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Johnson GM, Rossen JL, Simon SS, Weinstein JL, Ralay Ranaivo H, Yoon HH. Leukemic Optic Neuropathy in Pediatric Patients: A Case Series. J Pediatr Ophthalmol Strabismus 2024; 61:67-72. [PMID: 37227013 DOI: 10.3928/01913913-20230331-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To characterize the presentation, clinical course, and treatment of a series of children with leukemic optic neuropathy. METHODS Patients with leukemia who were treated at a tertiary children's hospital for optic nerve infiltration were included (n = 11). Demographic information, cancer history, ophthalmologic examination findings, treatment, and outcomes were retrospectively collected. RESULTS Mean age was 10.0 ± 4.8 years, and 63.6% were male and 36.4% were female. The most common underlying oncologic diagnosis was B-precursor acute lymphoblastic leukemia (n = 7, 63.6%). Notably, the majority presented with optic nerve infiltration during presumed remission (n = 9, 81.8%), but 2 patients (18.2%) presented with optic nerve infiltration at their initial leukemia diagnosis. Cerebrospinal fluid was positive for leukemic cells in 36.4% of patients. Magnetic resonance imaging demonstrated optic nerve enhancement and/or enlargement in only 8 patients (72.7%). In addition to other leukemia-directed treatment, 8 patients (72.7%) received emergent local radiation within 1.5 ± 1.2 days of initial ophthalmology examination. CONCLUSIONS The largely negative cerebrospinal fluid results and variable magnetic resonance imaging findings in this study emphasize the importance of clinical context for this diagnosis. Clinicians should consider optic nerve infiltration in patients with leukemia and visual or ocular complaints, because urgent treatment is required to preserve vision and manage systemic disease. [J Pediatr Ophthalmol Strabismus. 2024;61(1):67-72.].
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2
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Dini G, Capolsini I, Cerri C, Massei MS, Mastrodicasa E, Perruccio K, Gorello P, Caniglia M, Verrotti A, Arcioni F. Acute lymphoblastic leukemia relapse presenting with optic nerve infiltration. SAGE Open Med Case Rep 2023; 11:2050313X231175020. [PMID: 37250823 PMCID: PMC10214062 DOI: 10.1177/2050313x231175020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/23/2023] [Indexed: 05/31/2023] Open
Abstract
Acute lymphoblastic leukemia is the most common childhood malignancy. Despite many advances in therapy, about 15%-20% of children with acute lymphoblastic leukemia experience a disease relapse. Isolated ocular relapse is relatively rare. A 14-year-old male with T-cell acute lymphoblastic leukemia in remission presented with sudden onset of right eye pain and visual acuity impairment. Fundoscopic examination of the eye and magnetic resonance imaging of the orbits were consistent with optic nerve infiltration. The patient was treated with salvage chemotherapy, orbital radiation and eventual bone marrow transplantation, with notable improvement in vision and regression of retinal and optic nerve findings. Optic nerve infiltration represents an ophthalmic emergency and requires urgent management. The use of radiation therapy is a helpful adjunct with systemic chemotherapy in obtaining disease remission.
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Affiliation(s)
- Gianluca Dini
- Department of Pediatrics, University of
Perugia, Perugia, Italy
| | - Ilaria Capolsini
- Pediatric Oncology-Hematology Unit,
Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Carla Cerri
- Pediatric Oncology-Hematology Unit,
Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Maria Speranza Massei
- Pediatric Oncology-Hematology Unit,
Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Elena Mastrodicasa
- Pediatric Oncology-Hematology Unit,
Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Katia Perruccio
- Pediatric Oncology-Hematology Unit,
Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Paolo Gorello
- Department of Chemistry, Biology and
Biotechnology, University of Perugia, Perugia, Italy
| | - Maurizio Caniglia
- Pediatric Oncology-Hematology Unit,
Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Francesco Arcioni
- Pediatric Oncology-Hematology Unit,
Santa Maria della Misericordia Hospital, Perugia, Italy
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3
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Rachwani Anil R, Rocha-de-Lossada C, Zamorano Martín F, Santos Ortega A, Luque Aranda G, España Contreras M, Escudero Gómez J. Infiltrative optic neuropathy as a relapse of acute lymphoblastic leukemia. J Fr Ophtalmol 2020; 44:293-295. [PMID: 33097293 DOI: 10.1016/j.jfo.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/01/2020] [Accepted: 03/23/2020] [Indexed: 11/15/2022]
Affiliation(s)
- R Rachwani Anil
- Ophthalmology department, Hospital Regional Universitario de Málaga, Plaza del Hospital Civil s/n, 29009 Málaga, Spain.
