Central retinal vein occlusion as first manifestation of relapse in acute lymphoblastic leukemia

Retinal vein occlusion is the second most common cause of visual loss due to retinal vascular disease after diabetic retinopathy.1 Among the risk factors described, it is well known that the hypercoagulable state present in neoplasias can culminate in vein occlusion. It is described that any ocular structure may be involved in acute leukemia2; involvement of the choroid and retina is the most common. However, leukemic cells can infiltrate the conjunctiva and lacrimal glands, producing obvious masses. Karesh et al. published a two year prospective study of newly diagnosed adults with acute myeloid leukemia; 64% of patients had retinal or optic nerve abnormalities where hemorrhages and cotton wool spots (a consequence of nerve fiber ischemia) were the most frequent findings.3 The association between central retinal vein occlusion and acute lymphoblastic leukemia (ALL) relapse has rarely been described though.4–6 We hereby report