J Pediatr Ophthalmol Strabismus. 2024 Jan-Feb;61(1):67-72. doi: 10.3928/01913913-20230331-03. Epub 2023 May 25.
To characterize the presentation, clinical course, and treatment of a series of children with leukemic optic neuropathy.
Patients with leukemia who were treated at a tertiary children's hospital for optic nerve infiltration were included (n = 11). Demographic information, cancer history, ophthalmologic examination findings, treatment, and outcomes were retrospectively collected.
Mean age was 10.0 ± 4.8 years, and 63.6% were male and 36.4% were female. The most common underlying oncologic diagnosis was B-precursor acute lymphoblastic leukemia (n = 7, 63.6%). Notably, the majority presented with optic nerve infiltration during presumed remission (n = 9, 81.8%), but 2 patients (18.2%) presented with optic nerve infiltration at their initial leukemia diagnosis. Cerebrospinal fluid was positive for leukemic cells in 36.4% of patients. Magnetic resonance imaging demonstrated optic nerve enhancement and/or enlargement in only 8 patients (72.7%). In addition to other leukemia-directed treatment, 8 patients (72.7%) received emergent local radiation within 1.5 ± 1.2 days of initial ophthalmology examination.
The largely negative cerebrospinal fluid results and variable magnetic resonance imaging findings in this study emphasize the importance of clinical context for this diagnosis. Clinicians should consider optic nerve infiltration in patients with leukemia and visual or ocular complaints, because urgent treatment is required to preserve vision and manage systemic disease. .
描述一系列患有白血病性视神经病变儿童的临床表现、临床病程和治疗方法。
纳入在一家三级儿童医院接受视神经浸润治疗的白血病患者（n = 11）。回顾性收集人口统计学信息、癌症病史、眼科检查结果、治疗和结局。
平均年龄为 10.0 ± 4.8 岁，63.6%为男性，36.4%为女性。最常见的潜在肿瘤诊断是 B 前体急性淋巴细胞白血病（n = 7，63.6%）。值得注意的是，大多数患者在疑似缓解期出现视神经浸润（n = 9，81.8%），但有 2 例（18.2%）患者在初始白血病诊断时即出现视神经浸润。36.4%的患者脑脊液中存在白血病细胞。仅 8 例（72.7%）患者的磁共振成像显示视神经增强和/或增大。除了其他白血病靶向治疗外，8 例（72.7%）患者在首次眼科检查后 1.5 ± 1.2 天内接受了紧急局部放疗。
本研究中脑脊液结果主要为阴性，磁共振成像结果也存在差异，这强调了临床背景对于该诊断的重要性。对于有白血病和视觉或眼部症状的患者，临床医生应考虑视神经浸润，因为需要紧急治疗以保留视力和控制全身疾病。
