Leukemic Retinopathy Research Articles

Intraoperative optical coherence tomography (I-OCT)-guided identification of resolved sub-internal limiting membrane hemorrhage in leukemic retinopathy

Intraoperative optical coherence tomography (I-OCT)-guided identification of resolved sub-internal limiting membrane hemorrhage in leukemic retinopathy

Leukemic retinopathy with rare presentation in B-cell acute lymphoblastic leukemia

Leukemic retinopathy with rare presentation in B-cell acute lymphoblastic leukemia

Leukemic retinopathy secondary to hyperviscosity syndrome in acute lymphoblastic leukemia before and after treatment

Leukemic retinopathy secondary to hyperviscosity syndrome in acute lymphoblastic leukemia before and after treatment

Ocular manifestations of acute myeloid leukaemia

Each and every ocular tissue may be affected in leukemia and ocular involvement is a known entity since a long time . Prevalence of ocular involvement in leukemia ranges from 9% to 90% and can result from primary/direct infiltration of ocular tissues by leukemic cells or secondary/indirect involvement following systemic leukemic involvement.We present a case of a 30 years old female presented to emergency opd with history of epistaxis, low grade fever and headache from last 1 month and blurring of vision bilaterally from last 3-4 days. Examination reveals pallor, pedal edema, raised jugular venous pressure and hepatosplenomegaly. Hematology shows Hb - 4.1gm%,platelet count- 9000/mm, total leucocyte count - 11,000/mm ,international normalized ratio -2.02,elevated lymphocytes(82%) and deranged liver function tests. Peripheral smear shows microcytic hypochromic anaemia having metamyelocytes 3%, blast cells 71% with negative myeloperoxidase and periodic acid Schiff. Visual acuity was finger counting at one metres in both eyes. On slit lamp examination,there were bilateral diffuse subconjunctival hemorrhages, clear cornea, quite anterior chamber and anterior vitreous. Ocular movements were full and pupils were reactive bilaterally. Fundus examination in right eye shows dense intraretinal hemorrhages with central clearing in superior and inferior temporal arcade with macular hemorrhage and severe macular edema. In left eye, a large preretinal hemorrhage in superonasal and superotemporal arcade with vitreous hemorrhage was present along with multiple scattered intraretinal hemorrhages and severe macular hemorrhage with macular edema. Patient was diagnosed of having leukemic retinopathy with macular edema in a case of acute myeloid leukaemia.All leukemia patients should have an ocular acessment and examination at diagnosis and at least every 6 months . Ophthalmologist may have a secondary role in the treatment of leukemias but proper recognition of the ocular manifestations is crucial in the management of a case of leukemia.

Loss of the Figure 8 Appearance on OCT: A Useful Clue for Leukemic Retinopathy

Loss of the Figure 8 Appearance on OCT: A Useful Clue for Leukemic Retinopathy

IMPROVEMENT OF LEUKEMIC RETINOPATHY AFTER LEUKAPHERESIS IN CHRONIC MYELOGENOUS LEUKEMIA WITH LEUKOSTASIS

ABSTRACT 
 Introduction: to report a case of bilateral leukemic retinopathy due to leukostasis that was successfully managed by leukapheresis.
 Case Presentation: 31-year-old male with mild visual disturbance was referred to ophthalmology department. He suffered from Chronic Myelogenous Leukemia (CML) with white blood cell (WBC) count 533.900/microL. He was started on hydroxyurea, allopurinol, and once leukapheresis. Ophthalmologic evaluation revealed visual acuity of 4/4 in the right eye and 4/6,3 in the left eye. Funduscopy examination showed the presence of bilateral papilledema, venous engorgement, tortuosity, and retinal hemorrhages. Then this patient continued with second leukapheresis.
 Result: Visual acuity, laboratory examination, and funduscopic finding was evaluated. His visual acuity was improved, papilledema and retinal blood vessels abnormality had markedly reduced concurring with the patient’s hematological remission. Decreasing WBC count after leukapheresis has improved blood flow that reflected from the retinal findings and visual acuity improvement. 
 Conclusion: Leukapheresis treatment is sufficient to improved clinical condition for leukemic retinopathy caused by CML with leukostasis.
 Keywords: chronic myelogenous leukemia (CML), hyperleukocytosis, leukostasis, leukemic retinopathy

Rare Presentation of Bilateral Central Retinal Vein Occlusion and Leukemic Retinopathy in a Young Adult Diagnosed with T-cell Acute Lymphoblastic Leukemia

