FLORID NEOVASCULARIZATION OF THE RETINA IN A DIABETIC PATIENT UNDERGOING INDUCTION AND CONSOLIDATION THERAPY FOR ACUTE PROMYELOCYTIC LEUKEMIA.

PURPOSE: To report on a 39-year-old gentleman with a background of Type 2 diabetes mellitus who was diagnosed with acute promyelocytic leukemia (APL), which was treated by all-trans retinoic acid (ATRA), and subsequently developed bilateral neovascularization of the disk (NVD). METHODS: Ophthalmic examination and investigation including fundus photography and fluorescein angiography. RESULTS: Three months after commencement of ATRA therapy, the patient was found to have florid bilateral NVD with adjacent preretinal and intraretinal hemorrhages. Fundus fluorescein angiography was undertaken and NVD was confirmed in both eyes, which was significantly greater than expected for the extent of disease secondary to diabetic retinopathy. As a result of the fluorescein angiography findings, we believe ATRA-mediated upregulation of vascular endothelial growth factor may be the etiology of the NVD. Literature review shows some in vitro studies, which describe ATRA-induced upregulation of vascular endothelial growth factor in ocular tissues. The patient was managed successfully by cessation of ATRA and a single intravitreal injection of bevacizumab in each eye. CONCLUSION: Acute promyelocytic leukemia treated with ATRA may result in upregulation of vascular endothelial growth factor in retinal tissues. Subsequent development of NVD may occur; however, this resolves well by cessation of ATRA and intravitreal injection of bevacizumab. We recommend that all patients undergoing treatment with ATRA for acute promyelocytic leukemia be monitored by an ophthalmologist.

Vitreous cavity haemorrhage post-vitrectomy for diabetic eye disease: the effect of perioperative anticoagulation and antiplatelet agents.

BACKGROUND: To evaluate the effect of perioperative anticoagulation and antiplatelet therapy on postoperative vitreous cavity haemorrhage following pars plana vitrectomy for diabetic eye disease. DESIGN: Retrospective chart review. PARTICIPANTS: 139 patients. METHODS: Retrospective collection of demographic, medical, surgical and postoperative data of all patients undergoing vitrectomy for diabetic eye disease at The Royal Victorian Eye and Ear Hospital. MAIN OUTCOME MEASURE: Correlation of the rates of persistent vitreous cavity haemorrhage and anticoagulation or antiplatelet treatment. RESULTS: Sixty-eight of 155 (43.9%) eyes of 139 patients were on anticoagulation or antiplatelet therapy prior to surgery. At the time of surgery, 29 (42.6%) were on therapy. Eight of 29 (27.6%) patients had significant persistent vitreous cavity haemorrhage in the postoperative period, with four (13.8%) requiring secondary surgery. Thirty-nine (57.4%) patients had discontinued therapy prior to surgery. Among these, four (10.3%) had persistent bleeding, of which three (7.7%) required additional surgery. Six of 87 (6.9%) patients not on any anticoagulation/antiplatelet therapy had persistent postoperative vitreous cavity haemorrhage, with none requiring further surgery. Patients on anticoagulation/antiplatelet therapy at the time of surgery were more likely to experience persistent haemorrhage and subsequent reoperation (OR = 4.8, P = 0.0045 and OR = 6.6, P = 0.024, respectively). CONCLUSION: Perioperative continuation of anticoagulation or antiplatelet treatment appears to increase the risk of persistent postoperative vitreous cavity haemorrhage and the necessity for vitreous cavity washout in this diabetic cohort. Appropriate preoperative cessation of treatment appeared to reduce this risk; however, caution must be taken with regard to the systemic risk associated with cessation of therapy.

Congenital simple hamartoma of the retinal pigment epithelium with a full-thickness macular hole.

BACKGROUND: Congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a rare tumor that, to our knowledge, has not been previously reported as being associated with a full-thickness macular hole. METHODS: We report a case of a CSHRPE associated with a full-thickness macular hole. Findings of funduscopy and optical coherence tomography are described. RESULTS: A 10-year-old boy presented with visual acuity of 20/80 in the right eye. Funduscopy revealed a juxtafoveal pedunculated, well-circumscribed, darkly pigmented lesion measuring one third of a disk diameter. There was an associated full-thickness macular hole that separated the main dark mass nasally from a linear pigmented lesion. Optical coherence tomography showed a mass with optical shadowing and confirmed the presence of a full-thickness macular hole surrounded by intraretinal cystic edema. No evidence of a posterior vitreous detachment or significant epiretinal membrane was seen. CONCLUSION: We observed a full-thickness macular hole with a CSHRPE in a 10-year-old boy. The CSHRPE may have induced tangential traction along the posterior hyaloid or abnormal anteroposterior traction with foveal dehiscence. It is possible that exudation from the lesion into the vitreous cavity may result in vitreous changes with premature liquefaction and degenerative alterations that may induce abnormal vitreous adhesion and traction. Optical coherence tomography did not show evidence of such changes.