title: Enhanced depth imaging optical coherence tomography of precursor cell leukemic choroidopathy before and after chemotherapy.
abstract: Serous retinal detachment (SRD) can be the initial manifestation of leukemia. Herein, we explore the retinal and choroidal features on enhanced depth imaging optical coherence tomography (EDI-OCT) of SRD in a patient with undiagnosed leukemia. A 23-year-old male developed blurred visual acuity of 20/200 in the right eye oculus dexter (OD) and 20/200 in the left eye oculus sinister (OS). Funduscopically, he manifested serous macular detachment in both eyes oculi uterque (OU) without hemorrhagic retinal abnormalities. EDI-OCT disclosed macular detachment OU and homogeneous, marked choroidal opacification with thickening to 724 μm OD and estimated >600 μm OS and with loss of choroidal detail OU. Peripheral blood smears revealed severe thrombocytopenia and normal leukocyte count. Peripheral cytochemisty, immunophenotyping, and bone marrow aspirate confirmed the presence of atypical lymphoblasts, fulfilling criteria for precursor cell leukemia. Following systemic chemotherapy, the visual acuity improved to 20/25 OD and 20/20 OS. On EDI-OCT, the choroidal thickening resolved to 431 um OD and 443 um OS, leaving a normal choroidal appearance. Massive choroidal infiltration with leukemic cells could be the cause of serous macular detachment found in patients with newly diagnosed leukemia.
authors.affiliation: Retina Service, Wills Eye Hospital, Philadelphia, PA 19107, USA.
authors.forename: Murtaza K
authors.initials: MK
authors.lastname: Adam
authors.affiliation: Retina Service, Wills Eye Hospital, Philadelphia, PA 19107, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Pitcher
authors.affiliation: Oncology Service, Wills Eye Hospital, Philadelphia, PA 19107, USA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.affiliation: Retina Service, Wills Eye Hospital, Philadelphia, PA 19107, USA.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Maguire
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002830:Choroid Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D003561:Cytarabine / Q000008:administration & dosage; D005451:Fluorescein Angiography; D006801:Humans; D016130:Immunophenotyping; D007262:Infusions, Intravenous; D007278:Injections, Spinal; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy; D012163:Retinal Detachment / Q000175:diagnosis; D058471:Subretinal Fluid; D043823:Taxoids / Q000008:administration & dosage; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D043823:Taxoids; D003561:Cytarabine; D008727:Methotrexate
keywords: Acute Lymphoblastic Leukemia; Choroid Infiltration; Leukemia; Retina Detachment; Subretinal Fluid