A Case of Chronic Myelogenous Leukemia Involving Retina and Optic Nerve

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.