Yang Ling, Chen Yanwei, Zhang Yunxiang, Shen Ting, Shen Xi
Department of Ophthalmology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Ophthalmology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Med (Lausanne). 2023 Mar 13;10:1117204. doi: 10.3389/fmed.2023.1117204. eCollection 2023.
To investigate changes in retinal circulation and the choroid in patients with acute myeloid leukemia (AML) in the acute and remission stages, to analyze the correlation between retinal circulation and laboratory parameters, and to assess risk factors associated with leukemic retinopathy.
Forty-eight patients (93 eyes) with AML were enrolled and divided into two groups according to fundus examination findings: the retinopathy and no retinopathy groups. Patients underwent eye measurements before treatment and after remission. Macular vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ), and choroidal thickness (ChT) were measured using optical coherence tomography angiography. Patients with healthy eyes were recruited as control participants.
Patients with leukemic retinopathy had higher measurements of white blood cells (WBCs), circulating blasts, fibrin degradation products, and cross-linked fibrin degradation products (D-dimer) and a lower hemoglobin (HB) count ( < 0.05). In the acute phase of the disease, the VD and PD were lower and the ChT was thicker in patients with AML than in controls ( < 0.05), irrespective of the presence of leukemic retinopathy; however, the patients were partially recovered in the remission stage. The VD was lower in patients with higher WBC ( = -0.217, = 0.036), D-dimer ( = -0.279, = 0.001), fasting blood glucose (FBG) ( = -0.298, = 0.004) and triglyceride ( = -0.336, = 0.001) levels. The FAZ area was negatively correlated with HB ( = -0.258, = 0.012).
Patients with AML appear to have subclinical retinal perfusion loss and choroidal thickening in the acute phase of the disease, but this is reversible. Injury to bone marrow function may cause a decrease in retinal perfusion. Leukemic retinopathy is associated with abnormal hematologic parameters and coagulopathy.
研究急性髓系白血病（AML）患者在急性期和缓解期视网膜循环及脉络膜的变化，分析视网膜循环与实验室参数之间的相关性，并评估与白血病视网膜病变相关的危险因素。
纳入48例（93只眼）AML患者，根据眼底检查结果分为两组：视网膜病变组和无视网膜病变组。患者在治疗前和缓解后进行眼部测量。使用光学相干断层扫描血管造影术测量黄斑血管密度（VD）、灌注密度（PD）、中心凹无血管区（FAZ）和脉络膜厚度（ChT）。招募健康眼睛的患者作为对照参与者。
白血病视网膜病变患者的白细胞（WBC）、循环原始细胞、纤维蛋白降解产物和交联纤维蛋白降解产物（D-二聚体）水平较高，血红蛋白（HB）计数较低（P<0.05）。在疾病急性期，无论是否存在白血病视网膜病变，AML患者的VD和PD均低于对照组，ChT较厚（P<0.05）；然而，患者在缓解期部分恢复。WBC（r=-0.217，P=0.036）、D-二聚体（r=-0.279，P=0.001）、空腹血糖（FBG）（r=-0.298，P=0.004）和甘油三酯（r=-0.336，P=0.001）水平较高的患者VD较低。FAZ面积与HB呈负相关（r=-0.258，P=0.012）。
AML患者在疾病急性期似乎存在亚临床视网膜灌注丧失和脉络膜增厚，但这是可逆的。骨髓功能损伤可能导致视网膜灌注减少。白血病视网膜病变与血液学参数异常和凝血病有关。
