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Ophthalmic Images
August 11, 2016

Retinal Intra-arterial Thrombocytic Material Revealing Essential Thrombocythemia

Author Affiliations
  • 1Department of Ophthalmology, Poznań University of Medical Sciences, Poznań, Poland
  • 2Department of Vascular Surgery, Poznań University of Medical Sciences, Poznań, Poland
JAMA Ophthalmol. 2016;134(8):e161111. doi:10.1001/jamaophthalmol.2016.1111

A 59-year-old woman was observed for presumed choroidal granuloma of the left eye. At a scheduled visit, it was determined that yellow material was circulating but not causing complete occlusion of the retinal vessels of both eyes (Figure). The patient had no systemic or ocular complaints. Her visual acuity was 1.0 (Snellen chart) in both eyes. A complete blood cell count revealed an elevated platelet count (475 × 103/μL [to convert to ×109 per liter, multiply by 1.0]). The results of a bone marrow biopsy were normal. Six months later, despite antiplatelet treatment, she received a diagnosis of severe cerebral ischemia and thrombocythemia (platelet count, >2000 × 103/μL). She was found to have 80% blockage of her right internal carotid artery and subsequently died of cerebral embolism. Prior case reports have described essential thrombocythemia with retinal thrombosis.1-4 In the majority of these cases, the retinal veins were occluded, and the patients presented with visual impairment.