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Wang Y, Zhu L, Wang H, Li Z, Bai R, Wei Q, Huang L, Xu Y, Li S, Chen H. Bilateral optic nerve infiltration and leukemic retinopathy as initial signs of leukemia relapse with central nervous system involvement in an adult: a case report. BMC Ophthalmol 2024; 24:225. [PMID: 38807037 PMCID: PMC11134675 DOI: 10.1186/s12886-024-03486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND We describe a case in which bilateral optic nerve infiltration and leukemic retinopathy were the initial signs of disease relapse in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+-ALL) with central nervous system (CNS) involvement. CASE PRESENTATION A 65-year-old Asian female with Ph+-ALL in complete remission presented at our institution with symptoms of visual disturbance, central scotoma and pain with eye movement in both eyes for a 1-month duration. Ophthalmic examination revealed remarkable optic disc swelling with multiple flame-shaped peripapillary hemorrhages, retinal venous dilation and retinal hemorrhages in both eyes. She was subsequently referred to the treating oncologist and diagnosed with Ph+-ALL relapse with multiple relapsed diseases involving the bone marrow and CNS. After intrathecal (IT) therapy, her visual acuity dramatically improved, and her leukemic infiltrates decreased. CONCLUSIONS To the best of our knowledge, this is the first case report of ALL relapse with CNS involvement presenting as bilateral optic nerve infiltration and leukemic retinopathy in an adult. Hence, we highlight the priority and sensitivity of ophthalmic examinations, as they are noninvasive methods for detecting leukemia relapse.
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Affiliation(s)
- Yisai Wang
- Department of Ophthalmology, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Ling Zhu
- Department of haematology, Air Force Medical University, Beijing, China
| | - Hongtao Wang
- Department of Ophthalmology, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Zhen Li
- Department of Ophthalmology, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Ruomeng Bai
- Department of Ophthalmology, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Qinghua Wei
- Department of Ophthalmology, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Lin Huang
- Department of Ophthalmology, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Ying Xu
- Department of Ophthalmology, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Songguo Li
- Department of Ophthalmology, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Hui Chen
- Department of Ophthalmology, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China.
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Villagomez-Valdez LG, Colorado-Zavala MF, Ruiz-Lozano RE, Gonzalez E, Gomez-Valdez L, Gonzalez-Ramella O, Ancona-Lezama D. Leukemic infiltration of the ciliary body in a child with T-cell acute lymphoblastic leukemia. J AAPOS 2024:103937. [PMID: 38768773 DOI: 10.1016/j.jaapos.2024.103937] [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: 11/15/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 05/22/2024]
Abstract
A 14-year-old boy presented after 2 months of vision loss, redness, and pain in the right eye, initially treated as anterior uveitis with topical corticosteroids. He had a 1-year history of T-cell acute lymphoblastic leukemia, which had been in remission for 6 months. On examination, visual acuity in the right eye was light perception, with 4+ anterior chamber cells, pupillary membrane, and an intumescent cataract. Ultrasound biomicroscopy (UBM) revealed a ciliary body mass and capsular bag rupture. After consultation with his oncologist, he received 10 radiotherapy sessions. At 1 month, UBM showed resolution of the mass. After 1 year of remission, the patient underwent pars plana vitrectomy, pupillary membranectomy, and placement of a scleral-fixated intraocular lens. Thirty months after surgery, visual acuity was 20/25. Leukemic infiltration of the ciliary body is a rare manifestation of the disease that is often misdiagnosed as uveitis.
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3
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Lee JH, Kim JJ, Hong SY, Kim GH, Kim JY, Kim RY, Kim M, Park YG, Kim YJ, Cho BS, Lee S, Kim HJ, Park YH. Analysis of retinal and choroidal microvascular changes using optical coherence tomography and optical coherence tomography angiography in patients with acute leukemia. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06504-y. [PMID: 38713398 DOI: 10.1007/s00417-024-06504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE Although leukemic retinopathy accounts for 80% of ocular complications in acute leukemia, its pathogenesis remains unclear. To evaluate changes in retinal and choroicapillaris and structural parameters in patients with acute leukemia, we analyzed the correlation between vascular perfusion metrics and laboratory parameters and assessed the changes after hematopoietic stem cell transplantation (HSCT). METHODS Herein, 104 eyes of 52 patients aged 18 and above with acute leukemia were enrolled. 80 eyes of 40 healthy patients were recruited as control participants. All participants underwent optical coherence tomography (OCT) and OCT angiography (OCTA) at baseline. RESULTS Patients with acute leukemia had a significantly thicker ganglion cell-inner plexiform layer (GCIPL) and lower circularity index than the control participants. Post-HSCT perfusion metrics did not differ significantly, but parafoveal thickness decreased significantly. During the active phase of acute leukemia, lower platelet levels were associated with significant GCIPL thickening and increased foveal avascular zone and perimeter. D-dimer levels positively correlated with GCIPL thickness. CONCLUSION Patients with acute leukemia had subclinical retinal microvascular deficits on OCTA and GCIPL thickening on OCT, possibly associated with bone marrow function. GCIPL thickness may indicate acute ischemia in such patients. Further studies must elucidate their clinical and prognostic significance.
