1
|
Borrelli E, Serafino S, Reibaldi M. Bilateral Retinal Vascular Tortuosity and Hemorrhages. JAMA Ophthalmol 2024:2819809. [PMID: 38842890 DOI: 10.1001/jamaophthalmol.2024.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
A 28-year-old man presented with decreased visual acuity in his right eye for the past 2 weeks. Examination revealed dilated and tortuous veins, Roth spots, and white intraretinal agglomerates. What would you do next?
Collapse
Affiliation(s)
- Enrico Borrelli
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, City of Health and Science Hospital, Turin, Italy
| | - Sonia Serafino
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, City of Health and Science Hospital, Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, City of Health and Science Hospital, Turin, Italy
| |
Collapse
|
2
|
Diral E, Catalano G, Cicinelli MV, Distefano A, Mastaglio S, Vago L, Lupo Stanghellini MT, Bernardi M, Ponzoni M, Ciceri F, Carrabba MG. Spontaneous remission of choroidal involvement by chronic myelomonocytic leukemia: a case report. Front Oncol 2024; 14:1399894. [PMID: 38756666 PMCID: PMC11096476 DOI: 10.3389/fonc.2024.1399894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Chronic myelomonocytic leukemia (CMML) is a rare hematological disorder characterized by variable risk of evolution to acute myeloid leukemia; to date, allogeneic stem cell transplantation is the only curative treatment. We report a case of choroidal involvement in a woman affected by CMML and presenting only with visual impairment. The patient was initially evaluated for an intensive therapeutic approach, but after biopsy the ocular lesion spontaneously regressed. Thus a "watch and wait" strategy was preferred. One year and a half after initial diagnosis, the patient is alive, with stable hematological disease and without any ocular involvement. Therefore, a close, not invasive follow up could be useful to tailor treatment for patients affected by single ocular lesions in CMML.
Collapse
Affiliation(s)
- Elisa Diral
- Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maria Vittoria Cicinelli
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Sara Mastaglio
- Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Vago
- Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Massimo Bernardi
- Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurilio Ponzoni
- Vita-Salute San Raffaele University, Milan, Italy
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo G. Carrabba
- Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
3
|
Johnson GM, Rossen JL, Simon SS, Weinstein JL, Ralay Ranaivo H, Yoon HH. Leukemic Optic Neuropathy in Pediatric Patients: A Case Series. J Pediatr Ophthalmol Strabismus 2024; 61:67-72. [PMID: 37227013 DOI: 10.3928/01913913-20230331-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To characterize the presentation, clinical course, and treatment of a series of children with leukemic optic neuropathy. METHODS Patients with leukemia who were treated at a tertiary children's hospital for optic nerve infiltration were included (n = 11). Demographic information, cancer history, ophthalmologic examination findings, treatment, and outcomes were retrospectively collected. RESULTS Mean age was 10.0 ± 4.8 years, and 63.6% were male and 36.4% were female. The most common underlying oncologic diagnosis was B-precursor acute lymphoblastic leukemia (n = 7, 63.6%). Notably, the majority presented with optic nerve infiltration during presumed remission (n = 9, 81.8%), but 2 patients (18.2%) presented with optic nerve infiltration at their initial leukemia diagnosis. Cerebrospinal fluid was positive for leukemic cells in 36.4% of patients. Magnetic resonance imaging demonstrated optic nerve enhancement and/or enlargement in only 8 patients (72.7%). In addition to other leukemia-directed treatment, 8 patients (72.7%) received emergent local radiation within 1.5 ± 1.2 days of initial ophthalmology examination. CONCLUSIONS The largely negative cerebrospinal fluid results and variable magnetic resonance imaging findings in this study emphasize the importance of clinical context for this diagnosis. Clinicians should consider optic nerve infiltration in patients with leukemia and visual or ocular complaints, because urgent treatment is required to preserve vision and manage systemic disease. [J Pediatr Ophthalmol Strabismus. 2024;61(1):67-72.].
Collapse
|
4
|
Rothfield L, Falcone MM, Gaier ED, Heidary G, Gise R. Neuro-ophthalmic Complications in Pediatric Leukemia. J Neuroophthalmol 2023; 43:520-524. [PMID: 37247249 DOI: 10.1097/wno.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Optic neuropathy in childhood leukemia occurs through multiple direct and indirect mechanisms, including leukemic infiltration of the optic nerve, infection, blood dyscrasias, or adverse effects of treatment. We aimed to characterize visual outcomes in pediatric patients with leukemia-associated neuro-ophthalmic manifestations. METHODS We retrospectively identified patients with leukemia and optic nerve pathology over 13 years by diagnostic billing codes. We collected information on demographics, presentation, treatment course, and visual outcomes directly from medical records. RESULTS Of the 19 patients who met inclusion criteria, 17 (89.5%) had pseudotumor cerebri and 2 had direct optic nerve infiltration. Causes of increased intracranial pressure included central nervous system infiltration (6 of 17), hyperviscosity/leukemia (2 of 17), venous sinus thrombosis (3 of 17), medication induced (5 of 17), and bacterial meningitis (1 of 17). 47.1% (8 of 17) had papilledema at the time of leukemia diagnosis, and 94.1% (16 of 17) of patients with pseudotumor cerebri were treated with acetazolamide. At presentation, 3 patients had decreased vision secondary to macular ischemia, subhyaloid vitreous hemorrhage, or steroid induced glaucoma. Following treatment of pseudotumor cerebri, binocular visual acuity was ≥20/25 in all patients. One patient with optic nerve infiltration had a final visual acuity of count fingers in the affected eye. CONCLUSIONS In our chart review, the most common mechanism of neuro-ophthalmic involvement in pediatric leukemia was elevated intracranial pressure from a myriad of causes. Visual outcomes from patients with elevated intracranial pressure were excellent. Understanding the mechanisms by which leukemia can cause optic nerve disease in pediatric patients can facilitate earlier diagnosis and treatment and potentially improve visual outcomes.
Collapse
Affiliation(s)
- Lindsay Rothfield
- Department of Ophthalmology (LR), Boston Medical Center, Boston, Massachusetts; Bascom Palmer Eye Institute (MMF), University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology (EDG, GH, RG), Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School (EDG, GH, RG), Boston, Massachusetts; and Picower Institute for Learning and Memory (EDG), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | | | | | | |
Collapse
|
5
|
Beketova T, Mordechaev E, Murillo B, Schlesinger MD. Leukemic Retinopathy: A Diagnostic Clue for Initial Detection and Prognosis of Leukemia. Cureus 2023; 15:e50587. [PMID: 38222198 PMCID: PMC10788118 DOI: 10.7759/cureus.50587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Leukemia is a systemic malignancy that can compromise various physiological functions, including vision. We report a case of a 37-year-old male presenting with worsening bilateral central vision loss, fatigue, shortness of breath, and ankle edema. Ophthalmic examination revealed extensive retinal hemorrhages, Roth spots, and subhyaloid hemorrhages, consistent with leukemic retinopathy. Further hematologic workup confirmed chronic eosinophilic leukemia. The patient showed systemic and visual improvement after prompt treatment with imatinib. This case highlights the importance of ophthalmological assessment in diagnosing leukemia, as ocular manifestations may often be the first sign of hematological disease.
Collapse
Affiliation(s)
| | | | - Brian Murillo
- Ophthalmology, New York Medical College, Valhalla, USA
| | - Max D Schlesinger
- Ophthalmology/Retina, Westchester Medical Center/New York Medical College, Valhalla, USA
| |
Collapse
|
6
|
Strawbridge JC, Roelofs KA, Naderi J, Goh TY, Rootman DB. Orbital manifestations of B-cell acute lymphoblastic leukemia/lymphoma. Orbit 2023; 42:654-658. [PMID: 35580237 DOI: 10.1080/01676830.2022.2072901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
A 2-year-old boy presented with left periorbital edema, proptosis, hyperglobus and esotropia. Imaging revealed an inferotemporal orbital mass with adjacent bony erosion. Histological evaluation of an orbital biopsy revealed B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/BLL). The patient was subsequently treated with chemotherapy. Although orbital involvement in acute myelogenous leukemia has been well-described, orbital manifestations of B-ALL/BLL are uncommon, with only a limited number of previous reports in the literature.
