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Kawali A, Mahendradas P, Hazarika D, Shetty R. Multimodal imaging in a rare case of leukaemic masquerade. Can J Ophthalmol 2018; 53:e176-e179. [DOI: 10.1016/j.jcjo.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/27/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022]
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Gandhi A, Das S. Conjunctival chemosis or not? Indian J Ophthalmol 2018; 66:1394. [PMID: 30249821 PMCID: PMC6173016 DOI: 10.4103/ijo.ijo_456_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arpan Gandhi
- Ocular Pathology Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Sima Das
- Oculoplasty and Ocular Oncology Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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53
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Lee SY, Kim SH, Ha SG. Bilateral Optic Nerve Involvement Combined with Unilateral Facial Palsy in a Patient with Acute Myeloid Leukaemia: A Case Report. Neuroophthalmology 2018; 42:122-125. [PMID: 29563959 DOI: 10.1080/01658107.2017.1362444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/11/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022] Open
Abstract
Central nervous system (CNS) involvement, including optic nerve involvement, in a patient with acute myeloid leukaemia (AML) is an extremely rare condition. We report a case of bilateral optic nerve involvement combined with unilateral facial palsy in a patient with AML who achieved complete remission following allogenic peripheral blood stem cell transplantation as a young patient. After further evaluation, the patient was diagnosed with a recurrence of AML with CNS involvement. The presentation of multiple types of CNS involvement in AML may be suspicious evidence of AML recurrence.
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Affiliation(s)
- Suk-Yeon Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Seung-Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Suk-Gyu Ha
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Abstract
A previously healthy 2-year-old female infant presented with pancytopenia and was diagnosed with acute lymphoblastic leukemia. Before the initiation of treatment, she developed symptoms concerning for increased intracranial pressure. Head imaging revealed left parietal hemorrhage, in addition to a right vitreous hemorrhage, which was confirmed on ophthalmology examination later. Terson syndrome, in which intraocular hemorrhage is associated with intracranial hemorrhage, is more commonly reported in adults, although ocular manifestations of leukemia have been reported at presentation and are typically asymptomatic.
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Soman S, Kasturi N, Srinivasan R, Vinod KV. Ocular Manifestations in Leukemias and Their Correlation with Hematologic Parameters at a Tertiary Care Setting in South India. Ophthalmol Retina 2018; 2:17-23. [PMID: 31047297 DOI: 10.1016/j.oret.2017.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
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 0.5-0.9; P = 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/mm3 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/mm3, respectively, to prevent vision-threatening complications. Patients with acute leukemias should undergo ophthalmic screening at baseline and then periodically to prevent visual morbidity.
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Affiliation(s)
- Savya Soman
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India.
| | - Renuka Srinivasan
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - K V Vinod
- Department of General Medicine, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
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Gillette TB, Cabrera MT, Tarlock K, Murphy CE, Chisholm KM, Stacey AW. Rapidly Progressive, Isolated Subretinal Leukemic Relapse: A Case Report. Ocul Oncol Pathol 2017; 4:220-224. [PMID: 30643765 DOI: 10.1159/000484054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/05/2017] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Thomas B Gillette
- Clinical and Translational Research, Seattle Children's Hospital, University of Washington
| | | | - Katherine Tarlock
- Department of Hematology-Oncology, Seattle Children's Hospital, University of Washington, WA, USA
| | - Claire E Murphy
- Department of Laboratory Medicine, University of Washington, WA, USA
| | - Karen M Chisholm
- Department of Laboratory Medicine, University of Washington, WA, USA.,Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA
| | - Andrew W Stacey
- Department of Ophthalmology, University of Washington, WA, USA
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Evolution of Leukemic Retinal Hemorrhages Documented by Spectral-Domain OCT and Color Fundus Photography. Ophthalmol Retina 2017; 2:494-501. [PMID: 31047332 DOI: 10.1016/j.oret.2017.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE Retinal hemorrhages are observed frequently in patients with leukemia. However, little is known about the impact and natural history of these hemorrhages. The purpose of this study was to describe leukemic retinal hemorrhages using multimodal imaging and to monitor their evolution longitudinally. DESIGN Retrospective case series. PARTICIPANTS A total of 11 eyes of 7 symptomatic leukemic patients with posterior segment hemorrhages. METHODS Single-center study performed at the Johns Hopkins Hospital. Symptomatic leukemic patients with posterior segment hemorrhages underwent serial dilated fundus examinations. The hemorrhages were documented longitudinally with color fundus photographs and spectral-domain (SD) OCT. MAIN OUTCOMES MEASURES Microanatomic locations of leukemic retinal hemorrhages and their impact on vision and evolution over time. RESULTS A total of 7 patients (71.4% men; 57.1% white, 28.6% black, and 14.3% Hispanic) were included, with 11 eyes showing posterior segment hemorrhages. The median age at presentation was 49.8 years. All patients had intraretinal hemorrhages; these involved the vitreous and sub-internal limiting membrane (ILM) space in 1 and 3 patients, respectively. The median total follow-up duration was 4.0 months. At the final follow-up visits, 4 of 6 patients showed complete resolution of hemorrhages on examination and color fundus photographs. The final SD-OCT images of all patients did not show any retinal thinning, disruption of the ellipsoid zone, disorganization of the retinal layers, intraretinal fluid, or subretinal fluid. CONCLUSIONS Symptomatic leukemic retinal hemorrhages are associated with anemia and thrombocytopenia. These hemorrhages, including visually significant central sub-ILM hemorrhages, tend to be self-limiting and resolve within a few months with treatment of the underlying disease.
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Tyagi M, Agarwal K, Paulose RM, Rani PK. Retinal haemorrhages: a clue to the underlying leukaemia. BMJ Case Rep 2017; 2017:bcr-2017-219741. [PMID: 28951507 DOI: 10.1136/bcr-2017-219741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 40-year-old man presented with a sudden onset of diminution of vision in his left eye for 2 days. Anterior segment of both eyes was within normal limits. Right eye retinal evaluation was normal. However, the left eye retinal evaluation showed isolated subinternal limiting membrane haemorrhage at the fovea along with a white-centred haemorrhage above the fovea. There was no antecedent history of trauma or valsalva. He was normotensive and his glycaemic status was also normal. His blood investigations along with peripheral smear were done, which helped to clinch the diagnosis of an underlying chronic myeloid leukaemia.
