Title: Ocular manifestations in adult leukemia patients in a tertiary centre: A cross sectional study
Authors: Dr Swathi Karuppali, Dr Arun Kumar Ayoor, Dr Abdul Majeed K., Dr Padma B Prabhu
DOI: https://dx.doi.org/10.18535/jmscr/v7i2.85
Abstract
Background: Leukemias are clonal neoplastic disorders of the hematopoetic stem cells in which immature cells infiltrate the blood stream and various tissues of the body. Eye is one such structure which is commonly involved either primarily by direct infiltration by leukemic cells or secondary to changes in the haematological parameters. Hence detailed ocular examination should be an essential part of treatment of leukemias to identify early changes.
Objectives: To study the various ocular manifestations in adult leukemia patients.
Methods: A cross sectional descriptive study was conducted among 200 eyes of 100 diagnosed leukemia patients who presented to hematology and ophthalmology department of Government Medical College Kozhikode. The patients were divided into various types of leukemia and detailed ocular examination was conducted. The anterior and posterior segment manifestations in each type of leukemias were noted .The observed findings were analysed using SPSS version 16.
Results and Discussion: Out of the 100 patients, there were 47 males and 53 females. The mean age of the study group was 38.35±19.83 years. Acute myeloid leukemia was the commonest type (51%). 61%of the patients were symptomatic with defective vision being the commonest followed by watering as their chief complaints. Anterior segment manifestations were present in 76% patients with conjunctival congestion followed by pallor being the commonest. Posterior segment involvement was noted in 34% patients of which majority had retinal haemorrhages followed by papilledema and optic disc cupping. These findings were more in the myeloid group who again had poorer visual acuity .Some patients developed drug related complications for which further detailed evaluation is needed to confirm the same in view of the multidrug regimens on which these patients are on.
Conclusion: High prevalence of ocular manifestations in the leukemic patients can be a cause of ocular morbidity and vision loss in these subjects. These findings may also be an early indicator of relapse .Hence regular ophthalmic assessment and early diagnosis can improve the disease outcome.
Keywords: Leukemia; ocular manifestations; retinal hemorrhage.
References
- Alemayehu W, Shamebo M, Bedri A, Mengistu Z. Ocular manifestations of leukaemia in Ethiopians. Ethiop Med J 1996;34:217-24.
- Reddy SC, Jackson N, Menon BS. Ocular involvement in leukemia – a study of 288 cases. Ophthalmologica 2003;217:441-5.
- Schachat AP, Markowitz JA, Guyer DR, Burke PJ, Karp JE, Graham ML. Ophthalmic manifestations of leukemia. Arch Ophthalmol 1989;107:697-700.
- Reddy SC, Jackson N. Retinopathy in acute leukaemia at initial diagnosis: correlation of fundus lesions and haematological parameters. Acta ophthalmologica Scandinavica. 2004 Feb 1;82(1):81-5.
- Koshy J, John MJ, Thomas S, Kaur G, Batra N, Xavier WJ. Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India. Indian journal of ophthalmology. 2015 Aug;63(8):659.
- Dhasmana R, Prakash A, Gupta N, Verma S K. Ocular manifestations in leukemia and myeloproliferative disorders and their association with hematological parameters. Ann Afr Med 2016;15:97-103
- Eze BI, Ibegbulam GO, Ocheni S. Ophthalmic manifestations of leukemia in a tertiary hospital population of adult Nigerian Africans. Middle East African journal of ophthalmology. 2010 Oct;17(4):325
- Lochhead J, Salmon JF, Bron AJ. Cytarabine-induced corneal toxicity. Eye. 2003 Jul 1;17(5):677-8
- Hopen G, Mondino BJ, Johnson BL, Chervenick PA. Corneal toxicity with systemic cytarabine. American journal of ophthalmology. 1981 Apr 30;91(4):500- 4.
- Yamashita T, Kodama Y, Tanaka M, Yamakiri K, Kawano Y, Sakamoto T. Steroid-induced glaucoma in children with acute lymphoblastic leukemia: a possible complication. Journal of glaucoma. 2010 Mar 1;19(3):188-90.
- Buchan J, McKibbin M, Burton T. The prevalence of ocular disease in chronic lymphocytic leukaemia. Eye (Lond) 2003;17:27-30
- Kincaid MC, Green WR. Ocular and orbital involvement in leukemia. Surv Ophthalmol 1983;27:211-32.