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Bilateral optic nerve infiltration in central nervous system leukemia.
Lisa S Schocket1, Mina Massaro-Giordano, Nicholas J Volpe
1Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
American Journal of Ophthalmology
|December 31, 2002
Summary
Leukemic optic nerve infiltration can occur in patients with chronic myelogenous leukemia (CML) despite normal-appearing optic nerves and imaging. Prompt diagnosis and irradiation are crucial for vision preservation.
Area of Science:
- Ophthalmology
- Hematology
- Oncology
Background:
- Leukemic infiltration of the optic nerve is a rare but serious complication of hematologic malignancies.
- Early detection and treatment are critical to prevent irreversible vision loss.
Observation:
- A 58-year-old male with chronic myelogenous leukemia (CML) presented with rapid, sequential bilateral vision loss.
- Optic nerves appeared normal, with no enhancement on magnetic resonance imaging (MRI).
Findings:
- Despite treatment with external beam irradiation and intrathecal cytarabine, the patient experienced complete vision loss (no light perception) in both eyes.
- Optic nerve pallor developed, indicating significant optic nerve damage.
Implications:
- This case highlights that leukemic optic nerve infiltration can occur without typical signs of enhancement on MRI.
- Maintaining a high clinical suspicion for optic nerve infiltration in leukemia patients is essential for timely intervention.
- Prompt initiation of local irradiation may be crucial for preserving vision in such cases.