Secondary Ocular Manifestations in Acute Leukemia: Clinical Patterns and Hematologic Correlates

Abstract

Objective: To explore the clinical manifestations of secondary ocular changes in acute leukemia, classify these based on disease progression, investigate the etiology and treatment options for this rare retinal disease, and provide references for clinical management. Methods: This cohort study was conducted in collaboration between the Department of Ophthalmology and Hematology at Beijing Friendship Hospital, Capital Medical University. A total of 74 acute leukemia patients admitted to the Hematology Department from January 2018 to September 2023 were enrolled. Ocular screenings were performed, and 34 patients with ocular symptoms were categorized and followed up. Clinical data differences were statistically analyzed based on hematologic diagnosis, and ocular manifestations and treatment outcomes were observed to identify optimal treatment approaches. Results: Among the 74 patients, 34 (45.9%) exhibited ocular manifestations, with the majority being retinal changes (91.2%), mainly retinal hemorrhage or vascular occlusion. Ocular involvement in AML and ALL patients was classified into three severity levels, each corresponding to different treatments. Red blood cell hematocrit, white blood cell count, and platelet count were compared between AML and ALL patients with and without ocular involvement. Results showed that AML and ALL patients with retinal hemorrhage had lower hematocrit than those without ocular involvement (P<0.05). Platelet counts were higher in AML and ALL patients with Roth spots than in those without ocular involvement (P<0.05). Conclusion: Acute leukemia remains a rare condition in ophthalmology practice in China. This study fills a diagnostic gap, providing valuable theoretical support for clinicians in terms of etiology, clinical manifestations, and treatment strategies.