Miliary microaneurysms: An angiographic biomarker of leukemic retinopathy?

A 16-year-old girl was referred as retinitis and vasculitis post-typhoid fever. Fundus examination revealed bilateral pseudo-sheathing, scattered hemorrhages with retinal infiltrates. Wide-field fundus fluorescein angiography (FFA) showed peripheral vascular hyperfluorescence; 55° FFA images showed a "firecracker-like" peripheral vasculature, but a closer look revealed miliary microaneurysms (MAs). Peripheral smear examination clinched the diagnosis of chronic myeloid leukemia. MAs on FFA in leukemic retinopathy have been frequently described in the literature. Our report emphasizes its presence, miliary nature, and need for closer inspection of FFA images. We believe that this angiographic sign has potential to become one of the imaging biomarkers of leukemic retinopathy.