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Affiliation(s)
- Mudit Tyagi
- Smt Kanuri Santhamma Center for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Komal Agarwal
- Smt Kanuri Santhamma Center for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Remya Maureen Paulose
- Smt Kanuri Santhamma Center for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Padmaja Kumari Rani
- Smt Kanuri Santhamma Center for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Buzaid AN, Al-Amri AM. Sudden Visual Loss as an Initial Manifestation of Chronic Myeloid Leukemia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:278-280. [PMID: 30787803 PMCID: PMC6298301 DOI: 10.4103/sjmms.sjmms_35_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Chronic myelogenous leukemia (CML) is a pluripotent stem cell disease characterized by anemia, granulocytosis and granulocytic immaturity, basophilia, thrombocytosis and splenomegaly. It is associated with a reciprocal chromosomal translocation t (q34; q11), resulting in a breakpoint cluster region–Abelson fusion gene (Philadelphia chromosome). Ophthalmic manifestations as the first and the only presentation of CML in patients are very rare. Ocular lesions in CML patients are frequently asymptomatic, and thus all patients should undergo an eye evaluation at the initial diagnosis. Here, we report a previously healthy 36-year-old Saudi male who initially presented with progressive loss of vision. On examination, he was found to have a bilateral retinal hemorrhage. The investigations revealed findings consistent with CML. The patient was treated with tyrosine kinase inhibitors, and he had complete remission, including full recovery of his vision.
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Affiliation(s)
- Ahmed N Buzaid
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Ali M Al-Amri
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
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Yabas Kiziloglu O, Mestanoglu M, Totuk Gedar OM, Adiguzel C, Toygar O. Recurrence of acute lymphoblastic leukemia manifesting as serous retinal detachments and optic disc swelling. Int Ophthalmol 2017; 38:1791-1795. [PMID: 28712034 DOI: 10.1007/s10792-017-0648-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/05/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this case report is to describe a patient with acute lymphoblastic leukemia (ALL) who developed bilateral serous retinal detachments and unilateral optic disc swelling. METHODS A 23-year-old woman with ALL presented to the ophthalmology clinic with bilateral subacute visual loss. RESULTS Ophthalmologic examination revealed bilateral serous retinal detachments and unilateral optic disc swelling. Magnetic resonance imaging for differential diagnosis was inconclusive; however, cerebrospinal fluid sampling demonstrated leukemic involvement of the central nervous system. The patient's vision improved and fundus findings resolved with the institution of systemic and intrathecal chemotherapy. CONCLUSIONS Serous retinal detachment and optic disc swelling are unusual ocular manifestations of ALL. They may occur due to leukemic infiltration of ocular structures and may indicate extramedullary recurrence of the disease. Early recognition and treatment is crucial to improve prognosis.
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Affiliation(s)
- Ozge Yabas Kiziloglu
- Department of Ophthalmology, Faculty of Medicine, Göztepe Medical Park Hospital, Bahcesehir University, E-5 uzeri 23 Nisan sok No: 17 Merdivenkoy, Kadikoy, Istanbul, Turkey.
| | - Mert Mestanoglu
- Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Ozgun Melike Totuk Gedar
- Department of Ophthalmology, Faculty of Medicine, Göztepe Medical Park Hospital, Bahcesehir University, E-5 uzeri 23 Nisan sok No: 17 Merdivenkoy, Kadikoy, Istanbul, Turkey
| | - Cafer Adiguzel
- Department of Hematology, Faculty of Medicine, Bahcesehir University, E-5 uzeri 23 Nisan sok No: 17 Merdivenkoy, Kadikoy, Istanbul, Turkey
| | - Okan Toygar
- Department of Ophthalmology, Faculty of Medicine, Göztepe Medical Park Hospital, Bahcesehir University, E-5 uzeri 23 Nisan sok No: 17 Merdivenkoy, Kadikoy, Istanbul, Turkey
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Dhasmana R, Prakash A, Gupta N, Verma SK. Ocular manifestations in leukemia and myeloproliferative disorders and their association with hematological parameters. Ann Afr Med 2017; 15:97-103. [PMID: 27549412 PMCID: PMC5402809 DOI: 10.4103/1596-3519.188887] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To study the ocular manifestations in patients diagnosed with leukemia or myeloproliferative disorders and to derive an association between the ocular manifestations and hematological parameters of the patients. Materials and Methods: This observational and descriptive study was conducted in a Tertiary Care Center of Dehradun, North India over a period of 1 year. All the diagnosed cases of leukemia and myeloproliferative diseases attending the Oncology Department were included. Patients underwent a detailed ocular examination. The hematological parameters were also recorded including hemoglobin (Hb), total leukocyte count (TLC), and platelet count. Results: The study included 102 patients out of which, there were 66 males (64.7%), and 36 were females (35.3%) with an age range of 5–80 years. A total of forty patients showed ocular manifestations (39.3%). Extraocular manifestations were seen in 10.8% patients while intraocular manifestations were noted in 45.1% patients of acute leukemia and 7.7% patients of chronic leukemia. These ocular manifestations showed a significant association with low Hb (P = 0.000), raised TLC (P = 0.004), and low platelet count (P = 0.000). The most common ocular manifestation was intraretinal hemorrhages followed by roth spots. Among acute myeloid leukemia patients (23.5%), the presence of intraretinal hemorrhages was significantly associated with low Hb (Mann–Whitney U-test = 25.000, P = 0.007). The patients of acute lymphoblastic leukemia (25.4%) showed significant association between intraretinal hemorrhages and low platelet count (Mann–Whitney U-test = 44.000, P = 0.046) and roth spots with low Hb (Mann–Whitney U-test = 11.000, P = 0.000). Ocular manifestations were more commonly seen in acute leukemias as compared to chronic leukemias. Conclusion: Ocular examination is recommended in all leukemic patients as ocular manifestations may go unnoticed, most patients being asymptomatic and could be an early sign of worsening of disease.
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Affiliation(s)
- Renu Dhasmana
- Department of Ophthalmology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Amrita Prakash
- Department of Ophthalmology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Neeti Gupta
- Department of Ophthalmology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - S K Verma
- Department of Medicine, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Koshy J, John MJ, Thomas S, Kaur G, Batra N, Xavier WJ. Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India. Indian J Ophthalmol 2016; 63:659-64. [PMID: 26576524 PMCID: PMC4687193 DOI: 10.4103/0301-4738.169789] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Context: Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. Aims: This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India. Settings and Design: Subjects of leukemia presenting to a tertiary care center in India. Subjects and Methods: A prospective, cross-sectional study looking at the spectrum of ocular manifestations in all inpatients of acute or chronic leukemia. Statistical Analysis Used: The collected data were analyzed using the Statistical Package for Social Sciences for Windows software, version 16 (SPSS Inc., Chicago, Illinois, USA). Results: The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%). Conclusions: Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular changes are often picked up in asymptomatic patients.
