Sayadi Jihene, Gouider Dhouha, Allouche Yasmine, Choura Racem, Cherni Ines, Sayadi Malek, Benneji Hend, Zghal Imene, Malek Ines, Nacef Leila
Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Department of Hematology, Aziza Othmana Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Clin Ophthalmol. 2022 Oct 14;16:3425-3435. doi: 10.2147/OPTH.S365648. eCollection 2022.
To describe ocular manifestations of acute leukemia in a Tunisian cohort and to assess the associations between ophthalmic findings and epidemiological, clinical, and biological features of the disease.
A prospective study included patients newly diagnosed with acute leukemia referred to our clinics between January 2019 and July 2020. All patients underwent a complete ophthalmic evaluation and spectral-domain optical coherence tomography (SD-OCT) at presentation, then every two months during one year. We defined two groups: Group 1 included patients with leukemic ophthalmopathy and group 2 included patients with normal ophthalmic examination.
Forty-six patients were enrolled. The mean age of patients was 32.1±15.3 years. The sex ratio M/F was 1.55 (28 male patients and 18 females). Twenty-nine patients (63%) had acute myeloid leukemia (AML), and 17 (37%) had acute lymphoblastic leukemia (ALL). The average follow-up was 9.1 months (range: 3-12 months). We observed ophthalmic manifestations in 28 patients (61%). Among them, 17 (61%) had vision-threatening complications. The posterior segment was the most common site of ocular involvement (82% of group1). Primary leukemic infiltration (Disc edema, ptosis, exophthalmos) was present in 13 eyes (14.1%). Twenty-seven eyes (29.3%) had secondary involvement lesions (Subconjunctival hemorrhage, periorbital ecchymosis, retinal/sub-hyaloid hemorrhage, dilated/tortuous veins). Twenty-one eyes (22.8%) showed other ocular manifestations which etiopathogenesis is not yet fully understood (White-centred hemorrhages, cotton-wool spots, serous retinal detachment, hemorrhagic pigment epithelial detachment). Leukemic retinopathy was significantly more frequent in adults (23/39 and 1/7 in adult and pediatric groups, respectively; p=0.003). Patients suffering from AML were more likely to have secondary ocular involvement (20/29 and 7/17 in AML and ALL patients, respectively; p=0.047). Retinal hemorrhages were statistically associated with anemia and thrombocytopenia (p=0.041 and p=0.034; respectively).
Leukemic ophthalmopathy seems to be frequent and may lead to severe visual impairment. An ophthalmic assessment complemented with SD-OCT has paramount importance in all newly diagnosed acute leukemic patients.
描述突尼斯一组急性白血病患者的眼部表现，并评估眼科检查结果与该疾病的流行病学、临床及生物学特征之间的关联。
一项前瞻性研究纳入了2019年1月至2020年7月间转诊至我们诊所的新诊断急性白血病患者。所有患者在就诊时均接受了全面的眼科评估和频域光学相干断层扫描（SD-OCT），随后在一年中每两个月进行一次检查。我们将患者分为两组：第1组包括患有白血病性眼病的患者，第2组包括眼科检查正常的患者。
共纳入46例患者。患者的平均年龄为32.1±15.3岁。男女比例为1.55（28例男性患者和18例女性患者）。29例患者（63%）患有急性髓系白血病（AML），17例（37%）患有急性淋巴细胞白血病（ALL）。平均随访时间为9.1个月（范围：3 - 12个月）。我们在28例患者（61%）中观察到了眼部表现。其中，17例（61%）出现了威胁视力的并发症。眼后段是最常见的眼部受累部位（第1组中的82%）。原发性白血病浸润（视盘水肿、上睑下垂、眼球突出）出现在13只眼中（14.1%）。27只眼（29.3%）出现继发性受累病变（结膜下出血、眶周瘀斑、视网膜/玻璃膜下出血、静脉扩张/迂曲）。21只眼（22.8%）表现出其他眼部表现，其发病机制尚未完全明确（中心白色出血、棉絮斑、浆液性视网膜脱离、出血性色素上皮脱离）。白血病性视网膜病变在成人中明显更常见（成人组和儿童组分别为23/39和1/7；p = 0.003）。AML患者更易出现继发性眼部受累（AML和ALL患者分别为20/29和7/17；p = 0.047）。视网膜出血与贫血和血小板减少在统计学上相关（分别为p = 0.041和p = 0.034）。
白血病性眼病似乎较为常见，可能导致严重视力损害。对所有新诊断的急性白血病患者进行补充SD-OCT的眼科评估至关重要。
