Ocular involvement as the initial manifestation of T-cell chronic lymphocytic leukemia

PURPOSE: To present a case of T-cell chronic lymphocytic leukemia (T-CLL) manifesting as an intraocular lymphoma. DESIGN: Interventional case report. METHODS: We performed a vitreous biopsy in a 67-year-old woman who presented with blurred vision and vitreous cellular infiltration. Morphologic, immunohistochemical, flow cytometry, and molecular analysis by polymerase chain reaction of vitreous fluid, peripheral blood, bone marrow aspirate, and biopsy were performed. RESULTS: Cytofluorographic and molecular analysis of vitreous cells demonstrated a monoclonal T-cell population consistent with a T-cell intraocular lymphoma. Systemic evaluation established diagnosis of T-cell CLL. CONCLUSION: T-CLL is a rare disease with an aggressive clinical course. We present a case of T-cell intraocular lymphoma as the initial manifestation of an otherwise asymptomatic T-CLL.     

Optic atrophy following prophylactic chemotherapy and cranial radiation for acute lymphocytic leukemia.

Two patients with acute lymphocytic leukemia developed progressive optic nerve and chiasmal lesions eight to nine months after the initiation of identical chemotherapy protocols that included intrathecal medication and prophylactic radiation of only 2,400 rads to the central nervous system. Both patients eventually lost all vision despite additional radiotherapy, and there was no evidence of leukemia involving the central nervous system after acute lymphocytic leukemia was diagnosed. Optic nerve biopsy in one case showed changes consistent with radiation necrosis.     

Bilateral orbital myeloid sarcoma as initial manifestation of acute myeloid leukemia

Background Granulocytic sarcoma is a rare orbital complication of acute leukemia. It concerns primarily children under 10 years of age suffering from primitive acute myeloid leukemia. The diagnosis is made by clinical examination, computed tomography and confirmed by haematological investigations. The treatment approach is based on chemotherapy associated with intravenous steroid therapy. Case report We report the case of a 6-year-old girl who presented with bilateral proptosis revealing acute myeloid leukemia. The patient was treated by a combination of chemotherapeutic drugs in two phases, associated with intravenous steroids. After a follow-up period of 24 months, the patient was in complete remission. Conclusion The diagnosis of granulocytic sarcoma should be considered in any orbital mass of uncertain origin, particularly if it is bilateral. Special stains and immunohistochemistry play an important role in the diagnosis.     

Optic disc neovascularization associated with ocular involvement in acute lymphocytic leukemia

A case of vitreous involvement in acute lymphoblastic leukemia associated with neovascularization of the optic nerve head is presented. The diagnosis was made from a vitreous biopsy specimen obtained by pars plana vitrectomy and prepared by a membrane filter and modified Papanicolaou stain technique. Fibrovascular membranes and leukemic cells were seen on microscopic examination of the vitreous biopsy specimen. Retinal neovascularization associated with acute lymphoblastic leukemia is discussed.     

Unilateral optic disc edema in a patient with acute lymphocytic leukemia

A young male complained of acute left-eye visual loss. The right eye was normal. Only hand motions were seen with the left. The dilated fundus showed mild optic disk elevation, blurred margins, tortuous vessels, retinal vascular sheathing, and flame-shaped hemorrhages. Laboratory exam revealed acute lymphocytic leukemia. Following chemotherapy and radiotherapy, disk swelling and retinal changes resolved and visual acuity improved. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Aniseikonia of central serous chorioretinopathy]

Central serous chorioretinopathy (CRS) is one of the typical diseases that accompany micropsia. However very little is known about micropsia of CRS, because of the difficulty to measure "aniseikonia" in terms of micropsia. Aniseikonia in 65 cases of CRS was measured quantitatively by Awaya's New Aniseikonia Tests (NAT). The tests were performed at two different distances of 40 cm (visual angle: 6 degrees) and 20 cm (12 degrees) and under 4 meridians of the halfmoon on NAT, horizontal, 45 degrees, vertical and 135 degrees, respectively. The mean value of aniseikonia under each testing condition was as follows: 6 degrees horizontal -3.13%, 45 degrees -2.56%, vertical -2.13%, 135 degrees -2.57%, 12 degrees; horizontal -1.38%, 45 degrees -1.69%, vertical -1.84%, 135 degrees -1.50%. At 6 degrees aniseikonia is larger in the horizontal meridian than in the vertical with statistical significance (t-test, p less than 0.05), while at 12 degrees aniseikonia is smaller than at 6 degrees and shows no particular tendency in terms of meridian. The phenomenon observed at 6 degrees may be what is called "oriented metamorphopsia".     