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Affiliation(s)
- Jacob Koshy
- Department of Ophthalmology, Christian Medical College, Ludhiana, Punjab, India
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Abstract
PURPOSE OF REVIEW This article aims to describe the ocular manifestations of leukemia, resulting both from direct infiltration of neoplastic cells and from the more common secondary effects of leukemia and its treatment. The prevalence of these findings is also discussed, along with their clinical significance, association with hematologic markers and the ophthalmologist's role caring for these patients. RECENT FINDINGS Recent studies have included a large case series examining the prevalence of ocular manifestations in newly diagnosed leukemic patients as well as case reports of ocular manifestations of leukemia. SUMMARY Patients with leukemia often have ocular manifestations. These occur either from direct infiltration of neoplastic cells or from indirect or secondary causes, including hematologic abnormalities, central nervous system involvement, opportunistic infections, or from treatment. Although nearly all ocular structures can be affected, leukemic retinopathy is often the most clinically apparent manifestation. Awareness of the ophthalmic manifestations of leukemia is important as they may precede systemic diagnosis or may be a sign of leukemia recurrence.
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Orbital Mass in a Child With Acute Lymphoblastic Leukemia: A Case Report and Review of the Literature. J Pediatr Hematol Oncol 2016; 38:646-648. [PMID: 26925710 DOI: 10.1097/mph.0000000000000544] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute lymphoblastic leukemia arising from lymphoid precursor cells of the bone marrow, the lymphoreticular system, and the soft tissue can present with medullary and extramedullary involvement. Extramedullary involvement has the propensity to affect a multitude of organs. Presentation with proptosis secondary to orbital mass in childhood acute lymphoblastic leukemia (ALL) is very rare. We report a child with pre-B cell ALL with an extramedullary soft tissue mass involving both orbits presenting with proptosis, and give a brief overview of the literature about this unusual entity. Rapid investigation and timely initiation of treatment are needed to salvage the eye and the vision. Orbital involvement is considered to confer a poorer prognosis to children with ALL.
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Palme C, Bechrakis NE, Stattin M, Haas G, Zehetner C. Decreased Vision as Initial Presenting Symptom of Acute Lymphoblastic Leukemia: A Case Report. Case Rep Ophthalmol 2016; 7:377-383. [PMID: 27721787 PMCID: PMC5043257 DOI: 10.1159/000447994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This case illustrates that hematologic disorders must be considered as a potentially life-threatening cause for vision loss. Proper laboratory workup and timely interdisciplinary approach are essential to ensure the best possible care for ophthalmic patients. Historically, before the use of bone marrow biopsy, the ophthalmologist was often asked to assist in the diagnosis of leukemia. Since ophthalmological symptoms may be the initial presenting signs of leukemia as highlighted in this case, the ophthalmogist is still of crucial importance.
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Affiliation(s)
- Christoph Palme
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Martin Stattin
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Gertrud Haas
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Claus Zehetner
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
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Acute Myeloid Leukemia Relapse Presenting as Complete Monocular Vision Loss due to Optic Nerve Involvement. Case Rep Hematol 2016; 2016:3794284. [PMID: 27668104 PMCID: PMC5030445 DOI: 10.1155/2016/3794284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/17/2016] [Indexed: 11/18/2022] Open
Abstract
Acute myeloid leukemia (AML) involvement of the central nervous system is relatively rare, and detection of leptomeningeal disease typically occurs only after a patient presents with neurological symptoms. The case herein describes a 48-year-old man with relapsed/refractory AML of the mixed lineage leukemia rearrangement subtype, who presents with monocular vision loss due to leukemic eye infiltration. MRI revealed right optic nerve sheath enhancement and restricted diffusion concerning for nerve ischemia and infarct from hypercellularity. Cerebrospinal fluid (CSF) analysis showed a total WBC count of 81/mcl with 96% AML blasts. The onset and progression of visual loss were in concordance with rise in peripheral blood blast count. A low threshold for diagnosis of CSF involvement should be maintained in patients with hyperleukocytosis and high-risk cytogenetics so that prompt treatment with whole brain radiation and intrathecal chemotherapy can be delivered. This case suggests that the eye, as an immunoprivileged site, may serve as a sanctuary from which leukemic cells can resurge and contribute to relapsed disease in patients with high-risk cytogenetics.
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Sharma H, Majumder PD, Rao C, Biswas J. A case of Acute Myeloid Leukemia masquerading as unilateral exudative detachment. Am J Ophthalmol Case Rep 2016; 4:47-49. [PMID: 29503924 PMCID: PMC5757459 DOI: 10.1016/j.ajoc.2016.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 08/09/2016] [Indexed: 12/01/2022] Open
Abstract
Purpose Leukemias can involve almost every part of the human eye. Ophthalmic manifestations of leukemias can be divided into direct infiltration, secondary vascular changes and neuro-ophthalmological changes. Our case presented with exudative retinal detachment mimicking Vogt Koyanagi Harada's disease (VKH). Observations A 30-years old Asian (Indian) female presented with insidious onset of painless diminution of vision from her right eye for one month. She gave history of fever and severe headache at the time of onset of ocular symptoms. Fundus examination revealed exudative retinal detachment at the posterior pole of her right eye. Fundus fluorescein angiography showed early stippled pin point hyperfluorescence, placoid pooling of the dye and late disc staining in both the eyes. A provisional diagnosis of Vogt Koyanagi Harada disease was made and routine blood investigations and a physician check-up for fitness for systemic steroids was done. Peripheral blood smear showed the presence of blast cells. The patient was diagnosed to have Acute Myeloid Leukemia (AML) and was started on chemotherapy. Conclusions and Importance Acute myeloid leukemia can present as an exudative retinal detachment and can mimic similarly presenting conditions like VKH. Hence, this very important differential diagnosis should be kept in mind and it stresses the importance of simple laboratory investigations like whole and differential blood counts.
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Affiliation(s)
- Hitesh Sharma
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Sankara Nethralaya, Chennai 600 006, Tamil Nadu, India
| | - Parthopratim Dutta Majumder
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Sankara Nethralaya, Chennai 600 006, Tamil Nadu, India
| | - Chetan Rao
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Sankara Nethralaya, Chennai 600 006, Tamil Nadu, India
| | - Jyotirmay Biswas
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Sankara Nethralaya, Chennai 600 006, Tamil Nadu, India
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Abstract
PURPOSE To describe the risk factors, clinical course, ancillary test findings, treatment strategies, and visual outcomes of a series of patients with choroidal abscesses caused by endogenous Nocardia. METHODS This retrospective, consecutive noncomparative case series included all patients with Nocardia ocular infections at 3 tertiary medical centers over the past 20 years. RESULTS Five eyes in 5 patients were identified with choroidal abscesses because of Nocardia. All patients were immunocompromised: one suffered from AIDS and four had autoimmune disorders. Three of the 5 patients (60%) underwent systemic evaluation, and in all 3, nonocular nocardiosis was identified. Four patients (80%) underwent diagnostic ophthalmic surgery and received systemic and intravitreal antibiotics. The final patient deferred these interventions. Outcomes at the last follow-up examination were 20/25, 1/200, hand motion at 1 foot, and 2 patients underwent enucleation. Mean follow-up (± standard deviation) was 159 (± 103) days. CONCLUSION Immunosuppression is the most significant risk factor for developing Nocardia choroidal abscesses. Definitive diagnosis generally requires subretinal biopsy, which is also critical to implementing appropriate antibiotic therapy.
