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Year : 2020  |  Volume : 58  |  Issue : 3  |  Page : 213-214

Roth spots: A window to underlying systemic conditions

Department of Vitreoretinal Surgery, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India

Date of Submission28-May-2020
Date of Acceptance12-Jun-2020
Date of Web Publication14-Sep-2020

Correspondence Address:
Dr. Sashwanthi Mohan
No. 5, Vidyodaya East Second Street, T. Nagar, Chennai - 600 017, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjosr.tjosr_64_20

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Roth spots are white-centered hemorrhages which can be the first clinical presentation of an underlying systemic disorder such as subacute bacterial endocarditis, leukemia, and anemia. We present a case of Roth spots in a patient with acute myeloid leukemia.

Keywords: Leukemic retinopathy, retinal hemorrhages, Roth spots

How to cite this article:
Mohan S, Rajan M. Roth spots: A window to underlying systemic conditions. TNOA J Ophthalmic Sci Res 2020;58:213-4

How to cite this URL:
Mohan S, Rajan M. Roth spots: A window to underlying systemic conditions. TNOA J Ophthalmic Sci Res [serial online] 2020 [cited 2020 Oct 25];58:213-4. Available from: https://www.tnoajosr.com/text.asp?2020/58/3/213/295001

A 21-year-old male presented with complaints of blurred vision in both the eyes, left eye more than right eye for the past 1 week. He was diagnosed with acute myeloid leukemia 2 weeks ago and was under chemotherapy. Best-corrected visual acuity was 6/6p in the right eye and 6/18 in the left eye. Anterior segment of both the eyes was within normal limits. Fundus examination showed bilateral multiple retinal hemorrhages comprising superficial flame-shaped hemorrhages, intraretinal hemorrhages, and white-centered hemorrhages in the posterior pole [Figure 1]a and [Figure 1]b. The left eye also had a subinternal limiting membrane (ILM) hemorrhage at the macula. Optical coherence tomography (OCT) of the right eye macula was normal. The OCT of the macula of the left eye showed hyperreflectivity beneath the ILM at the macula with shadow effect correlating to the sub-ILM hemorrhage on fundus examination [Figure 2]a and [Figure 2]b.
Figure 1: (a and b) Bilateral superficial retinal and white-centered hemorrhages (arrow) and subinternal limiting membrane hemorrhage at the macula in the left eye

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Figure 2: (a and b) Optical coherence tomography of the macula showing a normal study of the right eye and hyperreflectivity below the internal limiting membrane at the macula in the left eye suggestive of hemorrhage under the internal limiting membrane

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White-centered hemorrhages known as “Roth spots” result from retinal capillary rupture and extrusion of whole blood.

This is followed by platelet adhesion to the damaged endothelium initiating a coagulation cascade and formation of a white lesion in the center of the hemorrhage which is a platelet-fibrin thrombus.[1]

They were first seen in individuals with subacute bacterial endocarditis.[2] They can also be seen in other conditions such as leukemia, anemia, anoxia, carbon monoxide poisoning, preeclampsia, HIV retinopathy, hypertensive and diabetic retinopathy, neonatal birth trauma, shaken baby syndrome, intracranial hemorrhage from arteriovenous malformation, and ocular decompression following trabeculectomy.[1]

In our case, the patient was already diagnosed with acute myeloid leukemia. Ocular complications of leukemia can either be direct due to leukemic infiltration or due to associated anemia and thrombocytopenia. Leukemic retinopathy can present with multiple preretinal and intraretinal hemorrhages that are usually present in the posterior pole, Roth's spots, cotton wool spots, exudates, retinal venous tortuosity, perivascular sheathing, and neovascularization.[3] Retinopathy usually resolves with the treatment of leukemia with chemotherapy. It is particularly important to identify Roth spots on fundus examination as this could be the first clinical presentation in a case of leukemia or other underlying systemic conditions. Thorough clinical and general examination to rule out the above-mentioned systemic conditions along with laboratory investigations such as complete blood count, peripheral smear, erythrocyte sedimentation rate, C reactive protein, blood culture, blood pressure, and blood sugar levels[1] is warranted in patients with Roth spots.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Ling R, James B. White-centered retinal haemorrhages (Roth spots). Postgrad Med J 1998;74:581-2.  Back to cited text no. 1
Roth M. Retinal manifestations of wound fever. DeutschA Chir 1872;1:471-84.  Back to cited text no. 2
Awuah A, Asiedu K, Adanusa M, Ntodie M, Acquah E, Kyei S. A case of leukemic retinopathy mimicking common ischemic retinopathies. Clin Case Rep 2016;4:133-7.  Back to cited text no. 3


  [Figure 1], [Figure 2]


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