Background: The intraocular manifestations of leukemia are diverse. The retina is the most common ophthalmic involvement site. The most common retinal manifestations of acute lymphoblastic leukemia (ALL) include dilated and tortuous vessels, serous retinal detachment (SRD), intraretinal hemorrhages as well as roth spots. Optic nerve infiltration and retinal neovascularization are unusual, especially in complete clinical remission of ALL. However, neovascularization in optic disk has not been observed in ALL during complete clinical remission. Objective: To report clinical characteristics of a bilateral optic disk neovascularization associated with relapse of ALL. Method: A 31-year-old male with ALL after having reached complete remission from chemotherapy complained about a vision loss in both eyes. First examination showed that best corrected visual acuity (BCVA) was 20/200 for his right eye and 20/160 for his left eye, respectively. Fundus examination revealed bilateral profound optic disk edema with multiple yellow-white exudates and retinal hemorrhages. Optical coherence tomography (OCT) showed bilateral optic disk edema and SRD in both maculas. Fundus fluorescein angiography (FFA) showed bilateral optic disk neovascularization. All these changes were present in remission. The patient received intravitreal Conbercept injection 0.5 mg (10 mg/ml) in both eyes for once on June 29, 2019. Optic disk neovascularization resolved three weeks after treatment. BCVA improved to 20/200 in his right eye, but still light perception in his right eye. No optic disk neovascularization recurrence was observed in 3-month follow-up. BCVA of the right eye maintained 20/200 at the latest follow-up. After intravitreal injection for 4 months the patient suffered from cerebral hemorrhage. He received bone marrow biopsy and cerebrospinal fluid sampling. The results showed relapse in hemogram and lymphocytes in central nervous system (CNS). Therefore, the chemotherapy treatment did not cause a new remission of the disease and the patient failed to recover. Conclusion: Optic disk neovascularization may appear as a sign of extramedullary relapse of ALL months in advance of the hematologic relapse. Intravitreal injection of conbercept could be beneficial and safe in treating this neovascularization.
| Published in | International Journal of Ophthalmology & Visual Science (Volume 7, Issue 1) |
| DOI | 10.11648/j.ijovs.20220701.14 |
| Page(s) | 26-29 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Acute Lymphoblastic Leukemia, Optic Disk Neovascularization, Anti-vascular Endothelial Growth Factor, Recurrence
| [1] | Alrobaian MA, Henderson AD. Neuro-Ophthalmic Manifestations of Acute Leukemia. J Neuroophthalmol. 2021 Dec 1; 41 (4): e584-e590. doi: 10.1097/WNO.0000000000001071. |
| [2] | Adaniya A, Luciano AD, Alvarado-Villacorta R, et al. Serous retinal detachment as a sign of leukemic choroidopathy: A systematic review. Surv Ophthalmol. 2022 Jan-Feb; 67 (1): 149-167. doi: 10.1016/j.survophthal.2021.04.007. |
| [3] | Tijani M, Albaroudi N, Sibari O, et al. Bilateral optic nerve head infiltration: Case report of relapse of acute lymphoblastic leukemia. J Fr Ophtalmol. 2016 Nov; 39 (9): e261-e263. doi: 10.1016/j.jfo.2016.07.011. |
| [4] | Alsurabi A, Souley Youssoufou AS, El Aoutassi N, et al. Massive bilateral infiltration of the retina and the optic nerve head secondary to a relapse of acute lymphoblastic leukemia - case report.J Fr Ophtalmol. 2018 Nov; 41 (9): e429-e432. doi: 10.1016/j.jfo.2017.11.042. |
| [5] | Bouladi M, Zerei N, Bouraoui R, et al. Unilateral infiltration of the optic nerve revealing relapse of an acute lymphoblastic leukemia. Tunis Med. 2019 Mar; 97 (3): 504-507. |
| [6] | Azad, SV, Banerjee, M, Parmanand, K, et al. Isolated optic nerve involvement in acute lymphoblastic leukaemia: a red flag for early relapse. BMJ Case Rep. 2021 Jun 28; 14 (6): e243689. doi: 10.1136/bcr-2021-243689. |