Collapse
Affiliation(s)
- Jason C Strawbridge
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelsey A Roelofs
- Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
| | - Jason Naderi
- Rosalind Franklin University School of Medicine, North Chicago, Illinois, USA
| | - Tracie Y Goh
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
| |
Collapse
|
7
|
Yee C, Scruggs BA, Flaxel CJ. RETINAL INFILTRATION IN A CASE OF CHRONIC MYELOID LEUKEMIA. Retin Cases Brief Rep 2023; 17:690-693. [PMID: 35385433 PMCID: PMC9525446 DOI: 10.1097/icb.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To describe a case of chronic myeloid leukemia with retinal leukemic infiltration identified by optical coherence tomography (OCT) and OCT angiography. METHODS Case report. RESULTS A 64-year-old man presented with bilateral painless blurred vision and three weeks of fatigue, unintentional weight loss, and complete hearing loss. Dilated fundus examination of both eyes showed peripheral intraretinal hemorrhages with white centers, vascular tortuosity, and peripheral nonperfusion. No macular lesions were identified by slit-lamp examination, fundus photography, fundus autofluorescence, or fluorescein angiography. Optical coherence tomography through the macula revealed multiple hyperreflective lesions throughout the inner retinal layers. Some of these lesions showed intrinsic flow by OCT angiography, but many lesions did not. The bone marrow biopsy confirmed chronic myeloid leukemia, and these intraretinal lesions were deemed to be leukemic infiltrates. The patient regained vision after systemic chemotherapy with resolution of the retinal infiltrates over time. CONCLUSION Primary leukemic retinal involvement can be challenging to diagnose, especially when the macula appears normal clinically. Optical coherence tomography and OCT angiography are useful imaging modalities for the detection of retinal leukemic infiltration. Completing a thorough review of systems and initiating an urgent, systemic work-up are warranted in cases of retinal infiltration.
Collapse
Affiliation(s)
- Claudine Yee
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; and
| | - Brittni A Scruggs
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; and
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Christina J Flaxel
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; and
| |
Collapse
|
8
|
Wang L, Suo L, Kou F, Zhang Y, Li M, Wang H, Casalino G, Peto T, Chakravarthy U, Wang Y, Wu W, Dong N. Ocular Phenotypes in Patients With Hemophagocytic Lymphohistiocytosis: A Retrospective Analysis in a Single Center Over 7 Years. Am J Ophthalmol 2023; 253:119-131. [PMID: 37178948 DOI: 10.1016/j.ajo.2023.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To investigate the presence and type of ocular abnormalities in patients with hemophagocytic lymphohistiocytosis (HLH). DESIGN A retrospective cross-sectional study. METHODS Observational report of ocular findings and their associations with age, sex, underlying disease, and hematologic parameters. HLH was defined according to the 2004 criteria, and the patients were enrolled from March 2013 to December 2021. Analysis began in July 2022 and ended in January 2023. The main outcome measures were ocular abnormalities associated with HLH and their potential risk factors. RESULTS Of 1525 HLH patients, 341 had ocular examinations, and 133 (133 of 341, 39.00%) had ocular abnormalities. Mean age at presentation was 30.21 ± 14.42 years. The multivariate analysis indicated that old age, autoimmune disorders, decreasing red blood cell count, decreasing platelet count, and increasing fibrinogen level were independent risk factors of ocular involvement in HLH patients. The most common presenting ocular findings were posterior segment abnormalities (66 patients, 49.62%), including retinal and vitreous hemorrhage, serous retinal detachment, cytomegalovirus retinitis, and optic disc swelling. Other HLH-associated ocular abnormalities included ocular surface infection (conjunctivitis, 34 patients, 25.56%; keratitis, 16 patients, 12.03%), subconjunctival hemorrhage (11 patients, 8.27%), chemosis (5 patients, 3.76%), anterior uveitis (11 patients, 8.27%), glucocorticoid-induced glaucoma (5 patients, 3.76%), radiation cataract (1 patient, 0.75%), dacryoadenitis (2 patients, 1.50%), dacryocystitis (1 patients, 0.75%), orbital cellulitis (2 patients, 1.50%), orbital pseudotumor (2 patients, 1.50%), and strabismus (2 patients, 1.50%). CONCLUSIONS Eye involvement is not uncommon in HLH. Better awareness among both ophthalmologists and hematologists is necessary for prompt diagnosis and institution of appropriate management strategies with potential to save sight and life.
Collapse
Affiliation(s)
- Luping Wang
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Lingge Suo
- Department of Ophthalmology, Peking University Third Hospital (L.S.), Beijing, China; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital (L.S.), Beijing, China
| | - Fangning Kou
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University (F.K.), Beijing, China
| | - Youjing Zhang
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Mingming Li
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Hao Wang
- Department of Clinical Epidemiology and Evidence-Based Medicine, Beijing Clinical Research Institute, Beijing Friendship Hospital, Capital Medical University (H.W.), Beijing, China
| | - Giuseppe Casalino
- Eye Clinic, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan (G.C.), Milan, Italy
| | - Tunde Peto
- Centre for Public Health, Queen's University of Belfast (T.P., U.C.), Belfast, United Kingdom
| | - Usha Chakravarthy
- Centre for Public Health, Queen's University of Belfast (T.P., U.C.), Belfast, United Kingdom
| | - Yanling Wang
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Weizhen Wu
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Ning Dong
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China.
| |
Collapse
|
9
|
Nanda T, Chin A, Rifkin L. A 27-YEAR-OLD FEMALE WITH MILD BLURRY VISION AND PROLONGED LIGHT ADJUSTMENT IN THE MORNING. Retin Cases Brief Rep 2023; 17:S11-S14. [PMID: 36007176 DOI: 10.1097/icb.0000000000001336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The following case report highlights a rare presentation of chronic myeloid leukemia-associated hyper-viscosity syndrome and provides a brief review of expected findings and treatment outcomes. METHODS An otherwise healthy 27-year-old woman presented to the ophthalmology clinic with mild bilateral blurriness (20/20 in both eyes) and prolonged light adaption in the morning for several months. Examination demonstrated severe bilateral venous stasis, white-centered hemorrhages, intraretinal hemorrhage, and peripheral ischemia with diffuse leakage. RESULTS Same-day CBC demonstrated a leukocytosis of >600,000. Subsequent bone marrow biopsy confirmed the 9,22 translocation (Philadelphia chromosome). On further examination, the patient had an enlarged cardiac silhouette, cytopenia, and splenomegaly past the umbilicus, consistent with a severe and life-threatening leukostasis. CONCLUSION Ocular involvement can occur in acute and chronic leukemia. Five to ten percentage of patients present to an eye physician first, without a known diagnosis. Prompt systemic treatment can result in near-complete reversal of any intraocular injury in most mild-to-moderate cases, as was the case here.
Collapse
Affiliation(s)
- Tavish Nanda
- New England Eye Center, Tufts University Medical Center, Boston Massachusetts
| | | | | |
Collapse
|
10
|
Szeto SK, Mohamed S, Tsang CW, Chan CK. Massive retinal infiltrates as the presenting sign of chronic myeloid leukemia: Clinical and imaging features of leukemic retinopathy. Eur J Ophthalmol 2023; 33:NP55-NP63. [PMID: 34595942 DOI: 10.1177/11206721211048792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To describe the clinical and optical coherence tomography (OCT) features of two cases with bilateral diffuse retinal infiltrates as the only presenting feature of chronic myeloid leukemia (CML) on initial diagnosis and upon relapse. METHODS We reported two patients with CML, one at initial diagnosis and one in remission who presented with bilateral subacute visual impairment. Fundal examination revealed bilateral symmetrical leukostatic appearance with increased vascular tortuosity, diffuse retinal infiltrates with size up to 6 disk diameters, retinal hemorrhages, and Roth's spots. OCT showed multiple intra-retinal hyper-reflective foci corresponding to intra-retinal hemorrhages, and outer retinal hyper-reflective foci in area corresponding to retinal infiltrate. The different retinal layers were relatively preserved and distinguishable. RESULTS White cell count (WCC) were elevated in both patients ranging from 544 to 810 × 109/L. Bone marrow biopsy confirmed the diagnosis of CML in the patient without prior diagnosis and relapse of CML in another patient. Cytogenetic test detected Abelson murine leukemia (ABL) - breakpoint cluster region (BCR) fusion transcript in both cases. Both patients were started on oral imatinib, subsequently WCC returned to within normal values in both cases. Vision and OCT abnormalities improved and reduction in retinal hemorrhages and infiltrates were observed in follow up. CONCLUSION This report highlights the important role of ophthalmologists and detailed fundus examination in making a prompt diagnosis of leukemia in patients with visual complaints. Appropriate systemic investigation and hematologist referrals for prompt treatment of CML may improve survival rate and preserve vision.
