Visual loss as initial presentation of chronic myelogenous leukemia

A previously healthy 17-year old girl presented with sudden visual loss in both eyes. Visual acuity on the right eye was 0.3 and on the left eye 0.1. Fundoscopic examination showed bilateral optic disc edema, retinal venous tortuousity and dilatation, retinal blot and flame-shaped hemorrhages, Roth spots and on the left eye dark blot preretinal hemorrhage covering the fovea. Laboratory evaluation showed white blood cell count of 455 x 10(9) L. Bone marrow biopsy confirmed the diagnosis of chronic myelogenous leukemia. Chemotherapy was initiated and led to the improvement of visual acuity. Fundus changes had resolved except for the preretinal hemorrhage on left eye which decreased in size. Preretinal hemorrhage in fovea caused maculopathy on the left eye. Three months after admisson visual acuity was 1.0 on the right eye and 0.3 on the left eye. Leukemia should always be included in the differential diagnosis of optic disc edema and retinal hemorrhages.