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Simultaneous bilateral central retinal vein occlusion associated with anticardiolipin antibodies in leukemia
N A Al-Abdulla1, J T Thompson, S E LaBorwit
1Krieger Eye Institute, Sinai Hospital, Baltimore, Maryland, USA.
Insights
This case report details a patient with leukemia who developed simultaneous bilateral central retinal vein occlusion. Increased anticardiolipin antibodies, not hyperviscosity, were implicated in this rare ocular complication.
Area of Science:
- Ophthalmology
- Hematology
- Immunology
Background:
- Central retinal vein occlusion (CRVO) is a significant cause of vision loss.
- Leukemia is a known risk factor for vascular occlusive events, including CRVO.
- Anticardiolipin antibodies are associated with hypercoagulable states and thrombosis.
Observation:
- A 65-year-old male with chronic myelogenous leukemia presented with sudden vision loss.
- He developed simultaneous bilateral nonischemic and subsequently nonperfused central retinal vein occlusion.
- Neovascular glaucoma developed in the left eye, despite normal white blood cell and platelet counts and low serum viscosity.
Findings:
- The patient exhibited elevated anticardiolipin antibodies.
- This case demonstrates a rare instance of simultaneous bilateral CRVO in a leukemic patient.
- The findings suggest anticardiolipin antibodies play a role in CRVO pathogenesis in leukemia, independent of hyperviscosity.
Implications:
- This case highlights a potential autoimmune mechanism contributing to CRVO in leukemia.
- Ophthalmologists and hematologists should consider screening for anticardiolipin antibodies in leukemic patients with CRVO.
- Further research is warranted to elucidate the precise mechanisms linking leukemia, anticardiolipin antibodies, and retinal vascular events.
Purpose:
To present a dramatic case of simultaneous bilateral central retinal vein occlusion associated with leukemia and anticardiolipin autoantibodies.
Methods:
Interventional case report. Clinical examination, fluorescein angiography, B-mode ultrasonography, and laboratory serologies were performed on a 65-year-old man with chronic myelogenous leukemia who presented with sudden onset of decreased vision in his right eye.
Results:
Fundus examination disclosed a nonischemic central retinal vein occlusion. Over the next 3 weeks, a nonperfused central retinal vein occlusion developed in both eyes and subsequent neovascular glaucoma developed in his left eye. Throughout this time, his white blood cell and platelet counts remained normal and his serum viscosity remained low, but anticardiolipin antibodies were increased.
Conclusion:
This case reveals the occurrence of simultaneous bilateral central retinal vein occlusion associated with anticardiolipin antibodies in leukemia and suggests an additional mechanism other than hyperviscosity for bilateral central retinal vein occlusions in leukemic patients.