Leukemic Infiltration of the Optic Nerve

Wallace, R. Trent; Shields, Jerry A.; Shields, Carol L.; Ehya, Hormoz; Ewing, Madeline

doi:10.1001/archopht.1991.01080070139051

Cited by 18 publications

(9 citation statements)

References 4 publications

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“…We postulate the progression into ischaemic optic neuropathy in our patient could be a result of hypercellularity. Emergent radiation and intrathecal chemotherapy have been shown to improve visual recovery and prolong survival 11 12…”

Section: Discussionmentioning

confidence: 99%

Optic neuropathy as the first sign of central nervous system relapse in acute myeloid leukaemia: MRI findings and its diagnostic challenge

2019

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We describe the case of a 22-year-old man who presented with right eye visual impairment and oral mucositis. MRI revealed findings compatible with right optic neuritis. Herpes simplex virus 1 was detected in oral swab. He has a previous history of acute myeloid leukaemia (AML) and was in clinical remission. Initial investigations for possible relapse of AML with central nervous system (CNS) involvement were negative. Treatment for HSV-related optic neuritis was initiated but the patient’s vision deteriorated. Repeat MRI revealed right optic nerve infarct, new left optic nerve abnormality and new leptomeningeal enhancement in the brain. Repeated cerebrospinal fluid analysis confirmed CNS relapse of AML. Despite prompt initiation of pulse steroid and high dose intrathecal cytarabine followed by cranial irradiation, the patient never regained his vision. We present a case of unexpected optic neuropathy as first and sole presentation of CNS relapse of AML.

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Section: Discussionmentioning

confidence: 99%

Optic neuropathy as the first sign of central nervous system relapse in acute myeloid leukaemia: MRI findings and its diagnostic challenge

2019

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“…It may present as retinal changes such as hemorrhages [16][17][18], whitish infiltrates often resembling cotton wool spots [16][17][18], peripheral ret inal microaneurysms [19,20] or peripheral retinal neo vascularization [21,22], Clinically, leukemic choroidal in filtrates frequently remain undetected but may present as serous retinal detachment [23,24], Leukemic iris infil tration [25,26], optic nerve infiltration [27,28], vitreous seeding [29], orbital involvement [3,30], and conjunctival infiltration [31] may also occur. Allen and Straatsma [32], in a histopathologic study, found ocular involvement in 38 of 76 eyes of patients who had died of leukemia or allied disorders.…”

Section: Discussionmentioning

confidence: 99%

Necrotic Malignant Melanoma of the Choroid and Concurrent Intraocular Manifestation of Malignant Non-Hodgkin’s B Cell Lymphoma

Küchle

Tiemann²,

Holbach³

et al. 1994

Ophthalmologica

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An 80-year-old white female developed clinical signs of a large choroidal malignant melanoma in her left eye. There were no signs of metastatic disease but an asymptomatic chronic lymphatic leukemia was discovered. Histopathologic examination of the enucleated left eye showed a mostly necrotic malignant melanoma of the choroid with areas of spindle B cell differentiation, episcleral extension and secondary angle-closure glaucoma with necrosis of the anterior segment of the eye. On the basis of immunocytochemical studies of the lymphocytic infiltrates in the iridal blood vessels, retinal blood vessels and the choroid, the leukemic disease was classified as B cell lymphoma of low malignancy (lymphoplasmacytoid immunocytoma). A reactive T lymphocytic infiltration of the conjunctival stroma was also noted. Patients with malignant melanomas of the uvea require exclusion of a second malignancy.

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“…Ocular manifestations of CNS lymphoma or leukemized metastases include direct invasion to the orbit, eyelid, uveal tract, and retina [11]. However, direct optic nerve infiltration remains rare [11,12,13,14]. Infiltration of the optic nerve can cause vascular occlusion or compression necrosis to occur, which can lead to severe vision loss [14].…”

Section: Introductionmentioning

confidence: 99%

“…However, direct optic nerve infiltration remains rare [11,12,13,14]. Infiltration of the optic nerve can cause vascular occlusion or compression necrosis to occur, which can lead to severe vision loss [14]. Lymphoproliferative optic nerve involvement is an oncologic emergency, and treatment generally involves prompt irradiation of the orbits and CNS with systemic and/or intrathecal chemotherapy [15,16].…”

Section: Introductionmentioning

confidence: 99%

Bilateral Central Retinal Artery Occlusion Associated with Bilateral Lymphoproliferative Infiltrative Optic Neuropathy

DeSouza¹,

Hooten²,

Läck³

et al. 2017

Ocul Oncol Pathol

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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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Leukemic Infiltration of the Optic Nerve

Cited by 18 publications

References 4 publications

Optic neuropathy as the first sign of central nervous system relapse in acute myeloid leukaemia: MRI findings and its diagnostic challenge

Optic neuropathy as the first sign of central nervous system relapse in acute myeloid leukaemia: MRI findings and its diagnostic challenge

Necrotic Malignant Melanoma of the Choroid and Concurrent Intraocular Manifestation of Malignant Non-Hodgkin’s B Cell Lymphoma

Bilateral Central Retinal Artery Occlusion Associated with Bilateral Lymphoproliferative Infiltrative Optic Neuropathy

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