A 39-year-old man, complained about a 3-day history of bilateral blurred vision. He had a past medical history of kidney transplantation 5 years ago and was receiving systemic immunosuppressive therapy. The patient was hospitalized for chickenpox and was treated with systemic antivirals 3 weeks prior to ocular symptoms onset. On ophthalmic examination, the patient’s best corrected visual acuity (BCVA) was 20/200 in the right eye (RE) and 20/25 in the left eye (LE). Slit-lamp examination showed stromal keratitis and few fine keratic precipitates in the RE (Fig. ) and 1+ anterior chamber cells in both eyes. Intraocular pressure was 22 mmHg in the RE and 20 mmHg in the LE. There were no vitreous cells, and results of dilated fundus examination were unremarkable in both eyes. The patient was diagnosed with keratouveitis in the RE and acute anterior uveitis in the LE secondary to chickenpox. He was treated with topical acyclovir five times a day, dexamethasone six times a day, beta blockers, and atropine 1% twice daily. He was lost to follow-up. One year later, he presented with a 1-week history of blurry vision bilaterally. On ophthalmic examination, BCVA was 20/200 in the RE and 20/30 in the LE. Slit-lamp examination showed “mutton-fat” pigmented keratic precipitates (Fig. ), 1+ anterior chamber cells, corneal scars, patchy iris atrophy with circumscribed depigmented spots of the iris, and distorted pupil (Fig. ) in both eyes. Intraocular pressure was 27 mmHg in the RE and 24 mmHg in the LE. Assessment of posterior segments revealed no abnormalities in both eyes. A diagnosis of recurrent granulomatous anterior uveitis was made. The patient was treated with topical dexamethasone six times a day, topical acyclovir five times a day, beta blockers, and atropine 1% twice daily. Intraocular inflammation gradually resolved, and visual acuity improved. Topical steroids and acyclovir were slowly tapered. Visual acuity improved to 20/25 in both eyes one month after presentation. No recurrence of intraocular inflammation was observed over a follow-up period of 24 months.
A 45-year-old woman suffering from intraocular hemorrhage associated with chronic myeloid leukemia complicated by subdural hematoma was referred to our institution. Chronic myeloid leukemia had been diagnosed 10 years earlier and the patient’s comorbidities were treated arterial hypertension, hepatitis B virus positivity, and orally treated type 2 diabetes mellitus diagnosed 3 years earlier. At presentation, she was in blast crisis for the second time and the disease was rapidly progressing. She was hospitalized in the Hematology-Oncology Department, University of Turin, with a very low platelet count (8,000/mm3) and red cell count (2,000 mm3), asthenia, fever, and occipital headache radiating to the anterior parts. A severe subdural hematoma was discovered, with ventricular dilatation and signs of high intracranial pressure. She was treated with repeated platelet transfusions and conservative medical therapy. The patient’s condition improved slowly, with progressive reabsorption of the hematoma and normalization of ventricular morphology on brain computed tomography scan.\nWe followed up this patient for a year by assessment of visual acuity, fundus examination, color retinography, and A-scan and B-scan ultrasonography. The patient complained of visual impairment in the left eye since the onset of her neurological symptoms, and was referred to our clinic. At presentation, her best corrected visual acuity on the right was 20/63 and on the left was 20/320. Retinal examination of the right eye revealed blurring of the optic margins surrounded by retinal and preretinal hemorrhages, preretinal fibrosis starting from the optic disc and extending along the vascular arcades, and perivascular retinal infiltrates (). Massive fibrosis with hard exudates and severe preretinal hemorrhage were observed in the left eye at the posterior pole (). The optic disc was surrounded by retinal and preretinal hemorrhages. Roth spots and many circular and preretinal hemorrhages were noted at the retinal periphery (). The other ocular structures were within normal limits. Ocular tension was good (right, 20 mmHg; left, 17 mmHg).\nA-scan and B-scan ultrasonography showed similar clinical features in both eyes, ie, an anechogenic vitreous cavity, a small increase in the thickness of the chorioretinal complex, and some minute retinal lines with higher reflectivity, likely representing hemorrhages. The patient was monitored for 12 months, with no changes in her clinical and functional characteristics.