Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
BMC Ophthalmol. 2021 Sep 15;21(1):335. doi: 10.1186/s12886-021-02097-w.
Leukemic involvement of the eyes is rare, therefore, treatment relies on previous case reports. The treatment of ocular complications poses additional difficulties, because the eye is considered as a pharmacological "sanctuary" for patients with acute lymphoblastic leukemia (ALL). Therefore, radiotherapy is the main therapeutic choice; however, it might lead to many important side effects. To the best of our knowledge, this is the first case report of a bilateral leukemic optic nerve infiltration that remitted with chemotherapy without adjuvant radiotherapy.
A 30-year-old female patient with previous history of remitted ALL presented with a one-week history of floaters in her right eye. Her ophthalmological exam showed remarkable optic disc swelling, in both eyes. She was diagnosed with ALL relapse presenting as a bilateral optic nerve leukemic infiltration. Local radiotherapy was planned for both eyes, however, due to efficient recovery with chemotherapy, it was cancelled. Allogenic bone marrow transplantation was subsequently performed. The patient is being followed up and ALL remitted.
Leukemia relapse on central nervous system, despite rare, is a sign of poor prognosis and requires prompt treatment. Its occurrence on ocular tissues is even rarer. It is hypothesized that the blood-brain barrier limits the delivery of chemotherapeutic drugs to the eye and infiltration of the optic nerve by leukemic cells might prejudice the flow of cerebrospinal fluid between the cranial space and the optic disc.
眼部白血病浸润较为罕见，因此治疗依赖于既往病例报告。眼部并发症的治疗带来了额外的困难，因为眼睛被认为是急性淋巴细胞白血病（ALL）患者的药理学“避难所”。因此，放射治疗是主要的治疗选择；但是，它可能会导致许多重要的副作用。据我们所知，这是首例双侧白血病视神经浸润经化疗缓解而无需辅助放疗的病例报告。
一名 30 岁女性患者，既往 ALL 缓解病史，出现右眼漂浮物一周。她的眼科检查显示双眼明显视盘肿胀。她被诊断为 ALL 复发，表现为双侧视神经白血病浸润。计划对双眼进行局部放射治疗，但由于化疗效果显著，取消了治疗。随后进行了异基因骨髓移植。目前患者正在接受随访，ALL 缓解。
尽管中枢神经系统的白血病复发较为罕见，但却是预后不良的标志，需要及时治疗。其发生在眼部组织更为罕见。据推测，血脑屏障限制了化疗药物向眼部的输送，而白血病细胞浸润视神经可能会损害颅腔和视盘之间的脑脊液流动。
