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Clinical profile of ocular manifestations associated with acute leukemia

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Case Series

Author Details : Rajiv Kumar Das, Jolly Rabha, Paramesh Bharali

Volume : 10, Issue : 4, Year : 2024

Article Page : 789-795

https://doi.org/10.18231/j.ijceo.2024.136

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Abstract

Background: Ocular manifestations in acute lymphoblastic leukemia (ALL) are not uncommon but rarely present as the sole symptom. They usually arise secondary to anemia, thrombocytopenia, and hyperviscosity. However, atypical features like optic disc edema and pseudo-hypopyon may indicate relapse. This case series of 9 ALL patients identified potential relapse markers. We advocate for routine ophthalmological referrals for all leukemic children to assess for atypical features during follow-up. Notably, there is a dearth of epidemiological and clinical studies on this topic in northeastern India.
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: Among 9 pediatric patients, 66.67% were from rural areas, 33.33% from semi-urban areas, and none from urban areas. Ocular involvement was observed in 22.22% of patients unilaterally, 22.22% had no ocular signs, and 55.55% exhibited bilateral involvement (representing 55.55% of all eyes). Conjunctival involvement was seen in 27.77% of eyes, with subconjunctival hemorrhage (16.66%) being the most common. Conjunctival congestion occurred in 11.11% of eyes. Anterior chamber involvement included uveitis (16.66%), hyphema (5.55%), and pseudo-hypopyon (5.55%). Iris bombe, a form of posterior synechiae, was observed in 16.66% of uveitic eyes. Elevated intraocular pressure was found in 16.66% of eyes. 72.22% of eyes showed no other anterior chamber involvement. Vitritis was the most common vitreous involvement, observed in 16.67% of eyes. 83.33% of eyes had no vitreous involvement. Retinal involvement included hemorrhages (16.67%) and edema (11.11%), while 72.22% of eyes had no retinal involvement. Epiretinal membrane was found in 5.56% of eyes, with 94.44% showing no macular involvement. Elevated LDH levels were present in 33.33% of patients.
Conclusion: Ocular involvement in leukemia can be primary or secondary to hematological abnormalities. Relapse should be suspected in any patient with ocular signs, especially after remission. Retinal hemorrhages are the most common manifestation of leukemic retinopathy. Atypical features like pseudo-hypopyon, hyphema, and optic disc swelling with elevated LDH warrant immediate investigation for relapse. Thorough oncological evaluation is crucial during follow-up. We recommend ophthalmological referral for all leukemic patients for comprehensive assessment.
 

Keywords: Ophthalmological manifestations, Leukemia, Pseudo- hypopyon, Retinal haemorrhages.

How to cite : Das R K, Rabha J, Bharali P, Clinical profile of ocular manifestations associated with acute leukemia. Indian J Clin Exp Ophthalmol 2024;10(4):789-795

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