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Affiliation(s)
- Ji Hye Lee
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Jae Jung Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Seo Yeon Hong
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Gee-Hyun Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Joo-Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Rae-Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Mirinae Kim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Young-Geun Park
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Yoo-Jin Kim
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Sik Cho
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Lee
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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4
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Rossi C, Buizza A, Alessio G, Borselli M, Taloni A, Carnevali A, Carnovale Scalzo G, Lucisano A, Scorcia V, Giannaccare G. Ophthalmic Manifestations in Patients with Blood Malignancies. Hematol Rep 2024; 16:193-203. [PMID: 38651449 PMCID: PMC11036248 DOI: 10.3390/hematolrep16020020] [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: 02/09/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Ocular complications can occur in up to 90% of patients with blood malignancies. Such complications range from direct infiltration to local hemostatic imbalance and treatment-related toxicity. This narrative review is based on a systematic computerized search of the literature conducted until January 2024 and examines the common ocular complications associated with blood cancers. Ocular complications from primary disease include mass effects from ocular adnexal lymphomas and intraocular lymphomas, with B-cell lymphomas accounting for 95% of primary ocular presentations. Secondary disease involvement from systemic hematological malignancies can lead to a wide range of ocular manifestations, such as leukemic retinopathy. Furthermore, toxicity from antineoplastic therapies and ocular graft versus host disease (oGVHD) after hematopoietic stem cell transplantation present additional risks to ocular health. In conclusion, ocular complications in blood cancer patients are an integral part of patient management, requiring regular ophthalmic evaluations and close collaboration between oncologists and ophthalmologists. Advances in therapy and an increased focus on early symptom recognition are essential for preserving vision and enhancing patient quality of life.
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Affiliation(s)
- Costanza Rossi
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Alessandro Buizza
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy;
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Italy
| | - Giuseppe Alessio
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Massimiliano Borselli
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Adriano Carnevali
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Giovanna Carnovale Scalzo
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Andrea Lucisano
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09123 Cagliari, Italy
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5
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Nistal D, Lee A, Ruzevick J. Pediatric Orbital and Skull Base Pathology. Oral Maxillofac Surg Clin North Am 2024:S1042-3699(24)00011-6. [PMID: 38522979 DOI: 10.1016/j.coms.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Pediatric orbital and skull base pathologies encompass a spectrum of inflammatory, sporadic, syndromic, and neoplastic processes that require a broad and complex clinical approach for both medical and surgical treatment. Given their complexity and often multicompartment involvement, a multidisciplinary approach for diagnosis, patient and family counseling, and ultimately treatment provides the best patient satisfaction and clinical outcomes. Advances in minimally invasive surgical approaches, including endoscopic endonasal and transorbital approaches allows for more targeted surgical approaches through smaller corridors beyond more classic transcranial or transracial approaches.
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Affiliation(s)
- Dominic Nistal
- Department of Neurological Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356470, Seattle, WA 98195, USA
| | - Amy Lee
- Department of Neurological Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356470, Seattle, WA 98195, USA; Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Jacob Ruzevick
- Department of Neurological Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356470, Seattle, WA 98195, USA; Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
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6
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Rothfield L, Falcone MM, Gaier ED, Heidary G, Gise R. Neuro-ophthalmic Complications in Pediatric Leukemia. J Neuroophthalmol 2023; 43:520-524. [PMID: 37247249 DOI: 10.1097/wno.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Optic neuropathy in childhood leukemia occurs through multiple direct and indirect mechanisms, including leukemic infiltration of the optic nerve, infection, blood dyscrasias, or adverse effects of treatment. We aimed to characterize visual outcomes in pediatric patients with leukemia-associated neuro-ophthalmic manifestations. METHODS We retrospectively identified patients with leukemia and optic nerve pathology over 13 years by diagnostic billing codes. We collected information on demographics, presentation, treatment course, and visual outcomes directly from medical records. RESULTS Of the 19 patients who met inclusion criteria, 17 (89.5%) had pseudotumor cerebri and 2 had direct optic nerve infiltration. Causes of increased intracranial pressure included central nervous system infiltration (6 of 17), hyperviscosity/leukemia (2 of 17), venous sinus thrombosis (3 of 17), medication induced (5 of 17), and bacterial meningitis (1 of 17). 47.1% (8 of 17) had papilledema at the time of leukemia diagnosis, and 94.1% (16 of 17) of patients with pseudotumor cerebri were treated with acetazolamide. At presentation, 3 patients had decreased vision secondary to macular ischemia, subhyaloid vitreous hemorrhage, or steroid induced glaucoma. Following treatment of pseudotumor cerebri, binocular visual acuity was ≥20/25 in all patients. One patient with optic nerve infiltration had a final visual acuity of count fingers in the affected eye. CONCLUSIONS In our chart review, the most common mechanism of neuro-ophthalmic involvement in pediatric leukemia was elevated intracranial pressure from a myriad of causes. Visual outcomes from patients with elevated intracranial pressure were excellent. Understanding the mechanisms by which leukemia can cause optic nerve disease in pediatric patients can facilitate earlier diagnosis and treatment and potentially improve visual outcomes.
