Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Orbit. 2022 Aug;41(4):480-484. doi: 10.1080/01676830.2021.1880443. Epub 2021 Feb 8.
Optic nerve infiltration is a rare but known complication of the central nervous system (CNS)-involving lymphoma and leukemic disorders. The diagnosis is often presumed and patients are empirically treated with systemic therapy and/or local radiation. Optic nerve biopsy is usually avoided due to the risk of permanent vision loss secondary to the procedure. We present a case of biopsy-proven leukemic optic neuropathy without optic nerve sheath or cerebrospinal fluid (CSF) involvement in a patient previously in remission from T-cell prolymphocytic leukemia (T-PLL). To our knowledge, this is the first documented case of T-PLL with biopsy-proven optic nerve invasion without CSF involvement and suggests possible perineural invasion or a sanctuary site from chemotherapy. We suggest that for patients with poor vision and suspected leukemic infiltration without other evidence of CNS involvement, both optic nerve and optic sheath biopsy should be performed for diagnosis and treatment.
视神经浸润是累及中枢神经系统（CNS）的淋巴瘤和白血病的罕见但已知的并发症。该诊断通常是推测性的，患者会接受全身性治疗和/或局部放疗进行经验性治疗。由于该过程可能导致永久性视力丧失，视神经活检通常是避免的。我们介绍了一例经活检证实的白血病性视神经病变，患者先前患有 T 细胞前淋巴细胞白血病（T-PLL），缓解后无视神经鞘或脑脊液（CSF）受累。据我们所知，这是首例有活检证实的 T-PLL 伴视神经浸润而无 CSF 受累的病例，提示可能存在神经周围浸润或化疗的避难部位。我们建议对于视力不佳且疑似白血病浸润而无其他 CNS 受累证据的患者，应同时进行视神经和视神经鞘活检以进行诊断和治疗。