Bilateral optic disk edema and blindness as initial presentation of acute lymphocytic leukemia

PURPOSE: To report bilateral optic disk edema and blindness as the unusual initial presentation of acute lymphocytic leukemia (ALL) in an adult. METHODS: A 19-year-old man presented with a history of headaches, back pain, and 10 days of worsening vision that progressed to blindness. Ocular examination revealed light perception acuity in the right eye and no light perception in the left eye. Fundus examination revealed bilateral profound optic disk edema, tortuous vessels, and retinal hemorrhages. Acute lymphocytic leukemia was diagnosed with complete blood count and bone marrow biopsy. Head computed tomography and magnetic resonance imaging, were normal. Lumbar puncture revealed normal opening pressure. Ocular ultrasonography showed bilateral optic nerve enlargement. DESIGN: Interventional case report and literature review. ESULTS: The presumptive diagnosis of leukemic infiltration of the optic nerves was made, and urgent radiotherapy, intrathecal methotrexate, and intravenous daunorubicin were instituted. Visual acuity improved to hand motions in the right eye. CONCLUSIONS: Acute lymphocytic leukemia can rarely present in adults as visual changes due to leukemic optic nerve infiltration. Radiation treatment should be considered as an urgent treatment modality for this rare condition.     

The etiology of central serous chorioretinopathy]

We found several fluorescein fundus angiographic findings of the retinal pigment epithelium in the experimental central serous chorioretinopathy (ECSC) i.e.; the typical leaking spot (smoke-stack type or inkblot type), acute retinal pigment epitheliitis-like, APMPPE-like, triangular syndrome-like, drusen-like lesions, and retinal pigment epithelium decompensation during the observations of the six months period in the same monkey. Immediately after onset of ECSC, we found that the typical leaking spot appeared after retinal venous filling phase or appeared in the margin of the choroidal filling delay. The leaking spot, acute retinal pigment epitheliitis-like, APMPPE-like and drusen-like lesions spontaneously healed without scar formation and were related to the mild choroidal ischemia. These findings correspond to those seen in human central serous chorioretinopathy. As an initial change, choroidal neovascularization in the macula was also found in the eye with recurrent or chronic ECSC by electron microscopy. Considering the fluorescein fundus angiographic findings of this monkey, it was suggested that the recurrent or chronic, mild choroidal ischemia seems to play an important role in the development of the choroidal neovascularization. Therefore, we believe that the ECSC is an animal model of the human central serous chorioretinopathy. We also found that the development of ECSC produced by intravenous injection of the adrenalin in rabbits is completely suppressed by the pretreatment of alpha-adrenergic receptor blocking agent and is incompletely suppressed by the pretreatment of beta adrenergic receptor blocking agent and ganglionic blocking agent. These results strongly suggest that the stress plays an important role in the development of the central serous chorioretinopathy.     

Unilateral eyelid swelling,proptosis and diplopia as initial manifestation of acute myeloid leukemia

Myeloid sarcoma is a tumor of immature myeloid cells occurring in many extramedullary sites, orbit being one of them where the tumor may occur prior to or after the diagnosis of underlying disease. We report a case of a 17-year-old male who presented with upper eyelid swelling, proptosis and diplopia after presumed blunt trauma without any other clinical signs and symptoms. Initial imaging suggested possibility of subperiosteal hematoma. Magnetic resonance imaging studies demonstrated a solid tumor. Complete excision of the tumor and histopathologic diagnosis revealed evidence of acute myeloid leukemia (AML). There were no other sites indicating any tumoral process; however, bone marrow aspirate revealed an evidence of systemic disease. After chemotherapy and allogenic bone marrow transplant, the patient had complete remission of his disease. An episode of graft vs host reaction resulting in severe dry eyes along with skin eruptions was treated successfully by immunosuppression and topical lubrication without any visual or systemic sequela. This case emphasizes on the need for an aggressive work-up for any unusual orbital lesion in the absence of any explainable etiology. Further, AML may be suspected in the cases of orbital tumors even in the absence of systemic manifestations of leukemia at any age.