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Mercaptopurine/methotrexate Radiation retinopathy in both eyes: case report

A 37-year-old man developed radiation retinopathy (RR) in both eyes during treatment with mercaptopurine and methotrexate for acute lymphocytic leukaemia. The man presented with diminution of vision in his both eyes from 1 month. It was reported that he had acute lymphocytic leukaemia from 1 year and received radiotherapy for CNS spread in the past. During current presentation, had was under remission with maintenance dose of mercaptopurine [6-mercaptopurine] 125mg 3 weeks a month and methotrexate 25mg once weekly [routes not stated]. Examination revealed that his best corrected visual acuity was 20/125 in the left eye and 20/400 in the right eye. Intraocular pressure in the left and right eye was 12 and 14mm Hg, respectively. Fundus examination of both eyes revealed cottonwool spots, venous beading, retinal haemorrhages microaneurysms and retinal pigment epithelial atrophy at macula. Fundus fluorescein angiography of both eyes showed macular ischaemia, multiple microaneurysms and extensive capillary non-perfusion areas. An optical coherence tomography of both eyes revealed macular oedema. Based on these findings and clinical presentation, he was diagnosed with RR of both eyes [duration of treatments to reaction onset not stated]. The man was treated with anti-vascular endothelial growth factor injection followed by panretinal photocoagulation in both the eyes [outcome not stated]. Reddy S, et al. Radiation retinopathy in a case of acute lymphocytic leukaemia. BMJ Case Reports 13: No. 9, 2020. Available from: URL: http://doi.org/10.1136/ bcr-2020-237291

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Reactions 21 Nov 2020 No. 1831