急性淋巴细胞白血病患者的增殖性白血病视网膜病变伴双侧渗出性视网膜脱离和视盘肿胀

Linda Susanti, Safaruddin Refa, Mirza Metita, N. Dewi
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摘要

简介:报告一例急性淋巴细胞白血病(ALL)患者发展为增殖性白血病视网膜病变,伴有双侧渗出性视网膜脱离和视盘肿胀。病例报告:一名11岁女孩,诊断为ALL-L2,接受维护性化疗,在过去的1年里双眼视力严重模糊。她的双眼视力为0.5 /60。前段裂隙灯检查正常。眼底扩张检查发现视网膜血管扭曲,视网膜出血,视网膜及视盘新生血管形成,视盘边缘不清,双眼视网膜完全脱离,左眼玻璃体出血。超声检查显示双侧视网膜下积液。讨论:患者诊断为双侧增殖性白血病视网膜病变伴渗出性视网膜脱离及浸润性视神经病变,左眼ALL所致玻璃体出血。给予保守治疗。她继续在儿科进行维持性化疗。随访2个月后,视网膜脱落虽有所减少,但视力未见明显改善。她两只眼睛的视网膜都出现了萎缩性病变。结论:本文报告一例罕见的增殖性白血病视网膜病变合并双侧渗出性视网膜脱离及视盘肿胀。早期识别和治疗对改善预后至关重要。
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PROLIFERATIVE LEUKEMIC RETINOPATHY WITH BILATERAL EXUDATIVE RETINAL DETACHMENTS AND OPTIC DISC SWELLING IN A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA
Introduction: To report a patient with acute lymphoblastic leukemia (ALL) who developed proliferative leukemic retinopathy with bilateral exudative retinal detachments and optic disc swelling. Case Report: A 11-year-old girl diagnosed with ALL-L2 on maintenance chemotherapy presented with severe blurred vision in both eyes for the past 1 year. Her visual acuity was 0,5/60 for both eyes. Slit-lamp examination of the anterior segment was found normal. Dilated fundus examination revealed tortuous retinal vessels, retinal haemorrhage, retinal and optic disc neovascularizations, optic disc with indistinct margins, and total retinal detachments in both eyes, as well as vitreous haemorrhage in the left eye. The ultrasonography examination revealed bilateral subretinal fluid. Discussion: The patient was diagnosed with bilateral proliferative leukemic retinopathy with exudative retinal detachments and infiltrative optic neuropathy, and left eye vitreous haemorrhage due to ALL. Conservative treatment was given. She continued the maintenance chemotherapy from pediatric department. After 2 months follow up, the visual acuity did not improve although retinal detachments were reduced. There were atrophic changes at the retina of her both eyes. Conclusion: It was reported a rare case of proliferative leukemic retinopathy with bilateral exudative retinal detachments and optic disc swelling. Early recognition and treatment is crucial to improve prognosis.
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