Ocular Manifestations of Leukemia and Results of Treatment with Intravitreal Methotrexate

Dai, Vicktoria Vishnevskia; King, Sara Sella; Lekach, Ruth; Fabian, Ido Didi; Zloto, Ofira

doi:10.1038/s41598-020-58654-8

Cited by 32 publications

(30 citation statements)

References 15 publications

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“…Intrathecal chemotherapy alone however may yield limited treatment efficacy. Recently, a retrospective cohort study by Vishnevskia et al stated that intravitreal methotrexate injections may be an effective mode of treatment for eyes with intraocular leukaemic tumour cell infiltration whereby in their study 11 treated eyes showed improvement in the inflammatory reaction and tumour cell infiltration and this could be a promising therapeutic approach in future [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated Ocular Manifestations in Chronic Myeloid Leukaemia

Maniam¹,

Zuhaimy²,

Vendargon³

et al. 2021

Cureus

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Background: Chronic myeloid leukaemia (CML) presenting with only ocular manifestations either at the initial stage of diagnosis or at relapse is uncommon. We report two cases of CML presenting with isolated visual symptoms. Case series: The first case is a 21-year-old healthy gentleman who presented with left eye painless loss of vision for a one-week duration. Visual acuity was 6/60 in the left eye and 6/6 in the right eye. There were scattered retinal haemorrhages in both eyes and a sub-macular bleed over the left eye. The full blood count revealed a high white cell count of 134.6 × 10 9 /L. Peripheral blood smear showed hyper-leucocytosis with absolute eosinophilia and basophilia and the presence of blasts suggestive of CML thus chemotherapy was commenced. The second case is a 28-year-old in haematological, molecular, and cytogenic remission from CML for the past two years, presented with left eye painless vision loss for five days duration. Vision in the left eye was counting fingers. There was a large subretinal mass involving the left optic disc. Magnetic resonance imaging of the brain and orbit showed an elliptical orbital mass at the left globe posteriorly with diffuse thickening of the optic nerve. The patient was diagnosed as CML relapsed to the left optic nerve. He underwent intrathecal chemotherapy and orbital irradiation. Conclusion: Both these cases are unique since the manifestation of CML was with only ocular features at the time of presentation as per in the first case during the initial diagnosis and in the second case during relapse. This highlights that it is evident that the knowledge of ocular involvement in leukaemia is crucial since the eye is the only organ where leukemic infiltration to nerves and blood vessels can be observed directly. Recognizing fundus changes in leukaemia allows earlier diagnosis and prompt treatment. These case reports highlight the importance of recognizing early fundus changes, which should allow earlier diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Isolated Ocular Manifestations in Chronic Myeloid Leukaemia

Maniam¹,

Zuhaimy²,

Vendargon³

et al. 2021

Cureus

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“…2008; Vishnevskia‐Dai et al. 2020). Intravitreal chemotherapy, such as MTX, has shown satisfactory results in cases with diffuse retinal or optic nerve leukaemic infiltration.…”

Section: Figmentioning

confidence: 99%

“…Leukaemic retinopathy is a common ophthalmic presentation of ocular leukaemia; (Talcott et al 2016), and it may occur at the time of primary diagnosis, but it has also been described as a form of leukaemic relapse (Lyu et al 2018). Treatment options are mainly based on chemotherapy, administered either systemically or intravitreally (Frenkel et al 2008;Vishnevskia-Dai et al 2020). Intravitreal chemotherapy, such as MTX, has shown satisfactory results in cases with diffuse retinal or optic nerve leukaemic infiltration.…”

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confidence: 99%

Ocular leukemic mass‐like relapse treated with CyberKnife stereotactic radiosurgery

Starace

Cicinelli

Cavalleri

et al. 2021

Acta Ophthalmologica

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“…They can be the first manifestation of leukemia (either primary or secondary), occur after the diagnosis has been established, or be the first sign of a relapse after remission [ 2 ]. Secondary ocular manifestations include retinal hemorrhages and retinal venous occlusions due to hematologic abnormalities [ 2 ]. Primary ocular leukemic infiltration can also affect the orbit, anterior segment, and the uvea.…”

Section: Introductionmentioning

confidence: 99%

Case report: atypical, unilateral optic nerve infiltration as the first sign of acute lymphoblastic leukemia (ALL) relapse

2022

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Background We describe a case of an atypical presentation of leukemic optic nerve infiltration. Case presentation A patient with acute lymphoblastic leukemia (ALL) in remission suffered from sudden right eye vision loss. At the time of presentation, the affected eye presented with an afferent pupillary defect, while the fundus examination was normal. A complete work up of the patient revealed no signs of ALL relapse, but MR imaging of the optic nerve showed contrast agent uptake consistent with optic nerve infiltration. The patient developed a fulminant ALL relapse and died shortly after. Histology of the optic nerve showed a leukemic infiltration with CD10 positive cells. Conclusions This is the first report of an ALL relapse in the optic nerve without intraocular signs. Patients’ medical history should therefore be taken into consideration in patients with unclear vision loss.

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Ocular Manifestations of Leukemia and Results of Treatment with Intravitreal Methotrexate

Cited by 32 publications

References 15 publications

Isolated Ocular Manifestations in Chronic Myeloid Leukaemia

Isolated Ocular Manifestations in Chronic Myeloid Leukaemia

Ocular leukemic mass‐like relapse treated with CyberKnife stereotactic radiosurgery

Case report: atypical, unilateral optic nerve infiltration as the first sign of acute lymphoblastic leukemia (ALL) relapse

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