Collapse
Affiliation(s)
- Simon Kh Szeto
- The Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.,Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shaheeda Mohamed
- The Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.,Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chi Wai Tsang
- The Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.,Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Carmen Km Chan
- The Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.,Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| |
Collapse
|
11
|
Sayadi J, Gouider D, Allouche Y, Choura R, Cherni I, Sayadi M, Benneji H, Zghal I, Malek I, Nacef L. Ophthalmic Manifestations of Newly Diagnosed Acute Leukemia Patients in a Tunisian Cohort. Clin Ophthalmol 2022; 16:3425-3435. [PMID: 36249442 PMCID: PMC9560867 DOI: 10.2147/opth.s365648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose To describe ocular manifestations of acute leukemia in a Tunisian cohort and to assess the associations between ophthalmic findings and epidemiological, clinical, and biological features of the disease. Methods A prospective study included patients newly diagnosed with acute leukemia referred to our clinics between January 2019 and July 2020. All patients underwent a complete ophthalmic evaluation and spectral-domain optical coherence tomography (SD-OCT) at presentation, then every two months during one year. We defined two groups: Group 1 included patients with leukemic ophthalmopathy and group 2 included patients with normal ophthalmic examination. Results Forty-six patients were enrolled. The mean age of patients was 32.1±15.3 years. The sex ratio M/F was 1.55 (28 male patients and 18 females). Twenty-nine patients (63%) had acute myeloid leukemia (AML), and 17 (37%) had acute lymphoblastic leukemia (ALL). The average follow-up was 9.1 months (range: 3–12 months). We observed ophthalmic manifestations in 28 patients (61%). Among them, 17 (61%) had vision-threatening complications. The posterior segment was the most common site of ocular involvement (82% of group1). Primary leukemic infiltration (Disc edema, ptosis, exophthalmos) was present in 13 eyes (14.1%). Twenty-seven eyes (29.3%) had secondary involvement lesions (Subconjunctival hemorrhage, periorbital ecchymosis, retinal/sub-hyaloid hemorrhage, dilated/tortuous veins). Twenty-one eyes (22.8%) showed other ocular manifestations which etiopathogenesis is not yet fully understood (White-centred hemorrhages, cotton-wool spots, serous retinal detachment, hemorrhagic pigment epithelial detachment). Leukemic retinopathy was significantly more frequent in adults (23/39 and 1/7 in adult and pediatric groups, respectively; p=0.003). Patients suffering from AML were more likely to have secondary ocular involvement (20/29 and 7/17 in AML and ALL patients, respectively; p=0.047). Retinal hemorrhages were statistically associated with anemia and thrombocytopenia (p=0.041 and p=0.034; respectively). Conclusion Leukemic ophthalmopathy seems to be frequent and may lead to severe visual impairment. An ophthalmic assessment complemented with SD-OCT has paramount importance in all newly diagnosed acute leukemic patients.
Collapse
Affiliation(s)
- Jihene Sayadi
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Dhouha Gouider
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,Correspondence: Dhouha Gouider, Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Bab Saadoun, Tunis, Tunisia, Tel +21640660114, Email
| | - Yasmine Allouche
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Racem Choura
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Cherni
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Malek Sayadi
- Department of Hematology, Aziza Othmana Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hend Benneji
- Department of Hematology, Aziza Othmana Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Imene Zghal
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Malek
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Leila Nacef
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
12
|
El Salloukh NA, Hage DG, Bashshur AZ, Kheir WJ. Early Ophthalmological Manifestations of Acute Myeloid Leukemia: Current Perspectives. Clin Ophthalmol 2022; 16:2119-2127. [PMID: 35800672 PMCID: PMC9255417 DOI: 10.2147/opth.s342720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Acute myeloid leukemia (AML) is a hematological malignancy affecting different organ systems including the eye. The purpose of this review is to present and evaluate the medical literature regarding the early ophthalmological manifestations of acute myeloid leukemia. AML affects the ocular system through direct infiltration of tissues, secondary to hematological abnormalities, or in the form of chloroma or myeloid sarcoma in the brain or orbit consequently leading to a variety of manifestations depending on the ocular tissue involved. It is imperative for ophthalmologists to be aware of the early ophthalmological manifestations of AML which will allow for earlier diagnosis and treatment of this life-threatening disease.
Collapse
Affiliation(s)
| | - Dany G Hage
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Anna Z Bashshur
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wajiha Jurdi Kheir
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
- Correspondence: Wajiha Jurdi Kheir, Department of Ophthalmology, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon, Tel +961-1-350000, Fax +961-1-370837, Email
| |
Collapse
|
13
|
Almater AI, Alhadlaq GS, Alromaih AZ. Unilateral Subhyaloid Hemorrhage as a Presenting Sign of Chronic Myeloid Leukemia. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e936266. [PMID: 35484832 PMCID: PMC9063587 DOI: 10.12659/ajcr.936266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/28/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic myelogenous leukemia (CML) is a malignant myeloproliferative neoplasm of pluripotent stem cell origin. Ophthalmic manifestation as an initial presentation in cases of CML is extremely rare. Frequently, ocular lesions in CML are asymptomatic. However, vitreous or foveal involvement can result in a symptomatic visual loss and earlier presentation. Here, we report a rare case of monocular vision loss due to subhyaloid hemorrhage in a case of CML. CASE REPORT A 19-year-old healthy woman presented to the Emergency Department with sudden painless decrease in vision in her left eye for 1 day. Fundus examination revealed multiple intraretinal hemorrhages with some white-centered hemorrhages in 4 quadrants in both eyes, and subhyaloid hemorrhage involving the fovea in the left eye. Complete blood count and peripheral blood smear were consistent with the diagnosis of chronic myeloid leukemia. After referral to the hematology service, the diagnosis was confirmed based on bone marrow aspiration and chromosomal analysis. The patient then received the appropriate management and continued to follow up with the hematology service. CONCLUSIONS This case report highlights the rarity of ocular involvement as an initial manifestation of chronic myeloid leukemia, and the importance of systemic work-up for the diagnosis of this entity. A multidisciplinary team approach involving ophthalmologists, hematologists, and oncologists is paramount for the diagnosis and management of CML.
Collapse
|
14
|
Gotti G, Stevenson K, Kay-Green S, Blonquist TM, Mantagos JS, Silverman LB, Place AE. Ocular abnormalities at diagnosis and after the completion of treatment in children and adolescents with newly diagnosed acute lymphoblastic leukemia. Pediatr Blood Cancer 2022; 69:e29542. [PMID: 35187841 DOI: 10.1002/pbc.29542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ocular abnormalities (OA) in pediatric patients with acute lymphoblastic leukemia (ALL) are common findings both at diagnosis and later in follow-up. The frequency, predictors, and prognostic impact of OA in the context of recent ALL protocols are not well characterized. PROCEDURE Single-center retrospective analysis of the medical records of 224 patients with ALL enrolled on Dana-Farber Cancer Institute (DFCI) ALL Consortium Protocol 05-001. RESULTS Overall, 217 (98%) patients had at least one ophthalmic exam. Retinal hemorrhages were the most frequent abnormalities at diagnosis (11%) and cataracts at later time points (13%). OA at diagnosis were associated with age ≥10 years and with the severity of anemia and thrombocytopenia; they were also univariately associated with lower 5-year event-free survival (EFS) (high risk [HR] = 3.09 [95% CI: 1.38-6.94]; p = .006), but not in a disease-free survival (DFS) model adjusted for end-induction minimal residual disease (p = .82). The cumulative incidence of cataract was 13.1% ± 2.8% at 43 months from diagnosis; its development was associated with high presenting white blood cell count (≥50,000/μl) (p = .010), male sex (p = .036), higher risk group (p = .025), and cranial radiation (p = .004). Cataract was associated with decreased visual acuity. CONCLUSIONS OA at diagnosis, present in 12% of patients, were associated with older age, anemia, and thrombocytopenia and did not carry a significant prognostic impact. Cataracts were detected in over 10% of patients and were associated with decreased visual acuity, thus supporting routine screening after completion of therapy, especially for those treated with high-risk protocols.
