History

A 65 year-old white female presented to an outside institution with sudden onset severe vision loss in the right eye on a Saturday morning. She was thought to have a central retinal artery occlusion and a temporal artery biopsy was performed. The patient has a history or Acute Myelogenous Leukemia (AML) managed at UAMS and she was referred to our service for an evaluation. The patient presented a report of an MRI of the head and orbit performed the day prior to our examination at an outside facility that was read as normal test. The results of the temporal artery biopsy were still pending.

Medical History

Acute Myelogenous Leukemia (AML). Status post chemotherapy 2 weeks ago. The patient was discharged from the hospital one week prior to presentation for neutropenia.

Examination:

• Vision: OD: No light perception, OS: 20/60
• Pupils: 4+ APD
• Intraocular pressures: Normal OU
• Slit lamp examination: Noncontributory
• External Examination
• Dilated Fundus Examination

External Examination

Dilated Fundus Examination

Fluorescein Angiogram

Follow up

An MRI of the brain and orbit was repeated and showed enhancement of right intraconal fat of right orbit along with enhancement of right optic nerve with mild right orbital proptosis. There was lace like enhancement in the subarachnoid space throughout the brain extending subcortical region. Bilateral enhancement at the basal ganglia was also identified. Findings were thought to be suggestive of leptomeningeal spread of AML. A spinal tap was performed and cytology confirmed the spread of AML.

The clinical appearace of the retina was unusual in that it combined the signs of both ischemic and hemorrhagic assult on the retina (pale retinal appreance in addition to diffuse retinal hemorrhages). This indicates simultanous blockage of both retinal vein and artery. Coupled with the cranial nerve dysfunction, an intraorbital compressive lesion was the most likely possibility.

If you have an interesting case you would like to post, please send a case presentation using a similar format (Microsoft office file please) along with any photographs to Retina@uams.edu