Título / Title

BILATERAL CENTRAL RETINAL VEIN OCCLUSION IN A YOUNG ADULT DIAGNOSED WITH CHRONIC MYELOID LEUKEMIA: CASE REPORT

Introdução / Purpose

To report a case of Bilateral Central Retinal Vein Occlusion due to hiperviscosity syndrome in a previous hygid as a manifestation of chronic myeloid leukemia.

Material e Método / Methods

Patient’s medical record review.

Resultados / Results

ERL, 35 y/o, presented at HCFMRP complainnig of blured vision, painful legs and petechias. She reported nausea and vomiting for the past 6 months and weight loss of 30 kg during this period. She also reported of decreased appetite , aphthae on the oral mucosa and significant splenomegaly. The patient’s ocular examination was notable for visual acuity of 20/200 in the right eye and 20/50 in the left eye.
Her fundus examination demonstrated bilateral diffuse intraretinal hemorrhages in all quadrants, white-centered retinal hemorrhage and dilated and tortuous retinal vessels with hyperemic disc, concerning for bilateral central retinal vein occlusion
Laboratory testing disclosed numerous chemical and serologic abnormalities with concerning findings for hyperviscosity syndrome secondary to leukocytosis. Fluorescein angiography showed hypofluoresce areas, hyperfluorescence of the optic disc, perivascular hyperfluorescence, peripheric areas of non perfusion. The patient was diagnosed with bilateral CRVO and leukemic retinopathy due to Hyperviscosity Syndrome . Hydroxyurea 1.5g was prescribed every 8 hours and it was also performed three leukocytoapheresis sessions by the hematology team. She returned after 4 months with visual acuity 20/40 in both eyes.

Discussão e Conclusões / Conclusion

Hyperviscosity syndrome can cause serous retinal conditions which, if left untreated, can lead to serious visual damage. Therefore, it is important to recognize this syndrome so that these changes do not become irreversible. This syndrome is most commonly associated with Waldenstrom's macroglobulinemia, hyperhomocysteinemia, multiple myeloma, acute myeloid leukemia. Symptoms occur when the number of cells and/or elements in the blood that are increased prevents normal blood flow, causing venous flow stasis.

Palavras Chave

Bilateral central retinal vein occlusion
Hiperviscosity Syndrome
Chronicle Myeloid Leukemia
Saussage vessels

Area

CLINICAL RETINA