Combined Central Retinal Arterial and Venous Occlusions due to Leukemic Infiltration.

PURPOSE: To report combined central arterial and venous occlusions secondary to bilateral leukemic interfascicular optic nerve infiltration in a 56-year-old man. This was the sole presentation of a relapse in T/Myeloid mixed-phenotype acute leukemia after 5 months of remission.

METHODS: Case report with clinical photography.

RESULTS: A 56-year-old man reported to be in complete remission of T/Myeloid mixed-phenotype acute leukemia (MPAL) presented with sudden painless loss of vision in his left eye. Fundoscopy showed unilateral severe optic disc swelling with characteristic findings of a central retinal vein occlusion (CRVO), namely, intra- and preretinal haemorrhages and cotton-wool spots, as well as the features of a central retinal artery occlusion (CRAO) resulting in a pale, edematous retina and a characteristic cherry-red spot. Blood, cerebrospinal fluid evaluation and bone marrow analysis were performed in combination with medical imaging. No evidence of leukemic relapse was found. An optic nerve biopsy was indicated, due to decompensation of the contralateral eye, and ultimately confirmed leukemic infiltration.

DISCUSSION: Regardless of no hematological and non-specific imaging findings, optic nerve biopsy may be crucial for clinical decision making in a patient with acute complete vision loss and a history of leukemia.