Viral necrotising retinitis with frosted branch angiitis: rapid progression into bilateral combined retinal detachment - a management challenge

Abstract

This case describes a mid-adolescent male with a history of B-cell acute lymphocytic leukaemia (B-cell ALL) t(1;19) positive hyperdiploidy, a high-risk variant, who developed bilateral acute necrotising retinitis and frosted branch angiitis, presenting with bilateral severe vision loss. Despite prompt intravitreal and systemic antiviral therapy, his condition worsened, leading to subretinal exudation, retinal traction and combined mechanism retinal detachment in both eyes. Systemic workup, including cerebrospinal fluid analysis with no malignant cells and neuroimaging without central nervous system infiltration, ruled out leukaemia recurrence, thus localising disease to the retina. The report highlights the challenges of managing active disease surgically and details the use of extensive retinectomy to remove fibrovascular tissue. Multiple staged surgeries successfully reattached the retinas with limited functional outcomes.

Keywords: Malignant and Benign haematology; Retina.