A 72-year-old woman with loss of vision in her left eye (LE) for several weeks.
His personal history included the diagnosis of essential thrombocytosis with one million platelets per mm3 treated with hydrourea (Hydrea®, 500 mg, Bristol-Myers, Squibb).
Three months before, the patient was hospitalized for upper gastrointestinal bleeding with 3 million platelets per mm3.
The corrected visual acuity in the right eye was 0.7 and 0.02 in the left eye.
Anterior biomicroscopic study was normal except for a bilateral nuclear cataract, with a flattening ocular tension of 19 mmHg in both eyes.
The left eye fundus showed the presence of diffuse hemorrhages in the lower retina and vessels of the upper hemiretinum converted into white strings avascular zone with punctiform hemorrhage in peripheral cords.
In the right eye fundus were observed multiple cotton swabs distributed in the peripapillary region.
Angiography was not performed because the family refused to perform any contrast study.
Platelet count was 974,000/mm3, with 7,250/mm3 white cells, hemoglobin 13.8 g/dl and hematocrit 40%.
The bone marrow biopsy obtained from the sternum showed an increase in cellularity with an increase in the number of excessively elongated and atypical megakaryocytes.
A peripheral blood smear showed marked atopic dermatitis with megakaryocytic colitis with a long duration.
Examination of the patient was stable during the year and a half of follow-up with corrected visual acuity in the left eye of 0.7 and in the right eye of 0.02.
There was no evidence of neovascularization in the iris or angle with ocular tensions of 20 mmHg in both eyes.
The hematological picture remains stable.