| [7] | Pflugrath AE, Brar VS. Bilateral optic nerve and retinal infiltration as an initial site of relapse in a child with T-cell acute lymphoblastic leukemia. Am J Ophthalmol Case Rep. 2020 Apr 10; 18: 100695. doi: 10.1016/j.ajoc.2020.100695. |
| [8] | Bentata R, Chan H, Coste V et al. Pseudo-hypopyon secondary to a meningeal recurrence of acute lymphoblastic leukemia: Case report. J Fr Ophtalmol. 2020 Oct; 43 (8): e259-e261. doi: 10.1016/j.jfo.2020.01.012. |
| [9] | Cekic O, Biberoglu E, Esen F. Peripapillary retinal leukemic infiltration associated with papilledema in a T-ALL patient without cranial or optic nerve involvement. Tumori. 2016 Nov 11; 102 (Suppl. 2). doi: 10.5301/tj.5000490. |
| [10] | Gora-Tybor J, Szemraj J, Robak T, et al. Clinical relevance of vascular endothelial growth factor type A (VEGFA) and VEGF receptor type 2 (VEGFR2) gene polymorphism in chronic lymphocytic leukemia.2015 Feb; 54 (2): 139-43. doi: 10.1016/j.bcmd.2014.11.022. |
| [11] | Guo B, Liu Y, Tan X, et al. Prognostic significance of vascular endothelial growth factor expression in adult patients with acute myeloid leukemia: a meta-analysis. Leuk Lymphoma. 2013 Jul; 54 (7): 1418-25. doi: 10.3109/10428194.2012.748907. |
| [12] | Yang X, Xu J, Yang J, et al. Unilateral macular choroidal neovascularization-a rare manifestation in acute myelocytic leukemia: Case report. Medicine (Baltimore). 2018 Apr; 97 (16): e0344. |
| [13] | Paesler J, Gehrke I, Poll-Wolbeck SJ. Targeting the vascular endothelial growth factor in hematologic malignancies. Eur J Haematol. 2012 Nov; 89 (5): 373-84. doi: 10.1111/ejh.12009. |
| [14] | Pour EK, Bazvand F, Mehrabi Bahar MR, et al. Unilateral Macular Choroidal Neovascularization; a Rare Manifestation in Chronic Myelogenous Leukemia. J Curr Ophthalmol. 2020 Mar 23; 32 (1): 103-106. doi: 10.1016/j.joco.2019.09.003. |
APA Style
Xuemei Liang, Li Li. (2022). Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report. International Journal of Ophthalmology & Visual Science, 7(1), 26-29. https://doi.org/10.11648/j.ijovs.20220701.14
ACS Style
Xuemei Liang; Li Li. Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report. Int. J. Ophthalmol. Vis. Sci. 2022, 7(1), 26-29. doi: 10.11648/j.ijovs.20220701.14
AMA Style
Xuemei Liang, Li Li. Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report. Int J Ophthalmol Vis Sci. 2022;7(1):26-29. doi: 10.11648/j.ijovs.20220701.14
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ijovs.20220701.14,
author = {Xuemei Liang and Li Li},
title = {Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report},
journal = {International Journal of Ophthalmology & Visual Science},
volume = {7},
number = {1},
pages = {26-29},
doi = {10.11648/j.ijovs.20220701.14},
url = {https://doi.org/10.11648/j.ijovs.20220701.14},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20220701.14},
abstract = {Background: The intraocular manifestations of leukemia are diverse. The retina is the most common ophthalmic involvement site. The most common retinal manifestations of acute lymphoblastic leukemia (ALL) include dilated and tortuous vessels, serous retinal detachment (SRD), intraretinal hemorrhages as well as roth spots. Optic nerve infiltration and retinal neovascularization are unusual, especially in complete clinical remission of ALL. However, neovascularization in optic disk has not been observed in ALL during complete clinical remission. Objective: To report clinical characteristics of a bilateral optic disk neovascularization associated with relapse of ALL. Method: A 31-year-old male with ALL after having reached complete remission from chemotherapy complained about a vision loss in both eyes. First examination showed that best corrected visual acuity (BCVA) was 20/200 for his right eye and 20/160 for his left eye, respectively. Fundus examination revealed bilateral profound optic disk edema with multiple yellow-white exudates and retinal hemorrhages. Optical coherence tomography (OCT) showed bilateral optic disk edema and SRD in both maculas. Fundus fluorescein