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MRI T1-weighted brain and optic nerve revealing left intraorbital optic nerve thickening (yellow arrow) associated with perineural enhancement and intraconal fat involvement on DWI/ADC (DWI/ADC image is not included in this figure). DWI: diffusion-weighted imaging; ADC: apparent diffusion coefficient
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Optic nerve infiltration as the first sign of isolated central nervous system relapse of acute lymphoblastic leukemia (ALL) is rare. A seven-year-old girl with standard-risk B-cell ALL who was in remission presented with sudden onset of left eye pain and loss of vision. Examination revealed no perception to light in the left eye with positive relat...
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Context 1
... clinical diagnosis of left leukemic optic nerve infiltration with central retinal artery and vein occlusion was made. An urgent magnetic resonance imaging (MRI) of the brain and optic nerve showed left intraorbital optic nerve thickening associated with perineural enhancement and intraconal fat involvement ( Figure 2). The right optic nerve was normal with an absence of enhancement or fat stranding. ...
Context 2
... clinical diagnosis of left leukemic optic nerve infiltration with central retinal artery and vein occlusion was made. An urgent magnetic resonance imaging (MRI) of the brain and optic nerve showed left intraorbital optic nerve thickening associated with perineural enhancement and intraconal fat involvement ( Figure 2). The right optic nerve was normal with an absence of enhancement or fat stranding. ...
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Acute lymphoblastic leukemia is the most common childhood malignancy. Despite many advances in therapy, about 15%–20% of children with acute lymphoblastic leukemia experience a disease relapse. Isolated ocular relapse is relatively rare. A 14-year-old male with T-cell acute lymphoblastic leukemia in remission presented with sudden onset of right ey...
Citations
... The optic disc presents as pale and swollen with blurred margins, and may be accompanied by hemorrhages [52]. Optic nerve infiltration is frequent in children affected by acute leukemias and should rain concern for CNS involvement [54][55][56]. ...
Ocular complications can occur in up to 90% of patients with blood malignancies. Such complications range from direct infiltration to local hemostatic imbalance and treatment-related toxicity. This narrative review is based on a systematic computerized search of the literature conducted until January 2024 and examines the common ocular complications associated with blood cancers. Ocular complications from primary disease include mass effects from ocular adnexal lymphomas and intraocular lymphomas, with B-cell lymphomas accounting for 95% of primary ocular presentations. Secondary disease involvement from systemic hematological malignancies can lead to a wide range of ocular manifestations, such as leukemic retinopathy. Furthermore, toxicity from antineoplastic therapies and ocular graft versus host disease (oGVHD) after hematopoietic stem cell transplantation present additional risks to ocular health. In conclusion, ocular complications in blood cancer patients are an integral part of patient management, requiring regular ophthalmic evaluations and close collaboration between oncologists and ophthalmologists. Advances in therapy and an increased focus on early symptom recognition are essential for preserving vision and enhancing patient quality of life.
... Infiltrative processes of the optic nerve likewise generate RGC degeneration. An example is the leukemic optic neuropathy, mainly associated with acute lymphoblastic leukemia [544][545][546]. The involvement of the optic nerve in leukemic cases remains, however, a rare circumstance, which may mostly appear in relapses and late in the disease course [547,548]. ...
Optic nerve disorders encompass a wide spectrum of conditions characterized by the loss of retinal ganglion cells (RGCs) and subsequent degeneration of the optic nerve. The etiology of these disorders can vary significantly, but emerging research highlights the crucial role of oxidative stress, an imbalance in the redox status characterized by an excess of reactive oxygen species (ROS), in driving cell death through apoptosis, autophagy, and inflammation. This review provides an overview of ROS-related processes underlying four extensively studied optic nerve diseases: glaucoma, Leber’s hereditary optic neuropathy (LHON), anterior ischemic optic neuropathy (AION), and optic neuritis (ON). Furthermore, we present preclinical findings on antioxidants, with the objective of evaluating the potential therapeutic benefits of targeting oxidative stress in the treatment of optic neuropathies.
... Infiltrative processes of the optic nerve likewise generate RGC degeneration. An example is the leukemic optic neuropathy, mainly associated with acute lymphoblastic leukemia [541][542][543]. Involvement of the optic nerve in leukemic cases remains anyway a rare circumstance, which may mostly appear in relapses and late in the disease course [544,545]. ...
