Retinal abnormalities in newly diagnosed adult acute myeloid leukemia

Chronic myelocytic leukemic fundus lesion: A case report

The current study reports a case of a patient with a chronic myelocytic leukemic fundus lesion, initially diagnosed in the Department of Ophthalmology, Rizhao People's Hospital (Rizhao, China). A male, 23-years-of-age, presented with a dark shadow in the front of the right eye, accompanied with blurred vision for 3 days (visual acuity of right eye, 0.4; visual acuity of left eye, 0.6). In addition, the patient had experienced gingival bleeding for 2 years, and recurrent upper respiratory infections for 1 year. A fundus examination revealed mild binocular papillary edema, dilated and tortuous veins, and the retina exhibited large quantities of scattered and dark red bleeding spots. The bleeding spots had white spots in the center, which exhibited typical Roth spots, whilst routine blood examination, abdominal ultrasound, marrow biopsy and other laboratory tests confirmed the diagnosis of chronic myelogenous leukemia. Patients with leukemia typically present with initial symptoms that include fever, fatigue, anemia and hepatosplenomegaly, and a diagnosis as a result of eye-related symptoms is rare, rendering the present case unique.

[Retinal abnormalities in adult acute myeloid leukemia: semeiological features and prognostic correlations. Analysis of 178 cases]

INTRODUCTION

Adult patients with acute myeloid leukemia (AML) frequently present retinal abnormalities. We tried to find a relationship between fundus lesions and treatment responsiveness, prognosis, and several hematologic parameters.

PATIENTS AND METHODS

We examined 178 adult patients with newly diagnosed AML. All patients were assigned to two groups regarding retinal parameters (1 or 2) and age (A or B). Group 1 included cases with retinal dysfunction classified as retinal abnormalities with impaired visual acuity; group 2 included cases with no or only minor retinal changes. Subgroup A included patients younger than 60 years (n=97), subgroup B patients older than 60 years (n=81).

RESULTS

In this study, higher age and a lower Hb value were associated with retinal findings (group 1). Among the younger patients (subgroup A), 78% of those with complete remission had no retinal findings (group 2) compared to 18% of the nonresponders. In the elderly population (subgroup B), this ratio was 58% versus 19%. In the younger patients (subgroup A), the mean overall survival was 50 months if they had no retinal abnormalities (group 2) and 7 months in the case of retinal changes (group 1). In the older population (subgroup B), the ratio was 15 months versus 3 months, respectively.

CONCLUSION

Retinal abnormalities in AML are generally associated with higher age, although they correlate with a shorter survival in both age groups. This association is stronger in younger patients.

Visual loss as a first sign of adult-type chronic myeloid leukemia in a child

PURPOSE

To report the unusual case of retinal leukemic infiltration in a child with adult-type chronic myelocytic leukemia.

DESIGN

Interventional case report.

METHODS

Complete ophthalmologic examination, including visual acuity measurement and funduscopy. The diagnosis was established by blood cell counts and confirmed by a positive Philadelphia-chromosome translocation (t [9,22]). Treatment consisted of hydroxyurea and stem-cell transplantation.

RESULTS

After therapy, complete regression of the retinal lesion was observed with full recovery of visual acuity.

CONCLUSION

This case underlines the importance of interdisciplinary cooperation between ophthalmologists and pediatric oncologists in the diagnosis and treatment of this disease.