[A case of leukemic optic nerve infiltration presenting as asymmetric papilledema in both eyes]

A 11-year-old male patient presented with a 4-month history of decreased vision in the left eye, which gradually worsened to complete loss of vision in the left eye over the past 1 month. The patient had a 6-year history of acute lymphoblastic leukemia and had been clinically cured after chemotherapy for 3 years. The visual acuity of the left eye was hand-motion at near. Fundus examination revealed asymmetric papilledema in both eyes. The right eye showed typical papilledema, while in the left eye, the optic disc margin was blurred, and there were numerous thick patchy yellow-white lesions and exudates in the subretinal area of the posterior pole around the optic disc, accompanied by obvious neurosensory retinal detachment. Through fluorescein fundus angiography, optical coherence tomography, magnetic resonance imaging of the orbit and skull, cerebrospinal fluid examination, and peripheral blood tests, the patient was diagnosed with central nervous system leukemia recurrence with infiltrative optic neuropathy in the left eye and papilledema in the right eye. After three courses of chemotherapy (methotrexate 3.4-7.5 g) combined with intrathecal injection (methotrexate 12.5 mg+cytarabine 35 mg), the intracranial pressure gradually decreased. The papilledema in the right eye completely subsided, and the visual acuity was not affected. The papilledema in the left eye gradually subsided, and the subretinal lesions and exudates decreased. During the 4-year follow-up, the patient's general condition was stable, and the visual acuity of the left eye recovered and stabilized at 0.05.