Bilateral central retinal vein occlusion as the first manifestation in chronic myeloid leukaemiaBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l685 (Published 21 February 2019) Cite this as: BMJ 2019;364:l685
- Weidar Chen, ophthalmologist1,
- Cih-En Huang, haematologist2,
- Chien-Hsiung Lai, ophthalmologist1,
- Evelyn Jou Chen Huang, ophthalmologist3 4
- 1Department of Ophthalmology, Chang Gung Memorial Hospital, Chaiyi, Taiwan
- 2Department of Hematology, Chang Gung Memorial Hospital, Chaiyi, Taiwan
- 3Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan
- 4Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Correspondence to Evelyn Jou Chen Huang
A previously well 20 year old woman described bilateral acute onset blurred
vision for two weeks. Visual acuity was 20/400 (right eye) and 20/200 (left eye). Funduscopy (fig 1) showed bilateral central retinal vein occlusion with optic disc swelling (a), diffuse engorged corkscrew vessels (b), scattered retinal haemorrhage (c), Roth’s spots (d), hard exudates (e), and cotton wool spots (f). Laboratory data showed leucocytosis with dominant myelocytes. Bone marrow analysis showed chronic myeloid leukaemia.
Bilateral central retinal vein occlusion is a rare presentation of chronic myeloid leukaemia. It is thought that hyperviscosity caused by chronic myeloid leukaemia may contribute to blood stagnation in the central retinal vein, increasing venous resistance and pressure, and giving rise to central retinal vein occlusion.
After one year of treatment with a tyrosine kinase inhibitor, visual acuity was 20/25 in both eyes.
Patient consent obtained.