PMC9464940_01
Ultra-widefield retinography of both eyes showing leukemic retinal infiltration before (A) and during (B) methotrexate treatment. OCT scans of both eyes before (C) and during (D) treatment, displaying reduced infiltration in the left eye. Fluorescein angiography at presentation showing signs of vasculitis (E).
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Figures 1A, C ). Fluorescein angiography confirmed bilateral retinal vasculitis of the large and small vessels ( Figure 1E ). During the first months of intravitreal treatment, vitreous and retinal infiltrates reduced in both eyes ( Figures 1B, D ), and visual acuity remained stable (improving to 20/20 in the left eye on one occasion).
Treatment timeline for patient 1. The patient was monitored with ophthalmologic evaluations before every injection or monthly if no injection was administered. ALL, acute lymphoblastic leukemia; CNS, central nervous system; CR, complete remission; Bu-Cy, busulfan + cyclophosphamide; HSCT, hematopoietic stem cell transplant; MTX, methotrexate; IVs, intravitreal injections; RE, right eye; LE, left eye; PD, progressive disease; FLA-Ida, fludarabine, cytarabine, idarubicin; DLI, donor lymphocyte infusion; GVHD, graft-versus-host disease.
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A timeline for patient 1 is presented in  Figure 2 .
PMC9464940_02
Ultra-widefield retinography of both eyes showing leukemic retinal infiltration before (A) and at the end (B) of our second patient's methotrexate course. OCT scans of both eyes before (C) and at the end (D) of the treatment confirm morphological improvement.
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Dilated fundus examination, UWF retinography, and OCT collectively showed yellowish retinal infiltration with retinal hemorrhages in the posterior pole in both eyes and prominent optic disc infiltration in the right eye ( Figures 3A,C ).
Treatment timeline for patient 2. The patient was monitored with ophthalmologic evaluations before every injection. ALL, acute lymphoblastic leukemia; CNS, central nervous system; HD, high dose; MTX, methotrexate; ARAC, cytarabine; CR, complete remission; IVs, intravitreal injections; RE, right eye; LE, left eye.
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ALL progression and systemic complications. A timeline for patient 2 is presented in  Figure 4 .