Collapse
Affiliation(s)
- Giacomo Gotti
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Pediatric Hematology-Oncology, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Kristen Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Massachusetts, USA
| | - Samantha Kay-Green
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Traci M Blonquist
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Massachusetts, USA
| | - Jason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Andrew E Place
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Mirshahi R, Ghassemi F, Koochakzadeh L, Faranoush M, Ghomi Z, Mehrvar A, Mousavi SA, Safaee Nodehi SR. Ocular Manifestations of Newly Diagnosed Acute Leukemia Patients. J Curr Ophthalmol 2022; 34:100-105. [PMID: 35620369 PMCID: PMC9128435 DOI: 10.4103/joco.joco_10_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To present primary ocular manifestations in acute leukemia. Methods This cross-sectional descriptive hospital-based study evaluated all newly diagnosed leukemia patients of three referral hospitals of Tehran University of Medical Sciences in 2015-2016 and Mahak Hospital in Tehran in 2017. Exclusion criteria included the patients with the previous history of chemotherapy, cases of relapsing disease, and the patients with a history of ocular disease or other systemic conditions with ophthalmic manifestations. Results A total of 85 patients (170 eyes) were evaluated in our study, including 29 children (34.1%) and 43 females (50.6%). The mean patient age was 37.84 ± 11.91 years in the adult group and 6.28 ± 4.70 years in the pediatric category. Ophthalmic involvement was seen in 27 patients (31.8%), including 6 pediatric patients (20.7%) and 21 adult patients (37.5%). Two patients (2.3%) had direct infiltration by leukemic cells and 76 patients (89.41%) of patients were asymptomatic. There was a correlation between ophthalmic involvement and platelet count and hemoglobin level. In patients with ocular signs, higher mortality rates were observed. Conclusions At the time of diagnosis in acute leukemia patients, complete ophthalmic evaluation including dilated fundus examination is suggested as ocular involvement in these patients is common and sometimes asymptomatic. Ophthalmic involvement in leukemic patients should be identified in a timely manner, particularly in individuals with low platelet counts and hemoglobin levels, due to the potential prognostic relevance.
Collapse
Affiliation(s)
- Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leili Koochakzadeh
- Department of Pediatrics, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric Growth and Development Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghomi
- Department of Radiology, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azim Mehrvar
- MAHAK Hematology Oncology Research Center, MAHAK Hospital, Tehran, Iran
| | - Seyed Asadollah Mousavi
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Reza Safaee Nodehi
- Department of Hematology and Medical Oncology, Cancer Research Center, Cancer Institute of Iran, Imam Khomeini Hospital Complex, Tehran, Iran
| |
Collapse
|
16
|
Maniam A, Zuhaimy H, Vendargon FMM, Othman O. Isolated Ocular Manifestations in Chronic Myeloid Leukaemia. Cureus 2021; 13:e19450. [PMID: 34912600 PMCID: PMC8664615 DOI: 10.7759/cureus.19450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Chronic myeloid leukaemia (CML) presenting with only ocular manifestations either at the initial stage of diagnosis or at relapse is uncommon. We report two cases of CML presenting with isolated visual symptoms. CASE SERIES The first case is a 21-year-old healthy gentleman who presented with left eye painless loss of vision for a one-week duration. Visual acuity was 6/60 in the left eye and 6/6 in the right eye. There were scattered retinal haemorrhages in both eyes and a sub-macular bleed over the left eye. The full blood count revealed a high white cell count of 134.6 × 109/L. Peripheral blood smear showed hyper-leucocytosis with absolute eosinophilia and basophilia and the presence of blasts suggestive of CML thus chemotherapy was commenced. The second case is a 28-year-old in haematological, molecular, and cytogenic remission from CML for the past two years, presented with left eye painless vision loss for five days duration. Vision in the left eye was counting fingers. There was a large subretinal mass involving the left optic disc. Magnetic resonance imaging of the brain and orbit showed an elliptical orbital mass at the left globe posteriorly with diffuse thickening of the optic nerve. The patient was diagnosed as CML relapsed to the left optic nerve. He underwent intrathecal chemotherapy and orbital irradiation. CONCLUSION Both these cases are unique since the manifestation of CML was with only ocular features at the time of presentation as per in the first case during the initial diagnosis and in the second case during relapse. This highlights that it is evident that the knowledge of ocular involvement in leukaemia is crucial since the eye is the only organ where leukemic infiltration to nerves and blood vessels can be observed directly. Recognizing fundus changes in leukaemia allows earlier diagnosis and prompt treatment. These case reports highlight the importance of recognizing early fundus changes, which should allow earlier diagnosis and treatment.
Collapse
Affiliation(s)
- Anita Maniam
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.,Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, MYS
| | - Hanis Zuhaimy
- Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, MYS
| | | | - Othmaliza Othman
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| |
Collapse
|
17
|
Türkoğlu EB, Ocal O. Anterior segment optical coherence tomography findings in leukemic iris infiltration. Photodiagnosis Photodyn Ther 2021; 37:102578. [PMID: 34653699 DOI: 10.1016/j.pdpdt.2021.102578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
Iris involvement by acute lymphoblastic leukemia is a very rare primary leukemic infiltration. Blurred vision, conjunctival injection, anterior chamber reaction, pseudohypopyon, thickening of the iris stroma, change in iris shape and color are common clinical signs in leukemic iris infiltration. There is no optimal treatment. Radiotherapy, systemic chemotherapy (high-dose of methotrexate and/or high-dose cytarabine), topical and systemic corticosteroids have been reported as treatment modalities. Herein we present anterior segment optical coherence tomography findings in a 21-years-old, male, diffuse B-cell Acute Lymphoblastic Leukemia (ALL) patient who has a leukemic iris infiltration in his left eye that was successfully treated with intravitreal methotrexate.
Collapse
Affiliation(s)
| | - Olgar Ocal
- Ophthalmology Department, Akdeniz University Hospital, Antalya, Turkey.
| |
Collapse
|
18
|
Willier S, Raedler J, Blaeschke F, Stenger D, Pazos Escudero M, Jurgeleit F, Grünewald TGP, Binder V, Schmid I, Albert MH, Wolf A, Feuchtinger T. Leukemia escape in immune desert: intraocular relapse of pediatric pro-B-ALL during systemic control by CD19-CAR T cells. J Immunother Cancer 2020; 8:jitc-2020-001052. [PMID: 32938628 PMCID: PMC7497522 DOI: 10.1136/jitc-2020-001052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background Relapsed/refractory B-precursor acute lymphoblastic leukemia (BCP-ALL) remains a major therapeutic challenge in pediatric hematology. Chimeric antigen receptor (CAR) T cells targeting CD19 have shown remarkable initial response rates in BCP-ALL patients, while long-term leukemia control rate is only about 50%. So far, main mechanisms of BCP-ALL relapse after CD19-CAR T-cell therapy have been either insufficient CAR T-cell persistence in vivo or loss of surface CD19. Case Report Here, we report an exceptional presentation of BCP-ALL relapse in the eye during the systemic control through CAR T-cell therapy. We report a case of fatal intraocular relapse in a pediatric patient with pro-B-ALL after initial response to CD19-CAR T-cell therapy. One month after CD19-CAR T-cell therapy, remission was documented by bone marrow aspirate analysis with absence of CD19+ cells and CD19-CAR T cells could be detected in both peripheral blood and bone marrow. At the same time, however, the patient presented with progressive visual disturbance and CD19+ cells were found within the anterior chamber of the eye. Despite local and systemic therapy, ocular relapse led to BCP-ALL dissemination and systemic relapse within weeks. The eye represents a rare site for local manifestation of BCP-ALL, but isolated intraocular relapse is a clinically unreckoned presentation of BCP-ALL in the era of CD19-CAR T cells. Conclusion During systemic control of BCP-ALL through CD19-CAR T cells, relapse can emerge in the eye as an immune-privileged organ. Ocular symptoms after CD19-CAR T-cell therapy should guide the clinician to elucidate the etiology in a timely fashion in order to adjust leukemia treatment strategy. Both, local immune escape as well as insufficient CAR T-cell persistence may have contributed to relapse in the reported patient. Mechanisms of relapse in an immune desert under CAR T-cell therapy require future clinical and experimental attention. In particular, ocular symptoms after CAR T-cell therapy should be considered a potentially early sign of leukemia relapse.
