Journal d'ophtalmologie clinique et expérimentale
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Unilateral Optic Nerve Leukemic Infiltration and Exudative Retinal Detachment as Initial Manifestations of Central Nervous System Relapse in Acute Lymphoblastic Leukemia of Children

Kuo-Chi Hung and Hsi-Kung Kuo

Acute lymphoblastic Leukemia (ALL) is a malignant neoplasm caused by the proliferation of poorly differentiated precursors of the lymphoid cells, which are known as blast cells. It is primarily the most common type of childhood Leukemia. Although 70-80% with ALL is cured with modern chemotherapy, 20-30% still have to endure relapse, particularly in the central nervous system (CNS) after attainment of remission. Treatment to prevent recurrence is based on cranial irradiation and intrathecal chemotherapy after conventional induction chemotherapy and the achievement of complete remission. However, the orbital cavity and optic nerve are relatively unaffected by being shielded during brain irradiation and serve as sanctuaries of ALL. Here, we describe a 12-year-old boy with ALL for one year who achieved complete remission after induction chemotherapy. He developed sudden loss of ipsilateral vision prior to CNS relapse twice. His initial ocular presentations noted on ophthalmic examination are unilateral optic nerve Leukemic infiltration and exudative retinal detachment (RD) respectively.