A prospective study of ocular manifestations in childhood acute leukaemia

Abstract

ABSTRACT.Purpose: To determine the prevalence of ocular manifestations in childhood acute leukaemia at the time of presentation. Methods: Eighty-two children with acute leukaemia were examined for ocular lesions within two days of diagnosis before starting chemotherapy. The detailed ocular examination of both eyes was carried out by the ophthalmologist irrespective of the presence or absence of eye symptoms in all cases. Results: Only 3 out of 82 children presented with eye symptoms (3.6%). However, ocular changes were found in 14 children (17%); ten with lymphoblastic and four with myeloid leukaemia. The ocular lesions observed were proptosis, intraretinal haemorrhages, white centered haemorrhages, cotton wool spots, macular haemorrhage, subhyaloid haemorrhage, vitreous haemorrhage, papilloedema, cortical blindness, sixth nerve palsy, and exudative retinal detachment with choroidal infiltration. Conclusion: In view of the high prevalence of asymptomatic ocular lesions in childhood acute leukaemia, routine ophthalmic examination should be included as a part of evaluation at the time of diagnosis.

Acute suprachoroidal haemorrhage with acute angle closure glaucoma as a presenting sign of chronic myelomonocytic leukemia

“…They extend from the limbus towards the central cornea involving the mid-stroma at the periphery to more superficial stroma centrally. 6 The visual acuity is good until later in life. LCD type III is a late onset LCD that appears with decreased vision in the fifth to seventh decades of life.…”

“…Leucocytosis with monocytosis Ocular involvement in all types of leukemia is very common with estimates ranging from 50-70% and appears to complicate acute leukemias approximately four times more commonly than the chronic forms. 5,6 The ocular changes due to leukemia ranged from orbital involvement with proptosis, sterile corneal ulcers, scleral infiltration by leukemic cells, iritis with hypopyon and leukemic nodules. 6,8 Choroidal involvement has been reported in over 50% of the cases and the choroid may in fact act as a sanctuary for the leukemic cells allowing them to escape the effects of radiation and cytotoxic therapy.…”

“…5,6 The ocular changes due to leukemia ranged from orbital involvement with proptosis, sterile corneal ulcers, scleral infiltration by leukemic cells, iritis with hypopyon and leukemic nodules. 6,8 Choroidal involvement has been reported in over 50% of the cases and the choroid may in fact act as a sanctuary for the leukemic cells allowing them to escape the effects of radiation and cytotoxic therapy. 9 Choroidal involvement can present with serous retinal detachment.…”

“…Optic nerve infiltration and papilloedema due to central nervous system involvement is well documented. 6,9 Spontaneous suprachoroidal haemorrhage has been variously described in patients undergoing treatment with systemic thrombolytic agents, low molecular weight heparin and disseminated intravascular coaugulation. [1][2][3]7 To the best of our knowledge, our patient is the first reported case of leukemia causing spontaneous suprachoroidal haemorrhage and acute angle closure glaucoma.…”

“…3 Its safety for ocular use has been demonstrated in viral keratitis 4 and in conjunctival malignancies. 5,6 Although systemic (intramuscular) therapy has been described for conjunctival papillomas, 7 topical interferon use for primary or recurrent lacrimal papillomas has not been reported previously.…”