Buchan J, McKibbin M, Burton T
Department of Ophthamology, St James University Hospital, Leeds, UK.
Eye (Lond). 2003 Jan;17(1):27-30. doi: 10.1038/sj.eye.6700277.
Previous surveys of ocular disease in leukaemia patients have shown the retina, choroid, and orbit as the most commonly involved sites. Depending on the type of leukaemia and the study design, the prevalence of ocular disease in leukaemia varies from 30 to 90%. Although chronic lymphocytic leukaemia (CLL) is the most common leukaemia in Western countries, the prevalence of ocular disease in CLL is not known. The aim of this prospective study was to estimate the prevalence of ocular disease in CLL.
All CLL patients attending either a teaching or district general hospital haematology clinic were invited to undergo a full eye examination. The clinical stage of the CLL (Binet) at the time of the eye examination and the most recent full blood count (FBC) indices were recorded for each patient.
Over 6 months, 25 patients with an average age of 65 were recruited. A total of 18 patients had Binet stage A disease, three had stage B, and four stage C. The mean FBC indices at the time of examination were haemoglobin 13.5 g/dl, white cell count 37.4 x 10(9)/l, and platelets 172 x 10(9)/l. Only three patients (12%) had ocular disease that was likely to be a secondary complication of CLL. These secondary complications included bilateral posterior subcapsular cataract following radiotherapy, unilateral acute retinal necrosis, and unilateral conjunctival vascular anomalies. The presence of ocular complications was not related to the CLL stage or to the current FBC parameters.
This study demonstrates that ocular involvement in CLL is uncommon, a reflection of the indolent course of CLL as compared to other leukaemias. Although sight-threatening ocular complications have been documented in this and other studies, the low prevalence of complications and the lack of association with disease parameters make it impossible to identify a 'high-risk' group. Routine screening of CLL patients for ocular complications is not justified.
先前针对白血病患者眼部疾病的调查显示，视网膜、脉络膜和眼眶是最常受累的部位。根据白血病的类型和研究设计，白血病患者眼部疾病的患病率在30%至90%之间。虽然慢性淋巴细胞白血病（CLL）是西方国家最常见的白血病，但CLL患者眼部疾病的患病率尚不清楚。这项前瞻性研究的目的是评估CLL患者眼部疾病的患病率。
邀请所有在教学医院或地区综合医院血液科门诊就诊的CLL患者接受全面的眼部检查。记录每位患者眼部检查时CLL的临床分期（比内分期）以及最近的全血细胞计数（FBC）指标。
在6个多月的时间里，招募了25名平均年龄为65岁的患者。共有18例患者处于比内A期疾病，3例处于B期，4例处于C期。检查时的平均FBC指标为血红蛋白13.5 g/dl、白细胞计数37.4×10⁹/L和血小板172×10⁹/L。只有3例患者（12%）患有可能是CLL继发并发症的眼部疾病。这些继发并发症包括放疗后双侧后囊下白内障、单侧急性视网膜坏死和单侧结膜血管异常。眼部并发症的存在与CLL分期或当前的FBC参数无关。
本研究表明，CLL患者眼部受累并不常见，这反映了CLL与其他白血病相比病程较为惰性。尽管在本研究和其他研究中已记录有威胁视力的眼部并发症，但并发症的低患病率以及与疾病参数缺乏关联使得无法确定“高危”人群。对CLL患者进行眼部并发症的常规筛查没有依据。
