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OPHTHALMIC IMAGE
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 23

Infiltration of optic nerve head in acute lymphoblastic leukaemia presenting as an initial isolated site of relapse


Department of Vitreo Retina Services and Ocular Oncology, Shri Bhawgan Mahavir Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India

Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Vikas Khetan
Sankara Nethralaya, Medical Research Foundation, No. 41, Old 18, College Rd, Opposite Women's Christian College, Thousand Lights West, Nungambakkam, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2023_20

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How to cite this article:
Vaidya H, Khetan V. Infiltration of optic nerve head in acute lymphoblastic leukaemia presenting as an initial isolated site of relapse. Indian J Ophthalmol Case Rep 2021;1:23

How to cite this URL:
Vaidya H, Khetan V. Infiltration of optic nerve head in acute lymphoblastic leukaemia presenting as an initial isolated site of relapse. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Mar 2];1:23. Available from: https://www.ijoreports.in/text.asp?2021/1/1/23/305515



A 10-year-old male, known case of acute lymphoblastic leukemia for 3 years, presented with a 1-day history of sudden onset painless diminution of vision in the left eye. He was on maintenance therapy with intravenous methotrexate and vincristine. Right eye examination was normal (visual acuity 20/20). Left eye had vision of HM, with normal anterior segment and fundus showed leukemic infiltration of optic nerve head suggesting a relapse of ALL [Figure 1]. MRI showed a soft tissue lesion over the ONH. Optic nerve infiltration in ALL is rare (1.4-2%) and its identification is pivotal as its management remains challenging.[1],[2],[3]
Figure 1: (a) Wide field fundus photograph (Optos) showing a whitish translucent lesion with ill-defined borders over the posterior pole obscuring ONH details, along with opaque white lesions along its border. (b) Ultrasound A and B scan showing a dome shaped elevation over the ONH shadow with moderate surface reflectivity (red arrow) and low internal reflectivity with widening of ONH shadow. (c) Swept source Optical coherence tomography shows hyper-reflectivity of the inner retinal layers and over the ONH, obscuring details of outer retina as well ONH respectively

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Somervaille TCP, Hann IM, Harrison G, Eden TOB, Gibson BE, Hill FG, et al. Intraocular relapse of childhood acute lymphoblastic leukaemia. Br J Haematol 2003;121:280-8.  Back to cited text no. 1
    
2.
Camera A, Piccirillo G, Cennamo G, Tranfa F, Rosa N, Frigeri F, et al. Optic nerve involvement in acute lymphoblastic leukemia. Leuk Lymphoma 1993;11:153-5.  Back to cited text no. 2
    
3.
Soman S, Kasturi N, Srinivasan R, Vinod KV. Ocular manifestations in leukemias and their correlation with hematologic parameters at a tertiary care setting in South India. Ophthalmol Retina 2018;2:17-23.  Back to cited text no. 3
    


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