Leukemic hypopyon

Hypopyon uveitis

Hypopyon uveitis has inflammatory, infective, and neoplastic causes and a high association with systemic disease. Careful questioning of the patient and detailed examination of the eye for other signs is necessary to guide the differential diagnosis and relevant investigations. Because the underlying causes require very different types of investigation and, if missed, can have serious sequelae for the patient, a rational approach based on the understanding of the causes of hypopyon uveitis is imperative. In this review, hypopyon uveitis is considered in the context of the associated ocular and systemic diseases that cause it.

Childhood leukaemia: relapse in the anterior segment of the eye

A proved first relapse occurred in the anterior segment of eight children with acute leukaemia, two of whom had concurrent central nervous system or bone marrow relapse. A further child developed uveitis after remission was induced, but in this patient no causal relationship with leukaemia was established. Uveitis in children who have had acute leukaemia should be regarded as evidence of relapse, and anterior chamber aspiration and iris biopsy are essential procedures in their evaluation. The outlook for children with anterior segment relapse remains poor despite intensive local and systemic treatment.

Leukemic iris infiltration

Three patients with acute lymphoblastic leukemia and leukemic infiltration of the iris are presented. The clinical features, diagnostic techniques, and treatment of this condition are described.

The eye in acute leukaemia. 2. The management of solitary anterior chamber relapse

Solitary relapse of acute lymphoblastic leukaemia (ALL) was diagnosed in the anterior chamber of the eye in five children. In all these cases, pathological confirmation of the diagnosis was obtained and there was no other evidence of relapse including cerebrospinal fluid (CSF) and bone marrow examinations. Each child had one adverse prognostic sign at the initial presentation (high white blood cell count, age or sex). Relapse always occurred soon after completion of maintenance chemotherapy (between one and 4 months), supporting the hypothesis that the eye is a pharmacological sanctuary to cytotoxic chemotherapeutic drugs. Radiotherapy to the involved orbit was given with an immediate response in all patients. The details of this treatment are discussed. Four of the five patients later relapsed, one locally and three in bone marrow; the prognosis of solitary ocular relapse therefore appears grave.

Sterile hypopyon secondary to ultrasonic cleaning solution

During a 20-week period, 21 cases of sterile hypopyon occurred 24 hours after uncomplicated extracapsular cataract extraction and in-the-bag posterior chamber intraocular lens implantation at the Valley Eye Institute. While all cases responded to steroid treatment and exhibited no residual ocular effects, the cause of the hypopyon remained a mystery despite an on-going reevaluation of the surgical procedure and sterilization techniques. Several suspected causes were investigated and eliminated. It was clinically determined that surgical instruments placed in older ultrasonic cleaning solution caused the hypopyons. Further analysis at the Center for Intraocular Research at the University of Utah revealed that the instruments were contaminated by a heat-stable endotoxin that remained on the instruments through the autoclaving process. Surgeons currently using ultrasonic instrument cleaners should be aware that, with some models, following the manufacturer's recommended fluid changing procedures could result in endotoxic contamination of surgical instruments which could, in turn, cause severe inflammatory reactions in the immediate postoperative period.

Leukemic iris infiltration as the only site of relapse in a child with acute lymphoblastic leukemia: temporary remission with high-dose chemotherapy

A 12-year-old Caucasian boy developed leukemic hyphema with iris infiltration as the only relapse site during the third complete remission of his acute lymphoblastic leukemia. With high-dose methotrexate, high-dose cytosine-arabinoside plus teniposide, and a 5-week course of vincristine, prednisolone, and L-asparaginase, a complete remission could be achieved. Maintenance treatment was reinstituted for 1 year. However, after stopping the treatment, the iris infiltrate reappeared, and this time the eye was irradiated after chemotherapeutic reinduction. Seven months later, the boy remains in complete remission. The pathogenesis of leukemic iris infiltration is discussed briefly.

Hypopyon in acute lymphoblastic leukemia

A child with acute lymphoblastic leukemia had central nervous system relapse 23 months after diagnosis while in bone marrow remission. This was followed by leukemic involvement of the eye as the only site of relapse 7 months later. Leukemic cells layered out in the anterior chamber and cytologic examination was the only way to make a definitive diagnosis of leukemic hypopyon. Topical treatment is generally ineffective and radiotherapy is the treatment of choice. The prognosis with this complication depends on whether it occurs during therapy or after therapy has been discontinued.

Ocular manifestations of leukemia. A review

Ophthalmologists are familiar with the commonly observed leukemic retinopathy and orbital infiltration in patients with both acute and chronic leukemia. With the advent of more successful and aggressive chemotherapeutic regimens and more sophisticated radiation therapy, the eye is not uncommonly involved in patients who are in either meningeal or hematological relapse. In rare instances, ophthalmologic involvement may be the only manifestation of recurrence of the leukemic process. In addition, retinal microaneurysms, capillary closure, and neovascularization have been documented in individuals with chronic leukemia. This paper will review leukemic retinopathy and leukemic infiltration of the orbit. In addition, a discussion of the frequency and pathogenesis of the retinal vascular abnormalities will be presented. The clinical picture and treatment of optic nerve, choroid and iris infiltration will be discussed. Unusual ocular manifestations as the presenting sign of leukemia will also be detailed.

Leukemic ophthalmopathy detected by ultrasound

Contact A- and B- scan ultrasonography was performed on 40 patients with acute lymphocytic leukemia at initial diagnosis, during therapy, during remission, and in patients with recurrences. This technique simply and consistently reveals tumor in the choroid, despite the fact that leukemic involvement may cause only 1-2 mm of choroidal thickening. Leukemic involvement may be diffuse or localized, detected with or without visual symptoms, and can be monitored repeatedly. Leukemic involvement of the choroid is difficult to see ophthalmoscopically, but easy to detect with contact ultrasound.