Balubaid Marwan M, Alqahtani Abdullah S
Internal Medicine, King Abdulaziz Medical City, Jeddah, SAU.
Ophthalmology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Cureus. 2021 Feb 17;13(2):e13387. doi: 10.7759/cureus.13387.
Leukemia is a systematic cancer of the blood and blood-forming tissues that affects multiple organs. Acute myeloid leukemia (AML) is the most common type of leukemia that affects adults. Ophthalmic manifestations of leukemia could be observed in both acute and chronic leukemias. Around 35.4% of leukemia patients present with leukemic retinopathy. In this report, we discuss the case of a patient who was diagnosed with acute promyelocytic leukemia (APL) and went on to develop leukemic retinopathy during chemotherapy. A 35-year-old male was diagnosed with APL and received induction therapy with daunorubicin, and all-trans retinoic acid (ATRA) in a seven + three regimen. During the remission phase, he presented with a complaint of decreased vision of the right eye for about three weeks after the initiation of the therapy. On examination, the best-corrected visual acuity (BCVA) was found to be 6/60 in the right eye and 6/6 in the left eye. Fundus examination showed intraretinal hemorrhages in the posterior pole of both eyes. Fundus photography of the right eye showed resolved macular bleeding, temporal retinal bleeding, fresh inferonasal, and supraoptic retinal hemorrhage. For the left eye, however, it showed a small hemorrhagic spot temporal to the macula. Optical coherence tomography (OCT) was performed on both eyes, which showed sub-inner limiting membrane (sub-ILM) hemorrhage in the right macula with normal OCT of the left eye. There are multiple reported ocular manifestations of leukemic retinopathy including flame-shaped hemorrhage, cotton wool spots, and Roth spots. In patients with APL, thrombocytopenia and intracranial hemorrhage are the proposed underlying mechanism of retinal hemorrhage. Terson's syndrome, which is an intracranial hemorrhage with associated retinal hemorrhage, has been reported to occur during ATRA induction therapy. Sub-ILM hemorrhage is relatively uncommon, and it has been associated with multiple primary pathologies such as Valsalva retinopathy, Terson's syndrome, and bleeding dyscrasias. Retinal hemorrhage is a serious complication in leukemic patients; it could be the presenting complaint or even manifest after the initiation of therapy. Early detection and frequent follow-ups are crucial for its management.
白血病是一种影响多个器官的血液及造血组织的系统性癌症。急性髓系白血病（AML）是影响成年人的最常见白血病类型。白血病的眼部表现可见于急性和慢性白血病。约35.4%的白血病患者会出现白血病性视网膜病变。在本报告中，我们讨论了一例被诊断为急性早幼粒细胞白血病（APL）并在化疗期间发生白血病性视网膜病变的患者病例。一名35岁男性被诊断为APL，并接受了柔红霉素和全反式维甲酸（ATRA）的七 + 三方案诱导治疗。在缓解期，他在治疗开始后约三周出现右眼视力下降的主诉。检查发现，右眼最佳矫正视力（BCVA）为6/60，左眼为6/6。眼底检查显示双眼后极部视网膜内出血。右眼眼底照相显示黄斑出血已消退、颞侧视网膜出血、新鲜的鼻下和视盘上视网膜出血。然而，左眼显示黄斑颞侧有一个小出血点。对双眼进行了光学相干断层扫描（OCT），结果显示右眼黄斑区存在内界膜下（sub-ILM）出血，左眼OCT正常。白血病性视网膜病变有多种已报道的眼部表现，包括火焰状出血、棉絮斑和Roth斑。在APL患者中，血小板减少和颅内出血是视网膜出血的潜在机制。据报道，在ATRA诱导治疗期间会发生Terson综合征，即伴有视网膜出血的颅内出血。内界膜下出血相对少见，它与多种原发性病变有关，如瓦尔萨尔瓦视网膜病变、Terson综合征和出血性疾病。视网膜出血是白血病患者的严重并发症；它可能是首发症状，甚至在治疗开始后才出现。早期发现和频繁随访对其治疗至关重要。
