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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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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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Timoumi R, Giocanti-Aurégan A, Fajnkuchen F, Torres-Villaros H. [One retinopathy can mask another]. J Fr Ophtalmol 2024; 47:104046. [PMID: 38216406 DOI: 10.1016/j.jfo.2023.104046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 01/14/2024]
Affiliation(s)
- R Timoumi
- Service d'ophtalmologie, université Paris 13, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Giocanti-Aurégan
- Service d'ophtalmologie, université Paris 13, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - F Fajnkuchen
- Service d'ophtalmologie, université Paris 13, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France; Centre d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris, France
| | - H Torres-Villaros
- Service d'ophtalmologie, université Paris 13, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France.
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