OCCLUSIVE MICROVASCULAR RETINOPATHY WITH OPTIC DISC AND RETINAL NEOVASCULARIZATION IN ACUTE LYMPHOCYTIC-LEUKEMIA

Background: Acute lymphocytic leukemia can be associated with an occlu sive microvascular retinopathy. There is a potential for worsening of this occlusive microvascular retinopathy by radiation damage to the re tinal vasculature (radiation retinopathy) and by the toxic effects of chemotherapy. Methods: An 18-year-old woman with T-cell acute lymphocy tic leukemia received low-dose irradiation to the brain and subsequent chemotherapy, which included cytosine arabinoside. Results: During th e chemotherapy, she developed severe bilateral occlusive microvascular retinopathy that progressed despite extensive panretinal photocoagula tion to bilateral optic disc and retinal neovascularization and eventu al traction retinal detachment involving the macula. Conclusion: The t oxic effect of a chemotherapeutic agent such as cytosine arabinoside w hen combined with radiation retinopathy may be additive, leading to a much more severe ischemic retinal vasculopathy than one would encounte r with acute lymphocytic leukemia alone. This must be kept in mind whe n planning combined radiation and chemotherapy for T-cell acute lympho cytic leukemia.