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69
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Kurosawa H, Tanizawa A, Tono C, Watanabe A, Shima H, Ito M, Yuza Y, Hotta N, Muramatsu H, Okada M, Kajiwara R, Moriya Saito A, Mizutani S, Adachi S, Horibe K, Ishii E, Shimada H. Leukostasis in Children and Adolescents with Chronic Myeloid Leukemia: Japanese Pediatric Leukemia/Lymphoma Study Group. Pediatr Blood Cancer 2016; 63:406-11. [PMID: 26485422 DOI: 10.1002/pbc.25803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/31/2015] [Accepted: 09/16/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The details of leukostasis in children and adolescents with chronic myeloid leukemia (CML) are unknown. This study determined the characteristics of leukostasis in children and adolescents with CML. PROCEDURE A total of 256 cases from a retrospective study of patients with CML conducted by the Japanese Pediatric Leukemia/Lymphoma Study Group from 1996 to 2011 were analyzed, and of these, 238 cases were evaluated in this study. RESULTS Leukostasis was diagnosed in 23 patients (9.7%). The median leukocyte count and spleen size below the left costal margin in cases with leukostasis were significantly higher and larger when compared to those in cases without leukostasis (458.5 × 10(9) /l vs. 151.8 × 10(9) /l (P < 0.01), and 13 vs. 5 cm (P < 0.01), respectively). Leukostasis occurred with ocular symptoms in 14 cases, priapism in four cases, and dyspnea, syncope, headache, knee pain, difficulty hearing, and aseptic necrosis of the femoral head in one case each. One case had two leukostasis symptoms simultaneously. Three cases were diagnosed before imatinib became available. Five cases received special treatment, and in the remaining 15 cases, all of these symptoms resolved after treatment with imatinib. CONCLUSIONS This retrospective study represents the largest series of children and adolescents in which leukostasis of CML has been reported. Our data provide useful insight into the characteristics of leukostasis in recent cases of children and adolescents with CML.
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Affiliation(s)
- Hidemitsu Kurosawa
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Akihiko Tanizawa
- Department of Pediatrics, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Chikako Tono
- Department of Pediatrics, Iwate Prefectural Chube Hospital, Iwate, Japan
| | - Akihiro Watanabe
- Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan
| | - Haruko Shima
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Masaki Ito
- Department of Pediatrics, Soma General Hospital, Fukushima, Japan
| | - Yuki Yuza
- Department of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Noriko Hotta
- Department of Pediatrics, Japan Community Healthcare Organization Tokuyama Central Hospital, Tokuyama, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Okada
- Department of Pediatrics, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Ryosuke Kajiwara
- Department of Pediatrics, Yokohama City University, Yokohama, Japan
| | - Akiko Moriya Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Shuki Mizutani
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Souichi Adachi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiroyuki Shimada
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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Khaja WA, Pogrebniak AE, Bolling JP. Combined orbital proptosis and exudative retinal detachment as initial manifestations of acute myeloid leukemia. J AAPOS 2015; 19:479-82. [PMID: 26486038 DOI: 10.1016/j.jaapos.2015.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 04/28/2015] [Accepted: 05/12/2015] [Indexed: 11/29/2022]
Abstract
We report bilateral orbital and choroidal involvement as the presenting sign of acute myeloid leukemia in a 2-year-old white girl. The patient presented with painless proptosis and subconjunctival hemorrhage. Ophthalmic examination and magnetic resonance imaging revealed bilateral leukemic infiltrates of the orbits and choroid, with an exudative retinal detachment in the right eye. Bone marrow biopsy confirmed acute myeloid leukemia. Following radiation treatment, chemotherapy, and hematopoietic stem cell transplantation, the patient was doing well 12 months after presentation. Outcomes can be poor, even with treatment; prompt recognition of ophthalmic manifestations of leukemia, including proptosis, choroidal infiltration, and retinal detachment, is necessary.
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Affiliation(s)
- Wassia A Khaja
- Department of Ophthalmology, University of Florida, College of Medicine, Jacksonville, Florida
| | | | - James P Bolling
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
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71
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Johnson JS, Lopez JS, Kavanaugh AS, Liang C, Mata DA. A 25-Year-Old Man with Exudative Retinal Detachments and Infiltrates without Hematological or Neurological Findings Found to Have Relapsed Precursor T-Cell Acute Lymphoblastic Leukemia. Case Rep Ophthalmol 2015; 6:321-7. [PMID: 26483676 PMCID: PMC4608654 DOI: 10.1159/000439375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Precursor T-cell acute lymphoblastic leukemia (pre-T-ALL) may cause ocular pathologies such as cotton-wool spots, retinal hemorrhage, and less commonly, retinal detachment or leukemic infiltration of the retina itself. However, these findings are typically accompanied by the pathognomonic hematological signs of acute leukemia. Case Presentation In this case report and review of the literature, we describe a particularly unusual case of a 25-year-old man who presented to our hospital with bilateral exudative retinal detachments associated with posterior pole thickening without any hematological or neurological findings. The patient, who had a history of previously treated pre-T-ALL in complete remission, was found to have leukemia cell infiltration on retinal biopsy. Conclusion Our case underscores the fact that the ophthalmologist may be the first provider to detect the relapse of previously treated leukemia, and that ophthalmic evaluation is critical for detecting malignant ocular infiltrates.
