title: FLORID NEOVASCULARIZATION OF THE RETINA IN A DIABETIC PATIENT UNDERGOING INDUCTION AND CONSOLIDATION THERAPY FOR ACUTE PROMYELOCYTIC LEUKEMIA.
abstract: OBJECTIVE
  To report on a 39-year-old gentleman with a background of Type 2 diabetes mellitus who was diagnosed with acute promyelocytic leukemia (APL), which was treated by all-trans retinoic acid (ATRA), and subsequently developed bilateral neovascularization of the disk (NVD).
  
  
  METHODS
  Ophthalmic examination and investigation including fundus photography and fluorescein angiography.
  
  
  RESULTS
  Three months after commencement of ATRA therapy, the patient was found to have florid bilateral NVD with adjacent preretinal and intraretinal hemorrhages. Fundus fluorescein angiography was undertaken and NVD was confirmed in both eyes, which was significantly greater than expected for the extent of disease secondary to diabetic retinopathy. As a result of the fluorescein angiography findings, we believe ATRA-mediated upregulation of vascular endothelial growth factor may be the etiology of the NVD. Literature review shows some in vitro studies, which describe ATRA-induced upregulation of vascular endothelial growth factor in ocular tissues. The patient was managed successfully by cessation of ATRA and a single intravitreal injection of bevacizumab in each eye.
  
  
  CONCLUSIONS
  Acute promyelocytic leukemia treated with ATRA may result in upregulation of vascular endothelial growth factor in retinal tissues. Subsequent development of NVD may occur; however, this resolves well by cessation of ATRA and intravitreal injection of bevacizumab. We recommend that all patients undergoing treatment with ATRA for acute promyelocytic leukemia be monitored by an ophthalmologist.
authors.affiliation: Department of Ophthalmology, University Hospital Geelong, Geelong, Australia.
authors.forename: John R
authors.initials: JR
authors.lastname: Rocke
authors.affiliation: Department of Ophthalmology, University Hospital Geelong, Geelong, Australia.
authors.forename: J Ben
authors.initials: JB
authors.lastname: Clark
authors.affiliation: Department of Haematology, University Hospital Geelong, Geelong, Australia.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Campbell
authors.affiliation: Department of Ophthalmology, University Hospital Geelong, Geelong, Australia.
authors.forename: Emil
authors.initials: E
authors.lastname: Kurniawan
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D060830:Consolidation Chemotherapy / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D015861:Retinal Neovascularization / Q000139:chemically induced*; D014212:Tretinoin / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D014212:Tretinoin