Authors : Richa Dhiman, Mandeep Tomar, Gaurav Sharma, Rajeev Tuli, R K Sharma
DOI : 10.18231/j.ijooo.2020.014
Volume : 6
Issue : 1
Year : 2020
Page No : 72-75
Aim: Each and every ocular tissue may be affected in leukemia and ocular involvement is a known entity
since a long time . Prevalence of ocular involvement in leukemia ranges from 9% to 90% and can result from
primary/direct infiltration of ocular tissues by leukemic cells or secondary/indirect involvement following
systemic leukemic involvement.
Materials and Methods: We present a case of a 30 years old female presented to emergency opd
with history of epistaxis, low grade fever and headache from last 1 month and blurring of vision
bilaterally from last 3-4 days. Examination reveals pallor, pedal edema, raised jugular venous pressure and
hepatosplenomegaly. Hematology shows Hb - 4.1gm%,platelet count- 9000/mm3, total leucocyte count -
11,000/mm3 ,international normalized ratio -2.02,elevated lymphocytes(82%) and deranged liver function
tests. Peripheral smear shows microcytic hypochromic anaemia having metamyelocytes 3%, blast cells
71% with negative myeloperoxidase and periodic acid Schiff.
Results: Visual acuity was finger counting at one metres in both eyes. On slit lamp examination,there were
bilateral diffuse subconjunctival hemorrhages, clear cornea, quite anterior chamber and anterior vitreous.
Ocular movements were full and pupils were reactive bilaterally. Fundus examination in right eye shows
dense intraretinal hemorrhages with central clearing in superior and inferior temporal arcade with macular
hemorrhage and severe macular edema. In left eye, a large preretinal hemorrhage in superonasal and
superotemporal arcade with vitreous hemorrhage was present along with multiple scattered intraretinal
hemorrhages and severe macular hemorrhage with macular edema. Patient was diagnosed of having
leukemic retinopathy with macular edema in a case of acute myeloid leukaemia.
Conclusions: All leukemia patients should have an ocular acessment and examination at diagnosis and at
least every 6 months . Ophthalmologist may have a secondary role in the treatment of leukemias but proper
recognition of the ocular manifestations is crucial in the management of a case of leukemia.
Keywords: Ocular manifestations, Acute myloid leukemia.