Occlusive Microvascular Retinopathy With Optic Disc and Retinal Neovascularization in Acute Lymphocytic Leukemia

Wiznia, Robert A.; Rose, Aron D.; Levy, Arthur L.

doi:10.1097/00006982-199414030-00011

Cited by 34 publications

(16 citation statements)

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“…Retinochoroidal infarction is uncommon as an ophthalmologic complication with pediatric ALL. Only a few reports of ischemic vasculopathy of ocular lesions associated with ALL have been published 2,3 . However, more attention should be paid to ophthalmologic symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Retinochoroidal infarction during the treatment of acute lymphoblastic leukemia

Kato

Kobayashi

Ito

et al. 2006

Pediatrics International

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Herein is described a case of retinochoroidal infarction during re-induction chemotherapy for biphenotypic acute lymphoblastic leukemia (ALL). Retinochoroidal infarction is uncommon in ALL patients. However, some serious problems of this complication, which pediatric oncologists should be aware of, are illustrated in the present case. Case reportA 4-year-old girl was admitted to Daisan Hospital, Jikei University School of Medicine, Tokyo because of fever, purpura and pale facial appearance. Her blood examination results showed anemia and thrombocytopenia. Her white blood cell count was elevated to 23 500/ L, containing 70% blasts in peripheral blood. In her bone marrow, mononuclear cells totalled 123 000 L and atypical lymphoblasts dominated at 96%. She was diagnosed with ALL, L1, based on the French -US -British classifi cation. Immunologically, CD 10, 19, 13, 33 and human leukocyte antigen-DR were positive in her leukemic blasts, which indicates biphenotypic ALL. Induction chemotherapy was started based on the Tokyo Children's Cancer Study Group (TCCSG) protocol for high-risk patients of ALL. 1 One week later her treatment was changed to an extremely highrisk regimen because of resistance to the initial steroid treatment. Complete remission (CR) was achieved on day 49 and all scheduled chemotherapy was completed in 14 months. Five months after the completion of chemotherapy, she relapsed. Re-induction chemotherapy in combination with l-asparaginase (l-asp), vincristine, daunorubicin and prednisolone was started based on the TCCSG protocol for the relapsed ALL. 1 During re-induction chemotherapy, three incidents of sepsis; pre-shock caused by l-asparaginase; pancreatitis; transient glucosuria; low level of antithrombin III (ATIII; minimum: 47%); and fi brinogen (minimum: 56 mg/dL); psychological symptoms; hypertension; stomatitis ; and liver dysfunction occurred. She was compensated with platelet (total: 105 units), red blood cell transfusion (total: 10 units) and ATIII concentrates (total: 3500 units). All of these symptoms were transient and improved. The second CR was achieved on day 62. On day 63, an exotropia in her right eye was noticed by her family. Her decimal visual acuity was 0.01 in the right and 1.2 in the left. Retinal edema, soft exudates and a degeneration on the right macular spot and old chorioretinal atrophy on the left were revealed by an ophthalmologic fundus examination. No infi ltration of leukemic cells, infection or hemorrhage was identifi ed ( Fig. 1). Interruption of blood fl ow on the macular spot was shown with fl uorescein angiography in the early stage. And hyperfl uorescence was shown in the same area and enhanced continuously during the late stage ( Fig. 2). The fi nal diagnosis was retinochoroidal infarction. Her brain magnetic resonance imaging, cerebroid fl uid and hematological data were not identifi ed with the tumor involvement. Her physical, ophthalmologic and other laboratory fi ndings were not identifi ed with any infectious pathogen. This ophthalmologic complication was...

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Section: Discussionmentioning

confidence: 99%

“…Only a few reports of ischemic vasculopathy of ocular lesions associated with ALL have been published. 2,3 However, more attention should be paid to ophthalmologic symptoms. The fi rst reason is the higher frequency of asymptomatic ophthalmologic complications than the frequency which pediatric oncologists may be aware of .…”

Section: Discussionmentioning

confidence: 99%

Retinochoroidal infarction during the treatment of acute lymphoblastic leukemia

Kato

Kobayashi

Ito

et al. 2006

Pediatrics International

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“…A whole spectrum of small vessel disease, ranging from mild ischaemia with scattered cotton wool spots to proliferative retinopathy1 appear to be associated with acute leukaemia and its management. A state of hypercoagulability has also been reported after induction chemotherapy which may reflect the release of thromboplastic material from large numbers of destroyed leukaemic cells 3.…”

Section: Commentmentioning

confidence: 99%

Sudden bilateral visual loss in acute myeloid leukaemia

Bom

2000

British Journal of Ophthalmology

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“…Only three case reports in literature where acute lymphoblastic leukemia (ALL) patients had proliferative retinopathy. 5,6,7 Here, we present a case of proliferative retinopathy with bilateral exudative retinal detachment and optic disc swelling in a child with ALL who was under maintenance phase of chemotherapy.…”

Section: Introductionmentioning

confidence: 98%

Proliferative Leukemic Retinopathy With Bilateral Exudative Retinal Detachments and Optic Disc Swelling in a Patient With Acute Lymphoblastic Leukemia

et al. 2019

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Introduction: To report a patient with acute lymphoblastic leukemia (ALL) who developed proliferative leukemic retinopathy with bilateral exudative retinal detachments and optic disc swelling. Case Report: A 11-year-old girl diagnosed with ALL-L2 on maintenance chemotherapy presented with severe blurred vision in both eyes for the past 1 year. Her visual acuity was 0,5/60 for both eyes. Slit-lamp examination of the anterior segment was found normal. Dilated fundus examination revealed tortuous retinal vessels, retinal haemorrhage, retinal and optic disc neovascularizations, optic disc with indistinct margins, and total retinal detachments in both eyes, as well as vitreous haemorrhage in the left eye. The ultrasonography examination revealed bilateral subretinal fluid. Discussion: The patient was diagnosed with bilateral proliferative leukemic retinopathy with exudative retinal detachments and infiltrative optic neuropathy, and left eye vitreous haemorrhage due to ALL. Conservative treatment was given. She continued the maintenance chemotherapy from pediatric department. After 2 months follow up, the visual acuity did not improve although retinal detachments were reduced. There were atrophic changes at the retina of her both eyes. Conclusion: It was reported a rare case of proliferative leukemic retinopathy with bilateral exudative retinal detachments and optic disc swelling. Early recognition and treatment is crucial to improve prognosis.

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Occlusive Microvascular Retinopathy With Optic Disc and Retinal Neovascularization in Acute Lymphocytic Leukemia

Cited by 34 publications

References 0 publications

Retinochoroidal infarction during the treatment of acute lymphoblastic leukemia

Retinochoroidal infarction during the treatment of acute lymphoblastic leukemia

Sudden bilateral visual loss in acute myeloid leukaemia

Proliferative Leukemic Retinopathy With Bilateral Exudative Retinal Detachments and Optic Disc Swelling in a Patient With Acute Lymphoblastic Leukemia

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