Ophthalmologic Manifestations of Leukemias Follow-up

Updated: Jul 22, 2022
  • Author: Lihteh Wu, MD; Chief Editor: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO  more...
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Ocular complications

Posterior segment complications from bone marrow transplants were seen in 13% of patients. Among the complications seen were vitreous hemorrhage, infectious retinitis, cotton-wool spots, and retinal detachment.

Radiation retinopathy has been reported to occur in patients undergoing bone marrow transplant and high-dose chemotherapy and who received low-dose teletherapy. High-dose chemotherapy may lower the threshold for radiation retinopathy.

Ocular ischemia evidenced by optic disc and retinal neovascularization may lead to tractional retinal detachment following chemotherapy and radiation therapy.

Dry eye, keratitis, and cataracts may be sequelae of external beam radiation therapy with 3000 rads to 4000 rads. However, as little as 1150 rads may cause lenticular opacities.

In one study, 82 ALL survivors and 15 AML survivors were followed for an average of 3 years. All of the AML survivors had a normal ocular examination. Cataracts developed in 52% of ALL survivors. However, only one patient suffered significant visual dysfunction as a result of ALL or its treatment. [35]



Almost 30% of patients with CLL and ophthalmic manifestations died within 36 months. Ocular infection was a poor prognostic sign, associated with a mortality rate of almost 50%. Median survival in this subgroup was 6 months. [20]

Leukemic retinopathy usually is seen in patients who show a relapse and does not imply a bad prognosis.

Leukemic infiltration portends a poor prognosis and usually is associated with CNS involvement.

Optic nerve head infiltration is associated with CNS disease and a poor prognosis.

Prognosis of ALL is age dependent. Children have a much better outlook than adults. See Mortality/Morbidity.


Patient Education

For patient education resources, see the Cancer Center and Leukemia.