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Lee JH, Kim JJ, Hong SY, Kim GH, Kim JY, Kim RY, Kim M, Park YG, Kim YJ, Cho BS, Lee S, Kim HJ, Park YH. Analysis of retinal and choroidal microvascular changes using optical coherence tomography and optical coherence tomography angiography in patients with acute leukemia. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06504-y. [PMID: 38713398 DOI: 10.1007/s00417-024-06504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE Although leukemic retinopathy accounts for 80% of ocular complications in acute leukemia, its pathogenesis remains unclear. To evaluate changes in retinal and choroicapillaris and structural parameters in patients with acute leukemia, we analyzed the correlation between vascular perfusion metrics and laboratory parameters and assessed the changes after hematopoietic stem cell transplantation (HSCT). METHODS Herein, 104 eyes of 52 patients aged 18 and above with acute leukemia were enrolled. 80 eyes of 40 healthy patients were recruited as control participants. All participants underwent optical coherence tomography (OCT) and OCT angiography (OCTA) at baseline. RESULTS Patients with acute leukemia had a significantly thicker ganglion cell-inner plexiform layer (GCIPL) and lower circularity index than the control participants. Post-HSCT perfusion metrics did not differ significantly, but parafoveal thickness decreased significantly. During the active phase of acute leukemia, lower platelet levels were associated with significant GCIPL thickening and increased foveal avascular zone and perimeter. D-dimer levels positively correlated with GCIPL thickness. CONCLUSION Patients with acute leukemia had subclinical retinal microvascular deficits on OCTA and GCIPL thickening on OCT, possibly associated with bone marrow function. GCIPL thickness may indicate acute ischemia in such patients. Further studies must elucidate their clinical and prognostic significance.
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Affiliation(s)
- Ji Hye Lee
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Jae Jung Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Seo Yeon Hong
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Gee-Hyun Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Joo-Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Rae-Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Mirinae Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Young-Geun Park
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Yoo-Jin Kim
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Sik Cho
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Lee
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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Thareja J, Minj A, Samal P, Panigrahi PK. Ophthalmic manifestations in hematological malignancies: An observational study from a tertiary care health center in Eastern India. Indian J Ophthalmol 2024; 72:659-663. [PMID: 38189493 DOI: 10.4103/ijo.ijo_815_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/08/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE This study aimed to document the spectrum of ocular manifestations of hematological malignancies presenting to a tertiary health center in Eastern India and their association with blood parameters. METHODS This hospital-based cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with leukemia, lymphoma, and multiple myeloma were enrolled in the study. A comprehensive ophthalmic evaluation was done in each case. RESULTS A total of 97 patients with a confirmed diagnosis of hematological malignancies and meeting the inclusion and exclusion criteria were included in the study. Ocular manifestations were noted in 48 (49.48%) patients. Acute lymphocytic leukemia accounted for 35.4% of cases, followed by acute myeloid leukemia (31.25%), lymphoma (4.2%), and minimum manifestation in multiple myeloma (2.1%) patients. Among 48 patients with ocular manifestations, anterior segment involvement was found in 6.2% of cases, with subconjunctival hemorrhage being the most common, and the posterior segment was involved in 100% of patients, with intraretinal hemorrhages being the most common manifestation. A statistically significant association was noted between hemoglobin, total red blood cell count, and total platelet count with posterior segment manifestations ( p < 0.001). On multivariable logistic regression, only total leucocyte count and total platelet count were significant predictors for ocular manifestation. CONCLUSION Indirect involvement of the retina is the most common ocular pathology in hematological malignancies, with intraretinal hemorrhages being the most common finding. Ophthalmic examination is highly recommended as a part of the routine evaluation at the time of diagnosis of hematological malignancies and periodically thereafter to diagnose any ocular involvement.
