Chronic myeloid leukemia (CML), a myeloproliferative neoplasm, can present with ocular manifestations, though such presentations are relatively rare. Leukemic retinopathy, characterized by retinal hemorrhages, cotton wool spots, and vascular changes, is the most frequent ocular manifestation observed in CML patients. Patients with CML may present with leukemic retinal infiltrates and venous stasis secondary to hyperviscosity, which may lead to secondary peripheral microaneurysms and neovascularisation.
We report the case of a 42-year-old woman with poorly controlled diabetes mellitus who presented with a five-month history of painless blurred vision, predominantly in the left eye, accompanied by floaters. Fundus examination revealed bilateral proliferative diabetic retinopathy with atypical features, including frosted branch angiitis appearance and extensive retinal thickening. Given the unusual retinal findings, further systemic evaluation was conducted. Laboratory investigations revealed a markedly elevated white blood cell count of 200 × 10⁹/L and severe anemia. Bone marrow biopsy confirmed CML in the chronic phase. The patient was initiated on appropriate hematological treatment.
This case underscores the importance of considering systemic hematologic disorders like CML in patients presenting with atypical retinal findings, even in the presence of known diabetic retinopathy. Early recognition and treatment are crucial to prevent further ocular and systemic complications.