Flaming Retinal Hemorrhage Revealing Acute Lymphoblastic Leukemia ( About a Case ) (original) (raw)
Related papers
Ocular manifestations of acute myeloid leukaemia
IP innovative publication pvt ltd, 2020
Aim: 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. Materials and Methods: 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/mm3, total leucocyte count - 11,000/mm3 ,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. Results: 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. Conclusions: 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.
Cureus, 2021
Background: Leukemia is a neoplastic disorder that affects blood and bone marrow and is characterized by white blood cells' abnormal proliferation. Leukemia patients may present with different ophthalmic manifestations. This study aims to provide an updated data about the prevalence and types of ocular manifestations in acute leukemia patients and their relation with the hematological parameters. Methods: This retrospective cross-sectional study included all acute leukemia patients diagnosed from 2015 to 2020 and underwent an ophthalmic examination during this period at King Abdulaziz Medical City in Jeddah. Results: Eighty-one patients met the inclusion and exclusion criteria and had ophthalmic examinations. Forty-three (53.1%) patients were males, and 38 (46.9%) patients were females. Acute lymphocytic leukemia (ALL) was diagnosed in 55 (67.9%) patients, while acute myelogenous leukemia (AML) was diagnosed only in 26 (32.1%). Ophthalmic manifestations were observed in 23 patients with a prevalence of 28.4%. AML patients had more manifestations with a rate of 38.5%. ALL had a rate of 23.6% (p=0.1). Retinal hemorrhage was the most commonly seen manifestation in six patients. Conclusion: Ophthalmic manifestations are not uncommon in acute leukemia patients. Low hemoglobin and RBC could give an idea about the type of ophthalmic manifestation, not the presence or absence. It is highly recommended to examine acute leukemia patients routinely prior, during, and after the treatment to prevent serious ocular damage and monitor the course of the disease.
Ophthalmology Retina, 2017
Purpose: To determine the prevalence of ocular manifestations and the association of these manifestations with hematologic parameters among patients with leukemia attending a hemato-oncology unit at a tertiary care government hospital in South India. Design: This was a cross-sectional observational study. Participants: All patients attending a hemato-oncology unit at a tertiary care government hospital in South India who were diagnosed with acute or chronic leukemia that was confirmed by a bone marrow biopsy. Methods: Consecutive patients with leukemia presenting at the hematology clinic underwent standardized leukemia blood workup and comprehensive ophthalmic evaluation. Patient demographics, the type of leukemia, ophthalmic features, and hematological parameters such as hemoglobin level, white blood cell count, and platelet counts were recorded. The association between ophthalmic manifestations and blood counts was analyzed using multivariable regression analysis. Main outcome measures: The study measured the prevalence of various ocular manifestations in different types of leukemias and their association with hematologic parameters. Results: In total, 133 eyes of 133 patients were examined during the study period. The prevalence of leukemic ophthalmopathy was found to be 68% in cases of acute myeloid leukemia, 42% in cases of acute lymphoid leukemia, 33% in cases of chronic lymphoid leukemia, and 13% in cases of chronic myeloid leukemia. Vision-threatening complications such as subhyaloid hemorrhage involving the posterior pole (20%) and vitreous hemorrhage (10%) were seen exclusively in patients with acute leukemias. Multivariable logistic regression after adjusting for the type of leukemia, patient age, and white blood cell and platelet counts showed that the hemoglobin level was the only factor predictive of developing subhyaloid hemorrhage (every 