Leukemia is a clonal hematological malignancy characterized by uncontrolled proliferation of abnormal white blood cells. Chronic Myeloid Leukemia (CML) is associated with the Philadelphia chromosome, resulting in the BCR-ABL fusion gene. Ocular manifestations occur in 9-20% of patients, with leukemic retinopathy being the most common and occasionally the first presenting sign. Early recognition of retinal findings can lead to timely diagnosis and improved outcomes. A 26-year-old male presented with painless diminution of vision in both eyes. The right eye had a gradual visual loss over two months, while the left eye had sudden, painless loss of vision. Visual acuity was 6/36 in the right eye and counting fingers at five meters in the left eye. Anterior segment examination was normal. Fundus examination revealed multiple retinal hemorrhages and Roth spots in all quadrants of both eye. Hematological evaluation showed markedly elevated white blood cells (28,629 ×10 3 /μL) with thrombocytosis. Peripheral blood smear suggested CML. Bone marrow aspiration confirmed CML in the chronic phase. The patient was referred to the Oncology department and initiated on appropriate systemic therapy. Ophthalmic management was conservative with close follow-up. Visual prognosis was explained to the patient, emphasizing the importance of systemic disease control.Leukemic retinopathy may be the initial manifestation of CML. The retina serves as a window for early detection of systemic diseases, highlighting the importance of fundus examination in unexplained visual loss.
Latha et al. (Mon,) studied this question.