| | - C Rocha-de-Lossada
- Ophthalmology department, Hospital Regional Universitario de Málaga, Plaza del Hospital Civil s/n, 29009 Málaga, Spain; Institut Clinic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, Carrer de Sabino Arana 1, 08028 Barcelona, Spain
| | - F Zamorano Martín
- Ophthalmology department, Hospital Regional Universitario de Málaga, Plaza del Hospital Civil s/n, 29009 Málaga, Spain
| | - A Santos Ortega
- Ophthalmology department, Hospital Regional Universitario de Málaga, Plaza del Hospital Civil s/n, 29009 Málaga, Spain
| | - G Luque Aranda
- Paediatric Ophthalmology Department, Hospital Materno Infantil, Hospital Regional Universitario de Málaga, Avenida del Arroyo de los Ángeles s/n, 29011 Málaga, Spain
| | - M España Contreras
- Ophthalmology department, Hospital Regional Universitario de Málaga, Plaza del Hospital Civil s/n, 29009 Málaga, Spain
| | - J Escudero Gómez
- Paediatric Ophthalmology Department, Hospital Materno Infantil, Hospital Regional Universitario de Málaga, Avenida del Arroyo de los Ángeles s/n, 29011 Málaga, Spain
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Pflugrath AE, Brar VS. Bilateral optic nerve and retinal infiltration as an initial site of relapse in a child with T-cell acute lymphoblastic leukemia. Am J Ophthalmol Case Rep 2020; 18:100695. [PMID: 32368688 PMCID: PMC7184527 DOI: 10.1016/j.ajoc.2020.100695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/20/2019] [Accepted: 04/02/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe a case of leukemic infiltration of bilateral optic nerves and retina as a site of relapse in a child with T-Cell Acute Lymphoblastic Leukemia (ALL). OBSERVATIONS We report a 7 year old female who presented one year following initial treatment for T-Cell ALL with visual acuity impairment, bilateral optic nerve infiltration and infiltration of the retina of both eyes. OCT demonstrated subretinal fluid in both eyes, which eventually resolved, and perivascular hyperreflectivity within the inner retinal layers. She was treated with systemic and intrathecal chemotherapy, total body and orbital radiation and eventual bone marrow transplantation with notable improvement in vision and regression of retinal and optic nerve findings. With continued remission, there was notable outer retinal thinning, specifically of the photoreceptors in the right eye. CONCLUSIONS AND IMPORTANCE Leukemic abnormalities of the eye are not uncommon, however optic nerve and retinal infiltration are rare manifestations. Leukemic infiltrates of the retina can be detected by OCT despite normal funduscopic examination and monitored for improvement. The optic nerve and other ocular tissues are considered a pharmacologic sanctuary and thus, the optic nerve can be a site of relapse in leukemia. The use of radiation therapy is a helpful adjunct with systemic, intrathecal chemotherapy and stem cell transplantation in obtaining clinical remission and visual acuity improvement.
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Affiliation(s)
- Adam E. Pflugrath
- Virginia Commonwealth University, Department of Ophthalmology, Richmond, VA, USA
| | - Vikram S. Brar
- Virginia Commonwealth University, Department of Ophthalmology, Richmond, VA, USA
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Jamoussi H, Kchaou M, Echebbi S, Fray S, Ben Ali N, Fredj M. Relapse of acute lymphoblastic leukemia revealed by an optic neuropathy. Rev Neurol (Paris) 2019; 176:131-136. [PMID: 31542177 DOI: 10.1016/j.neurol.2018.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/01/2022]
Affiliation(s)
- H Jamoussi
- Charles Nicolle Hospital, boulevard du 9-Avril-1006, Tunis Bab Souika, 1002 Tunis, Tunisia.