1-g/L increment increase in hemoglobin level led to a 30% reduction in the likelihood of developing subhyaloid hemorrhage; 95% confidence interval 0.5e0.9; P ¼ 0.02). The probability of developing subhyaloid hemorrhage was reduced by >50% when hemoglobin level improved from 5 to 7 g/L and when platelet count improved from 10 000 to 50 000 cells/mm 3 for both types of acute leukemia. There was no association between white blood cell counts and ophthalmic manifestations. Conclusion: Leukemic ophthalmopathy is more common in acute and myeloid cases and less common in chronic and lymphoid subtypes. It is predominantly due to secondary rheological changes. Blood transfusion should be considered when hemoglobin level and platelet count decrease below 7 g/L and 50 000 cells/mm 3 , respectively, to prevent vision-threatening complications. Patients with acute leukemias should undergo ophthalmic screening at baseline and then periodically to prevent visual morbidity. Ophthalmology Retina 2017;-:1e7 ª 2017 by the American Academy of Ophthalmology
[Ophthalmic manifestations of acute leukemia]
Journal français d'ophtalmologie, 2002
Orbital and ocular lesions are the third most frequent extramedullar locations of acute leukemia after the meninges and testicles. These lesions are treated as a central nervous system lesion; therefore diagnosis is essential to therapeutic adjustment. We present a retrospective study on charts of children treated for acute leukemia between 1996 and 1998. Ophthalmic examination was carried out when there were ocular symptoms. One hundred ninety-six children were treated for acute leukemia. Twelve children (6.1%) had an ocular and orbital lesion: 7 boys and 5 girls, with an average age of 6 years. Six had acute lymphoblastic leukemia, 6 had acute myeloid leukemia. Visual acuity was 1/10 in 9 children. Four children had an initial orbital lesion with a rapidly progressing exophthalmos. The hemogram and myelogram showed a granulocytic sarcoma. Two children who had been previously treated for acute leukemia presented a bilateral anterior uveitis with hypopyon; anterior chamber paracente...
Revista Brasileira de Oftalmologia, 2021
The Acute Lymphocytic Leukemia (ALL) is a disease characterized by a high survival rate, but the absolute number of children who die from it represents a large proportion of cases of infant deaths from cancer. The morbidity resulting from its treatment can leave sequelae in people with high life expectancy, making it extremely necessary to understand the pathogenesis of this disease, enabling the development of new treatments and reduction of sequelae caused by the disease. This early diagnosis is important to avoid ocular complications that may lead to low long-term visual acuity and to evaluate treatment relapses and determine the conducts.
Ophthalmological Manifestations in Acute Lymphoblastic Leukemia
InTech eBooks, 2011
The aim of the present chapter is to review the different ophthalmological signs and symptoms that can be observed in acute lymphoblastic leukemia and the importance of the examination of these patients by an ophthalmologist whenever an ocular affectation is suspected. Acute lymphoblastic leukemia is a malignant neoplasm caused by the proliferation of poorly differenciated precursors of the lymphoid cells, which are known as blast cells. Blast cells replace the normal elements of the bone marrow, decreasing the production of normal blood cells and, therefore, causing anemia, thrombocytopenia and neutropenia. They can also infiltrate other organs, such as liver, spleen, lymph nodes or, less frequently, central nervous system. (Florensa et al, 2006; Ribera & Ortega, 2003; Sharma et al, 2004) Acute lymphoblastic leukemia is the most common type of leukemia in children, although it is also seen in adult patients. If blood test results are abnormal or the doctor suspects leukemia despite normal cell counts, a bone marrow aspiration and biopsy are the next steps. Treatment is based on chemotherapy, radiotherapy and bone marrow transplantation.