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Affiliation(s)
- Japesh Thareja
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Anita Minj
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Priyanka Samal
- Department of Haematology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Pradeep Kumar Panigrahi
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
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Agrawal A, Aggarwal S, Singh R, Goyal J, Garg S. Evaluation of visual evoked potential in chronic myeloid leukemias. Oman J Ophthalmol 2023; 16:489-494. [PMID: 38059114 PMCID: PMC10697254 DOI: 10.4103/ojo.ojo_245_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Visual complaint is not very uncommon in chronic myeloid leukemia (CML) patients. Our study aims to evaluate the visual pathway using visual evoked potential (VEP) in cases of CML at the time of diagnosis and 6 weeks after tyrosine kinase therapy, to find out treatment impact in asymptomatic as well as symptomatic individuals and compare it with the general population. MATERIALS AND METHODS This is an analytical cross-sectional study. The study group comprised 20 newly diagnosed cases of CML and 20 age- and sex-matched healthy control population. A thorough history and clinical examination with detailed ophthalmological studies, including VEP, were done. Cases who had VEP abnormalities were then followed-up after 6 weeks post-Imatinib therapy and underwent repeat investigations, including VEP. RESULTS VEP in cases was significantly deranged (P < 0.001), where 15 patients (75%) had abnormalities in VEP compared to 3 (15%) in control. Post 6 weeks chemotherapy, Out of 10 cases that were followed up, 7 patients had achieved hematological remission with normal VEP finding (P = 0.02). Simultaneously, an increase in hemoglobin (P = 0.002) and reduction in total leukocyte count (TLC) (P = 0.004) were observed. CONCLUSION Considerable evidence appear to support the notion that CML patients have a higher prevalence of ophthalmic manifestations as compared to the general population, which can be screened earlier with objective tests like VEP. Concurrently, hematological parameters and VEP showed derangement at the time of diagnosis. After 6 weeks of Imatinib treatment, the improvement in VEP can then be attributed to a reduction in TLC. Hence it can be deduced that VEP has paramount importance in the early identification of ophthalmic manifestations, which are reversible with timely treatment.
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Affiliation(s)
| | - Sunita Aggarwal
- Department of Medicine, MAMC, LNJP Hospital, New Delhi, India
| | - Ranvijay Singh
- Department of Medicine, MAMC, LNJP Hospital, New Delhi, India
| | | | - Sandeep Garg
- Department of Medicine, MAMC, LNJP Hospital, New Delhi, India
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Paez-Escamilla M, Caplash S, Kalra G, Odden J, Price D, Marroquin OC, Koscumb S, Commiskey P, Indermill C, Finkelstein J, Gushchin AG, Coca A, Friberg TR, Eller AW, Gallagher DS, Harwick JC, Waxman EL, Chhablani J, Bonhomme G, Prensky C, Anetakis AJ, Martel JN, Massicotte E, Ores R, Girmens JF, Pearce TM, Sahel JA, Dansingani K, Westcott M, Errera MH. Challenges in posterior uveitis-tips and tricks for the retina specialist. J Ophthalmic Inflamm Infect 2023; 13:35. [PMID: 37589912 PMCID: PMC10435440 DOI: 10.1186/s12348-023-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/07/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gagan Kalra
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Commiskey
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jerome Finkelstein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna G Gushchin
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andreea Coca
- Department of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas R Friberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean C Harwick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gabrielle Bonhomme
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander J Anetakis
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erika Massicotte
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raphaelle Ores
- Department of Ophthalmology, McGill University Campus Outaouais, Gatineau, QC, Canada
| | | | - Thomas M Pearce
- Division of Neuropathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kunal Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Westcott
- Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Eye Center, University of Pittsburgh School of Medicine, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Zhou C, Zeng P, Wang J, Zhang Y, Fan SX, Hu YX, Nie DN, Xiao JH. Increased peripapillary capillaries in patients with acute leukemia by using optical coherence tomography angiography. Photodiagnosis Photodyn Ther 2023; 42:103569. [PMID: 37068646 DOI: 10.1016/j.pdpdt.2023.103569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/23/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE To evaluate the radial peripapillary capillary vessel density (RPC-VD) and thickness of the retinal nerve fiber layer (RNFL) in acute leukemia (AL) and the associations of these characteristics with blood laboratory parameters. METHODS A cross-sectional study was performed at the Ophthalmology Department of the Sun Yat-sen Memorial Hospital from February 2019 to April 2022. Sixty eyes of 30 patients diagnosed with AL and sixty eyes of 30 matched healthy controls were included. Optical coherence tomography angiography (OCTA) in the 4.5-mm Angio Disc scan mode and the Ganglion cell complex scan mode were performed for all participants. Correlation analyses were used to examine the associations of RPC-VD and RNFL with blood laboratory parameters. RESULTS Patients in the AL group had significantly increased RPC-VD in the whole-image (51.42±0.35 vs. 49.52±0.36) and peripapillary fields (53.90±0.43 vs. 51.17±0.50) compared with people in the control group (all P<0.001), while no difference was found for RPC-VD in the inside optic disc fields in the two groups. The RNFL in the AL group was significantly thicker than that in the control group (131.10±3.89 μm vs. 115.03±2.22 μm, P<0.05). Complete blood count (CBC) parameters, including red blood cells, hemoglobin and hematocrit, had a significant negative correlation with RPC-VD and RNFL (all P <0.05). CONCLUSION An increased RPC-VD and a thicker RNFL are evidence of fundus changes in patients with early-stage AL, and these metrics may be related to decreases in red blood cells, hemoglobin and hematocrit.
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Affiliation(s)
- Chong Zhou
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, the People's Republic of China
| | - Peng Zeng
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, the People's Republic of China
| | - Jing Wang
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, the People's Republic of China
| | - Yi Zhang
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, the People's Republic of China
| | - Shu-Xian Fan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, the People's Republic of China
| | - Yu-Xin Hu
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, the People's Republic of China
| | - Da-Nian Nie
- Department of hematology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, the People's Republic of China.
| | - Jian-Hui Xiao
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, the People's Republic of China.
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Yang L, Chen Y, Zhang Y, Shen T, Shen X. Changes in retinal circulation and choroidal thickness in patients with acute myeloid leukemia detected by optical coherence tomography angiography. Front Med (Lausanne) 2023; 10:1117204. [PMID: 36993797 PMCID: PMC10041655 DOI: 10.3389/fmed.2023.1117204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
PurposeTo investigate changes in retinal circulation and the choroid in patients with acute myeloid leukemia (AML) in the acute and remission stages, to analyze the correlation between retinal circulation and laboratory parameters, and to assess risk factors associated with leukemic retinopathy.MethodsForty-eight patients (93 eyes) with AML were enrolled and divided into two groups according to fundus examination findings: the retinopathy and no retinopathy groups. Patients underwent eye measurements before treatment and after remission. Macular vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ), and choroidal thickness (ChT) were measured using optical coherence tomography angiography. Patients with healthy eyes were recruited as control participants.ResultsPatients with leukemic retinopathy had higher measurements of white blood cells (WBCs), circulating blasts, fibrin degradation products, and cross-linked fibrin degradation products (D-dimer) and a lower hemoglobin (HB) count (p < 0.05). In the acute phase of the disease, the VD and PD were lower and the ChT was thicker in patients with AML than in controls (p < 0.05), irrespective of the presence of leukemic retinopathy; however, the patients were partially recovered in the remission stage. The VD was lower in patients with higher WBC (r = −0.217, p = 0.036), D-dimer (r = −0.279, p = 0.001), fasting blood glucose (FBG) (r = −0.298, p = 0.004) and triglyceride (r = −0.336, p = 0.001) levels. The FAZ area was negatively correlated with HB (r = −0.258, p = 0.012).ConclusionPatients with AML appear to have subclinical retinal perfusion loss and choroidal thickening in the acute phase of the disease, but this is reversible. Injury to bone marrow function may cause a decrease in retinal perfusion. Leukemic retinopathy is associated with abnormal hematologic parameters and coagulopathy.
