Reversal of impending central retinal vein occlusion secondary to hyperleukocytosis in chronic myeloid leukemia by leukapheresis: a case report

We report an uncommon case of bilateral impending central retinal vein occlusion (CRVO) in a young girl with newly diagnosed chronic myeloid leukaemia (CML) and its successful reversal with leukapheresis. A young girl presented with vomiting and fever. Examination revealed hepatosplenomegaly and multiple enlarged lymph nodes. Investigations show severe hyperleukocytosis and anaemia. Bone marrow aspirate and trephine biopsy confirmed CML in the chronic phase. She was promptly referred to the ophthalmology team for assessment of vasculopathy. Bilateral fundus showed swollen and hyperaemic optic discs. There were dilated and tortuous retinal venules with perivascular white cell extravasation, scattered intraretinal haemorrhages, and Roth spots at mid-periphery. She received four cycles of leukapheresis and, consequently, her leukocytes reduced dramatically with associated significant improvement in fundus findings. This case highlights uncommon impending CRVO in a young girl and the dramatic improvement in fundus signs following leukapheresis that halted and reversed the progression of impending CRVO.