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Abstract：
BACKGROUND: Chronic myeloid leukaemia (CML) presenting with only ocular manifestations either at the initial stage of diagnosis or at relapse is uncommon. We report two cases of CML presenting with isolated visual symptoms.
METHODS: The first case is a 21-year-old healthy gentleman who presented with left eye painless loss of vision for a one-week duration. Visual acuity was 6/60 in the left eye and 6/6 in the right eye. There were scattered retinal haemorrhages in both eyes and a sub-macular bleed over the left eye. The full blood count revealed a high white cell count of 134.6 × 109/L. Peripheral blood smear showed hyper-leucocytosis with absolute eosinophilia and basophilia and the presence of blasts suggestive of CML thus chemotherapy was commenced. The second case is a 28-year-old in haematological, molecular, and cytogenic remission from CML for the past two years, presented with left eye painless vision loss for five days duration. Vision in the left eye was counting fingers. There was a large subretinal mass involving the left optic disc. Magnetic resonance imaging of the brain and orbit showed an elliptical orbital mass at the left globe posteriorly with diffuse thickening of the optic nerve. The patient was diagnosed as CML relapsed to the left optic nerve. He underwent intrathecal chemotherapy and orbital irradiation.
CONCLUSIONS: Both these cases are unique since the manifestation of CML was with only ocular features at the time of presentation as per in the first case during the initial diagnosis and in the second case during relapse. This highlights that it is evident that the knowledge of ocular involvement in leukaemia is crucial since the eye is the only organ where leukemic infiltration to nerves and blood vessels can be observed directly. Recognizing fundus changes in leukaemia allows earlier diagnosis and prompt treatment. These case reports highlight the importance of recognizing early fundus changes, which should allow earlier diagnosis and treatment.
METHODS: The first case is a 21-year-old healthy gentleman who presented with left eye painless loss of vision for a one-week duration. Visual acuity was 6/60 in the left eye and 6/6 in the right eye. There were scattered retinal haemorrhages in both eyes and a sub-macular bleed over the left eye. The full blood count revealed a high white cell count of 134.6 × 109/L. Peripheral blood smear showed hyper-leucocytosis with absolute eosinophilia and basophilia and the presence of blasts suggestive of CML thus chemotherapy was commenced. The second case is a 28-year-old in haematological, molecular, and cytogenic remission from CML for the past two years, presented with left eye painless vision loss for five days duration. Vision in the left eye was counting fingers. There was a large subretinal mass involving the left optic disc. Magnetic resonance imaging of the brain and orbit showed an elliptical orbital mass at the left globe posteriorly with diffuse thickening of the optic nerve. The patient was diagnosed as CML relapsed to the left optic nerve. He underwent intrathecal chemotherapy and orbital irradiation.
CONCLUSIONS: Both these cases are unique since the manifestation of CML was with only ocular features at the time of presentation as per in the first case during the initial diagnosis and in the second case during relapse. This highlights that it is evident that the knowledge of ocular involvement in leukaemia is crucial since the eye is the only organ where leukemic infiltration to nerves and blood vessels can be observed directly. Recognizing fundus changes in leukaemia allows earlier diagnosis and prompt treatment. These case reports highlight the importance of recognizing early fundus changes, which should allow earlier diagnosis and treatment.
摘要：
背景：慢性髓性白血病（CML）在诊断初期或复发时仅表现为眼部表现并不常见。我们报告了2例表现为孤立视觉症状的CML。
方法：第一个病例是一位21岁的健康绅士，他表现为左眼无痛性视力丧失一周。左眼视力为6/60，右眼为6/6。双眼有分散的视网膜出血，左眼有黄斑下出血。全血计数显示白细胞计数高，为134.6×109/L。外周血涂片显示白细胞增多，绝对嗜酸性粒细胞增多和嗜碱性粒细胞增多，并且存在提示CML的母细胞，因此开始化疗。第二例是一名28岁的血液病患者，分子，过去两年CML的细胞遗传学缓解，表现为左眼无痛性视力丧失五天。左眼的视力是数着手指。有一个累及左视盘的大视网膜下肿块。大脑和眼眶的磁共振成像显示，左眼球后部有椭圆形眼眶肿块，视神经弥漫性增厚。患者被诊断为CML复发至左视神经。他接受了鞘内化疗和眼眶放疗。
结论：这两种病例都是独特的，因为CML的表现在表现时仅有眼部特征，如第一例在初始诊断期间，第二例在复发期间。这突出表明,由于眼睛是可以直接观察到神经和血管的白血病浸润的唯一器官,因此明显地了解眼部参与白血病是至关重要的。认识到白血病的眼底变化可以早期诊断和及时治疗。这些病例报告强调了识别早期眼底变化的重要性，这应该允许早期诊断和治疗。
方法：第一个病例是一位21岁的健康绅士，他表现为左眼无痛性视力丧失一周。左眼视力为6/60，右眼为6/6。双眼有分散的视网膜出血，左眼有黄斑下出血。全血计数显示白细胞计数高，为134.6×109/L。外周血涂片显示白细胞增多，绝对嗜酸性粒细胞增多和嗜碱性粒细胞增多，并且存在提示CML的母细胞，因此开始化疗。第二例是一名28岁的血液病患者，分子，过去两年CML的细胞遗传学缓解，表现为左眼无痛性视力丧失五天。左眼的视力是数着手指。有一个累及左视盘的大视网膜下肿块。大脑和眼眶的磁共振成像显示，左眼球后部有椭圆形眼眶肿块，视神经弥漫性增厚。患者被诊断为CML复发至左视神经。他接受了鞘内化疗和眼眶放疗。
结论：这两种病例都是独特的，因为CML的表现在表现时仅有眼部特征，如第一例在初始诊断期间，第二例在复发期间。这突出表明,由于眼睛是可以直接观察到神经和血管的白血病浸润的唯一器官,因此明显地了解眼部参与白血病是至关重要的。认识到白血病的眼底变化可以早期诊断和及时治疗。这些病例报告强调了识别早期眼底变化的重要性，这应该允许早期诊断和治疗。