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Affiliation(s)
- Jordan S Johnson
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, La, Boston, Mass., USA
| | - James S Lopez
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, La, Boston, Mass., USA
| | - Arthur Scott Kavanaugh
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, La, Boston, Mass., USA
| | - Chanping Liang
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, La, Boston, Mass., USA
| | - Douglas A Mata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass., USA
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72
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Ophthalmic manifestations in recently diagnosed childhood leukemia. Eur J Ophthalmol 2015; 26:88-91. [PMID: 26165325 DOI: 10.5301/ejo.5000647] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the prevalence and the pattern of ocular involvement in children with leukemia at the time of diagnosis. METHODS The data of patients with leukemia who underwent complete ophthalmic examination at the time of diagnosis between January 2005 and December 2014 were retrospectively reviewed. Demographic data, type of leukemia, ocular findings, blood parameters, and duration of follow-up were analyzed. RESULTS A total of 185 patients (111 male and 74 female) were included in the study, with a median age of 6.0 years (range 0.5-18.0 years) and a median follow-up time of 36.0 months (range 0.5-108.0 months). Ocular signs were present in 24.3% of the patients at the time of diagnosis and 37.8% of them were symptomatic. The prevalence of ocular involvement was 20.4% in patients with acute lymphocytic leukemia (ALL) and 36.4% in patients with acute myelocytic leukemia (AML) (p = 0.051). Fatality rate was significantly higher in subjects with AML compared with ALL (p = 0.019), but was not significantly different between patients with and without ocular involvement (p = 0.166). There were no significant differences in hemoglobin levels, white blood cell counts, or platelet counts between patients with ALL and AML. Platelet counts were significantly lower in patients with ocular signs compared with subjects without ocular involvement (p = 0.012), while hemoglobin levels and white blood cell counts did not differ significantly. CONCLUSIONS Various ocular signs may be present at the time of diagnosis in childhood leukemia, even in patients without any symptoms. Routine ophthalmic examination should be performed in recently diagnosed children with leukemia.
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73
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Awh CC, Miller JB, Wu DM, Eliott D. Leukostasis Retinopathy: A New Clinical Manifestation of Chronic Myeloid Leukemia With Severe Hyperleukocytosis. Ophthalmic Surg Lasers Imaging Retina 2015; 46:768-70. [DOI: 10.3928/23258160-20150730-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/19/2015] [Indexed: 11/20/2022]
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74
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Lee JY, Lim DH, Jung CW, Kim SJ. Radiation Therapy for Central Retinal Vein Occlusion with Macular Edema in Acute Lymphocytic Leukemia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.1.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ju Yeon Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul Won Jung
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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75
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Bilaterale Sehverschlechterung und zunehmender körperlicher Leistungsverlust. Ophthalmologe 2014; 111:781-4. [DOI: 10.1007/s00347-014-3041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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76
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Lamparter J, Raum P, Pfeiffer N, Peto T, Höhn R, Elflein H, Wild P, Schulz A, Schneider A, Mirshahi A. Prevalence and associations of diabetic retinopathy in a large cohort of prediabetic subjects: the Gutenberg Health Study. J Diabetes Complications 2014; 28:482-7. [PMID: 24630763 DOI: 10.1016/j.jdiacomp.2014.02.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 02/16/2014] [Accepted: 02/18/2014] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate the prevalence of diabetic retinopathy/maculopathy (DR/DMac) and its associations with cardiovascular risk factors (CRF) in participants with prediabetes (PwPD) in a large European cohort within the population-based Gutenberg Health Study (GHS). METHODS The study was based on a sub-cohort of the GHS (n=5,000, age: 35-74 y). Prediabetes was diagnosed according to HbA1c levels (5.7-6.4%). DR/DMac was graded from fundus photographs. Blood samples and comprehensive questionnaires served for evaluation of laboratory results and CRF. RESULTS The prevalence of prediabetes was 22.4%, and of DR/DMac 8.1%/0.2%, respectively. The majority of participants had mild DR (7.2%). A percentage of 0.5 of PwPD presented with moderate and 0.3% with severe non-proliferative disease. None of the subjects had proliferative DR. No independent association was found between any of the analyzed CRF [hypertension, smoking, (family) history of myocardial infarction, congestive heart failure, coronary heart disease, stroke, obesity, dyslipidemia, chronic obstructive pulmonary disease, peripheral artery disease and chronic kidney disease] and DR. CONCLUSIONS Although prevalences of prediabetes and DR in this Caucasian cohort are considerable, retinopathy findings are mainly mild, and no association was found for DR/DMac and CRF.
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Affiliation(s)
- Julia Lamparter
- Department of Ophthalmology, University Medical Centre Mainz, Mainz/Germany
| | - Philipp Raum
- Department of Ophthalmology, University Medical Centre Mainz, Mainz/Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Centre Mainz, Mainz/Germany
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London/UK
| | - René Höhn
- Department of Ophthalmology, University Medical Centre Mainz, Mainz/Germany
| | - Heike Elflein
- Department of Ophthalmology, University Medical Centre Mainz, Mainz/Germany
| | - Philipp Wild
- Department of Medicine 2, University Medical Center Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany; German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Germany
| | - Andreas Schulz
- Department of Medicine 2, University Medical Center Mainz, Germany
| | - Astrid Schneider
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz/Germany
| | - Alireza Mirshahi
- Department of Ophthalmology, University Medical Centre Mainz, Mainz/Germany
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77
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Samia L, Hamam R, Dbaibo G, Saab R, El-Solh H, Abboud M, Muwakkit S. Cytomegalovirus retinitis in children and young adults with acute lymphoblastic leukemia in Lebanon. Leuk Lymphoma 2014; 55:1918-21. [DOI: 10.3109/10428194.2013.854887] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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78
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Manrique Lipa R, González Sánchez E, Asencio Duran M, Gonzalez-Peramato P, Fonseca Santodomingo A. [Iris abscess after bacterial endocarditis in a patient with leukaemia. Differential diagnosis]. ACTA ACUST UNITED AC 2013; 89:143-5. [PMID: 24269469 DOI: 10.1016/j.oftal.2012.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 07/30/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To report a case of iris abscess due to bacterial endocarditis. CASE REPORT A 46-year-old male under diagnosis of promielocitic leukemia and endocarditis presented with decreased vision in left eye (OS). Ophthalmic exploration revealed iris abscess and hypopyon with fibrinous exudate in iris of the left eye and tyndall +1 in right eye (OD). Blood culture and anterior chamber paracentesis was positive for methicillin-sensitive Staphylococcus aureus and negative for blastic cells in citology. Treatment with systemic antibiotic was initiated with total resolution of inflammation. CONCLUSION Iris abscess is an unusual septic focus in bacterial endocarditis. It is crucial to rule out an extramedullary metastasis in a patient with leukemia due to the general prognosis.
