急性白血病是通过直接浸润组织或继发于血液学异常而影响包括眼睛和眼眶在内的不同器官系统的血液恶性肿瘤。急性白血病的眼科表现是可变的,从无症状表现到可以改变病程和治疗的严重表现。目的检测初诊急性白血病患者不同眼科表现的发生率,并评估眼部表现与血液学特征的关系及这些肿瘤的后遗症。对2022年1月至2023年2月在Mansoura大学肿瘤学中心(OCMU)就诊的222名新诊断的急性髓系和急性淋巴细胞白血病患者进行了一项具有分析成分的横断面研究。所有患者在Mansoura眼科中心(MOC)接受了完整的眼科评估。平均年龄为43.45±17.35岁(范围,17-85),M/F为137(61.7%)/85(38.3%)。一百四十四(64.9%)患有急性髓细胞性白血病(AML),急性淋巴细胞白血病(ALL)78例(35.1%)。96例(43.2%)患者有眼部表现。其中,4人(1.8%)视力差。最常见的眼部表现是视网膜出血(19.8%)和罗斯斑(17.1%)。观察到的其他眼科表现是眼眶受累(3.2%),眼运动问题(1.4%),结膜下出血(5.9%),结膜化疗(0.9%),眼睑肿胀(4.1%),眼睑瘀斑(3.2%),隐眼(0.5%),眼睑下垂(1.8%),视网膜静脉充血和弯曲(4.1%),视网膜前出血(3.2%),玻璃体出血(3.2%),黄斑病变(2.3%),视网膜浸润(1.8%),渗出性视网膜脱离(ERD)(1.8%),棉绒斑点(0.9%),视网膜静脉阻塞(0.5%),乳头水肿(2.8%),视盘浸润(1.8%),光盘苍白(1.8%)。AML患者与较高的眼部病变频率显着相关,视网膜出血,与ALL患者相比,Roth斑点(分别为P0.028、0.003和0.046)。视网膜出血与贫血有统计学意义(P<0.021)。急性白血病的眼科表现是异质性的;它们可以在初次表现或复发时检测到。有些表现是无症状的,其他人会影响视力,甚至改变疾病的进程。眼科医生和血液肿瘤学家之间的合作对于识别眼部受累和疾病管理至关重要。
Acute leukemia is a hematological malignancy affecting different organ systems including the eye and orbit through direct infiltration of tissues or secondary to hematological abnormalities. Ophthalmological manifestations in acute leukemia are variable ranging from asymptomatic presentation to serious manifestations that can alter the disease course and treatment. The purpose of this study is to detect the incidence of different ophthalmological manifestations in newly diagnosed acute leukemia patients and to assess the relationship between ocular findings and hematological characteristics and the sequel of these neoplasms. A cross-sectional study with analytical components was conducted on 222 newly diagnosed acute myeloid and acute lymphoblastic leukemia patients who presented at Oncology Center Mansoura University (OCMU) between January 2022 and February 2023.
All patients underwent a complete ophthalmic evaluation at Mansoura Ophthalmology Center (MOC). The mean age was 43.45 ± 17.35 years (range, 17-85), and M/F was 137 (61.7%)/85 (38.3%). One-hundred and forty-four (64.9%) had acute myeloid leukemia (AML), and 78 (35.1%) had acute lymphoblastic leukemia (
ALL). Ophthalmic manifestations were detected in 96 patients (43.2%). Among them, 4 (1.8%) had poor visual acuity. Retinal hemorrhage (19.8%) and Roth spots (17.1%) were the most common ocular manifestations. Other ophthalmological manifestations observed were orbital involvement (3.2%), ocular motility issues (1.4%), subconjunctival hemorrhage (5.9%), conjunctival chemosis (0.9%),lid swelling (4.1%), lid ecchymosis (3.2%), lagophthalmos (0.5%), lid ptosis (1.8%), retinal venous congestion & tortuosity (4.1%), preretinal hemorrhage (3.2%), vitreous hemorrhage (3.2%), macular affection (2.3%), retinal infiltration (1.8%), exudative retinal detachment (ERD) (1.8%), cotton-wool spots (0.9%), retinal vein occlusion (0.5%), papilledema (2.8%), optic disc infiltration (1.8%), disc pallor (1.8%).AML patients were significantly associated with a higher frequency of ocular affection, retinal hemorrhages, and Roth spots (P 0.028, 0.003, and 0.046, respectively) compared to
ALL patients. Retinal hemorrhage was statistically significantly associated with anemia (P 0.021). Ophthalmological manifestations of acute leukemia are heterogeneous; they can be detected at initial presentations or relapse. Some manifestations are asymptomatic, others can affect visual acuity or even alter the disease course. Cooperation between ophthalmologists and haemato-oncologists is crucial for recognizing ocular involvement and disease management.