Ophthalmic manifestations in hematological malignancies: An observational study from a tertiary care health center in Eastern India

Abstract

Purpose: This study aimed to document the spectrum of ocular manifestations of hematological malignancies presenting to a tertiary health center in Eastern India and their association with blood parameters.

Methods: This hospital-based cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with leukemia, lymphoma, and multiple myeloma were enrolled in the study. A comprehensive ophthalmic evaluation was done in each case.

Results: A total of 97 patients with a confirmed diagnosis of hematological malignancies and meeting the inclusion and exclusion criteria were included in the study. Ocular manifestations were noted in 48 (49.48%) patients. Acute lymphocytic leukemia accounted for 35.4% of cases, followed by acute myeloid leukemia (31.25%), lymphoma (4.2%), and minimum manifestation in multiple myeloma (2.1%) patients. Among 48 patients with ocular manifestations, anterior segment involvement was found in 6.2% of cases, with subconjunctival hemorrhage being the most common, and the posterior segment was involved in 100% of patients, with intraretinal hemorrhages being the most common manifestation. A statistically significant association was noted between hemoglobin, total red blood cell count, and total platelet count with posterior segment manifestations ( p < 0.001). On multivariable logistic regression, only total leucocyte count and total platelet count were significant predictors for ocular manifestation.

Conclusion: Indirect involvement of the retina is the most common ocular pathology in hematological malignancies, with intraretinal hemorrhages being the most common finding. Ophthalmic examination is highly recommended as a part of the routine evaluation at the time of diagnosis of hematological malignancies and periodically thereafter to diagnose any ocular involvement.

Figure 1

(a and b) Color fundus photograph of a patient with acute lymphoblastic leukemia showing bilateral intraretinal and preretinal hemorrhages. (c) Color fundus photograph of the right eye of a patient with acute myeloid leukemia showing retinal hemorrhages and cotton wool spots (d) Color fundus photograph of the left eye of a patient with acute myeloid leukemia with good vision showing intraretinal hemorrhages

Figure 2

(a) Color fundus photograph of the right eye of a patient with acute lymphoblastic leukemia showing disc edema and retinal hemorrhages (b) Color fundus photograph of the left eye of a patient who primarily presented to the ophthalmology department showing multiple white-centered retinal hemorrhages. The patient was later diagnosed with chronic myeloid leukemia. (c) Color fundus photograph of the left eye of a patient with acute lymphoblastic leukemia showing leukemic optic nerve infiltration (d) Magnetic resonance imaging of the same patient showing subtle enhancement of the left optic nerve with indistinct margins