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Andre Gomes and Luisa Racanelli
This 10YO male has a 1-year history of acute lymphoblastic leukemia with ongoing palliative treatment. He noticed decreased vision bilaterally for 3 months before presenting with light perception OU.
Fundus photography shows a bilateral cherry-red spot, pale nerves, peripapillary and peripheral retinal hemorrhages, and a white retinal arterial vascular tree.
Learning Points:
Ocular leukemic manifestations primarily result from accompanying hematologic abnormalities, including hyperviscosity, anemia, and thrombocytopenia (Soman et al, Ophthalmology Retina 2018;2:17-23). Posterior segment findings include retinal hemorrhages (sub-ILM, nerve fiber layer, or deeper, white-centered), cotton-wool spots, dilated retinal veins, and serous retinal detachment. Leukemic infiltration of the optic nerve, retina, and choroid can also occur.
Our patient’s fundus findings are most consistent with combined central retinal artery (CRAO) and central retinal vein (CRVO) occlusions. Leukemia is a well-documented though uncommon cause of CRVO (Chen et al, Retina 2026;46:796-810), and combined CRAO-CRVO is thankfully even less common (Kim et al, Graefes Arch Clin Exp Ophthalmol 2023;261:1893–1900).
We recommended bilateral panretinal photocoagulation. Unfortunately, he was immediately lost to follow-up.
Retina. 2026 Sep 1;46(9):1570-1577. doi: 10.1097/IAE.0000000000004875.
ICSC: Thin-choroid (250 microns or less) distinct phenotype with older age and females; CNV more frequent in this group — Retrospective, 355 eyes, MICRoN Study Group
Purpose: While central serous chorioretinopathy is typically associated with pachychoroid, a subset of patients presents with thin choroids. This study aims to compare the clinical features of central serous chorioretinopathy in thin versus thick choroid eyes.
Methods: In this retrospective multicenter study, patients were categorized by subfoveal choroidal thickness into thin (≤250 µ m) and thick (≥400 µ m) groups. Multimodal imaging was used to analyze central macular thickness, subfoveal choroidal thickness, neurosensory detachment height, Haller vessel thickness, and inner choroidal thickness at baseline and final visit.
Results: Among 355 eyes, 52 (14.6%) had thin and 303 (85.4%) had thick choroids. Patients with thin choroids were older ( P < 0.001) and more often female (38.5% vs. 23.1%, P = 0.019). Visual acuity was similar at baseline (0.30 log minimum angle of resolution [logMAR], Snellen equivalent [20/40] versus 0.22 [20/33], and P = 0.38) and final (0.18 logMAR, Snellen equivalent [20/30] vs. 0.15 [20/28], and P = 0.08) follow-up. Central macular thickness decreased in both groups, but subfoveal choroidal thickness, Haller vessel thickness, and inner choroidal thickness remained stable in the thin group. Spontaneous resolution and recurrence rates were similar; however, choroidal neovascularization development was significantly higher in the thin choroid group ( P = 0.003).
Conclusion: Thin-choroid central serous chorioretinopathy represents a distinct clinical phenotype with older age and female predominance. Although choroidal neovascularization occurred more frequently in this group compared with the thick choroid group, multivariate analysis indicates that age may be a key contributor to choroidal neovascularization risk.
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