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Combined central retinal artery and vein occlusions as the presenting signs of ocular relapse in acute lymphoblastic leukaemia

A 45-year-old female was diagnosed as having acute lymphoblastic leukaemia with central nervous system involvement in March 1999. She was in complete remission after second induction course of chemotherapy with intrathecal methotrexate and cytarabine when, in July 1999, she developed a painful left eye with loss of vision. The vision was 6/6 in her right eye and finger count in her left. Ophthalmoscopy of the right eye (left image) was unremarkable whereas that of the left eye (right image) showed optic disc swelling, engorged retinal veins, multiple superficial flame shape retinal haemorrhages, and macular oedema with a cherry red spot. An ocular relapse with leukaemic optic disc infiltration and secondary combined central retinal artery and central retinal vein occlusions were suspected, although other causes, such as opportunistic infection, had to be excluded. Bone marrow cytology confirmed the medullary relapse. Salvage with another course of chemotherapy was initiated. The vision in her left eye continued to drop, and by 1 week she had no light perception. Combined arterial and venous occlusion is a rare condition and should lead physicians to search for an underlying inflammatory, infiltrative, or vascular disease.