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Isolated optic nerve involvement in acute lymphoblastic leukaemia: a red flag for early relapse
  1. Shorya Vardhan Azad,
  2. Mousumi Banerjee,
  3. Kumar Parmanand and
  4. Pradeep Venkatesh
  1. Dr R P Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Mousumi Banerjee, Dr R P Centre for Ophthlamic Sciences, All India Institute Of Medical Sciences, New Delhi, India; banerjeemou12{at}


Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer, with 70%–80% of cases curable with modern chemotherapy. However, 20% of the cases suffer from disease relapse with bone marrow being the most common site. Isolated ocular involvement as the first sign of relapse is extremely rare, occurring in less than 2.2% of cases. The presentation of optic nerve involvement in leukaemia represents a visual emergency and a sign of isolated central nervous system relapse even in the absence of abnormal cerebrospinal fluid cytology. This case highlights the importance of routine ophthalmic screening in ALL even during maintenance phase and prompt initiation of treatment in cases with isolated optic nerve involvement.

  • haematology (incl blood transfusion)
  • malignant and benign haematology
  • chemotherapy
  • paediatric oncology
  • visual pathway

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  • Contributors SVA and MB have worked upon the case. KP has helped in the preparation of the manuscript. PV has edited the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.