639 UNILATERAL OPTIC NERVE DISEASE, A COMPLICATION OF CHEMOTHERAPY OF ACUTE LYMPHATIC LEUKEMIA (ALL)

Abstract

Ocular complications are not uncommon with the use of vincristine (VCR) but usually consist of ophthalmoplegias. A single case of optic neuropathy, presumably caused by VCR, has been previously reported in a patient with Hodgkin's disease (Am. J. Ophthal. 81:146, 1976). We have observed this complication in two subjects with ALL. In each case, severe unilateral retrobulbar pain occurred 5-7 days following the administration of VCR (2.0 mg/m2) during maintenance therapy. In the first subject, an 8 yr. old, eye exam several months after the onset of ocular symptoms revealed a visual acuity of 20/80 in the affected eye which failed to improve with refraction. A positive Marcus Gunn pupil, defective color vision and a central scotoma were noted. Fundoscopy was normal. Eye exam prior to the onset of symptoms had been unremarkable. In the second case, a 6 yr. old, acuity was 20/40 in the affected eye unimproved by refraction. Pupillary constriction in response to light was followed by rapid dilatation. Color vision was normal but a paracentral scotoma was present. A vitritis localized over the optic disc caused the disc to appear pale and indistinct. In each subject the contralateral eye exam was normal. In both cases repeated spinal fluid cytologies have been negative. Optic nerve disease in these cases is presumably related to the use of VCR. Retrobulbar or eye pain following the administration of VCR calls for careful ophthalmologic examination.