BILATERAL CYSTOID MACULAR EDEMA AS THE PRESENTING FEATURE OF CHRONIC MYELOID LEUKEMIA

Ophthalmic disease may rarely be a presenting feature of chronic myeloid leukemia (CML).

The authors report a case of a 53-year-old man with type 1 diabetes mellitus who presented with a rapid onset of bilateral blurred vision.

The patient was noted to have bilateral macular edema and was initially treated for presumed diabetic macular edema with intravitreal aflibercept injections. One month later, there was complete resolution of his macular edema. Review of the patient's history and imaging revealed features atypical for diabetic macular edema, specifically the rapid onset of bilateral blurred vision over 2 to 3 weeks, numerous cotton wool spots within the macula, the absence of any exudates, the symmetrical macular edema with a "vaulted ceiling" appearance (more typical of cystoid macular edema), and the dramatic response to a single intravitreal aflibercept injection. One week after intravitreal injection, the patient was diagnosed with CML following marked leukocytosis on a routine blood test by the patient's general practitioner. Although uncommon, sudden onset bilateral edema in the absence of other chronic diabetic changes should prompt consideration of an underlying hematological cause.

This case highlights the importance of considering CML as a differential diagnosis in patients presenting with sudden onset, bilateral cystoid macular edema. Vigilance is especially important in patients with coexisting diabetic retinopathy because the clinical features of leukemic retinopathy can overlap. Furthermore, the diagnosis of CML in a patient with diabetes mellitus should prompt extra observation for accelerated worsening of diabetic retinopathy.