Hyperviscosity retinopathy from chronic myelogenous leukemia

A 23-year-old male with chronic myelogenous leukemia presented with blurry vision and headaches. A montage colour photograph of the right eye demonstrated optic disc edema with a flame hemorrhage superiorly (Fig. A). There was diffuse vascular tortuosity. Retinal hemorrhage and exudates were present in the macula and peripheral retina. The venous phase of a fluorescein angiograph (Fig. B, left) and an indocyanine green angiograph (Fig. B, right) demonstrated dilated and tortuous retinal vasculature, microaneurysms, and hypofluorescence most notable temporally, consistent with non-perfusion. Macula optical coherence tomography demonstrated intraretinal hyperreflective material in both inner and outer retinal layers (Fig. C). There were similar findings in the left eye. The patient was diagnosed with hyperviscosity retinopathy and underwent emergent leukapheresis resulting in improvement in symptoms and examination findings.