Título

SPONTANEOUS IMPROVEMENT OF PAPILAR AND MACULAR EDEMA IN A PATIENT WITH APLASTIC ANEMIA

Objetivo

To report a case of spontaneous improvement of papillar and macular edema in a patient with aplastic anemia after treatment of underlying disease.

Relato do Caso

34-year-old male diagnosed with aplastic anemia secondary to pesticide use presented with progressive vision loss in both eyes. A complete ophthalmologic examination showed best corrected visual acuity (BCVA) of 20/100 in the right eye (OD) and 20/100 in the left eye (OS). Anterior segment biomicroscopy was unremarkable. Tonometry was normal in both eyes (OU). Fundoscopy evidenced bilateral papillar edema, numerous Roth spots, intraretinal hemorrhages scattered in posterior pole, and in the foveal region intraretinal fluid and neurosensory detachment was seen in OU (figure 1). The patient underwent blood transfusion for clinical and hematologic indications. 15 days after, vision improved to 20/30- 2 in OD and 20/60 in OS and also showed an improvement of the papillar and macular edema (figure 2).

Conclusão

Aplastic Anemia is a rare disease characterized by a hypoplastic bone marrow and pancytopenia. Anemic Retinopathy may present with cotton wool spots, retinal, preretinal and vitreous hemorrhages as well disc and macular edema. Patients with chronic severe anemia have a high cardiac output, low vascular resistance, low blood pressure and reduced blood viscosity. Studies consider that under this frame, the retinal vessels endothelial cell loses integrity, inducing permeability alterations such as vessel dilation, therefore allowing infiltration of red blood cells through interendothelial junctions. In parallel with platelets deficiency this set may lead to hemorrhages and macular/optic disc edema. Anemic retinopathy rarely causes acute vision loss and is subtle in the majority of cases being frequently under diagnosed. Sudden vision loss due to anemia is rare. Conversely aplastic anemia associated with pancytopenia might be sight threatening. Early treatment of underlying disease is important for controling the retinopathy and may prevent visual loss.