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Published on: January 25, 2019
Chronic myeloid leukaemia accelerates proliferative retinopathy in patients with co-existent diabetes: A risk factor
Rohan Chawla1, Suneel Kumar1, Devesh Kumawat1
1Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Insights
Patients with diabetes and chronic myeloid leukaemia can experience accelerated proliferative retinopathy. Early detection and aggressive management are crucial for preserving vision in these patients.
Area of Science:
- Ophthalmology
- Hematology
- Diabetology
Background:
- Diabetes mellitus is a common condition associated with various ocular complications, including retinopathy.
- Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm that can affect various organ systems.
- The co-occurrence of diabetes and CML presents unique challenges in managing ocular health.
Purpose of the Study:
- To investigate the retinal imaging characteristics in patients with diabetes and CML.
- To describe the management strategies for retinopathy in this patient cohort.
- To evaluate the visual outcomes associated with diabetes and CML.
Main Methods:
- Retrospective observational study of six patients with diabetes and CML.
- Review of ophthalmic and systemic evaluation, treatment, and follow-up records.
- Analysis of visual acuity, intra-ocular pressure, retinopathy severity, and surgical interventions.
Main Results:
- All studied eyes exhibited marked proliferative retinopathy, often disproportionate to exudation.
- No significant macular edema was observed in any eyes.
- Management included pan-retinal photocoagulation (83.33%), anti-VEGF injections (66.67%), and surgical interventions for advanced cases.
Conclusions:
- Accelerated proliferative retinopathy can manifest early in patients with diabetes and CML.
- Current screening guidelines for retinopathy in diabetic patients with CML may need revision.
- Prompt diagnosis and intensive treatment are vital for visual acuity preservation.
Objective:
To describe the retinal imaging characteristics, retinopathy management strategies and visual outcomes in cases of diabetes with chronic myeloid leukaemia.
Design:
Retrospective observational study.
Participants:
Patients with diabetes and chronic myeloid leukaemia managed at our tertiary eye care centre from January 2015 to December 2017.
Methods:
Detailed ophthalmic and systemic evaluation, treatment and follow-up records were reviewed. The main measures studied were visual acuity, intra-ocular pressure, retinopathy severity, and surgical indications and techniques.
Results:
Of the six patients studied, three had diabetes and chronic myeloid leukaemia at presentation, while in three cases chronic myeloid leukaemia was diagnosed following evaluation for proliferative retinopathy. The visual acuity ranged from 20/20 to perception of light. All eyes had marked proliferative retinopathy out of proportion to the exudation. None of the eyes had significant macular oedema. Pan-retinal photocoagulation (10/12, 83.33%), intravitreal anti-vascular endothelial growth factor injection (8/12, 66.67%), vitrectomy (2/12, 16.67%), cataract surgery (2/12, 16.67%) and trabeculectomy followed by cryoablation (2/12, 16.67%) was performed for management of the ocular disease as indicated. Median follow-up was 16.5 months (range: 6-24 months). Final visual acuity ranged from PL to 20/20 with acuity ⩾ 20/100 in eight eyes. Four eyes had advanced optic neuropathy from neovascular glaucoma.
Conclusion:
Accelerated proliferative retinopathy can be seen in cases of diabetes with chronic myeloid leukaemia at the very initial ophthalmic evaluation. Thus, there is a need to alter screening guidelines for retinopathy in cases of diabetes with chronic myeloid leukaemia. Early detection and aggressive management may help preserve visual acuity in such cases.
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