Radiation Therapy for Central Retinal Vein Occlusion with Macular Edema in Acute Lymphocytic Leukemia

ABSTRACT

PURPOSE: Central retinal vein occlusion (CRVO) as a complication of acute leukemia has rarely been reported. Here, we report a favorable outcome of radiation therapy for CRVO with severe macular edema in a patient with acute lymphocytic leukemia (ALL). CASE SUMMARY: A 21-year-old female presented with acute visual loss in the left eye and headache. Best-corrected visual acuity in the left eye was 0.3. Fundus examination showed some hemorrhagic spots in the right eye and flame-shaped retinal hemorrhage, tortuous retinal vessels, and a retinal infiltrative lesion in the left eye. Fluorescein angiography revealed CRVO in the left eye and severe central macular edema was observed by optical coherence tomography. Hematologic study revealed ALL. Even after leukapheresis and commencement of systemic chemotherapy, fundus findings showed no remarkable change. She was given low dose (400 cGy) ocular external beam radiation therapy (EBRT). Three days after EBRT, macular edema, fundus infiltration, and visual acuity improved dramatically. Visual acuity improved to 0.4 and to 0.8 at 1 month and 1 year after EBRT respectively. CONCLUSIONS: Early start of EBRT after diagnosis could lead to good visual prognosis. EBRT showed rapid resolution of macular edema associated with CRVO in a patient with ALL. Low dose EBRT may be considered as a suitable treatment option for CRVO associated with leukemia.