Leukemic Infiltration of the Optic Nerve with Intraocular Extension in Relapsing Acute Lymphoblastic Leukemia

以視神經浸潤及眼內侵犯為表現的復發性急性淋巴性白血病：病例報告

張耀中(Yao-Chung Chang) ； 王俊元(Chun-Yuan Wang)

《中華民國眼科醫學會雜誌》 49卷2期 (2010/06) Pp. 202-206

https://doi.org/10.30048/ACTASOS.201006.0012

摘要

目的：報告一名以視神經瀏閉及眼內侵犯為表現的復發性急性淋巴性白血病病患。
方法：病例報告。
結果：這名12歲女童右眼視力模糊兩週而前來求診。最佳矯正視力為眼前30公分見手晃動。裂隙燈檢查結果發現角膜正常，前房無發炎反應，水品體澄清透明。然而，我們發現此女童右眼有較明顯的瞳孔傳入障礙。眼底可見一乳脂色腫瘤從視神經盤處延伸至玻璃體腔中，並且合併多處火焰狀出血及視神經盤周圍滲出性視網膜剝離。核磁振影嶺現除了視神經有明顯的顯影外，視神經盤也有13×6×4 mm的浸潤延伸至玻璃體腔。由於，該女童有急性淋巴性白血病病史，因此刻非骨隨切片及腦脊髓液檢查，這些檢查均有較明顯的母細胞浸潤。也證實了該女童有復發性急性淋巴性白血病的產生。在化學治療及放射治療後半年，女童視力回復至0.4。然而視覺誘發這位間接顯示視神經有明顯的傷害。
結論：急性淋巴性白血病在眼球表現為多樣性。然而，這個案例是第一個以視神經浸潤合併眼內侵犯為表現的病例。核磁振影，骨髓切片以及腦脊髓液的檢查可確立是否為復發性病變。雖然，該名女童視力有進步，但視覺誘盡電位結果顯示無反應，間接顯示視神經已有明顯的傷害。即早接受化學治療及放射治療可謝變發位置淋巴瘤浸潤減少，同時也減少視神經的受損。

並列摘要

Purpose: To report a case of leukemic infiltration of the optic nerve with intraocular extension in relapsing acute lymphoblastic leukemia.
Method: Case report.
Results: A 12-year-old girl presented with progressive blurred vision over her right eye for 2 weeks before coming to our hospital. Her best corrected visual acuity was hand-motion at 30 cm. Slit lamp showed normal cornea, quiet anterior chamber and clear lens. However, relative afferent pupillary defect sign was noted. Fundus examination showed one creamy-white tumor mass protruding from the optic disc with flame-shaped hemorrhages and peripapillary exudative retinal detachment. MRI showed enhancement of the optic nerve with a 13×6×4 mm tumor mass protruding from the optic nerve into the vitreous cavity. Due to her history of leukemia, we performed bone marrow biopsy and CSF tapping study, which showed numerous blast cells, compatible with relapsing acute lymphoblastic leukemia. After chemotherapy and radiotherapy protocol were initiated for relapse, the leukemic infiltration of the optic nerve and peripapillary exudative retinal detachment were regressed. After 6 months of observation, the patient's best corrected visual acuity returned to 6/15. However, a poor response in the visual evoked potential test was noted.
Conclusion: Acute lymphoblastic leukemia has multiple ocular manifestations. The diagnosis depends on MRI, CSF studies and bone marrow biopsy. To our knowledge, this is the first report of a case of leukemic infiltration of the optic nerve with intraocular extension. Although the patient's visual acuity showed improvement, a poor visual evoked potential response was noted. Thus, early referral to a pediatrist for chemotherapy and radiotherapy protocol for relapse can reduce leukemic infiltration and prevent further optic disc damage.

並列關鍵字

relapsing acute lymphoblastic leukemia ； leukemic infiltration of optic nerve ； exudative retinal detachment