Isolated optic nerve involvement in acute lymphoblastic leukaemia: a red flag for early relapse

Azad, Shorya Vardhan; Banerjee, Mousumi; Parmanand, Kumar; Venkatesh, Pradeep

doi:10.1136/bcr-2021-243689

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Isolated ocular involvement as the first sign of relapse is extremely rare, occurring in less than 2.2% of cases [6]. Optic disk neovascularization is rarely found associated with ALL.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report

Liang¹,

Li²

2022

IJOVS

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Background: The intraocular manifestations of leukemia are diverse. The retina is the most common ophthalmic involvement site. The most common retinal manifestations of acute lymphoblastic leukemia (ALL) include dilated and tortuous vessels, serous retinal detachment (SRD), intraretinal hemorrhages as well as roth spots. Optic nerve infiltration and retinal neovascularization are unusual, especially in complete clinical remission of ALL. However, neovascularization in optic disk has not been observed in ALL during complete clinical remission. Objective: To report clinical characteristics of a bilateral optic disk neovascularization associated with relapse of ALL. Method: A 31-year-old male with ALL after having reached complete remission from chemotherapy complained about a vision loss in both eyes. First examination showed that best corrected visual acuity (BCVA) was 20/200 for his right eye and 20/160 for his left eye, respectively. Fundus examination revealed bilateral profound optic disk edema with multiple yellow-white exudates and retinal hemorrhages. Optical coherence tomography (OCT) showed bilateral optic disk edema and SRD in both maculas. Fundus fluorescein angiography (FFA) showed bilateral optic disk neovascularization. All these changes were present in remission. The patient received intravitreal Conbercept injection 0.5 mg (10 mg/ml) in both eyes for once on June 29, 2019. Optic disk neovascularization resolved three weeks after treatment. BCVA improved to 20/200 in his right eye, but still light perception in his right eye. No optic disk neovascularization recurrence was observed in 3-month follow-up. BCVA of the right eye maintained 20/200 at the latest follow-up. After intravitreal injection for 4 months the patient suffered from cerebral hemorrhage. He received bone marrow biopsy and cerebrospinal fluid sampling. The results showed relapse in hemogram and lymphocytes in central nervous system (CNS). Therefore, the chemotherapy treatment did not cause a new remission of the disease and the patient failed to recover. Conclusion: Optic disk neovascularization may appear as a sign of extramedullary relapse of ALL months in advance of the hematologic relapse. Intravitreal injection of conbercept could be beneficial and safe in treating this neovascularization.

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“…Isolated ocular involvement as the first sign of relapse is extremely rare, occurring in less than 2.2% of cases [6]. Optic disk neovascularization is rarely found associated with ALL.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report

Liang¹,

Li²

2022

IJOVS

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“…Overall, however, the prevalence of optic nerve infiltration only comprises 5% of secondary optic nerve tumors (14,15). Additionally, although not common, disease relapse in the central nervous system can present with isolated optic nerve infiltration (16) and has been reported most frequently in patients with acute lymphoblastic leukemia (ALL) (2.2% of relapse cases) (17,18). The orbit and optic nerve are potential sanctuary sites for leukemic relapse even with initial systemic central nervous system treatment.…”

Section: Leukemic and Lymphomatous Infiltration Of The Optic Nervementioning

confidence: 99%

Neuro-ophthalmic manifestations of cancer: a narrative review

Janetos¹,

Volpe²,

Simon³

2022

Chin Clin Oncol

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Background and Objective: Neuro-ophthalmic manifestations of cancer are vast and early recognition of a serious ocular condition due to either cancer or its therapy is important for both vision preservation as well as providing valuable treatment and prognostic information regarding the underlying malignancy. This review focuses on direct and indirect effects of cancer on the eye and its adnexa, hematologic malignancy, complications of traditional and novel oncologic therapies, and paraneoplastic syndromes as they relate to the eye as these disorders can lead to potentially devastating or irreversible vision loss.Methods: PubMed was searched primarily for the following topics: optic nerve infiltration, primary vitreoretinal lymphoma (PVRL), ocular paraneoplastic disorders, and ophthalmic complications of cancer therapeutics. Literature was selected based on historical significance and landmark studies (e.g., Cross et al.series of paraneoplastic optic neuritis patients; Chan's textbook on primary intraocular lymphoma) as well as publications published after 2000. References from select studies were additionally included. Given the sparsity of literature on many subjects, most publications were included during this time frame in our review.

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“…5 Primary ocular infiltration can involve orbit, anterior segment, uvea and the optic nerve. 6 We describe the case of a pediatric patient with optic nerve infiltration as initial manifestation of ALL relapse.…”

Section: Introductionmentioning

confidence: 99%

Acute lymphoblastic leukemia relapse presenting with optic nerve infiltration

Dini

Capolsini

Cerri

et al. 2023

SAGE Open Medical Case Reports

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Acute lymphoblastic leukemia is the most common childhood malignancy. Despite many advances in therapy, about 15%–20% of children with acute lymphoblastic leukemia experience a disease relapse. Isolated ocular relapse is relatively rare. A 14-year-old male with T-cell acute lymphoblastic leukemia in remission presented with sudden onset of right eye pain and visual acuity impairment. Fundoscopic examination of the eye and magnetic resonance imaging of the orbits were consistent with optic nerve infiltration. The patient was treated with salvage chemotherapy, orbital radiation and eventual bone marrow transplantation, with notable improvement in vision and regression of retinal and optic nerve findings. Optic nerve infiltration represents an ophthalmic emergency and requires urgent management. The use of radiation therapy is a helpful adjunct with systemic chemotherapy in obtaining disease remission.

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Isolated optic nerve involvement in acute lymphoblastic leukaemia: a red flag for early relapse

Cited by 4 publications

References 13 publications

Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report

Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report

Neuro-ophthalmic manifestations of cancer: a narrative review

Acute lymphoblastic leukemia relapse presenting with optic nerve infiltration

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