First Author: A.Camós Carreras SPAIN
Co Author(s): J. Cardemil M. Gomez A. Ale V. Llorens A. Urbano A. Adan
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The retina and the vitreous can be affected in different haematological diseases and can cause severe loss of visual acuity. A correct diagnosis is the key and in most cases constitutes a challenge for doctors. The purpose of this review is to analyse different vitreoretinal manifestations that present in haematological patients.
Vitreoretinal disease. Hematologic disease. Leukaemia. Lymphoma.
Retrospective case series study. We have reviewed the haematological and ophthalmologic clinical history of 28 patients with different haematological pathologies and who presented symptomatic vitreoretinal pathology. All patients included were submitted to an ophthalmologic examination including funduscopy and different complementary examinations were also done, such as optical coherence tomography (OCT), OCT-Angiography, retinography and wide field retinography.
Fifteen patients (53%) were affected by different forms of lymphoma, ten patients (36%) were affected by leukaemia and three patients (11%) were affected by other haematological pathologies (polycythemia vera, Waldenström's macroglobulinemia and autoimmune hemolytic anaemia). In thirteen patients (46%) vitrectomy surgery was necessary to make the diagnosis or for therapeutic purpose. In the group of patients with lymphoma, vitreitis was the most frequent clinical sign present in all cases. In this group, three patients were diagnosed by ophthalmologic examination, two cases presenting vitreitis and one with a choroidal tumour. Other forms with vitreoretinal manifestations were retinal haemorrhage, retinal infiltration, toxoplasma infections. In the group of patients with leukaemia no patient presented ophthalmic symptoms as the first manifestation of the disease. Six of ten patients presented non-infectious pathologies: two patients presented sub‐inner limiting membrane haemorrhage, two patients serous retinal detachment and one patient infiltration of the retina and vitreous by leukaemia. The four other patients in this group had retinal infections, three of them of herpetic aetiology.
Differential diagnosis of haematological diseases with vitreoretinal involvement should mainly include the pathology derived from haematological disease and the opportunistic germen infection. It is also important to distinguish between manifestation and infiltration of the disease. Clinical history, ophthalmoscopic appearance of the lesions, imaging tests and occasionally vitrectomy are the keys to make a correct diagnosis and treatment. Finally, it is important for ophthalmologists working together with haematologists and pathologists to make a correct diagnosis and adjust the best treatment for these types of patients.