Acute childhood leukemia and ophthalmic manifestations: An observational study from Eastern India

Table 1 Clinical profile of ocular manifestations of acute leukemia in children

Sl No.	Age in years	Sex	Type of leukemia	Systemic features	Ocular lesions	Laterality of eye	Treatment
1	12	F	ALL	Present	SH + IRH	Both	Chemotherapy
2	7	M	ALL	Nil	6th CN palsy	Left	Chemotherapy
3	5	M	T-ALL	Nil	Proptosis	Right	Chemotherapy
4	6	F	ALL	Present	VH + IRH	Both	Chemotherapy
5	2.5	M	ALL	Present	IRH	Both	Chemotherapy
6	2.5	M	ALL	Present	IRH	Right	Chemotherapy
7	5	M	ALL	Present	IRH	Both	Chemotherapy
8	4	F	T-ALL	Nil	Proptosis, disc edema	Left	Chemotherapy+ irradiation
9	6	M	AML	Present	VH	Right	Chemotherapy
10	13	F	AML	Nil	Chloroma, 6th CN Palsy, Proptosis, IRH	Left	Chemotherapy+ irradiation
11	3	F	AML	Present	IRH	Left	Chemotherapy
12	6	M	B-ALL	Nil	Anterior uveitis	Right	Chemotherapy
13	4	F	B-ALL	Present	IRH	Right	Chemotherapy
14	7	M	AML	Nil	Proptosis	Left	Chemotherapy
15	3	F	ALL	Present	IRH	Right	Chemotherapy
16	6	M	AML	Nil	Chloroma, IRH	Both	Chemotherapy
17	7	M	ALL	Nil	IRH	Right	Chemotherapy
18	5	F	AML	Nil	Proptosis, papilloedma	Right	Chemotherapy+ irradiation
19	4	M	ALL	Nil	IRH	Left	Chemotherapy

SH: Subconjunctival Hemorrhage; VH: VitreousHemorrhage; IRH: Intraretinal hemorrhage; ALL: Acute lymphoblastic leukemia; AML: Acute myelogenous/myeloblastic/myeloid; M: Male; F: Female; Nil: No early systemic features seen.

Table 2 Flow cytometric immunophenotyping of blasts in acute leukemia in children

