Benvenuto Franco, Sgroi Mariana, Guillen Soledad S, Ancona David, Fandiño Adriana
Department of Ophthalmology, SAMIC Pediatric Hospital "Prof. Dr. JP Garrahan", Buenos Aires, Argentina.
Department of Ocular Oncolology, Tecnologico de Monterrey, Hospital Zambrano-Hellion, Monterrey, México.
Oman J Ophthalmol. 2022 Jun 29;15(2):159-162. doi: 10.4103/ojo.ojo_347_20. eCollection 2022 May-Aug.
The purpose of this study was to evaluate ophthalmological findings in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in a Latin American population.
This was a single-center, retrospective study. The observational analysis was conducted in AML and ALL patients seen as a routine examination at the department of ophthalmology of tertiary care center in Argentina between March 1, 2017, and February 28, 2018.
Overall, 137 patients with acute leukemia were included. The mean age was 7.9 ± 5.2 years (0-18), and 55% were male ( = 75) and 45% female ( = 45). At least one-fifth ( = 31) of the patients presented some type of ocular manifestation (23%). The most frequently observed manifestation was retinal hemorrhages ( = 14), followed by papilledema ( = 9) and ocular surface involvement ( = 5). The eye involvement was more frequently identified in the AML group (24%), compared to the ALL group (22%), especially papilledema with central nervous system compromise ALL (5%) and AML (11%), < 0.01. The presence of hemorrhages was similar in both groups. In patients with retinal hemorrhage ( = 14), the mean hematological findings were hemoglobin 7.4 ± 0.4 g/dL (6.5-8.0), erythrocytes 2.5M ± 0.3/mm (confidence interval [CI], 2.0-3.1), and platelets 76,000 ± 32,000/mm (CI, 8000-384,000). Patients without retinal findings ( = 123), the mean hematological findings were hemoglobin 9.1 ± 0.6 g/dL (8.0-10.2), erythrocytes 3.2M ± 0.6/mm (CI, 2.5-3.5), and platelets 92,000 ± 44,000/mm (CI, 42.000-390.000). Multivariable analysis found that hemoglobin levels were the most reliable predictive factor for retinal findings. It was observed that the risk diminishes in patients with levels higher than 8.5 g/dL, and that it increased in patients with levels ranging between 6.5 and 7.5 g/dL at least twice ( < 0.01).
Our results show that ocular involvement occurs in a high percentage of patients with leukemia with a clear clinical, humoral, and sometimes prognostic correlation, suggesting routine ophthalmologic evaluation in these patients.
本研究旨在评估拉丁美洲人群中急性髓系白血病（AML）和急性淋巴细胞白血病（ALL）患者的眼科检查结果。
这是一项单中心回顾性研究。对2017年3月1日至2018年2月28日期间在阿根廷一家三级医疗中心眼科进行常规检查的AML和ALL患者进行观察性分析。
总体而言，共纳入137例急性白血病患者。平均年龄为7.9±5.2岁（0 - 18岁），其中55%为男性（n = 75），45%为女性（n = 45）。至少五分之一（n = 31）的患者出现了某种类型的眼部表现（23%）。最常观察到的表现是视网膜出血（n = 14），其次是视乳头水肿（n = 9）和眼表受累（n = 5）。与ALL组（22%）相比，AML组（24%）的眼部受累更常见，尤其是伴有中枢神经系统损害的ALL（5%）和AML（11%）患者的视乳头水肿，P < 0.01。两组中出血的发生率相似。在有视网膜出血的患者（n = 14）中，血液学检查的平均结果为血红蛋白7.4±0.4 g/dL（6.5 - 8.0），红细胞2.5M±0.3/mm³（置信区间[CI]，2.0 - 3.1），血小板76,000±32,000/mm³（CI，8000 - 384,000）。没有视网膜病变的患者（n = 123），血液学检查的平均结果为血红蛋白9.1±0.6 g/dL（8.0 - 10.2），红细胞3.2M±0.6/mm³（CI，2.5 - 3.5），血小板92,000±44,000/mm³（CI，42,000 - 390,000）。多变量分析发现血红蛋白水平是视网膜病变最可靠的预测因素。观察到血红蛋白水平高于8.5 g/dL的患者风险降低，而血红蛋白水平在6.5至7.5 g/dL之间至少出现两次的患者风险增加（P < 0.01）。
我们的结果表明，白血病患者中眼部受累的比例很高，且存在明确的临床、体液及有时与预后的相关性，提示应对这些患者进行常规眼科评估。