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Affiliation(s)
- Lindsay Rothfield
- Department of Ophthalmology (LR), Boston Medical Center, Boston, Massachusetts; Bascom Palmer Eye Institute (MMF), University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology (EDG, GH, RG), Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School (EDG, GH, RG), Boston, Massachusetts; and Picower Institute for Learning and Memory (EDG), Massachusetts Institute of Technology, Cambridge, Massachusetts
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7
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Beketova T, Mordechaev E, Murillo B, Schlesinger MD. Leukemic Retinopathy: A Diagnostic Clue for Initial Detection and Prognosis of Leukemia. Cureus 2023; 15:e50587. [PMID: 38222198 PMCID: PMC10788118 DOI: 10.7759/cureus.50587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Leukemia is a systemic malignancy that can compromise various physiological functions, including vision. We report a case of a 37-year-old male presenting with worsening bilateral central vision loss, fatigue, shortness of breath, and ankle edema. Ophthalmic examination revealed extensive retinal hemorrhages, Roth spots, and subhyaloid hemorrhages, consistent with leukemic retinopathy. Further hematologic workup confirmed chronic eosinophilic leukemia. The patient showed systemic and visual improvement after prompt treatment with imatinib. This case highlights the importance of ophthalmological assessment in diagnosing leukemia, as ocular manifestations may often be the first sign of hematological disease.
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Affiliation(s)
| | | | - Brian Murillo
- Ophthalmology, New York Medical College, Valhalla, USA
| | - Max D Schlesinger
- Ophthalmology/Retina, Westchester Medical Center/New York Medical College, Valhalla, USA
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8
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Aygun B, Biswas A, Taranath A, Yildiz H, Gore S, Mankad K. Neuroimaging of Ocular Abnormalities in Children. Neuroimaging Clin N Am 2023; 33:623-641. [PMID: 37741662 DOI: 10.1016/j.nic.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
In this article, we will discuss the essential MR imaging protocol required for the assessment of ocular abnormalities including malignancies. Then we will describe relevant anatomy, ocular embryogenesis, and genetics to establish a profound understanding of pathophysiology of the congenital ocular malformations. Finally, we will discuss pediatric ocular malignancies, benign mimics, and the most common congenital ocular malformations with case examples and illustrations and give tips on how to distinguish these entities on neuroimaging.
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Affiliation(s)
- Berna Aygun
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK; Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Asthik Biswas
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, South Australia Medical Imaging, University of Adelaide, South Australia, Australia
| | - Harun Yildiz
- Department of Radiology, Bursa Dortcelik Children's Hospital, Bursa, Turkey
| | - Sri Gore
- Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCL GOS Institute of Child Health
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9
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Mushtaq U, Shaman Ameen B, Nie C, Nechi D, Mazhar IJ, Yasir M, Sarfraz S, Shlaghya G, Narayana SH, Khan S. Association Between the Use of Systemic Steroids and Ocular Hypertension as a Side Effect in Pediatric Population: A Systematic Review. Cureus 2023; 15:e42112. [PMID: 37602115 PMCID: PMC10438628 DOI: 10.7759/cureus.42112] [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: 05/31/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Steroids are commonly used in children for the treatment of various medical conditions. However, systemic steroids can lead to the development of ocular hypertension (OHT), an increase in intraocular pressure. Limited literature is available on the systemic route of steroid administration in children and the development of this side effect. For literature writing and review, a thorough research was conducted across various platforms, such as PubMed, PubMed Central (PMC), Medline, and Cochrane Database of Systematic Reviews (CDSR). After all the screening processes and quality checks, 12 articles were finalized for review writing. The aim was to explore if OHT development is a common side effect developed in children on systemic steroid use for various medical conditions and if any particular risk factors were present among children that lead to its development. The results indicate that OHT is a common side effect of systemic steroid use in children. Children may or may not present with the symptoms of raised intraocular pressure. The development of OHT occurs within one month of the beginning of the steroid treatment in most of the reviewed studies. Several risk factors associated with developing this side effect were also found. In conclusion, systemic steroid use in children leads to the development of OHT. Awareness among healthcare professionals regarding this potential association is necessary. This information can be used to develop guidelines for serial ocular examinations in children on prolonged systemic steroid use.
