Acute myeloid leukemia relapsing in the vitreous

A 47-year-old female was a known case of acute myeloid leukemia (AML-M5) and presented with a diminution of vision in the right eye (OD) for two weeks. Examination revealed pigmented cells in the anterior vitreous of both eyes with vitritis OD. She was further treated with vitreous biopsy and diagnostic vitrectomy under air OD. The cytology examination of the vitreous biopsy revealed infiltration with myeloblasts confirming the diagnosis of extramedullary relapse of AML inside the vitreous. She was further treated with intrathecal chemotherapy. She did not have any further relapse till two years after her last follow-up. This case highlights a rare location of extramedullary relapse of AML inside the vitreous which has not been reported as per the literature search. Moreover, diagnostic vitrectomy under air helped in getting more undiluted vitreous fluid, which also helped in confirming the relapse with cytology examination.