Collapse
Affiliation(s)
- Semjon Willier
- Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany
| | - Johannes Raedler
- Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany
| | - Franziska Blaeschke
- Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany
| | - Dana Stenger
- Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Montserrat Pazos Escudero
- Department of Radiotherapy, University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany
| | - Florian Jurgeleit
- Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany
| | - Thomas G P Grünewald
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany.,Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany.,Partner site Munich, German Cancer Consortium (DKTK), Munich, Germany
| | - Vera Binder
- Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany
| | - Irene Schmid
- Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany
| | - Michael H Albert
- Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany
| | - Armin Wolf
- Department of Ophthalmology, University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany.,Department of Ophthalmology, University of Ulm, Ulm, Germany
| | - Tobias Feuchtinger
- Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany
| |
Collapse
|
19
|
Touhami S, Audo I, Terrada C, Gaudric A, LeHoang P, Touitou V, Bodaghi B. Neoplasia and intraocular inflammation: From masquerade syndromes to immunotherapy-induced uveitis. Prog Retin Eye Res 2019; 72:100761. [DOI: 10.1016/j.preteyeres.2019.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 12/18/2022]
|
20
|
Dambricourt L, Sampo M, Levy N, Arnould T, Ho Wang Yin G, Denis D. [Leukemic chorioretinal infiltrates with serous retinal detachment in acute pre-B lymphoblastic leukemia]. J Fr Ophtalmol 2019; 42:e247-e249. [PMID: 31079912 DOI: 10.1016/j.jfo.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022]
Affiliation(s)
- L Dambricourt
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - M Sampo
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - N Levy
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - T Arnould
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Ho Wang Yin
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - D Denis
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France; Service d'ophtalmologie, hôpital Nord, CHU, chemin des Bourrely, 13015 Marseille, France
| |
Collapse
|
21
|
A unique case of chronic myeloid leukemia presenting as monocular vision loss with unilateral retinopathy. Am J Ophthalmol Case Rep 2019; 14:67-69. [PMID: 30911698 PMCID: PMC6416657 DOI: 10.1016/j.ajoc.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/08/2018] [Accepted: 02/06/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To report a case of unilateral leukemic retinopathy secondary to chronic myeloid leukemia (CML). Observations Patient presented to clinic with a visual acuity (VA) of 20/200 in the right eye (OD) after several months of progressive monocular vision loss and was found to have dense pre-retinal hemorrhage. Patient underwent 23-gauge pars plana vitrectomy to clear the preretinal hemorrhage along with a complex macula-off retinal detachment repair to address retinal tear and multilayer retinal hemorrhage. The patient was subsequently diagnosed with CML as she was found to be positive for the fusion protein of break point cluster gene (BCR) with Abelson tyrosine kinase (ABL1), BCR-ABL1, upon systemic work-up. Imatinib therapy resulted in complete hematologic and cytogenetic resolution after one month, however, the patient's vision remained unchanged six months after surgery. Conclusion and importance To the authors' knowledge, this is the first reported case of unilateral leukemic retinopathy secondary to low risk CML, as determined by the Sokal and Hasford prognostic scoring systems. CML should be included in the differential diagnosis of patients with progressive monocular vision loss with suspicious multi-layer retinal compromise.
Collapse
|
22
|
Hafeez MU, Ali MH, Najib N, Ayub MH, Shafi K, Munir M, Butt NH. Ophthalmic Manifestations of Acute Leukemia. Cureus 2019; 11:e3837. [PMID: 30891378 PMCID: PMC6411336 DOI: 10.7759/cureus.3837] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Ocular involvement in leukemia may occur because of direct leukemic infiltration or because of secondary ophthalmic involvement as a result of abnormalities related to blood like anemia, thrombocytopenia, and leukocytosis. In some patients with leukemia, ophthalmic signs can precede the systemic features and can help in early diagnosis of systemic leukemia. Due to the scarcity of data on this topic from Pakistan, we conducted this study to determine the pattern of ocular involvement in patients with leukemia presenting in our settings. Methods This cross-sectional study was conducted in a tertiary care hospital of Pakistan over a period of one year. The study comprised of both newly diagnosed and follow-up patients of acute leukemia of age more than 15 years. Patients underwent detailed ophthalmic anterior and dilated posterior segment examination. Patient's demographic profile, type of leukemia, chemotherapy status, and hematologic findings were also documented. Results There were 97 leukemic patients in the study with 55 (56.7%) males and 42 (43.3%) females. Various ophthalmic manifestations were observed in 47 (48.45%) patients. Forty-two (43.3%) were diagnosed cases with acute lymphocytic leukemia (ALL) and 55 (56.7%) suffered from acute myelogenous leukemia (AML). Ophthalmic manifestations were present in 29 patients of AML (52.7%) and 18 patients of ALL (42.85%). Ocular involvement was significantly more common in newly diagnosed (n=32) as compared with follow-up patients (n=15) (p-value = 0.032). Posterior segment (n=48) was the most common site of ocular involvement (n=48, 49.5%) with retinal hemorrhages seen in 40 patients (41.2%) and papilloedema in seven cases (7.2%). Thirty-three (70.2%) out of 47 patients with ophthalmic manifestations were asymptomatic while 14 (29.8%) had ocular symptoms at the time of initial presentation. Conclusion Ophthalmic manifestations were present in about half of the patients with leukemia. Ocular involvement was more prevalent in newly diagnosed cases and in patients with AML.
Collapse
Affiliation(s)
- Mohammad Uzair Hafeez
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Muhammad Hassaan Ali
- Department of Ophthalmology, University of California at Los Angeles/ Stein Eye Institute, Los Angeles, USA
| | - Nimra Najib
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Muhammad Hammad Ayub
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Kaleem Shafi
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Mubashar Munir
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Nadeem Hafeez Butt
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| |
Collapse
|
23
|
|
24
|
Mello LGM, de Paula Effgen P, Kiefer K. Intravitreal Methotrexate for Iris and Ciliary Body Relapse in Acute Lymphoblastic Leukemia. J Pediatr Ophthalmol Strabismus 2018; 55:e16-e19. [PMID: 30180238 DOI: 10.3928/01913913-20180608-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/25/2018] [Indexed: 11/20/2022]
Abstract
The authors report a rare unilateral iris and ciliary body relapse in acute lymphoblastic leukemia. Ophthalmologic examination showed reduced visual acuity, pseudohypopyon, and iris irregularity. Ultrasound biomicroscopy and aqueous humor cytology confirmed leukemic infiltration. Lesions were treated with intravitreal methotrexate, which has not been described previously for acute lymphoblastic leukemia. [J Pediatr Ophthalmol Strabismus. 2018;55:e16-e19.].
Collapse
|
25
|
|
26
|
Soman S, Kasturi N, Srinivasan R, Vinod KV. Ocular Manifestations in Leukemias and Their Correlation with Hematologic Parameters at a Tertiary Care Setting in South India. Ophthalmol Retina 2018; 2:17-23. [PMID: 31047297 DOI: 10.1016/j.oret.2017.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the prevalence of ocular manifestations and the association of these manifestations with hematologic parameters among patients with leukemia attending a hemato-oncology unit at a tertiary care government hospital in South India. DESIGN This was a cross-sectional observational study. PARTICIPANTS All patients attending a hemato-oncology unit at a tertiary care government hospital in South India who were diagnosed with acute or chronic leukemia that was confirmed by a bone marrow biopsy. METHODS Consecutive patients with leukemia presenting at the hematology clinic underwent standardized leukemia blood workup and comprehensive ophthalmic evaluation. Patient demographics, the type of leukemia, ophthalmic features, and hematological parameters such as hemoglobin level, white blood cell count, and platelet counts were recorded. The association between ophthalmic manifestations and blood counts was analyzed using multivariable regression analysis. MAIN OUTCOME MEASURES The study measured the prevalence of various ocular manifestations in different types of leukemias and their association with hematologic parameters. RESULTS In total, 133 eyes of 133 patients were examined during the study period. The prevalence of leukemic ophthalmopathy was found to be 68% in cases of acute myeloid leukemia, 42% in cases of acute lymphoid leukemia, 33% in cases of chronic lymphoid leukemia, and 13% in cases of chronic myeloid leukemia. Vision-threatening complications such as subhyaloid hemorrhage involving the posterior pole (20%) and vitreous hemorrhage (10%) were seen exclusively in patients with acute leukemias. Multivariable logistic regression after adjusting for the type of leukemia, patient age, and white blood cell and platelet counts showed that the hemoglobin level was the only factor predictive of developing subhyaloid hemorrhage (every 1-g/L increment increase in hemoglobin level led to a 30% reduction in the likelihood of developing subhyaloid hemorrhage; 95% confidence interval 0.5-0.9; P = 0.02). The probability of developing subhyaloid hemorrhage was reduced by >50% when hemoglobin level improved from 5 to 7 g/L and when platelet count improved from 10 000 to 50 000 cells/mm3 for both types of acute leukemia. There was no association between white blood cell counts and ophthalmic manifestations. CONCLUSION Leukemic ophthalmopathy is more common in acute and myeloid cases and less common in chronic and lymphoid subtypes. It is predominantly due to secondary rheological changes. Blood transfusion should be considered when hemoglobin level and platelet count decrease below 7 g/L and 50 000 cells/mm3, respectively, to prevent vision-threatening complications. Patients with acute leukemias should undergo ophthalmic screening at baseline and then periodically to prevent visual morbidity.
