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Andrew Stacey, Thomas Bradford Gillette; Subretinal relapse of the leukemias. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1845.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the risk factors, presentation features, and clinical characteristics associated with the development of subretinal leukemic relapse
A systematic review of all reported cases of subretinal leukemic relapse was conducted following the “Preferred Reporting Items for Systematic Review and Meta-analysis” (PRISMA) guidelines. Four separate databases were searched (PubMed, Medline, Embase, Cochrane). Cases were included in the review if they described a patient with subretinal or choroidal leukemic relapse. Clinical information from the report was used in the analysis, but reports were not excluded if they did not contain specific clinical details.
A total of 14 patients from 14 reports met criteria for inclusion in the study. Nearly all (13) of these were reports of patients with acute lymphoblastic leukemia (ALL), only one patient carried the diagnosis of acute myelogenous leukemia (AML), and there was no report of subretinal relapse in the chronic leukemias. A total of 8 of the 14 patients were younger than 18 years old. Subretinal fluid presenting as a retinal detachment was common in all patients. The median time to relapse was 14 months (range: 1-47 months). A total of 8 patients had undergone central nervous system (CNS) prophylaxis during initial definitive treatment. Four patients were shown to have three normal systemic studies (lumbar puncture (LP), and bone marrow biopsy (BMB), MRI) at the time of ocular relapse. Various treatments were used for the subretinal relapse: orbital radiation, intrathecal chemotherapy, systemic chemotherapy. There was no evidence of prognostic difference between these treatments.
A leukemic relapse should be considered in any patient with an unexplained retinal detachment and a history of leukemia. Even in cases where systemic staging (LP, MRI, or BMB) are all normal, leukemic relapse cannot be ruled out as a cause of unexplained retinal detachment. In these situations, a biopsy should be considered. There was no report of a chronic leukemia relapsing in the subretinal space, this appears to be a unique presentation to the acute leukemias. Subretinal relapse of leukemia occurred even in patients who underwent CNS prophylaxis at the time of induction chemotherapy.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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