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Affiliation(s)
- R Manrique Lipa
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España.
| | | | - M Asencio Duran
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
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79
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Schmid S, Lang-Muritano M, Meier U, De Peron R, Konrad D, Schoenle E. Transient severe non-proliferative retinopathy in an adolescent with type 1 diabetes and chronic myeloid leukemia. Pediatr Diabetes 2013; 14:227-9. [PMID: 22817266 DOI: 10.1111/j.1399-5448.2012.00901.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/09/2012] [Accepted: 06/06/2012] [Indexed: 11/29/2022] Open
Abstract
The onset of diabetic retinopathy correlates with the long-term quality of glycemic control. A 17-yr-old adolescent with type 1 diabetes presented unexpectedly with acute non-proliferative retinopathy despite good glycemic control. Two months later chronic myeloid leukemia (CML) was diagnosed. Chemotherapy was initiated and within a few weeks the patient was in full remission concerning leukemia. Retinopathy completely resolved within 8 months. The patient was in good metabolic control throughout the course. To our knowledge, this is the first report of CML-triggered retinopathy in a well-controlled diabetic adolescent. In case of unexpected retinopathy in patients with type 1 diabetes, other potential causes of retinopathy should be considered.
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Affiliation(s)
- Silvia Schmid
- Department of Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland.
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80
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Do DV, Dhaliwal RS, Schachat AP. Leukemias and Lymphomas. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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81
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Taamallah-Malek I, Chebbi A, Bouladi M, Nacef L, Bouguila H, Ayed S. [Massive bilateral subconjunctival hemorrhage revealing acute lymphoblastic leukemia]. J Fr Ophtalmol 2012; 36:e45-8. [PMID: 23122838 DOI: 10.1016/j.jfo.2012.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/29/2012] [Accepted: 03/13/2012] [Indexed: 11/26/2022]
Abstract
We report the case of 20-year-old patient who presented in emergency with bilateral massive, spontaneous subconjunctival hemorrhage. Clinical findings suggested a blood dyscrasia, which was confirmed by blood cell count. The patient was urgently referred to hematology where the diagnosis of acute lymphoblastic leukemia was made. This case highlights the importance of working up any unusual subconjunctival hemorrhage, as it may reveal, in certain cases, a severe life-threatening disease.
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Affiliation(s)
- I Taamallah-Malek
- Service d'ophtalmologie A, institut Hédi Raies d'ophtalmologie, boulevard 9-Avril, 1004 Tunis, Tunisie.
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82
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Huang PK, Sanjay S. Visual Disturbance as the first Symptom of Chronic Myeloid Leukemia. Middle East Afr J Ophthalmol 2012; 18:336-8. [PMID: 22224030 PMCID: PMC3249827 DOI: 10.4103/0974-9233.90143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a well-studied entity and advances made in diagnosis and treatment have improved the disease outcome. Patients with ophthalmic manifestation of CML have been reported to have lower 5-year survival rates. Hence, recognizing the early fundus changes may improve outcome by allowing earlier diagnosis and treatment. We report a case of a previously healthy 30-year-old Myanmarese male, who presented with a minor visual disturbance, complaining of seeing a ‘black dot’ in his left visual field for the past 1 week. Fundoscopic examination revealed bilateral retinal blot hemorrhages, white-centered hemorrhage, and preretinal hemorrhage over the left fovea. The full blood count and peripheral blood film were abnormal, and bone marrow biopsy confirmed the diagnosis of CML. Cytoreduction therapy was promptly commenced and his symptoms resolved, with improvement in visual acuity. No complications were recorded at 1-year follow-up.
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Affiliation(s)
- Philemon K Huang
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital/ Alexandra Health, 90 Yishun Central, Singapore, 768828
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83
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Agrawal S, Peters MJ, Adams GGW, Pierce CM. Prevalence of retinal hemorrhages in critically ill children. Pediatrics 2012; 129:e1388-96. [PMID: 22614777 DOI: 10.1542/peds.2011-2772] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Retinal hemorrhages (RHs) with encephalopathy and subdural bleeding are considered suggestive of abusive head trauma (AHT). Existing studies describing RH focus on AHT and have potential selection bias. We undertook a prospective observational study to define the prevalence, distribution, and extent of RH in critically ill children. METHODS From February 2008 to December 2009, emergency intensive care admissions ≥ 6 weeks of age underwent dilated retinal examination by either a pediatric ophthalmologist or RetCam (retinal photograph) imaging after written informed consent. Patients with suspected or proven AHT, penetrating eye trauma, and elective admissions were excluded. RESULTS The prevalence of RH was 15.1% (24/159; 95% confidence interval [CI]: 9.5%-21%); 16/24 (66%) mild, and 2/24 (8%) moderate. Severe multilayered RH were seen in only 6 patients (3.7%), 3 with myeloid leukemia and sepsis, 2 with severe accidental head injury, and 1 with severe coagulopathy secondary to late onset hemorrhagic disease of newborn. There was no detectable impact of age, gender, seizures, coagulopathy or cardiopulmonary resuscitation on prevalence of severe multilayered RH; however, sepsis (odds ratio: 3.2; 95% CI: 1.3-8.0, P = .018) and coagulopathy (odds ratio: 2.8; 95% CI: 1.2-7.0, P = .025) were significantly associated with any RH. Only admission diagnosis was independently associated with severe multilayered RH on logistic regression. CONCLUSIONS RHs were seen in critically ill children with a prevalence of 15.1% (24/159); however, most were mild. Severe multilayered RH resembling those described in AHT were rare (6/24) and were only seen in patients with fatal accidental trauma, severe coagulopathy, sepsis with myeloid leukemia, or a combination of these factors.
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Affiliation(s)
- Shruti Agrawal
- Paediatric and Neonatal Intensive Care Units, Great Ormond Street Hospital for Children, London, United Kingdom.
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Abstract
A 5-year-old girl from Rwanda was referred to our pediatric oncology department with severe bilateral proptosis and a bloody, necrotic chemosis of the conjunctiva and infraorbital tissues. Furthermore, she presented with a left facial paresis, hemorrhagic gingiva, epistaxis, and bloody tears. There was a 3-month history of pancytopenia. Investigations that included a complete blood count, peripheral blood smear, and bone marrow aspirate, were conclusive for the diagnosis of acute myeloid leukemia.
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Abstract
PURPOSE To report a case of posterior scleritis in a 9-year-old boy. METHOD A case report. RESULTS Uniocular presentation in a 9-year-old boy. CONCLUSION Posterior scleritis is seen commonly in middle-aged women, associated with mild ocular congestion, globe tenderness, and varying amount of vision loss. We report an uncommon presentation of posterior scleritis in a young male child. The patient presented with decreased vision and extraocular and intraocular inflammatory signs in the left eye. Fundus examination showed disk and macular edema with a T-sign on B-scan ultrasound. The patient showed good response to oral steroids with resolution of inflammation and recovery of vision.
