J Korean Ophthalmol Soc.  2008 Mar;49(3):514-518. 10.3341/jkos.2008.49.3.514.

Bone Marrow Transplantation Retinopathy in a Patient with Acute Lymophocytic Leukemia Following Bone Marrow Transplantation

• Jo YJ
• Wang SJ
• Kim JY

• KMID: 2211328
• DOI: http://doi.org/10.3341/jkos.2008.49.3.514

Abstract

PURPOSE: To report a case in of a patient who developed bone marrow transplantation retinopathy at 18 months after receiving allograft bone marrow transplantation for acute lymphocytic leukemia.
CASE SUMMARY
A 20-year-old male patient complained of a decrease in visual activity in his left eye 18 months after receiving a bone marrow transplantation for acute lymphocytic leukemia. The corrected visual activity was 1.0 for the right eye and 0.6 for the left. On fundus examination, both eyes showed cotton wool patches and dot hemorrhage, and the left eye showed macula edema. On fluorescein angiography, capillary nonperfusion was observed in the superior nasal area of the left eye. Four months after initial examination, the corrected visual activity of the left eye decreased to 0.3 and neovascularization was observed on fundus examination. On fluorescein angiography, capillary nonperfusion, neovascularization, and macular ischemia were observed. Laser photocoagulation was performed twice on the area with neovascularization and capillary nonperfusion. One year later, the corrected visual activity of the left eye recovered to 0.8. However, the area of macular ischemia on fluorescein angiography showed no change, and neovascularization and capillary nonperfusion were observed in new areas, which were treated with two additional laser photocoagulations.

Keyword

Acute lymphocytic leukemia; Bone marrow transplantation retinopathy

MeSH Terms

Bone Marrow
Bone Marrow Transplantation
Capillaries
Edema
Eye
Fluorescein Angiography
Hemorrhage
Humans
Ischemia
Leukemia
Light Coagulation
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Transplantation, Homologous
Wool
Young Adult

Figure

• 

  Figure 1. Fundus photographs and fluorescein angiographs at the initial visit. (A) Fundus photographs show multiple cotton-wool spots and dotlike hemorrhages. (B) Fluorescein angiographs show capillary nonperfusion in both eyes and macular ischemia in the left eye.

• 

  Figure 2. Fundus photographs and fluorescein angiographs at 4 months after the initial visit. (A) Fundus photographs show new vessels. (B) Fluorescein angiographs show increased capillary nonperfusion and leakage from new vessels in both eyes.

• 

  Figure 3. Fundus photographs and fluoresein angiographs at 1 year after the initial visit. (A) Fundus photographs show new vessels in the other areas. (B) Fluoresein angiographs show leakage from new vessels.

Reference

References

1. Jack MK, Hicks JD. Ocular complications in high-dose che-moradiotherapy and marrow transplantation. Ann Ophthalmol. 1981; 13:709–11.

2. Coskuncan NM, Jabs DA, Dunn JP, et al. The eye in bone marrow transplantation. Retinal complications. Arch Ophthalmol. 1994; 112:372–9.

3. Fisher VL. Long-term follow-up in hematopoietic stem cell transplant patient. Pediatr Transplant. 1999; 3:122–9.

4. Franklin RM, Kenyon KR, Tutschka PJ, et al. Ocular manifestations of graft-vs-host disease. Ophthalmology. 1983; 90:4–13.

5. Kim RY, Anderlini P, Naderi AA, et al. Scleritis as the initial clinical manifestation of graft versus host disease after allogenic bone marrow transplantation. Am J Ophthalmol. 2002; 133:843–5.

6. Arocker-Mettinger E, Skorpik F, Grabner G, et al. Mani-festations of graft-versus-host disease following allogenic bone marrow transplantation. Eur J Ophthalmol. 1991; 1:28–32.

7. Anderson NG, Regillo C. Ocular manifestations of graft-host-versus disease. Curr Opin Ophthalmol. 2004; 15:503–7.

8. Avery R, Jabs DA, Wingard JR, et al. Optic disc edema after bone marrow transplantation. Possible role of cyclosporine toxicity. Ophthalmology. 1991; 98:1294–301.

9. Bernauer W, Gratwohl A, Keller A, Daicker B. Microvasculopathy in the ocular fundus after bone marrow transplantation. Ann Intern Med. 1991; 115:925–30.

10. Gloor B, Gratwohl A, Hahn H, et al. Multiple cotton wool spots following bone marrow transplantation for treatment of acute lymphatic leukaemia. Br J Ophthalmol. 1985; 69:320–5.

11. Lopez PF, Sternberg P Jr, Dabbs CK, et al. Bone marrow transplant retinopathy. Am J Ophthalmol. 1991; 112:635–46.

12. Cunningham ET Jr, Irvine AR, Rugo HS. Bone marrow transplantation retinopathy in the absence of radiation therapy. Am J Ophthalmol. 1996; 122:268–70.

13. Johnson DW, Cagnoni PJ, Schossau TM, et al. Optic disc and retinal microvasculopathy after high-dose chemotherapy and autologous hematopoietic progenitor cell support. Bone Marrow Transplant. 1999; 24:785–92.

14. Perrers-Taylor M, Brinkley D, Reynolds T. Choroido-retinal damage as a complication of radiotherapy. Acta Radiol Ther Phys Biol. 1965; 3:431.

15. Nakissa N, Rubin P, Strohl R. Keys H. Ocular and orbital complications following radiation therapy of paranasal sinus malignancies and review of literature. Cancer. 1983; 51:980–6.

16. Vogler WR, Winton EF, Helffner LT, et al. Ophthalmological and other toxicities related to cytosine arabinoside and total body irradiation as preparative regimen for bone marrow transplantation. Bone Marrow Transplant. 1990; 6:405–9.

17. Tiscelli A. Late ocular complications after bone marrow transplantation. Nouv Rev Fr Hematol. 1994; 36:S79–82.

18. Wingard JR, Piantadosi S, Burns WH, et al. Cytomegalovirus infections in bone marrow transplant recipients given intensive cytoreductive therapy. Rev Infect Dis. 1990; 12:793–804.

19. Walton RC, Reed KL. Herpes zoster ophthalmicus following bone marrow transplantation in children. Bone Marrow Transplant. 1999; 23:1317–20.

20. Rao NA, Hidayat A. A comparative clinicopathologic study of endogenous mycotic endophthalmitis: variations in clinical and histopathologic changes in candidiasis compared to aspergillosis. Trans Am Ophthalmol Soc. 2000; 98:183?93.

21. Karashima K, Fujioka S, Harino S. Two cases of central serous chorioretinopathy treated with photocoagulation after bone marrow transplantation. Retina. 2002; 22:651–3.

22. Fawzi AA, Cunningham ET Jr. Central serous chorioretinopathy after bone marrow transplantation. Am J Ophthalmol. 2001; 131:804–5.

23. Cheng LL, Kwok AK, Wat NM, et al. Graft-vs-host-disease-associated conjunctival chemosis and central serous chorioretinopathy after bone marrow transplant. Am J Ophthalmol. 2002; 134:293–5.