Simultaneous bilateral central retinal vein occlusion (CRVO) is a rare presentation that warrants consideration of an underlying hyperviscosity state. Increased serum viscosity can lead to the hematologic emergency of leukostasis with resultant vascular obstruction and hypoxic tissue damage. The following case demonstrates the first case of bilateral CRVO in a young adult secondary to acute lymphoblastic leukemia (ALL). A 23-year-old female presented to the emergency department (ED) with two days of worsening bilateral blurry vision and bitemporal headache. Her ocular exam was significant for bilateral intraretinal hemorrhages consistent with CRVO with chest radiograph demonstrating widened mediastinum with perihilar lymphadenopathy and serologic testing revealing ALL with blast crisis. The patient was subsequently admitted to the oncology service for induction chemotherapy. Patients with new headache and bilateral vision changes should prompt a thorough neurological and ophthalmologic exam to assess for underlying systemic pathologies. Concurrent bilateral CRVO is a rare but specific finding for systemic hyperviscosity syndrome, blood dyscrasia, polycythemia, or other serious illness. Early recognition and treatment of the underlying condition can prevent further vision loss and overall morbidity and mortality.

PROLIFERATIVE LEUKEMIC RETINOPATHY WITH BILATERAL EXUDATIVE RETINAL DETACHMENTS AND OPTIC DISC SWELLING IN A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA

Introduction: To report a patient with acute lymphoblastic leukemia (ALL) who developed proliferative leukemic retinopathy with bilateral exudative retinal detachments and optic disc swelling. 
 Case Report: A 11-year-old girl diagnosed with ALL-L2 on maintenance chemotherapy presented with severe blurred vision in both eyes for the past 1 year. Her visual acuity was 0,5/60 for both eyes. Slit-lamp examination of the anterior segment was found normal. Dilated fundus examination revealed tortuous retinal vessels, retinal haemorrhage, retinal and optic disc neovascularizations, optic disc with indistinct margins, and total retinal detachments in both eyes, as well as vitreous haemorrhage in the left eye. The ultrasonography examination revealed bilateral subretinal fluid.
 Discussion: The patient was diagnosed with bilateral proliferative leukemic retinopathy with exudative retinal detachments and infiltrative optic neuropathy, and left eye vitreous haemorrhage due to ALL. Conservative treatment was given. She continued the maintenance chemotherapy from pediatric department. After 2 months follow up, the visual acuity did not improve although retinal detachments were reduced. There were atrophic changes at the retina of her both eyes.
 Conclusion: It was reported a rare case of proliferative leukemic retinopathy with bilateral exudative retinal detachments and optic disc swelling. Early recognition and treatment is crucial to improve prognosis.

Leukemic Retinopathy before and after Chemotherapy

Leukemic Retinopathy before and after Chemotherapy

Presentation of Chronic Myeloid Leukaemia in Accelerated Phase Presenting with Bilateral Leukemic Retinopathy - A Case Report

The leukemias are malignant neoplasms of the hematopoietic stem cells, characterized by diffuse replacement of the bone marrow by neoplastic cells. There are 3 stages in Chronic Myeloid Leukemia-chronic phase, accelerated phase and blast phase. Ophthalmic manifestation can be classified into two categories: primary or direct leukemic infiltration and secondary or indirect involvement. Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. The prevalence of ocular involvement in leukemic patients has been reported to be 9% to 90% in various studies. To highlight the important ophthalmic manifestation in patients of leukemias we are presenting a case report on chronic myeloid leukemia in accelerated phase of a young male patient referred from medicine OPD with chief complaints of blurring of vision in both eyes since 2 days.

Ophthalmic manifestations of leukemia.

This article aims to describe the ocular manifestations of leukemia, resulting both from direct infiltration of neoplastic cells and from the more common secondary effects of leukemia and its treatment. The prevalence of these findings is also discussed, along with their clinical significance, association with hematologic markers and the ophthalmologist's role caring for these patients. Recent studies have included a large case series examining the prevalence of ocular manifestations in newly diagnosed leukemic patients as well as case reports of ocular manifestations of leukemia. Patients with leukemia often have ocular manifestations. These occur either from direct infiltration of neoplastic cells or from indirect or secondary causes, including hematologic abnormalities, central nervous system involvement, opportunistic infections, or from treatment. Although nearly all ocular structures can be affected, leukemic retinopathy is often the most clinically apparent manifestation. Awareness of the ophthalmic manifestations of leukemia is important as they may precede systemic diagnosis or may be a sign of leukemia recurrence.

