Tsneem H. S. Mbydeen
Kettering General Hospital, UK
Title: Sub retinal hyper reflective material in chronic myelogenous leukemia in the setting of decreased CSF absorption and possible benign intracranial hypertension
Biography
Biography: Tsneem H. S. Mbydeen
Abstract
Acute and chronic leukemia are associated with ocular signs such as: retinal hemorrhages and Roth spots. Sub Retinal Hyper Reflective Material (SHRM) are reported in Neovascular Age-Related Macular Degeneration (NVAMD) and Central Serous Chorioretinopathy (CSCR). We are presenting a patient with acute leukemia and SHRM.
Description: A 24-year-old man with a medical history of transient hypoglycemia was having blurry vision that started in the left eye and then involved the right as well as 30-lb weight loss over 4 months.
Examination 02/2022
|
Visual Acuity |
|
|
OD |
OS |
|
20/70 +1 |
20/150 |
|
Intraocular Pressure |
|
|
18 |
16 |
|
Anterior Chamber |
Deep, no cells, no flare OU |
Fundus Examination
|
Macula |
|
|
OD |
OS |
|
Roth spots Subfoveal deposits |
Dot blot hemorrhages OU |
Magnetic resonance imaging MRI (Figure 2) showed CSF prominence within the optic nerve sheaths, potential flattening of the posterior sclera, no partially empty turcica but the pituitary may have been slightly diminished in size and mild to moderate narrowing of the left transverse/sigmoid dural venous sinus junction. He was started on acetazolamide which was discontinued later as the blurry vision was due to retinal hemorrhages not idiopathic intracranial hypertension. BCR-ABL1 translocation (9; 22) confirmed chronic myelogenous leukemia (CML). The presentation was thought to be due to leukocytosis, hyper viscosity, reduced CSF absorption, benign intracranial hypertension and stasis in the arteries. He was started on dasatinib and hydroxyurea for CML.
Examination 03/2022
|
Visual Acuity |
|
|
OD |
OS |
|
20/40 |
20/150 |
|
Intraocular Pressure |
|
|
10 |
10 |
Conclusions: SHRM is a novel finding with chronic myelogenous leukemia in the setting of hyper viscosity, reduced CSF absorption and possible benign intracranial hypertension.