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Affiliation(s)
- Ujala Mushtaq
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Basim Shaman Ameen
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chuhao Nie
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Daniel Nechi
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Iqra J Mazhar
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohamed Yasir
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Saba Sarfraz
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Gandhala Shlaghya
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sri Harsha Narayana
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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10
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Sawada M, Takachi T, Watanabe K, Tsuchiya Y, Nishimura K, Hotta Y, Sato M. Steroid-induced ocular hypertensive response in pediatric patients with acute lymphoblastic leukemia. Jpn J Ophthalmol 2023:10.1007/s10384-023-01005-7. [PMID: 37310574 DOI: 10.1007/s10384-023-01005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/26/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE To report the characteristics of the steroid-induced ocular hypertensive response in pediatric patients with acute lymphoblastic leukemia (ALL) treated with prednisolone (PSL) during induction therapy and with dexamethasone (DEX) during reinduction therapy. STUDY DESIGN Retrospective. PATIENTS AND METHODS This study included pediatric patients diagnosed with B-cell precursor ALL and treated with systemic corticosteroids sometime during the period from 2016 to 2018 at Shizuoka Children's Hospital. Data were extracted from the hematology/oncology records related to the type, dose, and duration of systemic corticosteroids as well as to the ophthalmologic examination findings, intraocular pressure (IOP) data, symptoms of high IOP, and antiglaucoma medications obtained during corticosteroid administration. The maximal IOPs of the PSL and DEX groups were compared. RESULTS Twenty-eight patients (18 boys and 10 girls; mean age 5.5 years) were treated with systemic corticosteroids. Twelve of the 22 courses of PSL and 33 of the 44 courses of DEX were found to be associated with high IOP. The maximal IOP was higher with the use of DEX than with the use of PSL, including in those who received prophylactic therapy (PSL 25.2 mmHg, DEX 33.6 mmHg; P = 0.02). Antiglaucoma medication was given to 21 patients; 6 patients had symptoms of ocular hypertension. The maximal IOPs were 52.8 mmHg and 70.8 mmHg in the PSL and DEX groups, respectively. Both groups of patients reported severe headache. CONCLUSION Increased IOP was frequently observed during systemic corticosteroid therapy in pediatric patients with ALL. Although most patients were asymptomatic, they occasionally presented with severe systemic symptoms. Regular ophthalmologic examinations should be included in the treatment guidelines for ALL.
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Affiliation(s)
- Mayu Sawada
- Department of Ophthalmology, Shizuoka Children's Hospital, Shizuoka, Japan
- Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Takayuki Takachi
- Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kenichiro Watanabe
- Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yoko Tsuchiya
- Department of Ophthalmology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kasumi Nishimura
- Department of Ophthalmology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yoshihiro Hotta
- Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Miho Sato
- Department of Ophthalmology, Shizuoka Children's Hospital, Shizuoka, Japan.
- Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, 431-3192, Japan.
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11
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Le Calvez B, Rialland F, Bassi C, Richard C, Chucherko K, Bouzy S, Le Bris Y, Theisen O, Béné MC, Grain A, Eveillard M. Lineage switch and relapse in sanctuary site: Some lessons to learn about plasticity in KMT2Ar acute leukemia. Pediatr Blood Cancer 2022; 69:e29683. [PMID: 35441496 DOI: 10.1002/pbc.29683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | - Fanny Rialland
- Pediatric Oncology, Nantes University Hospital, Nantes, France
| | - Corentin Bassi
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Camille Richard
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Kevin Chucherko
- Pediatric Oncology, Nantes University Hospital, Nantes, France
| | - Simon Bouzy
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Yannick Le Bris
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Olivier Theisen
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Marie C Béné
- Hematology Biology, Nantes University Hospital, Nantes, France.,Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA, Nantes, France
| | - Audrey Grain
- Pediatric Oncology, Nantes University Hospital, Nantes, France.,Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA, Nantes, France
| | - Marion Eveillard
- Hematology Biology, Nantes University Hospital, Nantes, France.,Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA, Nantes, France
