Acute lymphoblastic leukemia relapse presenting as retinal vasculitis

Ksiaa, Imen; Kéchida, M.; Zina, Sourour; Lahdhiri, Marouane; Abroug, Nesrine; Khairallah, Moncef

doi:10.1002/ccr3.2895

Cited by 7 publications

(3 citation statements)

References 10 publications

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“…"Leukemic retinopathy" is a term used to describe vascular features secondary to severe anaemia, thrombocytopenia, andhyper viscosity rather than to direct leukemic infiltration. 9 One female patient with atypical retinitis pigmentosa presented with sudden drop of vision, FFA revealed exudative retinopathy, staining of vessels and leak from peripheral retinal vessels, started on oral steroids, there was dramatic improvement in vision. Retinal exudates in our case may be due to inflammation which usually occurs in Retinitis pigmentosa patients and cause macular edema, in our case there was inflammation of retinal vessels causing break down of blood ocular barrier and leading to the leak from vessels.…”

Section: Discussionmentioning

confidence: 99%

Retinal vasculitis – Clinical manifestations and outcome at tertiary eye care centre in south India

Sultana

Kumar²

2021

IJCEO

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To study the various causes, clinical presentation, management and outcome of the retinal vasculitis cases at tertiary eye care centre. Tertiary eye care centre, Telangana State, South India. Retrospective Interventional Study. Jan 2016 to Dec 2020. Fifty one patients of retinal vasculitis presented with various clinical manifestations were examined in detail and managed. Data collected from medical records. All young patients of different age group presented with retinal vascular changes are included in the study. Patients underwent examination and laboratory workup. Few patients showed ocular and systemic investigations were with in the normal limits. These patients were considered as idiopathic cases. BCVA, slit lamp examination, fundus examination, FFA, OCT, B SCAN in hazy media and documentation done in all cases. Bilateral presentation was common, some presented with aggressive disease in both eyes (early and delayed presentation). Common presentation was blurred vision and sudden drop of vision. Few patients showed tuberculin skin test positive and managed as presumed ocular tuberculosis. Patients who were HIV positive managed with HART, prognosis was poor in these patients. Medical and surgical management done based on the stage of presentation, oral steroids, laser therapy, anti VEGF followed by pars plana vitrectomy with or with silicone oil tamponade done. Oral steroids were started after physician clearance and tapered based on the activity of the disease. Patients followed regularly every month till the activity ceases in medically managed cases and in operated cases we followed till the silicone oil is removed from the eye. Few patients presented with the reactivity of the disease were managed again based on the presentation. Results were good in idiopathic cases, patients presented with inflammatory and ischemic stages also showed good outcome. Patients presented with proliferative stage showed fair outcome, patients presented with severe proliferative stage showed poor prognosis. Retinal vasculitis is one of the ocular condition which can cause vision loss in young adults, if present in early stage, can be managed medically. Prognosis is good in early stages. Recurrent vitreous haemorrhage, tractional retinal detachment, combined retinal detachment were common presentations. Infective cases showed more proliferative changes. Risk of neovascular glaucoma is one of the cause of blindness.

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Section: Discussionmentioning

confidence: 99%

Retinal vasculitis – Clinical manifestations and outcome at tertiary eye care centre in south India

Sultana

Kumar²

2021

IJCEO

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“…Although patients typically present with fatigue, bleeding, and fever, ocular manifestations have been reported to occur in up to 50% of cases at the time of diagnosis [1]. It is vital to assess for ocular symptoms, which may possibly be the first and isolated indicator for disease occurrence, relapse, or progression [2].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Imaging Features of Leukemic Retinopathy

Hui¹,

Szeto²

2023

Leukemia - From Biology to Clinic

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Hematological malignancies may be associated with ocular manifestations in up to 50% of cases, and ocular symptoms can be the initial presentation. Retinal leukemic infiltrates may be observed in up to 3% of leukemia patients. Leukemic retinopathy may present more commonly in acute leukemias than chronic leukemias as Roth’s spot, multi-level retinal hemorrhages, cotton wool spots, or opportunistic infection secondary to pancytopenia. On the other hand, patients with chronic leukemias, such as chronic myeloid leukemia (CML), may present with leukemic retinal infiltrates and venous stasis secondary to hyperviscosity, which may lead to secondary peripheral microaneurysms and neovascularization. Vascular complication, such as central retinal vein occlusion, may also occur as a result of venous stasis. In addition, leukemic retinopathy is associated with poorer overall survival as pediatric CML patients without ocular manifestation may have twice as high 5-years survival rate compared with those with ocular manifestation. The presence of leukemic retinopathy is associated with more severe systemic disease and is correlated with hematological parameters such as white blood cells count (WBC). In addition, a positive correlation was found between ocular leukemic infiltration and agonal leukocyte count and the severity of systemic disease in an autopsy study. Therefore, the presence of retinal infiltrate may be associated with leukemia with extreme leukocytosis. Optical Coherence Tomography (OCT) is a noninvasive retinal imaging tool that can help diagnose leukemic retinopathy. Inner retina hyper-reflective lesions were observed in areas with intra-retinal hemorrhages or hemorrhagic lesions, while outer retina hyper-reflective lesions were observed in areas with whitish retinal infiltrates. In addition, the loss of the physiological hourglass appearance on cross-sectional OCT scan of retinal vessels may be seen in leukemic retinopathy. It is believed that intraluminal blood flow is responsible for the physiological hourglass appearance, consisting of two paired hyper-reflectivities inside vessel wall on OCT. In leukemic retinopathy, hyperviscosity may disrupt normal intraluminal blood flow, leading to the loss of this physiological appearance. In summary, leukemic retinopathy can be the first presentation of leukemia. Ophthalmologists can play an important role in the diagnosis of leukemia. Noninvasive retinal imaging could help us to monitor and understand the pathophysiology of leukemic retinal infiltrates. Prompt diagnosis and treatment of underlying leukemia may preserve vision and prolong survival rate.

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“…Cases of RV are reported in patients with malignant conditions, including acute leukemia, ocular, or central nervous system (CNS) lymphoma, Hodgkin's lymphoma, metastatic B cell lymphoma, and pineal germinoma. [12][13][14][15][16][17][18][19][20] Given this, malignancy should be considered in the differential diagnosis in patients unresponsive to treatment for RV.…”

Section: Introductionmentioning

confidence: 99%

Treatment of non-infectious retinal vasculitis

2023

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Retinal vasculitis (RV) refers to an entity in which the retinal vasculature is inflamed, frequently with indications of inflammation elsewhere in the eye. Non-infectious RV can be idiopathic or associated with systemic disease, ocular conditions, and malignancy. It can also be classified based on the vessel affected: artery, vein, or both. Due to the lack of strong evidence-based treatment trials and algorithms for RV, physicians must often rely on their experience, which creates great variability in treating this entity. This article provides an overview of various treatment modalities used in the management of non-infectious RV, with a focus on immunomodulatory therapies. We outline a potential stepwise approach of starting with steroids to control the acute inflammation and subsequently changing to immunomodulatory therapy (IMT) for long-term treatment.

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Acute lymphoblastic leukemia relapse presenting as retinal vasculitis

Cited by 7 publications

References 10 publications

Retinal vasculitis – Clinical manifestations and outcome at tertiary eye care centre in south India

Retinal vasculitis – Clinical manifestations and outcome at tertiary eye care centre in south India

Clinical and Imaging Features of Leukemic Retinopathy

Treatment of non-infectious retinal vasculitis

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