Bilateral Macular Serous Retinal Detachment Revealing Acute Myeloblastic Leukemia (original) (raw)
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Bilateral macular detachment: Choroid as a sanctuary of acute lymphoblastic leukemia
American Journal of Ophthalmology Case Reports, 2020
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Unilateral Eye Findings: A Rare Herald of Acute Leukemia
Ocular Oncology and Pathology, 2016
Background/Aim: Unilateral choroidal infiltration as the initial manifestation of leukemic relapse in adults is rare, particularly after an extended period of remission. This report describes this unique ophthalmic presentation, highlights the associated diagnostic challenges, and reviews the literature. Methods: Two cases are described and an extensive literature review was conducted. Results: A 59-year-old male with acute lymphoid leukemia, in remission for 18 months, presented with unilateral scleritis, exudative retinal detachment, and choroidal thickening. A 57-year-old male with a history of acute myeloid leukemia, in remission for 4 years, presented with unilateral choroidal thickening leading to secondary angle closure. In both cases, there was a significant lag from the onset of eye symptoms to establishing a systemic diagnosis of acute leukemia, leading to a delay in definitive systemic treatment, despite a high suspicion of disease based on ophthalmic findings. Conclusion...
Turkish Journal of Hematology, 2012
Ocular findings are rarely the initial symptom of leukemia, although up to 90% of all leukemia patients have fundus changes during the course of the disease. Herein we report a relapsing acute lymphoblastic leukemia patient with the sole presentation of sudden visual loss and exudative retinal detachment. An 8-year-old boy with acute lymphoblastic leukemia developed sudden visual loss during his first remission period. Bullous retinal detachment with total afferent pupillary defect was observed. Orbital magnetic resonance imaging revealed an intraocular mass lesion; simultaneously obtained bone marrow and cerebrospinal fluid samples showed no evidence of leukemic cells. Following local irradiation, and systemic and intrathecal chemotherapy the mass disappeared. Local irradiation, and systemic and intrathecal chemotherapy effectively controlled the isolated ocular relapse of acute lymphoblastic leukemia and eliminated the need for enucleation.
Neurosensory detachment in acute myeloid leukemia
2020
Neurosensory retinal detachment is a rare ocular finding in acute myeloid leukemia. We describe a case of a 25 year-old female with history of acute myeloid leukemia under chemotherapy that was referred to the Ophthalmology Department due to blurred vision and metamorphopsia in the left eye for the last two weeks. On examination, there was an oval, high, paracentral lesion, superior to the macula with adjacent small hemorrhage. She performed macular spectral domain optic coherence tomography that showed macular edema with neurosensory detachment, fluorescein angiography that revealed a multifocal diffusion with hyperfluorescence and indocyanine green hypofluorescent spots suggesting choroidal ischemia. A diagnosis of neurosensorial retinal detachment that revealed a choroidal infiltration was made. The chemotherapy was continued and, one month after, progressive visual improvement was identified. A systemic disease with atypical retinal findings should alert to diagnose extramedulla...
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.
Akut Myeloid Lösemiye Bağlı Bilateral Seröz Maküla Dekolmanı
Türk Oftalmoloji Dergisi, 2014
A 31-year-old woman, diagnosed and treated for acute myelogenous leukemia (AML) type M2, complained of blurred vision and general deterioration in vital signs in her fourth week of hospitalization for induction chemotherapy. Her ophthalmologic examination revealed bilateral serous macular detachment. Despite immediate institution of salvage therapy for refractory disease, extensive intraretinal and preretinal hemorrhages developed in both eyes. Three weeks after reinstitution of chemotherapy, the patient deceased. Bilateral serous macular detachment is rarely an ocular manifestation of AML. This may be a sign of leukemic infiltration of the choroid and worsening of the clinical symptoms.
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.
Hemorrhagic retinal detachment in acute promyelocytic leukemia
Taiwan Journal of Ophthalmology, 2013
A 14-year-old male had unilateral visual loss, bloodstained rhinorrhea, and generalized bruises with fever. Ocular echography of the right eye revealed unilateral hemorrhagic retinal detachment with internal echogenicity, and therefore, a hemorrhagic retinal detachment (oculus dexter). Peripheral blood smear tests revealed pancytopenia with 78% leukemic cells. Bone marrow sampling and genetic analysis established the diagnosis of acute promyelocytic leukemia. Hemorrhagic retinal detachment can be a presentation of acute promyelocytic leukemia, and thrombocytopenia and disseminated intravascular coagulation may be the etiologies. The combined bleeding diathesis is a challenging status for surgical management with poor visual prognosis.