Collapse
Affiliation(s)
- Savya Soman
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India.
| | - Renuka Srinivasan
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - K V Vinod
- Department of General Medicine, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
27
|
Plötzliche bilaterale Visusminderung bei einem 14-jährigen Jungen. Ophthalmologe 2017; 114:748-750. [DOI: 10.1007/s00347-017-0448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
28
|
Yalcinbayir O, Baytan B, Gelisken O, Can B, Sezgin Evim M, Yildiz M, Meral Gunes A. Spectral domain optical coherence tomography findings of patients under treatment for pediatric acute lymphoblastic leukemia. J AAPOS 2017; 21:131-135.e1. [PMID: 28315402 DOI: 10.1016/j.jaapos.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/23/2016] [Accepted: 12/16/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the use of spectral domain optical coherence tomography (SD-OCT) findings in pediatric acute lymphoblastic leukemia (ALL) patients. METHODS Children that were diagnosed with precursor B-cell ALL and classified as belonging to the medium-risk group for relapse were selected for this study. Individuals who were in continuous remission and on maintenance therapy were included in the study group. Cases that had central nervous system involvement were excluded. Age-matched, otherwise healthy children were selected for the control group. Each study participant underwent a comprehensive eye examination and SD-OCT evaluation. Thickness measurements were made within the retinal nerve fiber layer (RNFL), central macula, posterior polar, and peripapillary choroid. RESULTS A total of 112 eyes of 56 children were included: 54 eyes in the study group and 58 in the control group. Compared to the control group, subfoveal and temporal choroidal thicknesses of the posterior pole were significantly thinner in the study group (P < 0.005). Similarly, peripapillary choroidal thicknesses were significantly thinner in most sectors of the study group (P < 0.005). There were no major differences between groups in terms of central macular thicknesses and overall RNFL thicknesses. CONCLUSIONS Evidence of choroidal attenuation was found in this subgroup of pediatric ALL patients. Further studies are warranted to clarify the utility of SD-OCT in detecting subclinical ocular involvement and monitoring treatment response and risk of relapse in patients with pediatric leukemia.
Collapse
Affiliation(s)
- Ozgur Yalcinbayir
- Department of Ophthalmology. Uludag University School of Medicine, Bursa, Turkey.
| | - Birol Baytan
- Department of Pediatric Hematology, Uludag University School of Medicine, Bursa, Turkey
| | | | - Basak Can
- Department of Ophthalmology. Uludag University School of Medicine, Bursa, Turkey
| | - Melike Sezgin Evim
- Department of Pediatric Hematology, Uludag University School of Medicine, Bursa, Turkey
| | - Meral Yildiz
- Department of Ophthalmology. Uludag University School of Medicine, Bursa, Turkey
| | - Adalet Meral Gunes
- Department of Pediatric Hematology, Uludag University School of Medicine, Bursa, Turkey
| |
Collapse
|
29
|
Dhasmana R, Prakash A, Gupta N, Verma SK. Ocular manifestations in leukemia and myeloproliferative disorders and their association with hematological parameters. Ann Afr Med 2017; 15:97-103. [PMID: 27549412 PMCID: PMC5402809 DOI: 10.4103/1596-3519.188887] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To study the ocular manifestations in patients diagnosed with leukemia or myeloproliferative disorders and to derive an association between the ocular manifestations and hematological parameters of the patients. Materials and Methods: This observational and descriptive study was conducted in a Tertiary Care Center of Dehradun, North India over a period of 1 year. All the diagnosed cases of leukemia and myeloproliferative diseases attending the Oncology Department were included. Patients underwent a detailed ocular examination. The hematological parameters were also recorded including hemoglobin (Hb), total leukocyte count (TLC), and platelet count. Results: The study included 102 patients out of which, there were 66 males (64.7%), and 36 were females (35.3%) with an age range of 5–80 years. A total of forty patients showed ocular manifestations (39.3%). Extraocular manifestations were seen in 10.8% patients while intraocular manifestations were noted in 45.1% patients of acute leukemia and 7.7% patients of chronic leukemia. These ocular manifestations showed a significant association with low Hb (P = 0.000), raised TLC (P = 0.004), and low platelet count (P = 0.000). The most common ocular manifestation was intraretinal hemorrhages followed by roth spots. Among acute myeloid leukemia patients (23.5%), the presence of intraretinal hemorrhages was significantly associated with low Hb (Mann–Whitney U-test = 25.000, P = 0.007). The patients of acute lymphoblastic leukemia (25.4%) showed significant association between intraretinal hemorrhages and low platelet count (Mann–Whitney U-test = 44.000, P = 0.046) and roth spots with low Hb (Mann–Whitney U-test = 11.000, P = 0.000). Ocular manifestations were more commonly seen in acute leukemias as compared to chronic leukemias. Conclusion: Ocular examination is recommended in all leukemic patients as ocular manifestations may go unnoticed, most patients being asymptomatic and could be an early sign of worsening of disease.
Collapse
Affiliation(s)
- Renu Dhasmana
- Department of Ophthalmology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Amrita Prakash
- Department of Ophthalmology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Neeti Gupta
- Department of Ophthalmology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - S K Verma
- Department of Medicine, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| |
Collapse
|
30
|
de Jong F, Mérelle ME, van Vuurden DG, Kaspers GJL. An 8-Year-Old Girl with Ocular Swelling. J Pediatr 2017; 181:324-324.e1. [PMID: 27855997 DOI: 10.1016/j.jpeds.2016.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Femke de Jong
- Department of General Practice Academic Medical Center Amsterdam - University of Amsterdam Amsterdam, The Netherlands
| | - Marieke E Mérelle
- Department of Pediatrics Spaarne Gasthuis Hoofddorp Hoofddorp, The Netherlands
| | - Dannis G van Vuurden
- Department of Pediatric Oncology/Hematology VU University Medical Center AmsterdamAmsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology/Hematology VU University Medical Center Amsterdam Amsterdam, The Netherlands; Academy of Princess Máxima Center for Pediatric Oncology Utrecht, The Netherlands
| |
Collapse
|
31
|
Koshy J, John MJ, Thomas S, Kaur G, Batra N, Xavier WJ. Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India. Indian J Ophthalmol 2016; 63:659-64. [PMID: 26576524 PMCID: PMC4687193 DOI: 10.4103/0301-4738.169789] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Context: Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. Aims: This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India. Settings and Design: Subjects of leukemia presenting to a tertiary care center in India. Subjects and Methods: A prospective, cross-sectional study looking at the spectrum of ocular manifestations in all inpatients of acute or chronic leukemia. Statistical Analysis Used: The collected data were analyzed using the Statistical Package for Social Sciences for Windows software, version 16 (SPSS Inc., Chicago, Illinois, USA). Results: The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%). Conclusions: Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular changes are often picked up in asymptomatic patients.
Collapse
Affiliation(s)
- Jacob Koshy
- Department of Ophthalmology, Christian Medical College, Ludhiana, Punjab, India
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW This article aims to describe the ocular manifestations of leukemia, resulting both from direct infiltration of neoplastic cells and from the more common secondary effects of leukemia and its treatment. The prevalence of these findings is also discussed, along with their clinical significance, association with hematologic markers and the ophthalmologist's role caring for these patients. RECENT FINDINGS Recent studies have included a large case series examining the prevalence of ocular manifestations in newly diagnosed leukemic patients as well as case reports of ocular manifestations of leukemia. SUMMARY Patients with leukemia often have ocular manifestations. These occur either from direct infiltration of neoplastic cells or from indirect or secondary causes, including hematologic abnormalities, central nervous system involvement, opportunistic infections, or from treatment. Although nearly all ocular structures can be affected, leukemic retinopathy is often the most clinically apparent manifestation. Awareness of the ophthalmic manifestations of leukemia is important as they may precede systemic diagnosis or may be a sign of leukemia recurrence.
Collapse
|
33
|
Bypareddy R, Takkar B, Azad SV, Chawla R. Anterior chamber exudation in chronic myeloid leukaemia. BMJ Case Rep 2016; 2016:bcr-2016-217173. [PMID: 27895079 DOI: 10.1136/bcr-2016-217173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Anterior chamber leukaemic hypopyon is a rare occurrence in chronic myeloid leukaemia. We discuss two cases marked by rapid exudation inside the anterior chamber, which were subsequently diagnosed as chronic myeloid leukaemia. The hypopyon in both the cases resolved on induction of chemotherapy.
