Successful Treatment of Ocular Chronic Lymphocytic Leukemia with Ibrutinib: Case Report and Review of the Literature

Chronic Lymphocytic Leukemia Presenting as Bilateral Periorbital Edema Treated With Low-dose Radiation Therapy

“…Current treatment options include high-dose systemic steroids, external beam radiation therapy, laser photocoagulation, and chemoimmunotherapy. 16 Certain ocular manifestations, such as conjunctival infiltration, are reported to respond better to systemic chemotherapy. 21 Leukemia cutis lesions have been shown to resolve after systemic treatment of CLL or local radiation.…”

“…2 Neuroimaging by MRI has a lower sensitivity (29%) for detecting meningeal involvement from leukemia or lymphoma compared with cerebrospinal fluid cytology (96.8%). 16 The yield of vitreous biopsy for intraocular CLL involvement is unknown, although in general there is a high false negative yield due to the low tumor burden. Biopsy and immunohistochemical study of the skin or orbital tissue may be helpful in cases where vitreous sampling was unrevealing.…”

“…2 There is no known correlation between Rai/Binet stage and occurrence of ocular disease. 4,16 Overall, Delestre et al found that among patients with ophthalmic manifestations of CLL, those with ophthalmic infection due to immunodeficiency had the worst prognosis (47% 6-month median survival rate), compared with a 75% survival rate for those presenting with ophthalmic findings due to CLL infiltration or lymphoma. 3 Skin findings are not known to significantly impact overall survival, although the presence of medium-sized and large B lymphocytes and epidermal changes on histology has been reported to portend a poor prognosis.…”