Leukemic Retinopathy - Khaled Moumneh - 2024 11 09 скачать в хорошем качестве

Leukemic Retinopathy - Khaled Moumneh - 2024 11 09

This presentation describes a 72-year-old female with progressive vision loss, floaters, and bruising, diagnosed with leukemic retinopathy in the context of chronic myelogenous leukemia (CML). Fundus findings included dilated, tortuous veins, retinal hemorrhages, cotton wool spots (CWS), and pseudo-Roth spots. OCT and fluorescein angiography (FA) confirmed retinal vascular and structural abnormalities. Her initial visual acuity improved from 20/100 to 20/50 after a single anti-VEGF injection for diabetic macular edema, but the underlying systemic malignancy necessitated comprehensive oncological management. Leukemic retinopathy, a manifestation of hematologic malignancies, arises from direct leukemic infiltration or secondary effects like anemia, thrombocytopenia, and hyperviscosity. Signs include retinal hemorrhages at various levels, perivascular gray or yellow-white infiltrates, and rarely, neovascularization. Pseudo-Roth spots are classic features caused by aggregated fibrin, WBCs, or platelets within white-centered hemorrhages, distinguishing them from Roth spots seen in endocarditis. Optic nerve involvement can cause severe vision loss and requires urgent treatment with external beam radiation and intrathecal chemotherapy. Diagnosis involves systemic workup with CBC, peripheral smear, bone marrow biopsy, and flow cytometry. Adjunctive imaging such as OCT and FA can localize and characterize retinal pathology. Treatment focuses on systemic chemotherapy tailored to the leukemia subtype, with adjunctive ocular therapies like anti-VEGF injections or steroids in select cases. Despite advancements, retinal involvement in leukemia portends a poorer prognosis, with five-year survival rates significantly lower in patients with ocular complications. This case highlights the importance of recognizing leukemic retinopathy as an indicator of systemic disease. Prompt interdisciplinary management can stabilize vision and address life-threatening hematologic abnormalities. Teaching points emphasize distinguishing pseudo-Roth spots from true Roth spots, understanding retinal manifestations in leukemia, and integrating systemic and ocular therapies.