Unrecognized chronic myeloid leukemia manifesting as hemorrhagic complications in proliferative diabetic retinopathy: A case report

Abstract

Purpose

To report a case of proliferative diabetic retinopathy (DR) complicated by concomitant undiagnosed chronic myeloid leukemia (CML).

Methods

A known diabetic presented with minimal vitreous hemorrhage in left eye, along with Roth's spots and retinal hemorrhages in both eyes. Fundus fluorescein angiography revealed Proliferative DR with mid peripheral capillary non perfusion and neovascularization. Panretinal photocoagulation was performed, but the patient subsequently developed a vitreous hemorrhage in both eyes, necessitating bilateral vitrectomy. Post operatively both eyes had unexpected massive sub-conjunctival and recurrent vitreous hemorrhage.

Results

Repeat surgery with vitreous lavage and silicon oil injection stabilized the ocular condition. Initial hematological evaluation at baseline had elevated blood sugar levels with normal cell counts. However, six months later, repeat testing revealed leukocytosis, prompting further investigation and a subsequent diagnosis of CML. After treatment for CML silicone oil was removed with a final visual acuity of 20/40 in both eyes.

Conclusion

This case reveals the intricate interplay between CML and DR. Subtle ocular findings, including Roth spots, mid-peripheral capillary non-perfusion areas with mid peripheral neovascularization can indicate coexistent CML. Diagnosis of CML may be obscured by normal blood counts, and an interdisciplinary collaboration is required in managing complex cases.