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Affiliation(s)
- Vivek Dave
- From the Smt. Kanuri Santhamma Retina Vitreous Service, L.V. Prasad Eye Institute, Hyderabad, India
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86
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Affiliation(s)
- Phoebe Lin
- Duke University Eye Center, 2351 Erwin Road, Durham, NC 27710, USA
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88
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Eze BI, Ibegbulam GO, Ocheni S. Ophthalmic manifestations of leukemia in a tertiary hospital population of adult nigerian africans. Middle East Afr J Ophthalmol 2011; 17:325-9. [PMID: 21180433 PMCID: PMC2991450 DOI: 10.4103/0974-9233.71599] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: To determine the prevalence and pattern of leukemic ophthalmopathy among adults at the University of Nigeria Teaching Hospital (UNTH), Enugu, south-eastern, Nigeria. Materials and Methods: This prospective, observational case series surveyed adult leukemia patients presenting at UNTH’s departments of Hematology/Immunology and Ophthalmology from July 2003 to August 2008. The demographic profile, clinical data from for each individual in the cohort were statistically collated and analyzed. A P <0.05 was considered as statistically significant. Results: There were 72 participants (45 males and 27 females), aged 32.7 ± 9.8 years (range, 18 years to 72 years). Leukemic ophthalmopathy was present in 77.8% of subjects. The leading ophthalmic manifestations of leukemia were retinal vascular abnormalities in 50.0% of subjects, conjunctival pallor in 27.8% of subjects, sub-conjunctival hemorrhage in 19.4% of subjects, and retinal hemorrhage in 16.7% of subjects. Ocular co-morbidity was present in 47.2% of subjects. Vision loss occurred in 37.5% of subjects, of which 32.1% was leukemia related, and the remaining due to ocular co-morbidity. Leukemic ophthalmopathy was more prevalent in chronic leukemia (P <0.05), frequently affected the ocular posterior segment (P < 0.05), and often resulted from secondary hematologic complications (P <0.05). There was no gender difference in the prevalence of leukemia (P = 0.0822) or leukemic ophthalmopathy (P = 0.6624). Conclusion: The prevalence of leukemic ophthalmopathy in Enugu is high. It is often associated with significant ocular co-morbidity and vision loss. These have implications for clinicians involved in leukemia management. Early diagnosis and regular ophthalmic examinations are recommended to optimize treatment outcomes.
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Affiliation(s)
- Boniface I Eze
- Department of Ophthalmology, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, PMB 01139, Enugu, Nigeria
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Hua LV, Le ST, Yudcovitch LB. Floaters and decreased vision as initial symptoms of acute lymphoblastic leukaemia. Clin Exp Optom 2011; 94:595-7. [PMID: 21668498 DOI: 10.1111/j.1444-0938.2011.00612.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Len V Hua
- Pacific University College of Optometry, Oregon 97116, USA.
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90
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Haustein M, Babatz J, Sommer F, Radke J, Hoffmann C, Pillunat L, Sandner D. Zahnfleischschwellung und Visusreduktion. Ophthalmologe 2011; 108:1039-44. [DOI: 10.1007/s00347-011-2352-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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91
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Aydin A, Çakir A, Sayan O, Haholu A, Velioglu M, Ersanli D. Intraocular pressure elevation in isolated extraocular muscle infiltration by leukaemia. Clin Exp Ophthalmol 2011; 39:283-5. [DOI: 10.1111/j.1442-9071.2010.02454.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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92
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Omoti AE, Omoti CE, Momoh RO. Ocular disorders in adult leukemia patients in Nigeria. Middle East Afr J Ophthalmol 2010; 17:165-8. [PMID: 20616925 PMCID: PMC2892134 DOI: 10.4103/0974-9233.63081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Context: Leukemias may present with, or be associated with ocular disorders. Aims: To determine the rates of ophthalmic disorders in adult patients with leukemia. Settings and Design: A prospective study of ocular disorders in adult patients with leukemia at the University of Benin Teaching Hospital, Benin City, Nigeria, between July 2004 and June 2008 was conducted. Methods and Materials: The patients were interviewed and examined by the authors and the ocular findings were recorded. Statistical analysis was performed using Instat GraphPad™ v2.05a statistical package software. The means, standard deviation, and the Kruskal-Wallis non parametric test were performed. Results: Forty-seven patients with leukemias were seen. Nineteen patients (40.4%) had CLL, 14(29.8%) had CML, 9(19.1%) had AML and 5(10.6%) had ALL. Seven patients (14.9%) had ocular disorders due to leukemia. The ocular disorders due to the leukemia were proptosis in two patients (4.3%), retinopathy in one patient (2.1%), conjunctival infiltration in one patient (2.1%), periorbital edema in one patient (2.1%), retinal detachment in one patient (2.1%), and subconjunctival hemorrhage in one patient (2.1%). There was no significant difference in rate of the ocular disorders in the various types of leukemia (Kruskal-Wallis KW= 4.019; corrected for ties. P=0.2595). One patient (2.1%) was blind from bilateral exudative retinal detachment while 1 patient (2.1%) had monocular blindness from mature cataract. Conclusions: Ophthalmic disorders that are potentially blinding occur in leukemias. Ophthalmic evaluation is needed in these patients for early identification and treatment of blinding conditions.
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Affiliation(s)
- Afekhide E Omoti
- Department of Ophthalmology, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria
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93
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Simultaneous Bilateral Central Retinal Vein Occlusion As the Initial Presentation of Acute Myeloid Leukemia. Am J Med Sci 2010; 339:387-9. [PMID: 20186040 DOI: 10.1097/maj.0b013e3181cf31ac] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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94
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Simpson-Haidaris PJ, Pollock SJ, Ramon S, Guo N, Woeller CF, Feldon SE, Phipps RP. Anticancer Role of PPARgamma Agonists in Hematological Malignancies Found in the Vasculature, Marrow, and Eyes. PPAR Res 2010; 2010:814609. [PMID: 20204067 PMCID: PMC2829627 DOI: 10.1155/2010/814609] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 11/30/2009] [Accepted: 12/16/2009] [Indexed: 12/19/2022] Open
Abstract
The use of targeted cancer therapies in combination with conventional chemotherapeutic agents and/or radiation treatment has increased overall survival of cancer patients. However, longer survival is accompanied by increased incidence of comorbidities due, in part, to drug side effects and toxicities. It is well accepted that inflammation and tumorigenesis are linked. Because peroxisome proliferator-activated receptor (PPAR)-gamma agonists are potent mediators of anti-inflammatory responses, it was a logical extension to examine the role of PPARgamma agonists in the treatment and prevention of cancer. This paper has two objectives: first to highlight the potential uses for PPARgamma agonists in anticancer therapy with special emphasis on their role when used as adjuvant or combined therapy in the treatment of hematological malignancies found in the vasculature, marrow, and eyes, and second, to review the potential role PPARgamma and/or its ligands may have in modulating cancer-associated angiogenesis and tumor-stromal microenvironment crosstalk in bone marrow.
