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Abstract
Abstract
Red Eye and Anisocoria in a Patient with B ALL
Hasselbach H., Holland D., Nölle B.
Augenklinik Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
Purpose: Ocular manifestations are rarely seen in patients suffering from leukemia. Lymphoid tumors and leukemias can affect almost any part of the eye or ocular adnexe. Diagnosis is difficult because these tumors frequently mimic better-known entities, like intraocular inflammation, amelanotic melanoma or other metastatic tumors. We saw in our institution a 67-year-old woman complaining about conjunctival injection and anisocoria which developed two days before. Visual loss or a history of ocular disease was not reported. An acute B - cell lymphoid leukemia was diagnosed seven month before, followed by a polychemotherapy according to a B-ALL-protocol. Two weeks before presentation clinical restaging was without pathological results. Ocular examination revealed a conjunctival injection of the left eye and a circular white thickening of the pupillar margin and an anisocoria. Fluoroescein angiogram showed an irregular vascular pattern at the pupillar margin with leakage. For proper treatment it was important to obtain tissue for histological diagnosis.
Method: Excisional iris biopsy and aqueous aspiration was performed in local anaesthesia.
Results: Cytological and histological examination revealed an infiltration of the previously diagnosed B-ALL. A brain manifestation was detected afterwords by further staging and a combined treatment with local and systemic steroids, MTX and Alexan was started intrathec