Dense perivenular clustering of microaneurysms: A pointer of leukemic retinopathy?

A boy in his late teens with a history of low-grade fever evaluated for a hematological malignancy was screened for ocular involvement. The fundus examination revealed a hyperemic disc with engorged tortuous retinal veins, pseudo sheathing of the peripheral retinal vasculature with surrounding retinal hemorrhages, and retinal infiltrates suggestive of leukemic retinopathy. Wide-field fundus fluorescein angiography showed areas of capillary non-perfusion along with characteristic dense segregation of multiple perivenular microaneurysms with sparing of the arterioles. The patient was diagnosed with chronic myeloid leukemia and treated with imatinib mesylate. No active ophthalmic treatment was carried out because there was no evidence of treatable retinal complications such as macular edema or retinal neovascularization. Clearance of leukemic infiltrates, along with complete regression of the microaneurysms, were observed 6 weeks after the treatment.