Concurrent hypopituitarism and leukemic retinopathy in a child with B-precursor acute lymphoblastic leukemia and isolated central nervous system relapse.

Hypopituitarism in leukemia is very rare. In addition, central nervous system (cns) relapse and leukemic retinopathy in childhood acute lymphoblastic leukemia (all) have declined with the use of modern systemic chemotherapy that includes cns prophylaxis. Here, we report the case of a 4-year-old girl who received chemotherapy and intrathecal therapy without cns radiation after a diagnosis of B-precursor all without cns involvement. Three months after chemotherapy completion, she presented with lower-extremity weakness and was diagnosed with an isolated cns relapse. Concurrent hypopituitarism and leukemic retinopathy were also found. After receiving craniospinal radiotherapy and systemic chemotherapy, her retinopathy and vision improved. She is now in complete remission, and she is still on chemotherapy according to the guideline from the Pediatric Oncology Group. Although rare, hypopituitarism and leukemic retinopathy should be taken into consideration in patients with cns involvement by leukemia.

Hypopyon as the first sign of relapse in acute lymphoblastic leukaemia

Ocular localizations ranging from leukemic retinopathy to involvement of the iris and anterior chamber may be observed as clinical manifestations of acute lymphoblastic leukaemia (ALL). Involvement of the anterior ocular segment is very rare in adult ALL, and is found in less than 1 % of leukaemic relapses [1, 2]. We report a case of leukemic hypopyon, secondary to sedimentation of leukemic blast cells in the ocular anterior chamber, occurring in a 62-year-old woman with T-ALL who was treated with the induction chemotherapy including methotrexate, cytarabine, cyclophosphamide, doxorubicin, vincristine, and dexamethasone, also with a central nervous system (CNS) prophylaxis, and achieved a complete remission. Fourteen months after the first complete remission, while receiving maintenance therapy (mercaptopurine and methotrexate), the patient complained of an ipsilateral reduction of visual acuity on the left associated with changes in head position. Ophthalmic evaluation was performed, showing a leukemic hypopyon with a horizontal fluid level (measuring 3 mm) in the left eye. The patient refused anterior chamber paracentesis. A lumbar puncture revealed CNS relapse with 50 blast cells/lL of cerebrospinal fluid (CSF). The lymphoid blasts were positive for CD7, CD5, CD2, and CD13. Although the patient was treated with intrathecal chemotherapy with methotrexate and cytarabine, and later with liposomal cytarabine, with a clearing of malignant cells from the CSF, a worsening of the anterior chamber hypopyon was noted and the patient required ocular radiotherapy with a transient and partial response. The patient died (7 months after the diagnosis of hypopyon) with ocular, cutaneous, and bone marrow leukemic involvement.

Chronic myelogenous leukemia and retinopathy treated with imatinib.

To describe a case of a rapid clinical response to treatment of leukemic retinopathy and optic nerve infiltration with cytoreductive therapy, including imatinib mesylate (Gleevec), without radiation therapy. Observational case report. A 13-year-old boy presented with blurry vision and a visual acuity of 20/20 in each eye. On examination, he had infiltrative retinopathy and optic nerve elevation bilaterally. Further testing revealed chronic myelogenous leukemia with severe leukocytosis. The results of the bone marrow biopsy showed the Philadelphia chromosome, t(9;22), which indicated he might respond to imatinib. He was treated with leukopheresis, followed by systemic imatinib and hydroxyurea, and his leukemic retinopathy and optic neuropathy quickly improved. This case demonstrates an excellent clinical response to systemic therapy, including imatinib, without urgent radiation. It is possible, in select cases, to consider treatment with systemic cytoreductive therapy in patients with infiltrative optic neuropathy and retinopathy with the Philadelphia chromosome.

NEODYMIUM: YAG LASER TREATMENT FOR DENSE PREMACULAR SUBHYALOID HEMORRHAGE

OBJECTIVE: To assess the efficacy of Neodymium: YAG laser membranotomy and posterior hyaloidotomy in achieving rapid intravitreal drainage of dense premacular hemorrhage and rapid visual rehabilitation. METHODS: Eight eyes of eight patients had Nd: YAG laser treatment to release trapped hemorrhage overlying the macula. Two to five laser membranotomies were performed. Colored fundus photographs were taken. Patient with diabetes had panretinal photocoagulation prior to YAG laser treatment. RESULTS: The premacular hemorrhage originated from proliferative diabetic retinopathy in four eyes, from a retinal macroaneurysm in two eyes, from leukemic retinopathy one eye and from valsalva retinopathy in one eye. Complete intravitreal dispersion was achieved in all eyes within one week with marked improvement of vision. One diabetic eye showed less improvement in vision due to diffuse dispersion of hemorrhage in the vitreous. CONCLUSION: Nd: YAG laser membranotomy seems helpful in rapid clearing of premacular hemorrhage and improvement of vision in certain eyes.