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Affiliation(s)
- Ling Yang
- Department of Ophthalmology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanwei Chen
- Department of Ophthalmology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yunxiang Zhang
- Department of Hematology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting Shen
- Department of Ophthalmology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Ting Shen,
| | - Xi Shen
- Department of Ophthalmology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Ophthalmology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Xi Shen,
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Al-Mujaini A, Al-Shaaibi M, Al-Mughaizwi T, Wali Y, Ganesh A. Unilateral Proptosis: A Rare Presenting Sign of Acute Myeloid Leukemia. Oman Med J 2022; 37:e400. [PMID: 35915765 PMCID: PMC9260739 DOI: 10.5001/omj.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/22/2020] [Indexed: 11/11/2022] Open
Abstract
Unilateral proptosis is a rare initial presenting sign of acute myeloid leukemia (AML). We report a case of unilateral proptosis in a six-year-old girl as the initial manifestation of AML. The cancer link was initially missed and the case was investigated as one of hyperthyroidism. Peripheral blood smear and bone marrow aspirate evaluation showed signs diagnostic of AML. Computed tomography scan of orbits showed infiltrative process in the right orbit, right maxillary, and right ethmoidal sinuses. Unilateral proptosis as an extramedullary first presenting feature of AML is very rare; however, it should always be considered in the differential diagnosis of proptosis in pediatric age group.
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Affiliation(s)
- Abdullah Al-Mujaini
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Majid Al-Shaaibi
- Ophthalmology Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Tahani Al-Mughaizwi
- Pediatric Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Yasser Wali
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Anuradha Ganesh
- Department of Ophthalmology, Pediatric Ophthalmology Unit, Sultan Qaboos University Hospital, Muscat, Oman
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10
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Benvenuto F, Sgroi M, Guillen SS, Ancona D, Fandiño A. Ocular findings in children with acute leukemia at a tertiary care center in South America. Oman J Ophthalmol 2022; 15:159-162. [PMID: 35937734 PMCID: PMC9351958 DOI: 10.4103/ojo.ojo_347_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate ophthalmological findings in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in a Latin American population. MATERIALS AND METHODS This was a single-center, retrospective study. The observational analysis was conducted in AML and ALL patients seen as a routine examination at the department of ophthalmology of tertiary care center in Argentina between March 1, 2017, and February 28, 2018. RESULTS Overall, 137 patients with acute leukemia were included. The mean age was 7.9 ± 5.2 years (0-18), and 55% were male (n = 75) and 45% female (n = 45). At least one-fifth (n = 31) of the patients presented some type of ocular manifestation (23%). The most frequently observed manifestation was retinal hemorrhages (n = 14), followed by papilledema (n = 9) and ocular surface involvement (n = 5). The eye involvement was more frequently identified in the AML group (24%), compared to the ALL group (22%), especially papilledema with central nervous system compromise ALL (5%) and AML (11%), P < 0.01. The presence of hemorrhages was similar in both groups. In patients with retinal hemorrhage (n = 14), the mean hematological findings were hemoglobin 7.4 ± 0.4 g/dL (6.5-8.0), erythrocytes 2.5M ± 0.3/mm3 (confidence interval [CI], 2.0-3.1), and platelets 76,000 ± 32,000/mm3 (CI, 8000-384,000). Patients without retinal findings (n = 123), the mean hematological findings were hemoglobin 9.1 ± 0.6 g/dL (8.0-10.2), erythrocytes 3.2M ± 0.6/mm3 (CI, 2.5-3.5), and platelets 92,000 ± 44,000/mm3 (CI, 42.000-390.000). Multivariable analysis found that hemoglobin levels were the most reliable predictive factor for retinal findings. It was observed that the risk diminishes in patients with levels higher than 8.5 g/dL, and that it increased in patients with levels ranging between 6.5 and 7.5 g/dL at least twice (P < 0.01). CONCLUSIONS Our results show that ocular involvement occurs in a high percentage of patients with leukemia with a clear clinical, humoral, and sometimes prognostic correlation, suggesting routine ophthalmologic evaluation in these patients.