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Chung SC, Mueller S, Green K, Chang WH, Hargrave D, Lai AG. Multimorbidity patterns and risk of hospitalisation in children: A population cohort study of 3.6 million children in England, with illustrative examples from childhood cancer survivors. Lancet Reg Health Eur 2022; 20:100433. [PMID: 35799614 PMCID: PMC9253994 DOI: 10.1016/j.lanepe.2022.100433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Population-level estimates of hospitalisation risk in children are currently limited. The study aims to characterise morbidity patterns in all children, focusing on childhood cancer survivors versus children without cancer. Methods Employing hospital records of children aged <19 years between 1997 to 2018 in England, we characterised morbidity patterns in childhood cancer survivors compared with children without cancer. The follow-up began on the 5th anniversary of the index hospitalisation and the primary outcome was the incidence of comorbidities. Findings We identified 3,559,439 eligible participants having 12,740,666 hospital admissions, with a mean age at study entry of 11.2 years. We identified 32,221 patients who survived for at least 5 years since their initial cancer diagnosis. During the follow-up period and within the whole population of 3.6 million children, the leading conditions for admission were (i) metabolic, endocrine, digestive renal and genitourinary conditions (84,749, 2.5%), (ii) neurological (35,833, 1.0%) and (iii) musculoskeletal or skin conditions (23,574, 0.7%), fever, acute respiratory and sepsis (22,604, 0.7%). Stratified analyses revealed that females and children from socioeconomically deprived areas had a higher cumulative incidence for morbidities requiring hospitalisation (p < 0.001). At baseline (5 years after the initial cancer diagnosis or initial hospitalisation for survivors and population comparisons, respectively), cancer survivors experienced a higher prevalence of individual conditions and multimorbidity (≥ 2 morbidities) compared with children without cancer. Cox regression analyses showed that survivors had at least a 4-fold increase in the risk of hospitalisation for conditions such as chronic eye conditions (hazard ration (HR):4.0, 95% confidence interval (CI): 3.5-4.7), fever requiring hospitalisation (HR: 4.4, 95% CI: 3.8-5.0), subsequent neoplasms (HR: 5.7, 95% CI:5.0-6.5), immunological disorders (HR: 6.5, 95% CI:4.5-9.3) and metabolic conditions (HR: 7.1, 95% CI:5.9-8.5). Interpretation The overall morbidity burden among children was low in general; however, childhood cancer survivors experienced a higher prevalence and subsequent risk of hospitalisation for a range of morbidities. Targeted policies may be required to promote awareness on health vulnerabilities and gender disparity and to improve advocacy for healthcare in deprived communities. Funding Wellcome Trust, National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre and Academy of Medical Sciences. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
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Gotti G, Stevenson K, Kay-Green S, Blonquist TM, Mantagos JS, Silverman LB, Place AE. Ocular abnormalities at diagnosis and after the completion of treatment in children and adolescents with newly diagnosed acute lymphoblastic leukemia. Pediatr Blood Cancer 2022; 69:e29542. [PMID: 35187841 DOI: 10.1002/pbc.29542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ocular abnormalities (OA) in pediatric patients with acute lymphoblastic leukemia (ALL) are common findings both at diagnosis and later in follow-up. The frequency, predictors, and prognostic impact of OA in the context of recent ALL protocols are not well characterized. PROCEDURE Single-center retrospective analysis of the medical records of 224 patients with ALL enrolled on Dana-Farber Cancer Institute (DFCI) ALL Consortium Protocol 05-001. RESULTS Overall, 217 (98%) patients had at least one ophthalmic exam. Retinal hemorrhages were the most frequent abnormalities at diagnosis (11%) and cataracts at later time points (13%). OA at diagnosis were associated with age ≥10 years and with the severity of anemia and thrombocytopenia; they were also univariately associated with lower 5-year event-free survival (EFS) (high risk [HR] = 3.09 [95% CI: 1.38-6.94]; p = .006), but not in a disease-free survival (DFS) model adjusted for end-induction minimal residual disease (p = .82). The cumulative incidence of cataract was 13.1% ± 2.8% at 43 months from diagnosis; its development was associated with high presenting white blood cell count (≥50,000/μl) (p = .010), male sex (p = .036), higher risk group (p = .025), and cranial radiation (p = .004). Cataract was associated with decreased visual acuity. CONCLUSIONS OA at diagnosis, present in 12% of patients, were associated with older age, anemia, and thrombocytopenia and did not carry a significant prognostic impact. Cataracts were detected in over 10% of patients and were associated with decreased visual acuity, thus supporting routine screening after completion of therapy, especially for those treated with high-risk protocols.
