A Case of Chronic Myelogenous Leukemia Involving Retina and Optic Nerve.

Kim, Jae Woong; Baek, Chul Min; Kim, Kwang Soo

Case Report

Journal of the Korean Ophthalmological Society 2003;44(11):2687-2693.
Published online November 1, 2003.

A Case of Chronic Myelogenous Leukemia Involving Retina and Optic Nerve.

Jae Woong Kim, Chul Min Baek, Kwang Soo Kim

Department of Ophthalmology, Keimyung University School of Medicine, Korea. kimks@dsmc.or.kr

망막과 시신경을 침범한 만성골수성 백혈병 1예

김재웅 ( Kim Jae Ung ) , 백철민 ( Baeg Cheol Min ) , 김광수 ( Kim Gwang Su )

Abstract

PURPOSE
We report a case of chronic myelogenous leukemia(CML) involving the retina and optic nerve, in which visual acuity had been improved after radiation therapy combined with steroid pulse therapy. METHODS: In a 44-year-old CML patient with central nervous system involvement who presented with retinal infiltration, initial uncorrected visual acuity was 1.0 in the right eye, 0.9 in the left eye. The patient was given 1% prednisolone acetate eye drops 4 times a day and 40mg of oral prednisolone a day. One month later, papilledema and exudative retinal detachment was developed in the left eye and we raised oral prednisolone dosage to 90mg a day. In spite of those kinds of treatment, papilledema in left eye and retinal infiltration in both eyes were much more aggravated at two months. So we used high-dose steroid(solumedrol 125mg qid) parenterally for initial 3 days followed by tapered oral dosage(prednisolone 60mg/day for 11 days, tapered with 10mg/day and maintain with 10mg/day) and performed simultaneously radiation therapy (total 2340 rads, 13 times) on both eyes through 2 weeks. RESULTS: Uncorrected visual acuity was decreased to 0.3 in the left eye at one month and to 0.6 in the right eye and 0.08 in the left eye at two months, and improved to 1.0 in the right eye and 0.5 in the left eye. Gradual resolution was noted in retinal and optic disc abnormalities at one month after high-dose steroid therapy combined with radiation therapy. CONCLUSIONS: This case suggests that visual acuity in CML patient with the retinal and optic nerve involvement can be improved by using radiation therapy combined with steroid pulse therapy.

Key Words: Chronic myelogenous leukemia;Papilledema;Radiation therapy;Retinal infiltration;Steroid pulse therapy