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Affiliation(s)
- Franco Benvenuto
- Department of Ophthalmology, SAMIC Pediatric Hospital “Prof. Dr. JP Garrahan”, Buenos Aires, Argentina,Address for correspondence: Dr. Franco Benvenuto, Pediatric Hospital Dr. Prof. JP Garrahan, Pichinchan 1850, ZIP 1245, Buenos Aires, Argentina. E-mail:
| | - Mariana Sgroi
- Department of Ophthalmology, SAMIC Pediatric Hospital “Prof. Dr. JP Garrahan”, Buenos Aires, Argentina
| | - Soledad S Guillen
- Department of Ophthalmology, SAMIC Pediatric Hospital “Prof. Dr. JP Garrahan”, Buenos Aires, Argentina
| | - David Ancona
- Department of Ocular Oncolology, Tecnologico de Monterrey, Hospital Zambrano-Hellion, Monterrey, México
| | - Adriana Fandiño
- Department of Ophthalmology, SAMIC Pediatric Hospital “Prof. Dr. JP Garrahan”, Buenos Aires, Argentina
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11
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Yunusova EM, Mukhamadeev TR, Bakirov BA. Assessment of ocular manifestation frequency and quality of life in chronic myeloproliferative disorders. BRSMU 2022. [DOI: 10.24075/brsmu.2022.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic myeloproliferative disorders (CMPD) include hemoblastoses with abnormal proliferation of myeloid lineages and concomitant alterations in the peripheral blood indicators. The aim of this study was to assess the frequency and structure of ophthalmic complications as a quality of life factor in patients with CMPD. A group of patients with hemoblastoses of this type (n = 41) were surveyed using National Eye Institute Visual Function Questionnaire-25 along with a comprehensive examination by noninvasive ophthalmological techniques. The patients typically reported impaired visual acuity, visual discomfort and foreign body sensation in the eyes. Though many of the patients assessed their general health and vision as satisfactory, the vast majority (68.3%) expressed serious concerns about their visual abilities. The ophthalmological examination revealed various defects including refractive errors (61%), corkscrew dilation and tortuosity of conjunctival and retinal vessels (77.9%), recurrent subconjunctival hemorrhages (39%) and dilated optic nerve sheaths (36.6%). The survey data indicate that visual impairments significantly affect quality of life in patients with CMPD. Overall, the results underscore the importance of interdisciplinary approach in the management of patients with CMPD to enable early diagnosis and feasible correction of the ophthalmic component.
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Affiliation(s)
- EM Yunusova
- Bashkir State Medical University, Ufa, Russia
| | | | - BA Bakirov
- Bashkir State Medical University, Ufa, Russia
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12
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Hmila L, Bonnafous M, Albornoz D, Renaudier P, Merle H. Leucémie aiguë promyélocytaire révélée par des taches de Roth et un œdème papillaire bilatéral au fond d’œil : à propos d’un cas. J Fr Ophtalmol 2022; 45:e217-e220. [DOI: 10.1016/j.jfo.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 10/18/2022]
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13
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Alsalem A, Almasoudi B, Alzahrani G, Sindi L, Alwan J. Orbital Swelling and Ptosis as an Initial Presentation of Childhood Acute Lymphoblastic Leukaemia: A Case Report and Review of the Literature. Case Rep Pediatr 2021; 2021:5587767. [PMID: 34123451 DOI: 10.1155/2021/5587767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
We are reporting the case of a 3-year-old-girl who initially presented with unilateral eyelid swelling and ptosis. A diagnosis of acute lymphoblastic leukaemia (ALL) was eventually made based on an orbital incisional biopsy and a bone marrow examination. Historically, orbital involvement had been linked to myeloid leukaemia; however, in lymphoid leukaemia, they are increasingly being implicated and had been reported as the sole presentation of the disease. These findings stress the importance of conducting ophthalmologic assessments in cases diagnosed with ALL in order to prevent delays in proper assessment and treatment. Management options in orbital disease are fortunately not significantly different than well-established treatment protocols.
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Lucas J, Bathini A, Greenberg K. Acute myeloid leukemia presenting as horizontal diplopia. Am J Emerg Med 2021; 49:441.e1-441.e2. [PMID: 33975743 DOI: 10.1016/j.ajem.2021.04.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022] Open
Abstract
Acute myeloid leukemia (AML) accounts for 16% of all leukemias in children. Prognosis in the pediatric population is better than that of older populations, with a younger age at diagnosis being a favorable prognostic factor [1]. Diplopia is a rare first presenting sign of AML. We present a 15 year old male complaining of diplopia and unilateral orbital swelling. Workup in the emergency department found normal neuroimaging but revealed a markedly elevated leukocytosis with anemia and thrombocytopenia. Peripheral smear showed increased blast cells >10%. This patient was ultimately diagnosed with AML. This case demonstrates an atypical presentation of AML and urges a thorough work up for patients presenting with unexplained diplopia.
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Affiliation(s)
- Joshua Lucas
- Joshua Lucas and Abhijith Bathini are from Drexel University College of Medicine, 2900 W Queen Ln, Philadelphia, PA 19129, USA.
| | - Abhijith Bathini
- Joshua Lucas and Abhijith Bathini are from Drexel University College of Medicine, 2900 W Queen Ln, Philadelphia, PA 19129, USA.
| | - Karen Greenberg
- Dr. Greenberg is from Global Neurosciences Institute, One Medical Center, Blvd ACP 232, Upland, PA 19103, USA.
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Tam EK, Ness S, Peeler CE. Exudative hemorrhagic retinopathy related to all-trans retinoic acid differentiation syndrome in a patient with acute promyelocytic leukemia. Int J Ophthalmol 2021; 14:323-325. [PMID: 33614465 DOI: 10.18240/ijo.2021.02.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Emily K Tam
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts 02118, USA
| | - Steven Ness
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts 02118, USA
| | - Crandall E Peeler
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts 02118, USA.,Department of Neurology, Boston Medical Center, Boston, Massachusetts 02118, USA
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Kim G, Desai T, Hagstrom JN, Romano TM. Papilledema on Point-of-Care Ultrasound as Presentation of Leukemia. J Emerg Med 2021; 60:387-9. [PMID: 33308917 DOI: 10.1016/j.jemermed.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/15/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022]
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17
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Saleh S, Esmail K, Albreiki D. Subjective intermittent colour vision loss as the initial presentation of chronic myeloid leukemia. Am J Ophthalmol Case Rep 2020; 19:100817. [PMID: 32695927 PMCID: PMC7364017 DOI: 10.1016/j.ajoc.2020.100817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To report a case of subjective intermittent loss of bilateral colour vision and episodic white-out vision in a patient with undiagnosed chronic myeloid leukemia (CML). Observations A patient initially diagnosed with diabetic retinopathy presented with a chief complaint of subjective intermittent loss of colour vision in both eyes, as well as intermittent bilateral white-out vision. These symptoms previously went uninvestigated until a thorough history revealed concurrent constitutional symptoms including recent night sweats and fevers. Closer fundus examination revealed that the lesions previously thought to be diabetic retinal hemorrhages were Roth spots. Conclusions: and Importance An unusual chief complaint of colour vision loss and multiple Roth spots in the context of chronic night sweats and fevers prompted further workup. A CBC with differential revealed a markedly increased WBC count and the patient was diagnosed with CML. Cytoreduction therapy led to complete resolution of the patient's visual symptoms and a return to normal WBC count at the most recent follow up appointment. We report, to our knowledge, the only case of colour vision loss as the initial presenting symptom of CML in the current literature, and reiterate the importance of a thorough history, neuro-ophthalmic examination and relevant investigations in patients with unusual visual symptoms, including intermittent loss of colour vision. In this case, we speculate that hyperviscosity syndrome secondary to CML was the cause of this patient's peculiar visual disturbance.
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Affiliation(s)
- Solin Saleh
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kaisra Esmail
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danah Albreiki
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Carter KL, Hassan M, Do DV, Nguyen QD. Acute lymphocytic leukemia masquerading as acute retinal necrosis. Am J Ophthalmol Case Rep 2020; 18:100629. [PMID: 32258824 DOI: 10.1016/j.ajoc.2020.100629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/13/2019] [Accepted: 02/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a case of B-cell acute lymphocytic leukemia (ALL) relapse presenting as acute retinal necrosis. Observations An 11-year old boy with history of B-cell ALL undergoing maintenance therapy presented with a three-month history of intermittent blurry vision and pain in the right eye when a routine lumbar puncture indicated an elevated lymphoblast-predominant white blood cell count. Bone marrow biopsy revealed 42% lymphoblasts, confirming ALL relapse. Ophthalmic imaging demonstrated a hyperemic optic disc, retinal whitening, perivascular sheathing, retinal hemorrhages, and retinal detachment in the right eye. Vitreous fluid biopsy revealed presence of rare atypical lymphoblasts. Chemotherapy, orbital radiation, and systemic prednisone resulted in improvement of visual acuity and retinal hemorrhages, and resolution of retinal detachment. Conclusions and importance We have described the clinical features, treatment, and response in a case of B-cell ALL relapse with presenting signs of acute retinal necrosis. The uncommon finding in B-cell ALL highlights the possibility of intraocular involvement and the importance of routine ophthalmologic evaluation in leukemia remission.
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Karuppannasamy D, Andavar R, Arumugam J, Muthuvel K. DRESS Syndrome Secondary to Carbamazepine Therapy Presenting with Bilateral Acute Anterior Uveitis and Angle Closure Glaucoma. J Ophthalmic Vis Res 2019; 14:382-386. [PMID: 31660117 PMCID: PMC6815337 DOI: 10.18502/jovr.v14i3.4795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, life-threatening multi-system adverse drug reaction characterized by febrile skin rash, hematologic abnormalities, and involvement of internal organs. We report a case of DRESS syndrome in a child presenting with primary ophthalmic manifestations. Case Report An 11-year-old boy presented with severe pain and diminished vision in both eyes six weeks after starting carbamazepine therapy for seizure disorder. Ocular examination revealed features of bilateral acute anterior uveitis, acute onset myopia, and angle closure glaucoma secondary to uveal effusion. Additionally, the patient was febrile with a generalized maculopapular rash, and blood investigations revealed eosinophilic leukocytosis. A diagnosis of carbamazepine-induced DRESS syndrome was made, and carbamazepine therapy was discontinued. Treatment with cycloplegics, topical, and systemic steroids resulted in prompt clinical recovery. Conclusion Ophthalmologists should be aware that hypersensitivity to anticonvulsants, such as carbamazepine, can present with bilateral uveitis and uveal effusion along with systemic symptoms. Prompt diagnosis and treatment can prevent vision loss and life-threatening complications. Patients should be counselled about potential adverse effects of anticonvulsants before therapy.
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Affiliation(s)
- Divya Karuppannasamy
- Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Raghuram Andavar
- Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Jayavardhana Arumugam
- Department of Paediatrics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Kumaresan Muthuvel
- Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Sabrane I, Belkhadir K, Saoudi S, Benchekroun S, El Ikhloufi M, Cherkaoui O. Taches de Roth évoquant une leucémie myéloïde : à propos d’un cas. J Fr Ophtalmol 2018; 41:e423-e424. [DOI: 10.1016/j.jfo.2018.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 11/29/2022]
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