Leukemic Retinopathy in a Patient with Diabetic Retinopathy

This 67 year old woman was referred by her optometrist with the diagnosis of diabetic retinopathy. She did have diabetes mellitus, but the pattern of deep round intraretinal hemorrhages was not consistent with that diagnosis, but rather leukemic retinopathy. Her visual acuity was 20/125 in the right eye. She had concomitant chronic myelogenous leukemia with hemoglobin of 10.2 gms/dL (normal 12-15 gms/dL) and platelet count of 208K/microliter (normal 150-400K). This appearance was not consistent with diabetic retinopathy. The hemorrhages of diabetic retinopathy are more often superficial in the retina instead of uniformly deep and round. There are more often splinter and flame hemorrhages in diabetic retinopathy with more microaneurysms relative to hemorrhages. It is difficult to determine in many cases if it the anemia, the thrombocytopenia, or the abnormal leukemic cells that are most responsible for the retinopathy.