Collapse
Affiliation(s)
- Ravi Bypareddy
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shorya Vardhan Azad
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
34
|
Hossain IT, Moosajee M, Abou-Rayyah Y, Pavasovic V. Orbital mass secondary to infantile acute lymphoblastic leukaemia. BMJ Case Rep 2016; 2016:bcr-2016-214872. [PMID: 27143162 DOI: 10.1136/bcr-2016-214872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 8-month-old Asian infant girl was referred with a 1-week history of left periorbital swelling on a background of a narrowed left palpebral aperture over the preceding 8 weeks. There was no history of chronic illness, fever or other systemic features. Examination revealed a tender and fluctuant medial canthal swelling with associated periorbital haematoma. There were no other ophthalmic findings and neurological examination was normal. A MRI scan of the brain and orbit demonstrated abnormal soft tissue with features of an aggressive tumour in the left orbital region with no globe invasion. Peripheral blood smear revealed blast cells, confirmed by bone marrow aspirate. A diagnosis of infant acute lymphoblastic leukaemia was made. The patient was started on risk-stratified chemotherapy according to the Interfant-06 Protocol The periorbital swelling resolved by day eight following a course of prednisolone, the patient continues on chemotherapy and is currently in molecular remission.
Collapse
Affiliation(s)
| | - Mariya Moosajee
- Department of Paediatric Ophthalmology, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Yassir Abou-Rayyah
- Department of Paediatric Ophthalmology, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Vesna Pavasovic
- Department of Malignant Haematology, Great Ormond Street Hospital For Children NHS Trust, London, UK
| |
Collapse
|
35
|
Orhan B, Malbora B, Akça Bayar S, Avcı Z, Alioğlu B, Özbek N. Ophthalmologic Findings in Children with Leukemia: A Single-Center Study. Turk J Ophthalmol 2016; 46:62-67. [PMID: 27800262 PMCID: PMC5082251 DOI: 10.4274/tjo.03880] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/11/2015] [Indexed: 12/04/2022] Open
Abstract
Objectives: Ophthalmologic disease in patients with acute leukemia occurs due to primary leukemic infiltration (involvement), or secondary to the disease and its treatment. In recent years the life expectancy of acute leukemia patients has increased with the advent of modern therapies. The present study aimed to determine the incidence of ocular manifestations in children with acute leukemia. Materials and Methods: The study included 120 patients diagnosed with acute leukemia at Başkent University Hospital, Pediatric Hematology Department between 1995 and 2010. All the patients were examined by an ophthalmologist via direct and indirect ophthalmoscopy. Results: Among the patients, 83 (69.2%) were diagnosed with acute lymphoblastic leukemia, 35 (29.1%) with acute myeloblastic leukemia, and 2 (1.7%) with mixed-lineage leukemia. In all, 58 ophthalmic manifestations were noted in 41 patients (34.2%). In our patients, 12 ophthalmologic involvements were present at admission and 46 ocular findings occurred during follow-up. The incidence of these manifestations increased with age. Conclusion: Ophthalmologic manifestations were not correlated with gender, hematological parameters at disease onset, type of leukemia, or the frequency of relapse and survival. To more clearly determine the effect of ophthalmologic manifestations on the prognosis of leukemia, larger scale and multi-center studies are needed.
Collapse
Affiliation(s)
- Betül Orhan
- Başkent University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Barış Malbora
- Başkent University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Sezin Akça Bayar
- Başkent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Zekai Avcı
- Başkent University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Bülent Alioğlu
- Başkent University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Namık Özbek
- Başkent University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| |
Collapse
|
36
|
Khaja WA, Pogrebniak AE, Bolling JP. Combined orbital proptosis and exudative retinal detachment as initial manifestations of acute myeloid leukemia. J AAPOS 2015; 19:479-82. [PMID: 26486038 DOI: 10.1016/j.jaapos.2015.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 04/28/2015] [Accepted: 05/12/2015] [Indexed: 11/29/2022]
Abstract
We report bilateral orbital and choroidal involvement as the presenting sign of acute myeloid leukemia in a 2-year-old white girl. The patient presented with painless proptosis and subconjunctival hemorrhage. Ophthalmic examination and magnetic resonance imaging revealed bilateral leukemic infiltrates of the orbits and choroid, with an exudative retinal detachment in the right eye. Bone marrow biopsy confirmed acute myeloid leukemia. Following radiation treatment, chemotherapy, and hematopoietic stem cell transplantation, the patient was doing well 12 months after presentation. Outcomes can be poor, even with treatment; prompt recognition of ophthalmic manifestations of leukemia, including proptosis, choroidal infiltration, and retinal detachment, is necessary.
Collapse
Affiliation(s)
- Wassia A Khaja
- Department of Ophthalmology, University of Florida, College of Medicine, Jacksonville, Florida
| | | | - James P Bolling
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
37
|
Adam MK, Pitcher JD, Shields CL, Maguire JI. Enhanced depth imaging optical coherence tomography of precursor cell leukemic choroidopathy before and after chemotherapy. Middle East Afr J Ophthalmol 2015; 22:249-52. [PMID: 25949087 PMCID: PMC4411626 DOI: 10.4103/0974-9233.150630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Serous retinal detachment (SRD) can be the initial manifestation of leukemia. Herein, we explore the retinal and choroidal features on enhanced depth imaging optical coherence tomography (EDI-OCT) of SRD in a patient with undiagnosed leukemia. A 23-year-old male developed blurred visual acuity of 20/200 in the right eye oculus dexter (OD) and 20/200 in the left eye oculus sinister (OS). Funduscopically, he manifested serous macular detachment in both eyes oculi uterque (OU) without hemorrhagic retinal abnormalities. EDI-OCT disclosed macular detachment OU and homogeneous, marked choroidal opacification with thickening to 724 μm OD and estimated >600 μm OS and with loss of choroidal detail OU. Peripheral blood smears revealed severe thrombocytopenia and normal leukocyte count. Peripheral cytochemisty, immunophenotyping, and bone marrow aspirate confirmed the presence of atypical lymphoblasts, fulfilling criteria for precursor cell leukemia. Following systemic chemotherapy, the visual acuity improved to 20/25 OD and 20/20 OS. On EDI-OCT, the choroidal thickening resolved to 431 um OD and 443 um OS, leaving a normal choroidal appearance. Massive choroidal infiltration with leukemic cells could be the cause of serous macular detachment found in patients with newly diagnosed leukemia.
Collapse
Affiliation(s)
- Murtaza K Adam
- Retina Service, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - John D Pitcher
- Retina Service, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Carol L Shields
- Oncology Service, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | | |
Collapse
|
38
|
Ophthalmic manifestations in recently diagnosed childhood leukemia. Eur J Ophthalmol 2015; 26:88-91. [PMID: 26165325 DOI: 10.5301/ejo.5000647] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the prevalence and the pattern of ocular involvement in children with leukemia at the time of diagnosis. METHODS The data of patients with leukemia who underwent complete ophthalmic examination at the time of diagnosis between January 2005 and December 2014 were retrospectively reviewed. Demographic data, type of leukemia, ocular findings, blood parameters, and duration of follow-up were analyzed. RESULTS A total of 185 patients (111 male and 74 female) were included in the study, with a median age of 6.0 years (range 0.5-18.0 years) and a median follow-up time of 36.0 months (range 0.5-108.0 months). Ocular signs were present in 24.3% of the patients at the time of diagnosis and 37.8% of them were symptomatic. The prevalence of ocular involvement was 20.4% in patients with acute lymphocytic leukemia (ALL) and 36.4% in patients with acute myelocytic leukemia (AML) (p = 0.051). Fatality rate was significantly higher in subjects with AML compared with ALL (p = 0.019), but was not significantly different between patients with and without ocular involvement (p = 0.166). There were no significant differences in hemoglobin levels, white blood cell counts, or platelet counts between patients with ALL and AML. Platelet counts were significantly lower in patients with ocular signs compared with subjects without ocular involvement (p = 0.012), while hemoglobin levels and white blood cell counts did not differ significantly. CONCLUSIONS Various ocular signs may be present at the time of diagnosis in childhood leukemia, even in patients without any symptoms. Routine ophthalmic examination should be performed in recently diagnosed children with leukemia.