Patient	Age (years)	Gender	Initial presentation	Hemoglobin (g/dL)	Total platelet count (× 103/μL)	WBC count (× 103/μL)	Flow cytometric immunophenotyping of the blasts	Type of leukemia	Systemic features	Ocular lesions	Laterality of eye	Treatment
1	12	F	Fever	3	20	120	CD19+/CD10+/dim CD34+/HLA-DR/CD79a+/Tdt+/CD20-/aberrant CD33+/other markers negative	B-ALL	Present	SH and IRH	BE	Chemotherapy
2	7	M	Diplopia	9.8	65	77	CD10+/CD19+/CD20 dim+/CD34 dim+/HLA-DR+/CD79a+/Tdt+/other markers negative	B-ALL	Nil	6th Cranial Nerve Palsy	LE	Chemotherapy
3	5	M	Proptosis	5.5	45	54	CD7+/CD34+/ HLA-DR+/ surface CD3-/surface CD5-/surface CD10-/cytoplasmic CD3+/cytoplasmic Tdt+/other markers negative	T-ALL	Nil	Proptosis	RE	Chemotherapy
4	6	F	Fever	7.4	18	90	CD10+/CD19+/CD20 dim+/CD34+/HLA-DR+/CD79a+/Tdt+/other markers negative	B-ALL	Present	VH and IRH	BE	Chemotherapy
5	2.5	M	Fever	10.1	21	107	CD10+/CD19+/CD34+/HLA-DR+/CD79a+/Tdt+/ CD20-/other markers negative	B-ALL	Present	IRH	BE	Chemotherapy
6	2.5	M	Fever	6.5	34	95	CD10+/CD19+/CD20 dim+/CD34 dim+/HLA-DR+/CD79a+/Tdt+/other markers negative	B-ALL	Present	IRH	RE	Chemotherapy
7	5	M	Fever	4	23	83	CD10+/CD19+/CD20 moderate+/CD34+/HLA-DR+/CD79a+/Tdt+/other markers negative	B-ALL	Present	IRH	BE	Chemotherapy
8	4	F	Fever	9.4		29	CD7+/CD5+/dim CD4/surface CD3+/ CD38+/cytoplasmic CD3+/Tdt+/dim CD34+/CD8-/HLA-DR-/other markers negative	T-ALL	Nil	Proptosis and Disc Edema	LE	Chemotherapy and irradiation
9	6	M	Fever	4.5	27	112	CD34+/CD117+/CD33+/CD13+/HLA-DR-/cytoplasmic MPO+/other markers negative	AML	Present	VH	RE	Chemotherapy
10	13	F	Fever	7.2	29	97	CD38+/CD117+/CD33+/CD13+/ HLA-DR+/dim CD56/dim CD36/cytoplasmic MPO-/other markers negative	AML	Nil	Chloroma, 6th Cranial Nerve Palsy, Proptosis, and IRH	LE	Chemotherapy and Irradiation
11	3	F	Fever	5.5	35	96	CD34+/CD117+/HLA-DR+/CD33+/dim CD13/cytoplasmic MPO/other markers negative	AML	Present	IRH	LE	Chemotherapy
12	6	M	Fever	3.8	32	105	CD19+/CD10+/CD34+/ CD38+/HLA-DR+/CD79a+/CD20-/other markers negative	B-ALL	Nil	Anterior uveitis	RE	Chemotherapy
13	4	F	Fever	7.5	29	98	CD10+/CD19+/CD20 dim+/CD34 dim+/HLA-DR+/CD79a+/Tdt+/other markers negative	B-ALL	Present	IRH	RE	Chemotherapy
14	7	M	Proptosis	5	78	75	CD38+/CD33+/CD117+/dim CD4/dim CD64/dim CD15/ CD34+/HLA-DR-/CD14-/cytoplasmic MPO-/other markers negative	AML	Nil	Proptosis	LE	Chemotherapy
15	3	F	Fever and vomiting	10.5	64	59	CD7+/CD10+/dim CD5/surface CD3-/cytoplasmic CD3+/Tdt+/other markers negative	T-ALL	Present	IRH	RE	Chemotherapy
16	6	M	Fever	7.8	31	101	CD34+/CD117+/CD33+/CD13+/HLA-DR-/cytoplasmic MPO+/others markers negative	AML	Nil	Chloroma and IRH	BE	Chemotherapy
17	7	M	Fever	4	35	94	CD10+/CD19+/CD34+/HLA-DR+/CD79a+/Tdt+/variable CD20/other markers negative	B-ALL	Nil	IRH	RE	Chemotherapy
18	5	F	Proptosis	3.7	54	123	CD13+/CD33+/CD117+/CD38+/CD64+/HLA-DR+/cytoplasmic MPO+/other markers negative	AML	Nil	Proptosis and papilledma	RE	Chemotherapy and irradiation
19	4	M	Blurring of vision	9.5	24	39	CD19+/CD10+/HLA-DR+/dim CD34/CD79a+/Tdt+/CD20-/other markers negative	B-ALL	Nil	IRH	LE	Chemotherapy

ALL: Acute lymphoblastic leukemia; M: Male; F: Female; B-ALL: Type B acute lymphoblastic leukemia; AML: Acute myeloid leukemia; T-ALL: Type T acute lymphoblastic leukemia; SH: Subconjunctival hemorrhage; VH: Vitreous hemorrhage; IRH: Intra-retinal hemorrhage; RE: Right eye: LE: Left eye; WBC: White blood cells; Nil: No early systemic features seen.