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Published on: June 6, 2025
130
OUTER RETINOPATHY AND MICROANGIOPATHY IN ACUTE MYELOGENOUS LEUKEMIA
Charles G Miller1, Alexander J Brucker1, Linda M Perry2
1Department of Ophthalmology, Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; and.
Retinal Cases & Brief Reports
|October 30, 2023
Summary
This case study details a patient with acute myelogenous leukemia experiencing recurrent retinopathy. Treatment with stem cell transplant and immunosuppressants led to partial vision recovery, suggesting an immune-mediated cause.
Area of Science:
- Ophthalmology
- Hematology
- Immunology
Background:
- Acute myelogenous leukemia (AML) can present with ocular complications.
- Peripheral blood stem cell transplantation (PBSCT) is a treatment for AML.
- Graft-versus-host disease (GVHD) can occur after PBSCT and affect various organs, including the eyes.
Observation:
- A 23-year-old woman with AML developed recurrent, bilateral outer retinopathy with paracentral scotomas.
- Ophthalmic imaging revealed photoreceptor outer segment loss and hyperreflective lesions.
- Vision loss in one eye occurred after PBSCT complicated by chronic GVHD.
Findings:
- Spectral domain optical coherence tomography showed localized loss of inner segment ellipsoid (EZ) and photoreceptor outer segment (IZ) signals.
- Multifocal electroretinograms demonstrated depression corresponding to cone dysfunction.
- Treatment with prednisone and rituximab improved visual acuity and retinal sensitivity, restoring EZ/IZ signals but leaving residual photoreceptor loss.
Implications:
- An immune-mediated microangiopathy is proposed as the cause of the recurrent photoreceptor abnormalities in AML patients.
- This mechanism may also explain previously documented outer retinal findings in leukemia.
- Understanding these mechanisms can guide the management of ocular complications in AML and post-transplant patients.
