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. 2022 Jun 29;15(2):159-162.
doi: 10.4103/ojo.ojo_347_20. eCollection 2022 May-Aug.

Ocular findings in children with acute leukemia at a tertiary care center in South America

Franco Benvenuto  1 , Mariana Sgroi  1 , Soledad S Guillen  1 , David Ancona  2 , Adriana Fandiño  1
Affiliations

Ocular findings in children with acute leukemia at a tertiary care center in South America

Franco Benvenuto et al. Oman J Ophthalmol. .

Abstract

Purpose: The purpose of this study was to evaluate ophthalmological findings in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in a Latin American population.

Materials and methods: This was a single-center, retrospective study. The observational analysis was conducted in AML and ALL patients seen as a routine examination at the department of ophthalmology of tertiary care center in Argentina between March 1, 2017, and February 28, 2018.

Results: Overall, 137 patients with acute leukemia were included. The mean age was 7.9 ± 5.2 years (0-18), and 55% were male (n = 75) and 45% female (n = 45). At least one-fifth (n = 31) of the patients presented some type of ocular manifestation (23%). The most frequently observed manifestation was retinal hemorrhages (n = 14), followed by papilledema (n = 9) and ocular surface involvement (n = 5). The eye involvement was more frequently identified in the AML group (24%), compared to the ALL group (22%), especially papilledema with central nervous system compromise ALL (5%) and AML (11%), P < 0.01. The presence of hemorrhages was similar in both groups. In patients with retinal hemorrhage (n = 14), the mean hematological findings were hemoglobin 7.4 ± 0.4 g/dL (6.5-8.0), erythrocytes 2.5M ± 0.3/mm3 (confidence interval [CI], 2.0-3.1), and platelets 76,000 ± 32,000/mm3 (CI, 8000-384,000). Patients without retinal findings (n = 123), the mean hematological findings were hemoglobin 9.1 ± 0.6 g/dL (8.0-10.2), erythrocytes 3.2M ± 0.6/mm3 (CI, 2.5-3.5), and platelets 92,000 ± 44,000/mm3 (CI, 42.000-390.000). Multivariable analysis found that hemoglobin levels were the most reliable predictive factor for retinal findings. It was observed that the risk diminishes in patients with levels higher than 8.5 g/dL, and that it increased in patients with levels ranging between 6.5 and 7.5 g/dL at least twice (P < 0.01).

Conclusions: Our results show that ocular involvement occurs in a high percentage of patients with leukemia with a clear clinical, humoral, and sometimes prognostic correlation, suggesting routine ophthalmologic evaluation in these patients.

Keywords: Leukemia; ocular oncology; pediatric retina.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Fundus photograph of a patient with acute lymphoid leukemia, superficial (white arrow) and deep hemorrhages, and a subhyaloid bleed involving the macula (black arrow)
Figure 2
Figure 2
(a) Fundus photograph of a patient with acute myeloid leukemia, showing multiple retinal hemorrhages (white arrow) and optic nerve infiltration (black arrow). (b) Fundus photograph of a patient with acute myeloid leukemia, showing papilledema
See this image and copyright information in PMC

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