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

Ju Yeon Lee; Do Hoon Lim; Chul Won Jung; Sang Jin Kim

doi:10.3341/jkos.2015.56.1.134

Journal List > J Korean Ophthalmol Soc > v.56(1) > 1010075

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Lee, Lim, Jung, and Kim: Radiation Therapy for Central Retinal Vein Occlusion with Macular Edema in Acute Lymphocytic Leukemia

Original Article

J Korean Ophthalmol Soc 2015;56(1):134-137.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.1.134

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

Ju Yeon Lee, MD¹, Do Hoon Lim, MD, PhD², Chul Won Jung, MD, PhD³, Sang Jin Kim, MD, PhD^1,

¹Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

²Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

³Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Sang Jin Kim, MD, PhD, Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea, Tel: 82-2-3410-6775, Fax: 82-2-3410-0074 E-mail: sangjinkim@skku.edu

Received 27 June 201429 August 2014 Accepted 20 December 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 hemor-rhage, 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 in-filtration, 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.

Keywords: Acute lymphocytic leukemia, Central retinal vein occlusion, Radiation therapy

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Figure 1.

21-year-old female patient presented with acute visual loss of left eye. Best corrected visual acuity in the left eye was 0.3. (A) Fundus photo showed a few hemorrhagic spots in the right eye and flame-shaped retinal hemorrhage, dilated and tortuous retinal vessels, retinal infiltrative lesion in the left eye. (B) Central macular thickness was over 1000 μ m measured by optical coherence tomography (OCT). (C) Three days after ocular external beam radiation therapy (EBRT), prompt resolution of macular edema was observed on OCT. (E) One month after EBRT, nearly complete resolution of macular edema was observed on OCT. (F) At the last visit (one year after EBRT), macular edema was totally resolved except photoreceptor inner and outer segment defect. (D) At the last visit, fundus photo showed disappearance of retinal hemorrhage and retinal infiltrative lesion.

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