacification with thickening to 724 μm OD and estimated >600 μm OS and with loss of choroidal detail OU. Peripheral blood smears revealed severe thrombocytopenia and normal leukocyte count. Peripheral cytochemisty, immunophenotyping, and bone marrow aspirate confirmed the presence of atypical lymphoblasts, fulfilling criteria for precursor cell leukemia. Following systemic chemotherapy, the visual acuity improved to 20/25 OD and 20/20 OS. On EDI-OCT, the choroidal thickening resolved to 431 um OD and 443 um OS, leaving a normal choroidal appearance. Massive choroidal infiltration with leukemic cells could be the cause of serous macular detachment found in patients with newly diagnosed leukemia.
浆液性视网膜脱离（SRD）可能是白血病的首发表现。在此，我们探讨了一名未确诊白血病患者SRD的增强深度成像光学相干断层扫描（EDI-OCT）下的视网膜和脉络膜特征。一名23岁男性右眼视力降至20/200，左眼视力降至20/200。眼底检查发现双眼均有浆液性黄斑脱离，无视网膜出血异常。EDI-OCT显示双眼黄斑脱离，脉络膜均匀性明显增厚，右眼增厚至724μm，左眼估计>600μm，双眼脉络膜细节消失。外周血涂片显示严重血小板减少，白细胞计数正常。外周血细胞化学、免疫表型分析和骨髓穿刺证实存在非典型淋巴母细胞，符合前体细胞白血病的标准。全身化疗后，右眼视力提高到20/25，左眼视力提高到20/20。在EDI-OCT上，脉络膜增厚消退，右眼降至431μm，左眼降至443μm，脉络膜外观恢复正常。白血病细胞大量浸润脉络膜可能是新诊断白血病患者浆液性黄斑脱离的原因。
