De Laey J J, De Gersem R
Service d'ophtalmologie, Hôpital universitaire de Pintelaan, Gand, Belgique.
J Fr Ophtalmol. 1989;12(11):819-25.
A case of presumed leukemic infiltration of the choroid and two cases of leukemic involvement of the optic nerve are presented. These complications are rarely observed clinically. Leukemic infiltration of the choroid may cause a serous detachment of the retina, which is often bilateral. The fluoroangiographic aspect is similar to what is observed in acute choriocapillaris occlusion. Leukemic involvement of the optic nerve first appears as papilledema. In more advanced cases the optic disc and the peripapillary retina are covered by a white-yellowish infiltrate which protrudes into the vitreous. The diagnosis is confirmed by CT scan of the orbit and the cerebro-spinal fluid often contains leukemic cells. As optic nerve infiltration is often associated with CNS involvement the prognosis is usually poor. Intrathecal chemotherapy has little effect on the intraocular manifestations, which however respond to orbital radiotherapy.
本文报告了1例疑似脉络膜白血病浸润病例和2例视神经白血病累及病例。这些并发症在临床上很少见。脉络膜白血病浸润可导致视网膜浆液性脱离,通常为双侧性。荧光血管造影表现与急性脉络膜毛细血管阻塞所见相似。视神经白血病累及首先表现为视乳头水肿。在更晚期病例中,视盘和视乳头周围视网膜被灰白色浸润物覆盖,并突入玻璃体。眼眶CT扫描可确诊,脑脊液中常含有白血病细胞。由于视神经浸润常与中枢神经系统受累相关,预后通常较差。鞘内化疗对眼部表现几乎没有效果,但眼眶放疗对此有效。