Journal of Ophthalmic and Vision Research

ISSN: 2008-322X

The latest research in clinical ophthalmology and the science of vision.

Unilateral Blurred Vision as the Sole Presenting Symptom of Chronic Lymphocytic Leukemia

Published date: Feb 03 2020

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: January–March 2020, Volume 15, Issue 1

Pages: 109–112

DOI: 10.18502/jovr.v15i1.5958

Authors:

Rajesh K. Sharmarsharma@umc.eduDepartment of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA; Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA

Kevin MaysDepartment of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA

Abstract:

Purpose: To describe a case of infiltrative optic neuropathy caused by chronic lymphocytic leukemia.

Case Report: A 41-year-old white male presented with painless, blurry vision in the left eye. Examination revealed unilateral optic nerve swelling confirmed by optical coherence tomography (OCT). Initial workup revealed mild leukocytosis, eventually diagnosed as chronic lymphocytic leukemia (CLL). No other cause of optic neuropathy was identified despite extensive investigation. The patient developed rapidly progressive retinal ganglion cell nerve fiber layer (NFL) atrophy and relative afferent pupillary defect (RAPD) of the left eye despite steroid treatment but stabilized after four cycles of CLLtargeted chemotherapy. Although infiltrative optic neuropathy is well-known in leukemia, presentation with only subtle vision loss is rare. Vision loss usually presents late in leukemic infiltrative optic neuropathy and therefore must be considered in patients with optic disc swelling and leukocytosis.

Conclusion: When treating CLL, progressive visual decline with coexistent optic neuropathy may warrant chemotherapy.

Keywords: Chronic Lymphocytic Leukemia, Optic Neuropathy

References:

1. Gonsalves WI, Zent CS, Pulido JS, Patnaik MM. Visual loss in early-stage chronic lymphocytic leukemia. J Clin Oncol 2013;31:e280–e282.

2. Strati P, Uhm JH, Kaufmann TJ, Nabhan C, Parikh SA, Hanson CA, et al. Prevalence and characteristics of central nervous system involvement by chronic lymphocytic leukemia. Haematologica 2016;101:458–465.

3. Stunkel L, Kung NH, Wilson B, McClelland CM, Van Stavern GP. Incidence and causes of over diagnosis of optic neuritis. JAMA Ophthalmol 2018;136:76–81.

4. The clinical profile of optic neuritis. Experience of the optic neuritis treatment trial. Optic Neuritis Study Group. Arch Ophthalmol 1991;109:1673–1678.

5. Volpe NJ. The optic neuritis treatment trial: a definitive answer and profound impact with unexpected results. Arch Ophthalmol 2008;126:996–999.

6. Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Kosary CL, et al (eds). SEER Cancer Statistics Review, 1975–2014, National Cancer Institute. Bethesda, MD. Based on November 2016 SEER data submission, posted to the SEER website, April 2017. Available from: https:// seer.cancer.gov/csr/1975_2014/

7. Hoorbakht H, Bagherkashi F. Optic neuritis, its differential diagnosis and management. Open Ophthalmol J 2012;6:65–72.

8. Beck RW, Cleary PA. Optic neuritis treatment trial. Oneyear follow-up results. Arch Ophthalmol 1993;111:773–775.

9. Currie JN, Lessell S, Lessell IM, Weiss JS, Albert DM, Benson EM. Optic neuropathy in chronic lymphocytic leukemia. Arch Ophthalmol 1988;106:654–660.

Download
HTML
Cite
Share
statistics

1377 Abstract Views

384 PDF Downloads