CLL Coverage from Every Angle

Rare Case of Acute Macular Neuroretinopathy in a Woman With CLL

By: Vanessa A. Carter, BS
Posted: Tuesday, April 20, 2021

David S. Ehmann, MD, of the University of Alberta, Canada, and colleagues presented reportedly the first known instance of bilateral acute macular neuroretinopathy manifesting from leukemic radiopathy in the Canadian Journal of Ophthalmology. This individual had treatment-naive chronic lymphocytic leukemia (CLL) and also demonstrated optic neuropathy.

“Our patient’s ophthalmic manifestations of CLL facilitated an urgent oncology referral that ultimately resulted in the prompt initiation of systemic chemotherapy,” the authors commented. “We suspect that acute macular neuroretinopathy lesions may also occur in patients with other forms of leukemia.”

A 43-year-old woman presented with blurry vision and “spots” in both eyes for 1 week, with pupils equal and reactive to light. A diagnosis of CLL was made several years ago, but she denied chemotherapy and chose to follow an alternative naturopathic regimen. Upon observation, her uncorrected visual sharpness was 20/25 in her right eye and 20/30 in her left eye; the intraocular pressures were 10 mm Hg and 9 mm Hg, respectively.

Bilateral, diffuse, intraretinal hemorrhages with Roth spots were discovered, extending from the posterior pole to the periphery. Optic disc edema and bilateral tortuous retinal vessels were found in both eyes. Bilateral hyporeflective, wedge-shaped lesions centered around the fovea, tortuous retinal vasculature, and blockage of fluorescence by retinal hemorrhages were also uncovered.

A presumptive diagnosis of optic neuropathy and leukemic retinopathy with acute macular neuroretinopathy was made, and the subject was referred to her oncologist. Given her low white blood cell count, hemoglobin, and platelets, she agreed to chemotherapy.

At the 2-month follow-up, the patient’s vision was stable. While on chemotherapy, her hematologic levels improved, and fewer retinal hemorrhages and reduced optic disc edema were observed in her fundus. Ultimately, the patient must attend ongoing follow-up to monitor her acute macular neuroretinopathy and leukemic retinopathy.

Disclosure: The study authors reported no conflicts of interest.

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