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Background
Leukaemia is known to have varied ocular features, and may at times be associated with visual loss. Commonly, these features are observed in the posterior segment as a resultant of direct cellular invasion, immune suppression, non-perfusion, bleeding or toxicity of chemotherapy. 1 However, anterior chamber (AC) exudation with hypopyon is a less frequent manifestation of the disease, typically seen in relapsing cases of acute leukaemia, though it has been rarely described in chronic myeloid leukaemia (CML) as well. 2-13 We discuss two such cases with posterior segment manifestations, complicated by a sudden occurrence of exudates in the AC appearing like a hypopyon, consequently diagnosed as CML.
Case presentation
Case 1
An 18-year-old young, healthy-looking man presented with sudden and painless loss of vision in the left eye since 2 weeks. There was no history of systemic illness. He was earlier diagnosed with Eales' retinal vasculitis elsewhere and had been worked up extensively for associations like tuberculosis, sarcoidosis and viral infections, all of which were found to be negative. There was no abnormality detected on physical examination. Best corrected visual acuity (BCVA) was 6/6 in the right eye (OD) and 6/60 in the left eye (OS). The anterior segment of either eye was unremarkable while intraocular pressures (IOPs) were within normal limits. The fundus examination of either eye showed clear media with a normal optic disc, 360° perivascular cuffing and exudation (vein >artery; OS>OD)( figure 1 ). Multiple pre-retinal bleeds with few pale centred haemorrhages suggestive of Roth spots and macular oedema were also noted (figure 1 ). Fundus fluorescein angiography revealed normal macular perfusion with blocked fluorescence corresponding to the haemorrhages along with paravascular leakage.
Considering the common differential diagnosis of Roth spots, a complete hemogram with peripheral blood smear, antinuclear antobody and echocardiogram was ordered. To our surprise, the patient came back the next day with complete loss of vision in the left eye. On examination, total hyphaema along with streaks of white exudative material over it were noted ( figure 2 ). The exudates appeared like a hypopyon (1.5 mm) superior to the blood level. On examination, OD was the same as before. The IOP was 20 mm Hg in OS. Sonography of OS revealed an anechoic vitreous cavity.
Case 2
A...