OPHTHALMIC MANIFESTATIONS OF ACUTE LEUKEMIA

Abstract

Background: Acute leukemia is a malignant disorder characterized by rapid progression and systemic involvement. Ocular manifestations, including fundoscopic findings, can significantly impact vision and may serve as early indicators of systemic disease or complications. Retinal changes, such as hemorrhages or papilledema, may also hold prognostic value in the management of acute leukemia. Despite their importance, data on the frequency and patterns of these manifestations are limited, particularly in regional populations, necessitating further research to guide clinical practice.

Objective: To evaluate the frequency and associations of fundoscopic manifestations, including papilledema and retinal hemorrhages, in patients with acute leukemia.

Methods: This cross-sectional study was conducted at the Department of Oncology, PIMS, Islamabad, from 6th March 2024 to 5th September 2024. A total of 210 patients, aged 12 to 40 years, with confirmed acute leukemia based on bone marrow aspirate showing ≥20% blast cells, were included. Patients with media opacities, diabetes mellitus, sickle cell disease, HIV, or retinal vascular disease were excluded. Ophthalmologic evaluation included detailed fundoscopic examination using direct and indirect ophthalmoscopes to detect papilledema and retinal hemorrhages. Demographic and clinical data, including age, gender, BMI, disease duration, and treatment status, were recorded. Statistical analysis was performed using IBM SPSS version 24.

Results: The mean age of the patients was 24.89 ± 7.30 years, with 50% aged above 25 years. Males constituted 65.7% (n=138), while 34.3% (n=72) were females, with a male-to-female ratio of 1.9:1. Treatment-naïve patients accounted for 51.0% (n=107). Papilledema was observed in 17.6% (n=37), while retinal hemorrhages were found in 22.9% (n=48). Significant associations were noted between retinal hemorrhages and age >25 years (p=0.049) and gender (p=0.009), while no significant correlations were found for papilledema with any analyzed factors.

Conclusion: Fundoscopic findings, particularly papilledema and retinal hemorrhages, are common in patients with acute leukemia. Routine fundoscopic evaluation should be integrated into the clinical management of these patients to facilitate early detection and management of ocular complications.