Ocular manifestations of childhood leukemia
Ohkoshi, K.
Nippon Ganka Gakkai Zasshi 92(11): 1787-1796
1988
ISSN/ISBN: 0029-0203 PMID: 3228027 Document Number: 316547
From January, 1972 to June 1987, 178 children with leukemia were admitted to St. Luke's International Hospital and Juntendo University Hospital. Seventy eight cases were referred by pediatricians to the Ophthalmology Departments for the evaluation of ocular abnormalities. We detected 49 cases with ocular abnormalities associated with leukemia and classified these cases into four types as follows: Type I. Leukemic cell infiltration of ocular tissues in 13 cases; optic nerve (5 cases), uveal tissue (4 cases), retina (2 cases) and orbit (3 cases). Type II. Ophthalmopathy due to hemorrhagic diatheses and related symptoms in 19 cases; retinal hemorrhage (17 cases), subconjunctival hemorrhage (2 cases). Type III. Ocular signs of central nervous system leukemia in 15 cases; papilledema (3 cases), opthalmoplegia and facial nerve palsy (14 cases). Type IV. Other diseases related with leukemia in 20 cases; infection (6 cases), side effects of chemotherapy (14 cases). In five cases of type I, histopathological study revealed leukemic cell infiltration into the ocular tissues. The five-year-survival rate in the cases with type I, II, III ocular manifestations was 19.4%, which was worse than in: type IV cases and cases without ocular manifestations (46.9%). Following ocular manifestations such as uveal infitration, retinal hemorrhage and ocular signs of central nervous system leukemia, death occurs 7 months earlier on average than in cases of optic nerve or orbital infiltration. Visual impairment was observed in 7 cases, and following visual impairment, all of them died within 2 years and 9 months. Nine cases out of 13 five-year-survival cases without recurrence had ocular abnormalities. However, none of them developed visual impairment. Ten cases out of eighteen 5-year-survival cases had ophthalmopathy due to side effects of chemotherapy. Compared with a previous report published in the U.S.A., the number of cases with ocular manifestations was greater in acute leukemic children suffer from ophthalmopathy. Ophthalmic evaluation should be done in order to preserve visual function and to estimate the prognosis of leukemia. Systemic chemotherapy and irradiation specific for the eye should be performed in cases of leukemic infiltration of ocular tissues.