Ophthalmic Manifestations in Hematological Malignancies: An Observational Study from a Tertiary Care Health Center in Eastern India

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2024 Jan 8

PMID 38189493

Authors

Japesh Thareja

Anita Minj

Priyanka Samal

Pradeep Kumar Panigrahi

Affiliations

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Abstract

Purpose: This study aimed to document the spectrum of ocular manifestations of hematological malignancies presenting to a tertiary health center in Eastern India and their association with blood parameters.

Methods: This hospital-based cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with leukemia, lymphoma, and multiple myeloma were enrolled in the study. A comprehensive ophthalmic evaluation was done in each case.

Results: A total of 97 patients with a confirmed diagnosis of hematological malignancies and meeting the inclusion and exclusion criteria were included in the study. Ocular manifestations were noted in 48 (49.48%) patients. Acute lymphocytic leukemia accounted for 35.4% of cases, followed by acute myeloid leukemia (31.25%), lymphoma (4.2%), and minimum manifestation in multiple myeloma (2.1%) patients. Among 48 patients with ocular manifestations, anterior segment involvement was found in 6.2% of cases, with subconjunctival hemorrhage being the most common, and the posterior segment was involved in 100% of patients, with intraretinal hemorrhages being the most common manifestation. A statistically significant association was noted between hemoglobin, total red blood cell count, and total platelet count with posterior segment manifestations ( p < 0.001). On multivariable logistic regression, only total leucocyte count and total platelet count were significant predictors for ocular manifestation.

Conclusion: Indirect involvement of the retina is the most common ocular pathology in hematological malignancies, with intraretinal hemorrhages being the most common finding. Ophthalmic examination is highly recommended as a part of the routine evaluation at the time of diagnosis of hematological malignancies and periodically thereafter to diagnose any ocular involvement.

References

Dhasmana R, Prakash A, Gupta N, Verma S . Ocular manifestations in leukemia and myeloproliferative disorders and their association with hematological parameters. Ann Afr Med. 2016; 15(3):97-103. PMC: 5402809. DOI: 10.4103/1596-3519.188887. View

Bukhari Z, Alzahrani A, Alqarni M, Alajmi R, Alzahrani A, Almarzouki H . Ophthalmic Manifestations in Acute Leukemia Patients and Their Relation With Hematological Parameters in a Tertiary Care Center. Cureus. 2021; 13(11):e19384. PMC: 8655321. DOI: 10.7759/cureus.19384. View

Reddy S, Jackson N, Menon B . Ocular involvement in leukemia--a study of 288 cases. Ophthalmologica. 2003; 217(6):441-5. DOI: 10.1159/000073077. View

Nuzzi R, Scalabrin S, Becco A, Panzica G . Gonadal Hormones and Retinal Disorders: A Review. Front Endocrinol (Lausanne). 2018; 9:66. PMC: 5840201. DOI: 10.3389/fendo.2018.00066. View

Omoti A, Omoti C . Ophthalmic manifestations of multiple myeloma. West Afr J Med. 2008; 26(4):265-8. DOI: 10.4314/wajm.v26i4.28324. View

Sharma T, Grewal J, Gupta S, Murray P . Ophthalmic manifestations of acute leukaemias: the ophthalmologist's role. Eye (Lond). 2004; 18(7):663-72. DOI: 10.1038/sj.eye.6701308. View

Singh A . The prevalence of ocular disease in chronic lymphocytic leukaemia. Eye (Lond). 2003; 17(1):3-4. DOI: 10.1038/sj.eye.6700278. View

Bouazza M, Youssefi H, Bouanani N . Ocular Manifestations in Hematological Disorders. Cureus. 2022; 14(8):e27941. PMC: 9468511. DOI: 10.7759/cureus.27941. View

Ilo O, Adenekan A, Alabi A, Onakoya A, Aribaba O, Kehinde M . Ocular manifestations of leukaemia: A teaching hospital experience. Niger Postgrad Med J. 2019; 26(4):205-210. DOI: 10.4103/npmj.npmj_50_19. View

10.

Orhan B, Malbora B, Bayar S, Avci Z, Alioglu B, Ozbek N . Ophthalmologic Findings in Children with Leukemia: A Single-Center Study. Turk J Ophthalmol. 2016; 46(2):62-67. PMC: 5082251. DOI: 10.4274/tjo.03880. View

11.

Aisenberg A . Historical review of lymphomas. Br J Haematol. 2000; 109(3):466-76. DOI: 10.1046/j.1365-2141.2000.01988.x. View

12.

Eze B, Ibegbulam G, Ocheni S . Ophthalmic manifestations of leukemia in a tertiary hospital population of adult nigerian africans. Middle East Afr J Ophthalmol. 2010; 17(4):325-9. PMC: 2991450. DOI: 10.4103/0974-9233.71599. View

13.

Soman S, Kasturi N, Srinivasan R, Vinod K . Ocular Manifestations in Leukemias and Their Correlation with Hematologic Parameters at a Tertiary Care Setting in South India. Ophthalmol Retina. 2019; 2(1):17-23. DOI: 10.1016/j.oret.2017.05.009. View

14.

Chin K, Kempin S, Milman T, Finger P . Ocular manifestations of multiple myeloma: three cases and a review of the literature. Optometry. 2011; 82(4):224-30. DOI: 10.1016/j.optm.2010.10.009. View

15.

Omoti A, Omoti C, Momoh R . Ophthalmic disorders in adult lymphoma patients in Africa. Middle East Afr J Ophthalmol. 2010; 16(4):252-5. PMC: 2855666. DOI: 10.4103/0974-9233.58420. View

16.

Koshy J, John M, Thomas S, Kaur G, Batra N, Xavier W . Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India. Indian J Ophthalmol. 2015; 63(8):659-64. PMC: 4687193. DOI: 10.4103/0301-4738.169789. View