Ocular Manifestations of Leukemia and Results of Treatment with Intravitreal Methotrexate

Vicktoria Vishnevskia-Dai,Ofira Zloto,Ruth Lekach,Sara Sella King,Ido Didi Fabian

doi:10.1038/s41598-020-58654-8

Vicktoria Vishnevskia-Dai, Ofira Zloto + Show 3 more

Open Access

https://doi.org/10.1038/s41598-020-58654-8

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Abstract

Ocular involvement in leukemia is considered rare. Ocular symptoms can be the presenting signs of leukemia, they can appear after diagnosis has been established, or they can be the first manifestation of a relapse after remission. We report, to the best of our knowledge for the first time, the ocular manifestation of a series of patients with ocular leukemia and the result of their treatment with intravitreal methotrexate (MTX) injections. This is a retrospective cohort study. The medical records of 12 consecutive patients with ocular leukemia (24 eyes, 11 eyes treated with MTX) treated at the Sheba Medical Center from January 2010 to December 2017 were retrospectively reviewed. Details on ocular inflammatory reaction and tumor cell infiltration at presentation and the end of follow-up were recorded as main outcome measures. The 12 patients included 7 women and 5 men (mean age ± standard deviation at diagnosis 25.92 ± 23.91 years, range 2–82 years). Eleven eyes of 6 patients were treated with intravitreal MTX injections. The indication for treatment was biopsy proven, tumor cell infiltration. The mean number of MTX injections was 3.37 ± 5.35 (range 1–18). The mean follow-up was 27.08 ± 36.79 months (range 1–93). All treated eyes showed improvement in the inflammatory reaction and tumor cell infiltration. In conclusion we found that Intravitreal MTX injections may be an effective therapeutic approach for eyes with intraocular leukemic tumor cell infiltration.

Highlights

Leukemias are a group of malignant neoplasms derived from the hematopoietic stem cells as a result of abnormal proliferation of blood cells in the bone marrow[1]
The purpose of this study is to summarize our experience with the ocular manifestations and outcomes of patients with ocular leukemia and to present, for what we believe to be the first time, a series of patients with ocular leukemia treated with intravitreal MTX injections
Ocular symptoms can be the presenting signs of leukemia, they can appear after diagnosis has been established, or they can be the first manifestation of a relapse after remission

Summary

Introduction

Leukemias are a group of malignant neoplasms derived from the hematopoietic stem cells as a result of abnormal proliferation of blood cells in the bone marrow[1]. Leukemia is classified according to the mode of presentation, i.e., acute or chronic, and the predominant proliferating cell type. Infiltration of the optic nerve presenting with or without another cranial nerve involvement (cranial nerves III, IV, or VI) clinically mimicking palsies and swollen discs. Some forms of hemorrhages representing leukemic cell infiltration while others forms of hemorrhages in leukemic patients are secondary to the systemic conditions. The current treatment of patients with ocular leukemia includes systemic chemotherapy and biological treatments[10,11]. It may not be adequate since penetration of systemic chemotherapy to the involved ocular structure may be insufficient. Another treatment option is irradiation, but it frequently involves local complications. Treatments with intravitreal injections of dexamethasone[12], anti–vascular endothelial growth factor (anti-VEGF)[13], or methotrexate (MTX)[14] have been recently investigated

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