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Affiliation(s)
- Giacomo Gotti
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Pediatric Hematology-Oncology, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Kristen Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Massachusetts, USA
| | - Samantha Kay-Green
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Traci M Blonquist
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Massachusetts, USA
| | - Jason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Andrew E Place
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
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14
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Steroid-Induced Ocular Hypertension in a Pediatric Patient with Acute Lymphoblastic Leukemia: A Case Report. CHILDREN 2022; 9:children9030440. [PMID: 35327812 PMCID: PMC8947331 DOI: 10.3390/children9030440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
Glucocorticoids play a pivotal role in therapeutic protocols in acute lymphoblastic leukemia (ALL) treatment. Systemic steroids are known to be less likely to elevate the intraocular pressure when compared to topical administration, and reports addressing hypertensive ocular response in the Asian pediatric ALL population are currently limited. We report a case of a nine-year-old girl with acute lymphoblastic leukemia (ALL) who was found to have highly elevated intraocular pressure (IOP) during maintenance treatment when taking oral dexamethasone (6 mg/m2/day). Her IOP increased on day 5 after taking dexamethasone, reached a peak on day 7 or 8, and returned back to baseline on day 13 before anti-glaucoma medications were used. Thus, we prescribed IOP-lowering agents for 10 consecutive days starting on the day oral dexamethasone was administered, and observed that not only did the peak levels lower remarkably, but the IOP levels returned to baseline more rapidly as well.
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15
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Khanna S, Mackin AG, Dao DT, Komati R, Morocco PC, LaBelle JL, Shah HA, Blair MP. Exudative Retinal Detachment Following Chimeric Antigen Receptor T-Cell Therapy in Relapsed B-Cell Acute Lymphoblastic Leukemia. Ophthalmic Surg Lasers Imaging Retina 2022; 53:113-115. [PMID: 35148216 DOI: 10.3928/23258160-20220124-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has become a novel approach in the treatment of many hematologic malignancies. However, ocular adverse effects have not been well described. This report presents a case of a pediatric patient with relapsed B-cell acute lymphoblastic leukemia with ocular involvement treated with CAR T-cell therapy who developed an exudative retinal detachment likely secondary to an inflammatory response to CAR T-cell therapy. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:113-115.].
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16
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Mirshahi R, Ghassemi F, Koochakzadeh L, Faranoush M, Ghomi Z, Mehrvar A, Mousavi SA, Safaee Nodehi SR. Ocular Manifestations of Newly Diagnosed Acute Leukemia Patients. J Curr Ophthalmol 2022; 34:100-105. [PMID: 35620369 PMCID: PMC9128435 DOI: 10.4103/joco.joco_10_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To present primary ocular manifestations in acute leukemia. Methods This cross-sectional descriptive hospital-based study evaluated all newly diagnosed leukemia patients of three referral hospitals of Tehran University of Medical Sciences in 2015-2016 and Mahak Hospital in Tehran in 2017. Exclusion criteria included the patients with the previous history of chemotherapy, cases of relapsing disease, and the patients with a history of ocular disease or other systemic conditions with ophthalmic manifestations. Results A total of 85 patients (170 eyes) were evaluated in our study, including 29 children (34.1%) and 43 females (50.6%). The mean patient age was 37.84 ± 11.91 years in the adult group and 6.28 ± 4.70 years in the pediatric category. Ophthalmic involvement was seen in 27 patients (31.8%), including 6 pediatric patients (20.7%) and 21 adult patients (37.5%). Two patients (2.3%) had direct infiltration by leukemic cells and 76 patients (89.41%) of patients were asymptomatic. There was a correlation between ophthalmic involvement and platelet count and hemoglobin level. In patients with ocular signs, higher mortality rates were observed. Conclusions At the time of diagnosis in acute leukemia patients, complete ophthalmic evaluation including dilated fundus examination is suggested as ocular involvement in these patients is common and sometimes asymptomatic. Ophthalmic involvement in leukemic patients should be identified in a timely manner, particularly in individuals with low platelet counts and hemoglobin levels, due to the potential prognostic relevance.
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Affiliation(s)
- Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leili Koochakzadeh
- Department of Pediatrics, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric Growth and Development Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghomi
- Department of Radiology, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azim Mehrvar
- MAHAK Hematology Oncology Research Center, MAHAK Hospital, Tehran, Iran
| | - Seyed Asadollah Mousavi
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Reza Safaee Nodehi
- Department of Hematology and Medical Oncology, Cancer Research Center, Cancer Institute of Iran, Imam Khomeini Hospital Complex, Tehran, Iran
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17
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Bukhari ZM, Alzahrani A, Alqarni MS, Alajmi RS, Alzahrani A, Almarzouki H, Alqahtani AS. Ophthalmic Manifestations in Acute Leukemia Patients and Their Relation With Hematological Parameters in a Tertiary Care Center. Cureus 2021; 13:e19384. [PMID: 34925986 PMCID: PMC8655321 DOI: 10.7759/cureus.19384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Leukemia is a neoplastic disorder that affects blood and bone marrow and is characterized by white blood cells' abnormal proliferation. Leukemia patients may present with different ophthalmic manifestations. This study aims to provide an updated data about the prevalence and types of ocular manifestations in acute leukemia patients and their relation with the hematological parameters. Methods: This retrospective cross-sectional study included all acute leukemia patients diagnosed from 2015 to 2020 and underwent an ophthalmic examination during this period at King Abdulaziz Medical City in Jeddah. Results: Eighty-one patients met the inclusion and exclusion criteria and had ophthalmic examinations. Forty-three (53.1%) patients were males, and 38 (46.9%) patients were females. Acute lymphocytic leukemia (ALL) was diagnosed in 55 (67.9%) patients, while acute myelogenous leukemia (AML) was diagnosed only in 26 (32.1%). Ophthalmic manifestations were observed in 23 patients with a prevalence of 28.4%. AML patients had more manifestations with a rate of 38.5%. ALL had a rate of 23.6% (p=0.1). Retinal hemorrhage was the most commonly seen manifestation in six patients. Conclusion: Ophthalmic manifestations are not uncommon in acute leukemia patients. Low hemoglobin and RBC could give an idea about the type of ophthalmic manifestation, not the presence or absence. It is highly recommended to examine acute leukemia patients routinely prior, during, and after the treatment to prevent serious ocular damage and monitor the course of the disease.