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Affiliation(s)
- P. J. Simpson-Haidaris
- Department of Medicine/Hem-Onc Division, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
- Department of Microbiology and Immunology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
- Department of Pathology and Laboratory Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - S. J. Pollock
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - S. Ramon
- Department of Microbiology and Immunology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - N. Guo
- Department of Opthalmology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - C. F. Woeller
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - S. E. Feldon
- Department of Opthalmology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - R. P. Phipps
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
- Department of Opthalmology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
- The Lung Biology and Disease Program, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
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95
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Kiratli H, Balci KE, Himmetoğlu Ç, Üner A. Isolated extraocular muscle involvement as the ophthalmic manifestation of leukaemia. Clin Exp Ophthalmol 2009; 37:609-13. [DOI: 10.1111/j.1442-9071.2009.02099.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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96
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Alexander C, Lee GA, Whitehead K, Bashford J, Jefferies PD. Life-threatening conjunctival presentation of myeloid sarcoma. Clin Exp Ophthalmol 2009; 36:775-7. [PMID: 19128384 DOI: 10.1111/j.1442-9071.2008.01885.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Myeloid sarcoma is a life-threatening condition that can present rarely as a conjunctival lesion. This case report describes a 48-year-old woman who was diagnosed after conjunctival biopsy, subsequently systemically investigated and then treated with chemotherapy. Collaboration of the ophthalmologist, pathologist and oncologist was critical in the successful management of this patient.
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97
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Acute sixth nerve palsy in a young man, beware of the ‘red herring’. Ir J Med Sci 2008; 179:301-3. [DOI: 10.1007/s11845-008-0245-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 10/03/2008] [Indexed: 11/25/2022]
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98
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Russo V, Scott IU, Querques G, Stella A, Barone A, Delle Noci N. Orbital and ocular manifestations of acute childhood leukemia: clinical and statistical analysis of 180 patients. Eur J Ophthalmol 2008; 18:619-23. [PMID: 18609485 DOI: 10.1177/112067210801800420] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the association between presence of orbital or ocular lesions and type and stage of leukemia and to investigate whether orbital and ocular lesions are significant in predicting leukemia prognosis. METHODS The authors evaluated 180 patients with acute childhood leukemia. Lesions associated with leukemia may be classified as specific (due to leukemic infiltration of various ocular tissues), nonspecific (due to one of the secondary complications), or iatrogenic manifestations caused by chemotherapy. Risk-based treatment assignment is based on clinical and laboratory features at diagnosis. Children with presenting white blood cell count below 50,000 mm3 are considered at standard risk for treatment failure, while all others are considered at high risk for treatment failure. RESULTS Specific lesions were noted in 66% of patients with acute myeloid leukemia (AML) and 11.5% patients with acute lymphocytic leukemia (ALL) (p<0.05), and were more severe in patients with high risk leukemia than in patients with standard risk leukemia. Orbital or ocular lesions were noted more commonly in patients with AML (66.6%) compared to patients with ALL (15.1%). In both the AML and ALL groups, there was a higher frequency of leukemic relapses in the bone marrow and/or central nervous system in patients with specific lesions (63.1%) compared to patients with nonspecific lesions (42%), and in patients without orbital or ocular lesions (29.2%) (p<0.05). CONCLUSIONS In both the AML and ALL groups, the presence of specific orbital or ocular lesions was associated with a higher frequency of bone marrow relapses and CNS involvement (p<0.05), leading to a lower survival rate.
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Affiliation(s)
- V Russo
- Institute of Ophthalmology, University of Foggia, Foggia, Italy.
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99
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Lakhtakia R, Sinha A, Anand SK, Dhar AK, Thakur PK, Mehta A. Acute Bilateral Hypopyon in Acute Lymphocytic Leukaemia. Med J Armed Forces India 2008; 64:177-8. [PMID: 27408129 DOI: 10.1016/s0377-1237(08)80074-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 10/26/2006] [Indexed: 11/26/2022] Open
Affiliation(s)
- R Lakhtakia
- Senior Advisor (Pathology), Command Hospital (Central Command), Lucknow
| | - A Sinha
- Adv Course Trainee Officer (Pathology), AFMC, Pune
| | - S K Anand
- Classified Specialist (Ophthalmology) Command Hospital (Eastern Command), Kolkata
| | - A K Dhar
- Senior Advisor (Medicine and Medical Oncology), AH (R&R), Delhi Cantt-10
| | - P K Thakur
- Classified Specialist (Radiotherapy), MDTC, Command Hospital (Southern Command), Pune-40
| | - A Mehta
- Prof & Head Department of Pathology, AFMC, Pune
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100
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Head JE, Shen D, Santiago-Maysonet M, Bishop RJ, Chan CC. Ocular pathology of uncommon hematologic malignancies: a case series. J Med Case Rep 2007; 1:158. [PMID: 18045486 PMCID: PMC2211492 DOI: 10.1186/1752-1947-1-158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 11/28/2007] [Indexed: 11/29/2022] Open
Abstract
Introduction In general, ocular complications of hematologic malignancies such as leukemia are well documented. However, reports of ocular involvement in such diseases as lymphomatoid granulomatosis and chronic myelomonocytic leukemia are uncommon. Here we present cases of these two relatively rare hematologic malignancies demonstrating clinical and subclinical ocular involvement. Case Presentation In the first case, a 54-year-old man with a previous diagnosis of lymphomatoid granulomatosis presented with a new-onset conjunctival lesion while his systemic disease was thought to be in remission. A biopsy was taken that revealed heavy infiltrates of B and T cells at the site of the lesion. Molecular analysis confirmed that these cells were positive for both Epstein-Barr viral DNA and immunoglobulin heavy chain gene rearrangement, consistent with a manifestation of his systemic disease. In the second case, a 51-year-old man with chronic myelomonocytic leukemia died after a waxing and waning clinical course. Post-mortem studies revealed the presence of atypical monocytes in the choroidal and subretinal spaces, consistent with his previous diagnosis. Conclusion While ocular involvement in hematologic malignancies is not uncommon, these two cases describe involvement of the eye by two relatively rare neoplasms. We herein emphasize novel findings in each case, including conjunctival involvement as the first sign of recurrent lymphomatoid granulomatosis and the combination of subretinal and choroidal myelomonocytic leukemic infiltration. With the evolution of new antineoplastic therapies that may prolong life, these cases exemplify the importance of eye care in patients diagnosed with hematologic malignancies.
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Affiliation(s)
- James E Head
- Immunopathology Section, National Institutes of Health, Bethesda, MD, USA.
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