angiography (FFA) showed bilateral optic disk neovascularization. All these changes were present in remission. The patient received intravitreal Conbercept injection 0.5 mg (10 mg/ml) in both eyes for once on June 29, 2019. Optic disk neovascularization resolved three weeks after treatment. BCVA improved to 20/200 in his right eye, but still light perception in his right eye. No optic disk neovascularization recurrence was observed in 3-month follow-up. BCVA of the right eye maintained 20/200 at the latest follow-up. After intravitreal injection for 4 months the patient suffered from cerebral hemorrhage. He received bone marrow biopsy and cerebrospinal fluid sampling. The results showed relapse in hemogram and lymphocytes in central nervous system (CNS). Therefore, the chemotherapy treatment did not cause a new remission of the disease and the patient failed to recover. Conclusion: Optic disk neovascularization may appear as a sign of extramedullary relapse of ALL months in advance of the hematologic relapse. Intravitreal injection of conbercept could be beneficial and safe in treating this neovascularization.},
year = {2022}
}
TY - JOUR T1 - Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report AU - Xuemei Liang AU - Li Li Y1 - 2022/02/28 PY - 2022 N1 - https://doi.org/10.11648/j.ijovs.20220701.14 DO - 10.11648/j.ijovs.20220701.14 T2 - International Journal of Ophthalmology & Visual Science JF - International Journal of Ophthalmology & Visual Science JO - International Journal of Ophthalmology & Visual Science SP - 26 EP - 29 PB - Science Publishing Group SN - 2637-3858 UR - https://doi.org/10.11648/j.ijovs.20220701.14 AB - Background: The intraocular manifestations of leukemia are diverse. The retina is the most common ophthalmic involvement site. The most common retinal manifestations of acute lymphoblastic leukemia (ALL) include dilated and tortuous vessels, serous retinal detachment (SRD), intraretinal hemorrhages as well as roth spots. Optic nerve infiltration and retinal neovascularization are unusual, especially in complete clinical remission of ALL. However, neovascularization in optic disk has not been observed in ALL during complete clinical remission. Objective: To report clinical characteristics of a bilateral optic disk neovascularization associated with relapse of ALL. Method: A 31-year-old male with ALL after having reached complete remission from chemotherapy complained about a vision loss in both eyes. First examination showed that best corrected visual acuity (BCVA) was 20/200 for his right eye and 20/160 for his left eye, respectively. Fundus examination revealed bilateral profound optic disk edema with multiple yellow-white exudates and retinal hemorrhages. Optical coherence tomography (OCT) showed bilateral optic disk edema and SRD in both maculas. Fundus fluorescein angiography (FFA) showed bilateral optic disk neovascularization. All these changes were present in remission. The patient received intravitreal Conbercept injection 0.5 mg (10 mg/ml) in both eyes for once on June 29, 2019. Optic disk neovascularization resolved three weeks after treatment. BCVA improved to 20/200 in his right eye, but still light perception in his right eye. No optic disk neovascularization recurrence was observed in 3-month follow-up. BCVA of the right eye maintained 20/200 at the latest follow-up. After intravitreal injection for 4 months the patient suffered from cerebral hemorrhage. He received bone marrow biopsy and cerebrospinal fluid sampling. The results showed relapse in hemogram and lymphocytes in central nervous system (CNS). Therefore, the chemotherapy treatment did not cause a new remission of the disease and the patient failed to recover. Conclusion: Optic disk neovascularization may appear as a sign of extramedullary relapse of ALL months in advance of the hematologic relapse. Intravitreal injection of conbercept could be beneficial and safe in treating this neovascularization. VL - 7 IS - 1 ER -
Information
Email: