合并慢性粒细胞白血病的增生型糖尿病视网膜病变患者五例

目的:观察5例合并慢性粒细胞白血病（CML）的增生型糖尿病视网膜病变（PDR）患者的临床特征及治疗预后。方法:回顾性研究。2011年5月至2020年12月在复旦大学附属眼耳鼻喉科医院住院治疗的合并CML的PDR患者5例10只眼纳入研究。收集患者的年龄、性别、糖尿病病史及CML病史等基本信息。检测其内分泌、血液学指标以评...

Clinical observations of proliferative diabetic retinopathy with chronic myeloid leukemia of five cases

Objective To observe and analyze the clinical features and prognosis of proliferative diabetic retinopathy(PDR)with chronic myeloid leukemia.Methods A retrospective case series study.From May 2011 to December 2020,5 patients(10 eyes)were included in this study in Eye-ENT Hospital of Fudan University.Basic information about the patient's age,gender,diabetes history and CML history were collected.The endocrine and hematological indexes of all patients were evaluated.All the patients were undertaken visual acuity,intraocular pressure,slit lamp and fundus examination and other examinations to observe the eye conditions.Ophthalmic treatments included panretinal laser photocoagulation,intravitreal injection of antivascular endothelial growth factor,vitrectomy.During the follow up period from 5 months to 6 years,prognosis was observed at each office visit.During the follow up period,patients'vision,intraocular pressure,anterior segment and retinal status were observed.Results There were 4 males and a female in 5 patients.The ages were from 27 to 49 years,with the mean age of 39 years.All patients were bilateral.All patients suffered type 2 diabetes for 3 months to 13 years.Four of them were diagnosed as chronic myeloid leukemia before visiting to ophthalmologists,while the other visited to ophthalmology first due to poor vision.The initial visual acuity ranged from light perception to 0.4 and 6 eyes were less than 0.1.In addition to the typical manifestations of diabetic retinopathy,such as venous tortuous dilation,exudation,microaneurysm and neovascularization,patients also presented with Roth spot as leukemic fundus manifestations.All eyes developed to PDR stage.Abnormal thickening of the neovascular membranes may occur in the lower part of the retina,with secondary traction retinal detachment.All the eyes were treated with pan retinal photocoagulation and 9 eyes underwent pars plana vitrectomy.After treatment,retina of 8 eyes kept flat.The best corrected visual acuity ranged from no light perception to 1.0,and only 4 eyes reached more than 0.2.Unfortunately,one eye lost vision because of secondary neovascular glaucoma.Conclusions PDR patients with CML of fundus not only have venous tortuous dilation,exudation,microaneurysm and neovascularization,also present with Roth spot as leukemic fundus manifestations.Diabetic retinopathy combined with CML could progress rapidly,and its aggravating complications such as hyperplastic membrane,vitreous hemorrhage and traction retinal detachment may result in poor visual prognosis.Early screening and treatment can help improve the prognosis of patients.