Sir,

I read with interest the comprehensive article by Sharma et al.1 reviewing the ophthalmologist's role in the ophthalmic manifestations of acute leukaemia. I would like to report a case of chronic myeloid leukaemia that presented to a DGH eye casualty.

Case report

A 29-year-old man presented with sudden onset diminution of vision in his left eye. He had glandular fever infection 10 years ago. Visual acuity was normal in right eye but restricted to 6/18, N10 in the left eye. Fundus examination revealed bilateral venous stasis retinopathy with scattered roth spots, the left eye being more severely affected than the right. The left eye also revealed macular haemorrhages (Figure 1).

Figure 1
figure 1

Fundus photograph of left eye showing venous stasis retinopathy, roth spots and macular haemorrhages.

Full size image

On further history taking, he agreed to easy bruising, decreased appetite, and night sweats. General examination revealed gross hepatospleenomegaly in addition to multiple bruises of different ages on his body. Urgent blood test revealed marked leukocytosis with blood film consistent of Philadelphia-positive chronic myeloid leukaemia.

He was urgently referred to haematology where he received leukophoresis and cell and sperm storage. Oral hydroxyurea, allopurinol, and later imatinib-achieved cytoreduction and remission. His general and ophthalmic condition improved with resolution of macular haemorrhages and roth spots.

I feel this case highlights the high index of suspicion of leukaemia necessary when a patient presents with roth spots or venous stasis retinopathy. As ophthalmologists, we play a pivotal role as prompt diagnosis and treatment can benefit patients with both acute and chronic leukaemia.