Ophthalmic manifestations of leukemia

Talcott, Katherine E.; Garg, Ravin J.; Garg, Sunir J.

doi:10.1097/icu.0000000000000309

Cited by 99 publications

(104 citation statements)

References 56 publications

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“…In acute leukemia, common retinal findings include preretinal and retinal hemorrhages due to anemia and thrombocytopenia, while chronic leukemia more commonly presents with venous stasis due to hyperviscosity [12]. Additional reported findings in leukemic retinopathy include venous dilation and tortuosity as well as white-centered hemorrhages which may consist of leukemic cells, platelet-fibrin aggregates, or septic emboli [13]. In contrast to the diffuse retinal hemorrhages seen in CRVO, retinal hemorrhages in leukemic retinopathy are usually isolated in the posterior pole [13].…”

Section: Discussionmentioning

confidence: 99%

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

Uhr¹,

Thau²,

Chung³

et al. 2020

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

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

Uhr¹,

Thau²,

Chung³

et al. 2020

Cureus

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“…The choroid is the most commonly infiltrated anatomic location within the eye and may result in a markedly thickened choroid with concurrent serous retinal detachment [8]. Secondary involvement of the eye is most commonly visualized in the retina with angiopathy, venous dilation and tortuosity, hemorrhages, cotton wool spots, central retinal vein occlusion, neovascularization, and microaneurysms [9]. …”

Section: Introductionmentioning

confidence: 99%

Rapidly Progressive, Isolated Subretinal Leukemic Relapse: A Case Report

et al. 2017

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Purpose: The aim of this paper is to describe a case of relapsed pediatric acute lymphoblastic leukemia (ALL) presenting as a rapidly progressive subretinal infiltrate, as diagnosed by ultrasound-guided fine needle aspiration (FNA). Methods: We conducted a clinical pathological retrospective chart review. Results: Eleven months after documented remission of T-cell ALL while on maintenance therapy, this 17-year-old patient presented with acute open angle glaucoma in the right eye. B-scan ultrasonography suggested total retinal detachment. Eight weeks later, based on routine cerebrospinal fluid analysis, the patient was diagnosed with central nervous system relapse of T-cell ALL. Repeat B-scan 1 week later showed a new hyperechoic subretinal mass. FNA of the mass confirmed leukemic infiltrate. The involved eye was enucleated, demonstrating leukemic cells throughout the subretinal space, choroid, and the optic nerve. Following hematopoietic stem cell transplant, the patient continues to maintain bone marrow remission 5 months after enucleation without involvement in the opposite eye. Conclusion: Retinal detachment in any patient with a history of leukemia should raise the possibility of relapse and may warrant aspiration/biopsy if other means of diagnosing relapse are inconclusive. Subretinal infiltrate may progress rapidly and prompt diagnosis is paramount to tailoring therapy and preserving vision.

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“…Ocular involvement of leukaemia accounts for 3% of the cases, most resulting from anaemia, thrombocytopenia and hyperviscosity . Leukemic retinopathy is characterized by pre‐retinal and retinal haemorrhages, Roth's spots, cotton wool spots and exudates . Hyperviscosity can cause peripheral non‐perfusion and subsequent neovascularization .…”

mentioning

confidence: 99%

“…Leukemic retinopathy is characterized by pre‐retinal and retinal haemorrhages, Roth's spots, cotton wool spots and exudates . Hyperviscosity can cause peripheral non‐perfusion and subsequent neovascularization . Direct infiltration cases are uncommon, including foveal infiltrates, macular lesions and retinal infiltrate .…”

mentioning

confidence: 99%