J Korean Ophthalmol Soc.  2015 Jan;56(1):134-137. 10.3341/jkos.2015.56.1.134.

Radiation Therapy for Central Retinal Vein Occlusion with Macular Edema in Acute Lymphocytic Leukemia

• Lee JY
• Lim DH
• Jung CW
• Kim SJ

• KMID: 2216167
• DOI: http://doi.org/10.3341/jkos.2015.56.1.134

Abstract

PURPOSE
Central retinal vein occlusion (CRVO) as a complication of acute leukemia has rarely been reported. Here, we report a favorable outcome of radiation therapy for CRVO with severe macular edema in a patient with acute lymphocytic leukemia (ALL).
CASE SUMMARY
A 21-year-old female presented with acute visual loss in the left eye and headache. Best-corrected visual acuity in the left eye was 0.3. Fundus examination showed some hemorrhagic spots in the right eye and flame-shaped retinal hemorrhage, tortuous retinal vessels, and a retinal infiltrative lesion in the left eye. Fluorescein angiography revealed CRVO in the left eye and severe central macular edema was observed by optical coherence tomography. Hematologic study revealed ALL. Even after leukapheresis and commencement of systemic chemotherapy, fundus findings showed no remarkable change. She was given low dose (400 cGy) ocular external beam radiation therapy (EBRT). Three days after EBRT, macular edema, fundus infiltration, and visual acuity improved dramatically. Visual acuity improved to 0.4 and to 0.8 at 1 month and 1 year after EBRT respectively.
CONCLUSIONS
Early start of EBRT after diagnosis could lead to good visual prognosis. EBRT showed rapid resolution of macular edema associated with CRVO in a patient with ALL. Low dose EBRT may be considered as a suitable treatment option for CRVO associated with leukemia.

Keyword

Acute lymphocytic leukemia; Central retinal vein occlusion; Radiation therapy

MeSH Terms

Diagnosis
Drug Therapy
Female
Fluorescein Angiography
Headache
Humans
Leukapheresis
Leukemia
Macular Edema*
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
Prognosis
Retinal Hemorrhage
Retinal Vein*
Retinal Vessels
Retinaldehyde
Tomography, Optical Coherence
Visual Acuity
Young Adult
Retinaldehyde

Figure

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  Figure 1. 21-year-old female patient presented with acute visual loss of left eye. Best corrected visual acuity in the left eye was 0.3. (A) Fundus photo showed a few hemorrhagic spots in the right eye and flame-shaped retinal hemorrhage, dilated and tortuous retinal vessels, retinal infiltrative lesion in the left eye. (B) Central macular thickness was over 1000 μ m measured by optical coherence tomography (OCT). (C) Three days after ocular external beam radiation therapy (EBRT), prompt resolution of macular edema was observed on OCT. (E) One month after EBRT, nearly complete resolution of macular edema was observed on OCT. (F) At the last visit (one year after EBRT), macular edema was totally resolved except photoreceptor inner and outer segment defect. (D) At the last visit, fundus photo showed disappearance of retinal hemorrhage and retinal infiltrative lesion.

Reference

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