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Affiliation(s)
- Ziad M Bukhari
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU.,Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdulmalek Alzahrani
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU.,Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Mohammed S Alqarni
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU.,Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Rakan S Alajmi
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ali Alzahrani
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Hashim Almarzouki
- Ophthalmology, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdullah S Alqahtani
- Ophthalmology, King Abdullah Medical Complex, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
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18
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Barzilai-Birenboim S, Elitzur S, Nirel R, Ehrenberg M, Zahavi A, Avrahami G, Gabbay IE, Gilad G, Dotan G, Izraeli S, Daood RH, Geffen N. Elevated intraocular pressure in children with acute lymphoblastic leukaemia: A prospective study. Br J Haematol 2021; 196:1248-1256. [PMID: 34862597 DOI: 10.1111/bjh.17987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
Most childhood acute lymphoblastic leukaemia (ALL) protocols include high-dose steroid therapy. However, the known potential of high-dose steroids to significantly elevate intraocular pressure (IOP) and lead to glaucomatous optic neuropathy has not been intensively investigated in children with ALL. Moreover, as children with ALL do not routinely undergo IOP measurements, the need for IOP monitoring and therapy is unknown. We prospectively measured IOP in 90 children with newly diagnosed ALL attending a tertiary paediatric haematology/oncology centre, at diagnosis and at the middle and end of induction therapy. Ocular hypertension (IOP > 21 mm Hg) at any time point was documented in 64 children (71%), and the prevalence increased during induction. Thirty-six children (40%) had elevated IOP at ALL diagnosis before therapy initiation, and stratification to non-standard ALL was a risk factor. IOP reduction therapy was administered to 13 children (14%); none required surgery. Values normalised in all cases. On multivariate logistic regression analysis, dexamethasone therapy was a significant risk factor for ocular hypertension. High body mass index was an additional risk factor in children with elevated IOP at ALL diagnosis. Routine evaluation of IOP during steroid therapy is very important in children with ALL to ensure early intervention which may prevent permanent ocular damage.
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Affiliation(s)
- Shlomit Barzilai-Birenboim
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Elitzur
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Nirel
- Department of Statistics and Data Science, Hebrew University, Jerusalem, Israel
| | - Miriam Ehrenberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Alon Zahavi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Galia Avrahami
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itay E Gabbay
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Gil Gilad
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Shai Izraeli
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rabeea Haj Daood
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Noa Geffen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
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19
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Krag S, Larsen D, Albertsen BK, Glerup M. Risk of ocular hypertension in children treated with systemic glucocorticoid. Acta Ophthalmol 2021; 99:e1430-e1434. [PMID: 33629533 DOI: 10.1111/aos.14820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the risk of steroid-induced ocular hypertension in children treated with systemic glucocorticoid. METHODS Prospective cohort study of children treated with high-dose systemic glucocorticoid (prednisolone-equivalent >0.5 mg/kg/day) for more than 2 weeks. Intraocular pressure (IOP) was measured by an Icare tonometer. An intraocular hypertensive response was defined as a net increase in IOP ≥6 mmHg from baseline or a peak IOP ≥21 mmHg in either eye. Patients with a peak IOP ≥31 mmHg or a net increase in IOP ≥15 mmHg were considered as high responders. RESULTS Sixteen children with median age 12 years (range 5-17) were included in the study. Nine children (56%) developed a steroid-induced ocular hypertensive response. Two children (12%) were high responders with peak IOP between 32 and 44 mmHg and a net increase in IOP between 15 and 23 mmHg. All children were asymptomatic and IOP was normalized in all after withdrawal of steroid. Steroid responders were significantly younger than nonresponders (p = 0.03). No associations were found between net IOP increase and time to peak pressure, steroid dose at peak pressure or accumulated prednisolone dose at peak IOP. CONCLUSION Systemic treatment of children with glucocorticoid can cause a significant increase in IOP which indicates the need for IOP screening of these children. The risk of steroid-induced ocular hypertension may depend on age and ethnicity. In this perspective, further studies on Caucasian children are needed.
