Ocular involvement in leukaemia. Report of three cases

Three patients with treated acute lymphoblastic leukaemia acquired visual symptoms believed to be caused by ocular infiltration by malignant cells. All three patients had other evidence of systemic disease including bone-marrow involvement at the time. One patient had a previous history of meningeal leukaemia and none had received "prophylactic" cranial irradiation. The ophthalmoscopic appearances were similar in each case and were thought to have been caused by obstruction of axoplasmic flow associated with infiltration of the optic nerve by neoplastic cells. The three patients were treated by local irradiation and two also received intrathecal chemotherapy. Response to treatment was variable but the use of radiotherapy combined with intrathecal cytoxic drugs is probably the best available approach.