Collapse
|
39
|
Chocron IM, Morrison DG, Friedman DL, Desai NA, Donahue SP. Ophthalmic manifestations of relapsing acute childhood leukemia. J AAPOS 2015; 19:284-6. [PMID: 25890837 DOI: 10.1016/j.jaapos.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/24/2022]
Abstract
Acute lymphoblastic leukemia is the most common malignancy in children. We report 3 patients who presented to their general pediatricians and pediatric oncologists with ocular complaints as the only evidence of their leukemic relapses. All patients presented with persistent conjunctival injection and were referred to an ophthalmologist for further management. Two patients were diagnosed with recurrent anterior uveitis, which after extensive workup and treatment with topical glucocorticoids was found to be a result of leukemic ocular disease. One patient had a conjunctival tumor, which was biopsied and confirmed to be leukemic infiltration. All children eventually succumbed to their recurrent disease. These cases demonstrate the need for a high index of suspicion when evaluating ocular symptoms in patients with a prior history of acute lymphoblastic leukemia. Anterior chamber paracentesis and biopsy of suspicious lesions should be considered as possible diagnostic procedures in addition to standard hematologic studies. Collaboration between a primary care physician, pediatric oncologist, and ophthalmologist is essential for optimal diagnosis and treatment.
Collapse
Affiliation(s)
- Isaac M Chocron
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David G Morrison
- Vanderbilt Eye Institute, Nashville, Tennessee; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Debra L Friedman
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Neerav A Desai
- Vanderbilt University School of Medicine, Nashville, Tennessee; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
| | - Sean P Donahue
- Vanderbilt Eye Institute, Nashville, Tennessee; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| |
Collapse
|
40
|
Transient optic perineuritis as the initial presentation of central nervous system involvement by pre-B cell lymphocytic leukemia. J Neuroophthalmol 2014; 33:162-4. [PMID: 23470986 DOI: 10.1097/wno.0b013e318281b84d] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 20-year-old man with a history of pre-B cell acute lymphocytic leukemia (ALL) presented with optic perineuritis of the right eye while undergoing chemotherapy. Evaluation failed to reveal an infectious or neoplastic cause, and the patient improved with oral corticosteroid treatment. He returned 10 weeks later with complete loss of vision in the right eye. Optic nerve biopsy revealed leukemic infiltration of the optic nerve, and the patient was treated for central nervous system (CNS) relapse of ALL. Transient optic perineuritis may be the initial manifestation of CNS involvement of pre-B cell ALL.
Collapse
|
41
|
Do DV, Dhaliwal RS, Schachat AP. Leukemias and Lymphomas. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
42
|
Taamallah-Malek I, Chebbi A, Bouladi M, Nacef L, Bouguila H, Ayed S. [Massive bilateral subconjunctival hemorrhage revealing acute lymphoblastic leukemia]. J Fr Ophtalmol 2012; 36:e45-8. [PMID: 23122838 DOI: 10.1016/j.jfo.2012.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/29/2012] [Accepted: 03/13/2012] [Indexed: 11/26/2022]
Abstract
We report the case of 20-year-old patient who presented in emergency with bilateral massive, spontaneous subconjunctival hemorrhage. Clinical findings suggested a blood dyscrasia, which was confirmed by blood cell count. The patient was urgently referred to hematology where the diagnosis of acute lymphoblastic leukemia was made. This case highlights the importance of working up any unusual subconjunctival hemorrhage, as it may reveal, in certain cases, a severe life-threatening disease.
Collapse
Affiliation(s)
- I Taamallah-Malek
- Service d'ophtalmologie A, institut Hédi Raies d'ophtalmologie, boulevard 9-Avril, 1004 Tunis, Tunisie.
| | | | | | | | | | | |
Collapse
|
43
|
Huang PK, Sanjay S. Visual Disturbance as the first Symptom of Chronic Myeloid Leukemia. Middle East Afr J Ophthalmol 2012; 18:336-8. [PMID: 22224030 PMCID: PMC3249827 DOI: 10.4103/0974-9233.90143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a well-studied entity and advances made in diagnosis and treatment have improved the disease outcome. Patients with ophthalmic manifestation of CML have been reported to have lower 5-year survival rates. Hence, recognizing the early fundus changes may improve outcome by allowing earlier diagnosis and treatment. We report a case of a previously healthy 30-year-old Myanmarese male, who presented with a minor visual disturbance, complaining of seeing a ‘black dot’ in his left visual field for the past 1 week. Fundoscopic examination revealed bilateral retinal blot hemorrhages, white-centered hemorrhage, and preretinal hemorrhage over the left fovea. The full blood count and peripheral blood film were abnormal, and bone marrow biopsy confirmed the diagnosis of CML. Cytoreduction therapy was promptly commenced and his symptoms resolved, with improvement in visual acuity. No complications were recorded at 1-year follow-up.
Collapse
Affiliation(s)
- Philemon K Huang
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital/ Alexandra Health, 90 Yishun Central, Singapore, 768828
| | | |
Collapse
|
44
|
Abstract
A 5-year-old girl from Rwanda was referred to our pediatric oncology department with severe bilateral proptosis and a bloody, necrotic chemosis of the conjunctiva and infraorbital tissues. Furthermore, she presented with a left facial paresis, hemorrhagic gingiva, epistaxis, and bloody tears. There was a 3-month history of pancytopenia. Investigations that included a complete blood count, peripheral blood smear, and bone marrow aspirate, were conclusive for the diagnosis of acute myeloid leukemia.
Collapse
|
45
|
|
46
|
Ocular biopsy through external needle drainage for isolated bilateral ocular relapse of childhood acute lymphoblastic leukemia. Retin Cases Brief Rep 2011; 5:333-5. [PMID: 25390428 DOI: 10.1097/icb.0b013e3181ff074c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Isolated ocular relapse of acute lymphoblastic leukemia is not commonly seen. Subretinal infiltration and exudative retinal detachment may not provide a positive vitreous biopsy for histopathologic confirmation. METHOD We present a case of a 5-year-old male patient with acute lymphoblastic leukemia in remission, who presented with bilateral subretinal leukemic infiltrates and exudative retinal detachment. An ocular biopsy through external needle drainage histopathologically confirmed an ocular relapse of acute lymphoblastic leukemia. RESULTS Isolated ophthalmic relapse of acute lymphoblastic leukemia can present as bilateral exudative retinal detachment with subretinal infiltration. CONCLUSION External needle drainage of the subretinal fluid and subretinal infiltration can increase the diagnostic yield for histopathologic confirmation of the relapse.
Collapse
|
47
|
Lad EM, Jain A, Lad SP, Lin RC, Alcorn DM, Moshfeghi DM. Orbital recurrence of B-progenitor acute lymphoblastic leukemia in a child. J Pediatr Ophthalmol Strabismus 2010; 47:46-50. [PMID: 20128555 DOI: 10.3928/01913913-20100106-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 03/19/2008] [Indexed: 11/20/2022]
Abstract
Orbital mass is an exceedingly rare presentation of acute lymphoblastic leukemia. This report describes a 12-year-old boy with recurrent orbital pre-B-cell acute lymphoblastic leukemia and reviews the literature on the incidence, presentation, prognosis, and management of orbital tumors in acute lymphoblastic leukemia. Early diagnosis and treatment of orbital acute lymphoblastic leukemia with a multidisciplinary approach is essential to minimize or prevent deterioration of vision and optimize clinical outcomes.
Collapse
Affiliation(s)
- Eleonora M Lad
- Departments of Pohthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
PURPOSE To report a case of leukemia relapse in the subretinal space that was diagnosed by transvitreal subretinal biopsy. METHODS Case report and literature review. RESULTS A 5-year-old girl with prior history of acute lymphocytic leukemia who was in clinical remission was examined for a unilateral subretinal mass. Her systemic evaluation was negative for recurrence of the acute lymphocytic leukemia. Pars plana vitrectomy with a subretinal biopsy showed leukemic cells confirmed by flow cytometric immunophenotyping. The patient subsequently underwent bone marrow transplantation with regression of the subretinal mass. CONCLUSION Leukemia relapse may occur in the subretinal space. A relapse may be successfully diagnosed with a subretinal biopsy through a pars plana vitrectomy.
Collapse
|
49
|
Puvanachandra N, Goddard K, Lyons CJ. Dramatic visual recovery after prompt radiotherapy and chemotherapy for leukaemic infiltration of the optic nerve in a child. Eye (Lond) 2009; 24:927-8. [DOI: 10.1038/eye.2009.204] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
50
|
Char DH, Miller T, O'brien JM. Intraocular Lymphomas: Diagnosis and Therapy. Semin Ophthalmol 2009. [DOI: 10.3109/08820539309060244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|