Miller Jason M L, Chang Emily, Besirli Cagri G, Johnson Mark W, Demirci Hakan
Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.
Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI, 48105, USA.
Graefes Arch Clin Exp Ophthalmol. 2021 May;259(5):1315-1322. doi: 10.1007/s00417-020-05055-2. Epub 2021 Jan 4.
With therapeutic advances, central nervous system (CNS) involvement in leukemia has become more common. Leukemic optic disc infiltration, often a clinical diagnosis, can present as an isolated finding in primary or relapsed CNS disease and therefore requires early recognition. Not previously well appreciated, we report here signs of intraocular inflammation accompanying leukemic optic disc infiltration, suggesting infectious or non-infectious uveitis as an alternative diagnosis. We describe a novel optical coherence tomography (OCT) sign favoring leukemic infiltration.
Retrospective consecutive case series of all leukemic patients with disc edema (5 patients, 6 eyes) presenting to the University of Michigan's Ocular Oncology Clinic between October 2019 and March 2020.
We report five leukemic patients (6 eyes) who were evaluated for disc edema and vitritis and eventually diagnosed with leukemic papillopathy. All five patients initially had a bland lumbar puncture (LP), and all four patients who underwent magnetic resonance imaging (MRI) had no retrobulbar nerve involvement. Clinical findings included preserved visual acuity (n = 5 eyes, 83%), anterior chamber (AC) cell (n = 3 eyes, 50%), vitreous cell (n = 6 eyes, 100%), and retinal whitening (n = 4 eyes, 66%). In five eyes (83%), a diagnosis of infectious or non-infectious uveitis was initially considered. The OCT finding of inner retinal thickening and loss of inner retinal lamination with largely preserved outer retinal architecture helped point towards a leukemic infiltrative process emanating from the disc and spreading retrograde through the nerve fiber layer.
These cases highlight the difficulty of distinguishing intraocular inflammation associated with leukemic papillopathy from infectious or non-infectious uveitis, especially considering bland LP and negative retrobulbar MRI signal in all our patients. We propose juxtapapillary inner retinal infiltration with the loss of inner retinal lamination and relative preservation of outer retinal architecture on OCT imaging as a finding that supports the diagnosis of leukemic papillopathy.
随着治疗进展，白血病累及中枢神经系统（CNS）已变得更为常见。白血病性视盘浸润通常为临床诊断，可表现为原发性或复发性CNS疾病的孤立发现，因此需要早期识别。此前未得到充分认识，我们在此报告白血病性视盘浸润伴发的眼内炎症体征，提示感染性或非感染性葡萄膜炎可作为一种替代诊断。我们描述了一种有助于白血病浸润诊断的新型光学相干断层扫描（OCT）体征。
对2019年10月至2020年3月间就诊于密歇根大学眼肿瘤诊所的所有患有视盘水肿的白血病患者（5例，6只眼）进行回顾性连续病例系列研究。
我们报告了5例白血病患者（6只眼），这些患者因视盘水肿和玻璃体炎接受评估，最终被诊断为白血病性视乳头病变。所有5例患者最初腰椎穿刺（LP）结果均正常，接受磁共振成像（MRI）检查的4例患者均无球后视神经受累。临床检查结果包括视力保留（5只眼，83%）、前房（AC）细胞（3只眼，50%）、玻璃体细胞（6只眼，100%）和视网膜变白（4只眼，66%）。5只眼（83%）最初被考虑诊断为感染性或非感染性葡萄膜炎。OCT检查发现视网膜内层增厚及视网膜内层分层消失，而外层视网膜结构基本保留，这有助于提示病变是由视盘起源的白血病浸润过程，并通过神经纤维层逆行扩散。
这些病例凸显了区分白血病性视乳头病变相关的眼内炎症与感染性或非感染性葡萄膜炎的困难，尤其是考虑到我们所有患者的LP结果正常且球后MRI信号阴性。我们提出，OCT成像显示视乳头旁视网膜内层浸润、视网膜内层分层消失且外层视网膜结构相对保留，这一表现支持白血病性视乳头病变的诊断。