Inpatient Diabetes Mellitus in the Oncology Setting

A.B. is a 32-year-old Caucasian man with a significant, 12-year medical history of diabetes mellitus type I as well as a history of hypertension and hypercholesterolemia. He presented to his primary care doctor with blurred vision and was referred to a retinal specialist, who diagnosed hemorhagic and leukemic retinopathy resulting in limited vision. A complete blood count was drawn during the visit with his retinal specialist. The results were abnormal, revealing a white blood cell count of 30,000/mm3, platelet count of 70,000/mm3, and a hemoglobin of 12.2 gm/dl. The peripheral smear showed peripheral blasts. A.B. was referred to a hematologist, who performed a bone marrow aspiration, confirming the diagnosis of pre-B-cell acute lymphocytic leukemia (ALL). Cytogenetic studies revealed positivity for the Philadelphia chromosome and a translocation of genes 4 and 11.

Resolution of leukemic retinopathy following treatment with imatinib mesylate for chronic myelogenous leukemia

PurposeTo report a case of leukemic retinopathy before and after treatment with imatinib mesylate (formerly STI-571) for chronic myelogenous leukemia (CML). DesignInterventional case report. MethodsA 58-year-old man diagnosed with stable phase CML (SP-CML) presented with blurry vision. Fundoscopy revealed several flame-shaped hemorrhages in the macular region in both eyes. One month after this initial visit, imatinib therapy was initiated. ResultsThe patient noticed improvement in his visual as well as his medical symptoms; on repeat examination 6 months after the initial visit, the retinal hemorrhages had resolved and remained so after 18 months. ConclusionsImatinib appears to be an effective treatment for SP-CML, and the improvement in visual and medical symptoms in our case report correlates with this.

Ocular Manifestation of Hairy Cell Leukemia With Dramatic Response to 2-Chloro-deoxy-adenosine

To demonstrate that hairy cell leukemia may involve the eye. We examined a patient who had a unique ocular manifestation of hairy cell leukemia with severe panuveitis in one eye and leukemic retinopathy in the fellow eye. Therapy with 2-chloro-deoxy-adenosine, a drug recently introduced for treatment of hairy cell leukemia, led to dramatic improvement of the ocular complications. Hairy cell leukemia may involve the eye and ocular symptoms may respond to systemic treatment with 2-chloro-deoxy-adenosine.

Prognostic importance of retinopathy in acute leukemia.

This prospective study evaluates the relationship, between the fundus findings in leukemic retinopathy and the survival in patients with newly diagnosed acute leukemia. Fifty-four newly diagnosed consecutive patients with acute leukemia were included in this study. The patients were examined within few days of initial admission and diagnosis. Leukemic retinopathy was detected in 19 (35%) patients. The observation period ranged from 434 days to 1220 days (mean +/- SD 880 +/- 225) for those patients who survived. Despite similar chemotherapy compared to those without retinopathy (332.4 +/- 99.6 and 76 vs. 640.7 +/- 106 and 192 days respectively) although survival did not differ significantly (p = 0.073). Patients with cotton-wool spots had lower mean and median survival times than did those without such lesions (168.8 +/- 70.9 and 27 vs. 609.4 +/- 91.4 and 289 days respectively) and survival differed significantly (p = 0.04). The presence of cotton-wool spots and age > or = 40 years were the major adverse prognostic factors for survival in multivariate analysis. Cotton-wool spots had a more significant adverse prognostic effect than age > or = 40 years (hazard function coefficients: 1.0708 for cotton-wool spots vs 0.0355 for age > or = 40 years). The relative odds of dying among patients with cotton-wool spots were about 8 times higher than that for those without this feature, and about 7 times higher in patients aged > or = 40 years than that for patients aged < 20 years. Our findings suggest that the presence of leukemic retinopathy in general, and cotton-wool spots, in particular is a poor prognostic sign for survival in acute leukemia.

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.