Ophthalmic Manifestations of Newly Diagnosed Acute Leukemia Patients in a Tunisian Cohort
Clinical Ophthalmology
To describe ocular manifestations of acute leukemia in a Tunisian cohort and to assess the associations between ophthalmic findings and epidemiological, clinical, and biological features of the disease. Methods: A prospective study included patients newly diagnosed with acute leukemia referred to our clinics between January 2019 and July 2020. All patients underwent a complete ophthalmic evaluation and spectral-domain optical coherence tomography (SD-OCT) at presentation, then every two months during one year. We defined two groups: Group 1 included patients with leukemic ophthalmopathy and group 2 included patients with normal ophthalmic examination. Results: Forty-six patients were enrolled. The mean age of patients was 32.1±15.3 years. The sex ratio M/F was 1.55 (28 male patients and 18 females). Twenty-nine patients (63%) had acute myeloid leukemia (AML), and 17 (37%) had acute lymphoblastic leukemia (ALL). The average follow-up was 9.1 months (range: 3-12 months). We observed ophthalmic manifestations in 28 patients (61%). Among them, 17 (61%) had vision-threatening complications. The posterior segment was the most common site of ocular involvement (82% of group1). Primary leukemic infiltration (Disc edema, ptosis, exophthalmos) was present in 13 eyes (14.1%). Twenty-seven eyes (29.3%) had secondary involvement lesions (Subconjunctival hemorrhage, periorbital ecchymosis, retinal/subhyaloid hemorrhage, dilated/tortuous veins). Twenty-one eyes (22.8%) showed other ocular manifestations which etiopathogenesis is not yet fully understood (White-centred hemorrhages, cotton-wool spots, serous retinal detachment, hemorrhagic pigment epithelial detachment). Leukemic retinopathy was significantly more frequent in adults (23/39 and 1/7 in adult and pediatric groups, respectively; p=0.003). Patients suffering from AML were more likely to have secondary ocular involvement (20/29 and 7/17 in AML and ALL patients, respectively; p=0.047). Retinal hemorrhages were statistically associated with anemia and thrombocytopenia (p=0.041 and p=0.034; respectively). Conclusion: Leukemic ophthalmopathy seems to be frequent and may lead to severe visual impairment. An ophthalmic assessment complemented with SD-OCT has paramount importance in all newly diagnosed acute leukemic patients.
Yousef Alotaibi
Leukemia is a proliferative and malignant syndrome of hematopoietic stem cells of the bone marrow. The ocular manifestations could be used as predictors of leukemiaor they can be detected after confirming the diagnosis of leukemia. We report a case of 19 years old male presented with sudden painless decrease of vision of both eyes, left more than right, for 3 days associated with fatigue, headache, and palpation for 2 days duration. After diagnosis, the case suffered from acute lymphoid leukemia which was associated with some ophthalmic manifestations including multiple blots and flame shaped hemorrhage of the right eye, macular hemorrhage, cotton wall spot of the left eye and white centered hemorrhage of both eyes. OCT revealed left thickening of sensorial retinal consistent with macular hemorrhage. After conducting all investigations, the patient was confirmed to be suffering from acute lymphoid leukemia.
International Journal of Public Health and Clinical Sciences, 2019
Background: Acute lymphoblastic leukaemia (ALL) is the commonest childhood malignancy and ocular manifestations are uncommon in ALL. Patients may present with non-specific systemic symptoms which are overlooked and life threatening symptoms of leukostasis often present late. Here, we present a rare case of ALL where ocular symptoms preceded constitutional symptoms. Materials and Methods: A case report. Result: A 11-year-old girl presented with a syncopal attack during the fasting month to a primary health center. She was investigated at a tertiary center and diagnosed to have ALL. Further history revealed she had sudden painless severe reduced vision in the right for one month prior to this. Ocular assessment noted her right visual acuity was 5/60 and left visual acuity was 6/6. Her right fundus had a large subhyaloid haemorrhage over the macula and multiple large white-centered haemorrhages (Roth's spot); while the left fundus showed multiple large Roth's spots and some intraretinal haemorrhages. Chemotherapy was instituted after immunophenotyping was reported as precursor B-cell ALL. Ocular condition was managed conservatively. There was total resolution of the subhyaloid haemorrhage and retinal haemorrhages in both eyes and she regained full vision bilaterally while on induction therapy over 5 months. Conclusion: Life threatening conditions such as ALL should be considered in children with sudden, painless, reduced vision and urgent ophthalmology assessment is important for early detection. Blurry vision could be the earliest symptom in ALL. Awareness on eye health must be emphasized in school by the educators for early detection of both sight and life threatening condition among children.