Leukemic ophthalmopathy: A report of 21 pediatric cases

Abstract

A multicentric retrospective study on leukemic ophthalmopathy (LO) is reported. It includes 21 patients, 16 males and 5 females, with acute leukemia (AL) observed in 10 SIOP centers. LO developed in three patients at the time of diagnosis of AL; five patients were in first complete remission (three off therapy); four patients were in second or third remission; and nine were in combined relapse. Most frequent symptoms were blurred vision, photophobia, and ocular pain. Two patients with acute nonlymphoblastic leukemia died before treatment; another underwent bone marrow transplantation; one patient with B-cell acute lymphoblastic leukemia (B-ALL) treated with chemotherapy and radiotherapy died 4 months after LO; the remaining 17 children were treated according to different schedules with (10) or without (7) radiotherapy on the affected eye. Twelve patients achieved ocular remission and four of these had a second ocular relapse. Complete remission after LO treatment lasting for more than 3, 7, 24, 29 months was observed in four patients. The authors conclude that cure is possible in patients who had LO in first complete remission treated with chemotherapy and radiotherapy at high dose on the affected eye.

Relapsed Lymphoblastic Leukaemia in Children: A Continuing Challenge

“…Relapse in the ovaries is, in contrast, rare, usually presenting with an abdominal mass; most reported cases have occurred within the first 3 years and some patients have survived intensive retreatment ( Pais et al , 1991 ). Ocular relapses frequently present within the first year off treatment ( Bunin et al , 1987 ) with local iritis, and again local irradiation and intensive treatment may afford control in some patients, but there is a high risk of marrow relapse ( Lo Curto et al , 1994 ).…”

A prospective study of ocular manifestations in childhood acute leukaemia

“…The spectrum of ocular involvement in childhood leukaemia can be divided into three groups: (i) direct infiltration in orbit and ocular tissues (iris, choroid, retina, optic nerve) (ii) vascular abnormalities affecting the retina (intraretinal haemorrhages, white centered haemorrhages, cotton wool spots, macular haemorrhage, subhyaloid haemorrhage and vitreous haemorrhage) which reflect changes in haematological status and (iii) neuro-ophthalmic signs (papilloedema secondary to raised intracranial pressure and isolated cranial nerve palsies) of central nervous system disease (Rennie, 1992). The reports available on this subject in the literature (Ridgway et al, 1976;Cavdar et al, 1978;Robb et al, 1978;Novokovic et al, 1989;Stewart et al, 1989;Ohkoshi & Tsiaras, 1992;Humayun et al, 1992;Shome et al, 1992;Lo Curto et al, 1994;Mc Manaway & Neely, 1994) are either studies done at any time in the course of the disease or isolated reports or pathological studies. Ridgway et al (1976) reported 9% (59 of 657) of ocular abnormalities in children suffering from acute leukemia.…”

Concurrent Hypopituitarism and Leukemic Retinopathy in a Child with B-Precursor Acute Lymphoblastic Leukemia and Isolated Central Nervous System Relapse

“…Overt leukemic infiltration of the eye is uncommon at presentation and is usually associated with leukemic relapse 17,18 . It suggested that, like the cns and testes, the eye could be a sanctuary site in all 19 .…”