Clinical Profile of Ocular manifestations associated with Acute Leukemia

• Rajiv kumar Das,*  
• Jolly Rabha,  
• Paramesh Bharali,  
• Sunny PGT

Abstract

ABSTRACT: Background: Ocular manifestations of acute lymphoblastic leukemia are not very uncommon but rarely be seen as the sole presenting clinical features of this disease. Ocular involvements are usually secondary to anaemia, thrombocytopenia and hyperviscocity of the blood.1 But, presence of atypical clinical features like optic disc edema, pseudo-hypopyon are sometimes might be the exquisite clinical features of relapse after remission.2,3 We conducted a case series study of 9 nos of acute lymphoblastic leukemia patients where we found that some manifestations were linked to relapse after remission of the disease. There is need for a protocol referral of every leukemic child to the ophthalmology outpatient department for evaluation of the atypical features and these should be done in every follow up of the patients. In northeastern India, there is no epidemiological or clinical study available on this context. Materials and methods: This prospective, descriptive hospital based study was conducted on 9 nos of patients with Acute Leukemia whose duration were over 1 year and whose diagnosis were already confirmed by the paediatrics oncology outpatient department physicians ; based on the peripheral blood smear and bone marrow biopsy. These patients were underwent a comprehensive ophthalmological clinical evaluation, dilated fundus examination, optical coherence tomography and other tailored investigations. Results: Of the total 9 paediatric patients, 6 patients 9( 66.66%) belong to the Rural Population, 3 patients ( 33.33%) belongs to the semi-urban population and none of the patients ( 00.00%) belongs to Urban population. Of the total 9 paediatric patients, 2 nos of patients (22.22%) are with uniocular involvement, 2 nos of patients (22.22%) are without any signs of ocular involvement and the rest 5 nos of patients (55.55 %) are with bilateral ocular involvement. The percentage of bilateral involvements of the eyes is 55.55% among all the 18 eyes. The frequency of Unilateral Involvement of the eye is 22.22% and the frequency of no signs of ocular Involvement of the eye is 22.22%. Conjunctival involvement is seen in 5 nos of eyes ( 27.77%). The most common Conjunctival involvement is in the form of subconjunctival haemorrharge which are found in 3 nos of eyes(16.66%).Conjunctival congestion has been found in 2 nos of eyes(11.11%). The Anterior Chamber involvement in the form of Uveitis is found in 3 nos of eyes (16.66 %).Other findings are hyphema is in 1 no of eye (5.55%),Pseudo-Hypopyon is in 1 no of eye ( 5.55%).It has been found that posterior synechiae is quite common in the form of Iris Bombe in uveitic cases where typical forward bowing of iris has been noted in 3 nos of eyes ( 16.66% ). Elevated Intraocular Pressure has been found in 3 nos of eyes (16.66%). 13 nos of eye have not shown any involvement of Anterior Chamber (72.22%)in any other forms. It has been found that the most common involvement of Vitreuos is in the form of Vitritis and has been noted in 3nos of eyes (16.66%) and with No involvement of vitreous are seen in 15 eyes (83.33%). The frequency of Retinal Involvement in the form of Retinal Haemorrhages are seen in 3 eyes (16.66%), in the form of Retinal Edema are seen in 2eyes (11.11%) and with No Involvement of Retina are seen in 13 eyes (72.22%). The frequency of Macula Involvement in the form of Epi-Retinal Membrane is seen in 1 eye (5.55%) and with No Macula Involvement are seen in 17 eyes (94.44%). Out of 9 patients , 3 patients ( 33.33 %) with elevated LDH level have been found. Conclusion: Ocular manifestations of leukemia may be the primary involvement of the leukemic cells or it may be secondary to haematological de-arranged profile. Every ocular signs should be seen with the suspicion of relapse after remission. Retinal hemorrhages is a most common manifesttations of leukemic retinopathy. Atypical features such as pseudo-hypopyon, hyphema , optic nerve head swelling with elevated LDH level should be always treated as a signs of relapse. And further oncological evaluation must be considered in each follow up. We have the opinion that each leukemic patients should be referred to the ophthalmological ward for the comprehensive evaluation.

Keywords

Acute leukemia,Ophthalmic manifestations,Paediatric age group,Iris bowing,Retinal haemorrhage,Assam,pseudohypopyon,retinal haemorrhage,disc edema,north east india,LDH,RELAPSE