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Affiliation(s)
- Susanne Krag
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
| | - Dorte Larsen
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
| | | | - Mia Glerup
- Department of Paediatrics and Adolescent Medicine Aarhus University Hospital Aarhus Denmark
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20
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Complete Recovery of Vision after Optic Nerve Relapse of Acute Lymphoblastic Leukemia. Can J Neurol Sci 2021; 47:431-433. [PMID: 32051053 DOI: 10.1017/cjn.2020.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Yan W, Wang Y, Zheng X, Chen X, Ye Q, Chen Y, Chen M. Acute lymphocytic leukemia with initial manifestation of serous retinal detachment and choroidal thickening: case report and literature review. J Int Med Res 2021; 49:300060520964373. [PMID: 33765851 PMCID: PMC8166396 DOI: 10.1177/0300060520964373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This report describes a patient who had acute lymphocytic leukemia with exudative retinal detachment (RD), which mimicked Vogt–Koyanagi–Harada disease (VKH). A 61-year-old woman presented with painless loss of vision in the left eye. Fundus examination revealed RD in her left eye. B-scan ultrasonography confirmed localized RD and choroidal thickening. Fundus fluorescein angiography revealed stippled pinpoint hyperfluorescence in the upper macula. One week later, reduced visual acuity was noted in the right eye. B-scan ultrasonography and optical coherence tomography revealed serous RD in both eyes. A provisional diagnosis of VKH was made. However, subsequent hematologic analysis detected an extremely high leukocyte count. Elevated numbers of leukocytes and tumor cells were found in cerebrospinal fluid. Bone marrow biopsy revealed 77% primary atypical blood cells, 89% of which were immature lymphocytes. The patient was subsequently diagnosed with acute lymphocytic leukemia and transferred to the Department of Hematology. However, the patient and her family refused chemotherapy; she eventually died. Our findings suggest that exudative RD, similar to VKH, could be a sign of leukemia. Pinpoint hyperfluorescence leakage is important for differential diagnosis, particularly with respect to VKH.
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Affiliation(s)
- Weiming Yan
- Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hopsital Affiliated to Xiamen University), Fuzhou, China
| | - Yunpeng Wang
- Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hopsital Affiliated to Xiamen University), Fuzhou, China
| | - Xiangrong Zheng
- Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hopsital Affiliated to Xiamen University), Fuzhou, China
| | - Xiaohong Chen
- Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hopsital Affiliated to Xiamen University), Fuzhou, China
| | - Qian Ye
- Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hopsital Affiliated to Xiamen University), Fuzhou, China
| | - Yanjin Chen
- Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hopsital Affiliated to Xiamen University), Fuzhou, China
| | - Meizhu Chen
- Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hopsital Affiliated to Xiamen University), Fuzhou, China
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22
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Ocular Manifestations of Leukemia and Results of Treatment with Intravitreal Methotrexate. Sci Rep 2020; 10:1994. [PMID: 32029770 PMCID: PMC7005017 DOI: 10.1038/s41598-020-58654-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/06/2020] [Indexed: 11/08/2022] Open
Abstract
Ocular involvement in leukemia is considered rare. Ocular symptoms can be the presenting signs of leukemia, they can appear after diagnosis has been established, or they can be the first manifestation of a relapse after remission. We report, to the best of our knowledge for the first time, the ocular manifestation of a series of patients with ocular leukemia and the result of their treatment with intravitreal methotrexate (MTX) injections. This is a retrospective cohort study. The medical records of 12 consecutive patients with ocular leukemia (24 eyes, 11 eyes treated with MTX) treated at the Sheba Medical Center from January 2010 to December 2017 were retrospectively reviewed. Details on ocular inflammatory reaction and tumor cell infiltration at presentation and the end of follow-up were recorded as main outcome measures. The 12 patients included 7 women and 5 men (mean age ± standard deviation at diagnosis 25.92 ± 23.91 years, range 2-82 years). Eleven eyes of 6 patients were treated with intravitreal MTX injections. The indication for treatment was biopsy proven, tumor cell infiltration. The mean number of MTX injections was 3.37 ± 5.35 (range 1-18). The mean follow-up was 27.08 ± 36.79 months (range 1-93). All treated eyes showed improvement in the inflammatory reaction and tumor cell infiltration. In conclusion we found that Intravitreal MTX injections may be an effective therapeutic approach for eyes with intraocular leukemic tumor cell infiltration.
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