| | - M Kchaou
- Charles Nicolle Hospital, boulevard du 9-Avril-1006, Tunis Bab Souika, 1002 Tunis, Tunisia
| | - S Echebbi
- Charles Nicolle Hospital, boulevard du 9-Avril-1006, Tunis Bab Souika, 1002 Tunis, Tunisia
| | - S Fray
- Charles Nicolle Hospital, boulevard du 9-Avril-1006, Tunis Bab Souika, 1002 Tunis, Tunisia
| | - N Ben Ali
- Charles Nicolle Hospital, boulevard du 9-Avril-1006, Tunis Bab Souika, 1002 Tunis, Tunisia
| | - M Fredj
- Charles Nicolle Hospital, boulevard du 9-Avril-1006, Tunis Bab Souika, 1002 Tunis, Tunisia
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LaRiviere MJ, Avery RA, Dolan JG, Adamson PC, Zarnow DM, Xie Y, Avery SM, Kurtz GA, Hill-Kayser CE, Lustig RA, Lukens JN. Emergent Radiation for Leukemic Optic Nerve Infiltration in a Child Receiving Intrathecal Methotrexate. Pract Radiat Oncol 2019; 9:226-230. [PMID: 30978466 DOI: 10.1016/j.prro.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/22/2019] [Accepted: 04/03/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Michael J LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Robert A Avery
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J Gregory Dolan
- Department of Pediatric Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Peter C Adamson
- Department of Pediatric Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deborah M Zarnow
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yunhe Xie
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephen M Avery
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Goldie A Kurtz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine E Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatric Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert A Lustig
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Nicholas Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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DeSouza PJ, Hooten CG, Lack CM, John VJ, Martin TJ. Bilateral Central Retinal Artery Occlusion Associated with Bilateral Lymphoproliferative Infiltrative Optic Neuropathy. Ocul Oncol Pathol 2017; 3:229-234. [PMID: 29071274 DOI: 10.1159/000458414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leukemic infiltration of the optic nerve is relatively rare. While previously described in acute leukemia, the infiltration in our case represents central nervous system (CNS) metastasis of Burkitt-type lymphoma that developed as a complication of solid-organ transplantation, resulting in a bilateral infiltrative optic neuropathy with sequential, bilateral central retinal artery occlusion (CRAO) and devastating vision loss. METHODS The medical record, serial ophthalmic examination findings, clinical course, and imaging including magnetic resonance imaging (MRI), fundus photographs, and fluorescein angiography of a single patient were retrospectively reviewed. RESULTS MRI demonstrated multifocal cortical and leptomeningeal CNS involvement, including the left optic nerve. Serial fundus examination/photography and fluorescein angiography showed that despite urgent whole-brain irradiation and systemic chemotherapy, CNS disease progressed to bilateral optic nerve infiltration and CRAO with no light perception vision in both eyes. CONCLUSION CRAO can occur as a devastating and irreversible complication of lymphoproliferative optic nerve infiltration.
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Affiliation(s)
- Philip J DeSouza
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Claudia G Hooten
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Christopher M Lack
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Vishak J John
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Timothy J Martin
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Chronic Myelogenous Leukemia Relapse Presenting With Central Nervous System Blast Crisis and Bilateral Optic Nerve Infiltration. J Neuroophthalmol 2016; 36:73-7. [DOI: 10.1097/wno.0000000000000326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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9
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Ra YH, Park SY, Im SA, Kim JY, Chung NG, Cho B. Enhancement of Optic Nerve in Leukemic Patients: Leukemic Infiltration of Optic Nerve versus Optic Neuritis. ACTA ACUST UNITED AC 2016. [DOI: 10.13104/imri.2016.20.3.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Yo Han Ra
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Young Park
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Ah Im
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jee Young Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nak Gyun Chung
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bin Cho
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Shah P, Yohendran J, Lowe D, McCluskey P. Devastating bilateral optic nerve leukaemic infiltration. Clin Exp Ophthalmol 2011; 40:e114-5. [PMID: 21668784 DOI: 10.1111/j.1442-9071.2011.02616.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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