Optic nerve disorders encompass a wide spectrum of conditions characterized by the loss of retinal ganglion cells (RGCs) and subsequent degeneration of the optic nerve. The etiology of these disorders can vary significantly, but emerging research highlights the crucial role of oxidative stress, an imbalance in the redox status characterized by an excess of reactive oxygen species (ROS), in driving cell death through apoptosis, autophagy, and inflammation. This review provides an overview of ROS-related processes underlying four extensively studied optic nerve diseases: glaucoma, Leber's hereditary optic neuropathy (LHON), anterior ischemic optic neuropathy (AION), and optic neuritis (ON). Furthermore, we present preclinical findings on antioxidants, with the objective of evaluating the potential therapeutic benefits of targeting oxidative stress in the treatment of optic neuropathies.
... Normal RT There was no improvement in the visual acuity of the right eye, yet there was a substantial reduction of the papillary mass Kuan et al. 21 7 patient's vision. Indeed, the eye is considered as a pharmacologic sanctuary, 22 which may not be treated adequately by systemically administered drugs. ...
Acute lymphoblastic leukemia is the most common childhood malignancy. Despite many advances in therapy, about 15%–20% of children with acute lymphoblastic leukemia experience a disease relapse. Isolated ocular relapse is relatively rare. A 14-year-old male with T-cell acute lymphoblastic leukemia in remission presented with sudden onset of right eye pain and visual acuity impairment. Fundoscopic examination of the eye and magnetic resonance imaging of the orbits were consistent with optic nerve infiltration. The patient was treated with salvage chemotherapy, orbital radiation and eventual bone marrow transplantation, with notable improvement in vision and regression of retinal and optic nerve findings. Optic nerve infiltration represents an ophthalmic emergency and requires urgent management. The use of radiation therapy is a helpful adjunct with systemic chemotherapy in obtaining disease remission.
... Presumiblemente, se debe a la inadecuada penetración de la terapia antileucémica en el sitio donde comienza la recaída. (9,10) Publicaciones de casos recientes (2,(4)(5)(6)(7)(8)(9)(11)(12)(13)(14)(15)(16)(17) muestran un rango entre 6 y 48 meses entre el diagnóstico de LLA y la infiltración del NO como sitio inicial de la recaída, con una media de 19,8+-13,8 meses (media + -desviación estándar). Como un hecho aislado y extremadamente raro, se ha reportado un caso de recaída bajo el régimen de tratamiento inicial. ...
... Como un hecho aislado y extremadamente raro, se ha reportado un caso de recaída bajo el régimen de tratamiento inicial. (10) Los casos publicados en los últimos seis años (2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) indican que en el 42,9 % la infiltración del NO como forma inicial de recaída se presenta de forma bilateral y asimétrica, y en el 95,2 % el disco óptico (DO) está involucrado. En solo un caso (9) se presentó como una infiltración exclusivamente retrobulbar del NO. ...
... (23) El 85 % de los casos se presenta con disminución de la visión, el 15 % con dolor ocular y el 5 % con visión de flotadores. (2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)22) La AVMC, al diagnóstico de la recaída, oscila entre un rango de no percepción luminosa a unidad de visión y la mitad de los ojos tiene visión de movimiento de manos o peor. (2,(4)(5)(6)(8)(9)(10)(11)(12)(14)(15)(16)(17)19,21) Otros síntomas como cefalea (16)(17)(18) y visión borrosa también se han reportado. ...
Introducción:
La infiltración del nervio óptico como forma inicial de recaída de la leucemia linfoblástica aguda es rara, aunque altamente indicativa de que el sistema nervioso central está involucrado.
Objetivo:
Actualizar el conocimiento sobre infiltración del nervio óptico como forma inicial de recaída de la leucemia linfoblástica aguda.
Métodos:
Se realizó una revisión de las publicaciones más relevantes relacionadas con el tema durante los últimos años. La búsqueda y la localización de la información se apoyaron en la elección de palabras clave/descriptores que configuraron el perfil de búsqueda. Se utilizó el MeSH Database de PubMed. Se realizó una extensa revisión en Google Académico y otros megabuscadores de revisión sistemática mediante TripDatabase y Cochrane.
Conclusiones:
La infiltración directa de células tumorales y las alteraciones hematológicas propias de la enfermedad constituyen los mecanismos fundamentales de la fisiopatogenia. El edema del disco óptico es su signo oftalmoscópico más distintivo. La imagen por resonancia magnética de cráneo, el análisis citológico del fluido cerebroespinal y la biopsia de médula ósea negativas no deben excluir el diagnóstico. La terapia combinada que incluye la radiación localizada constituye una buena opción de tratamiento. Un número considerable de ojos recuperan su agudeza visual y muestran resolución del cuadro infiltrativo.
