Complications
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]
Prognosis
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.
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A 4-year-old boy presented with sudden proptosis of his left eye.
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Same patient as in the image above. A CBC revealed anemia (Hb 8.6 mg/dL), thrombocytopenia (64,000), and leukocytosis (12,900). The peripheral smear revealed the presence of blasts 28%, lymphocytes 44%, segmented 14%, monocytes 6%, bands 2%, metamyelocytes 1%, and myelocytes 1%. The boy was diagnosed with AML type M4-M5 chloroma of the left orbit.
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CT scan reveals infiltration in the left orbit. Notice that the bone is uninvolved. A lumbar puncture revealed that the cerebral spinal fluid was clean of leukemic cells.
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Systemic chemotherapy was instituted, and the proptosis resolved. Unfortunately, 4.5 months later, the boy passed away secondary to multiorgan failure.
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An impending bilateral central retinal vein obstruction was discovered during a routine examination of a 76-year-old man. Further workup revealed a WBC count of 709,000, a hemoglobin count of 12 mg/dL, and a platelet count of 104,000. The man was eventually diagnosed with CML. This image is a red-free photograph of the right fundus. Notice the intraretinal hemorrhages.
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Same patient as in the image above. This image is a red-free photograph of the left eye showing intraretinal hemorrhages.
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A 14-year-old boy with a past medical history of ALL complained of a sudden loss of vision OD. Visual acuities were counting fingers OD and 20/20 OS. Notice the macular hemorrhage responsible for the loss of vision. Courtesy of Dr Rafael Jiménez.
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Same patient as in the previous image. The hematological workup revealed a hemoglobin count of 5.6, a WBC count of 1800, and a platelet count of 3000. Courtesy of Dr Rafael Jiménez.
