Título

Chronic Myeloid Leukemia Presenting as Neovascular Glaucoma and Leukostasis Retinopathy

Objetivo

To report an uncommon presentation CML as Neovascular glaucoma with hyphema and Roth's spots.

Relato do Caso

A 65 year old patient with past medical history of diabetes mellitus presented to the ophthalmologic ER with sudden loss of visual acuity and pain in the right eye. He had no spontaneous systemic complaints. When inquired referred asthenia, night sweats and weight loss for the past 8 months. In his ophthalmologic exam he had a visual acuity of counting fingers at 1m in the OD and 20/20 in the OS. Intraocular pressure at presentation was 35 mmHg in OD with hyphema and corneal edema. Fundus examination revealed intraretinal hemorrhages as well as multiple Roth's spots in both eyes. His blood count showed a leukocytosis of 495.248 with a left shift and 4% of abnormal cells. This patient was immediately admitted to the ICU to perform cytoreduction with hydroxyurea and leukapheresis, bcr/abl test in peripheral blood and myelogram, whilst controlling the IOP with acetazolamide, timolol and brimonidine.

The results of the myelogram suggested chronic myeloproliferative neoplasia and the bcr/abl test was positive, thus confirming the diagnosis of chronic myeloid leukemia. After 2 months of follow up and treatment, the patient remained with low visual acuity (hand motion), high IOP (35mmHg) and hyphema in the OD. In this scenario it was programmed to perform cyclophotocoagulation and an anterior chamber washout due to the diagnosis of neovascular glaucoma.

Conclusão

Despite not being usual, myeloproliferative disorders should be among the differential diagnosis not only of retinopathies presenting with hemorrhages and Roth's spots, but also of neovascular glaucoma. The complete ophthalmologic exam as well as early investigation are fundamental to a proper diagnosis, which leads to prompt intervention and, therefore, to a better prognosis. Also, the distinction between a diabetic retinopathy and those caused by leukostasis should be precise as one could mimic the others' fundus findings.