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Leukaemic infiltration of the optic nerve head: a rare site of initial relapse
  1. Shailaja Bhat Shenoy1,
  2. Thoiba Karam2,
  3. Karthik Udupa3,
  4. Bhavna Nayal4
  1. 1Department of Ophthalmology, Kasthurba Medical College, Manipal University, Manipal, India
  2. 2Kasturba Medical College Manipal, Manipal, Karnataka, India
  3. 3Department of Medical Oncology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
  4. 4Department of Pathology, Kasturba Medical College, Manipal, Manipal University, Manipal, Karnataka, India
  1. Correspondence to Dr Shailaja Bhat Shenoy, bhat_shailu{at}


A 24-year-old male patient with acute lymphoblastic leukaemia (ALL), in complete remission, presented with the symptoms of gradual onset painless diminution of vision in the right eye (OD) of 2-month duration. On examination, best-corrected visual acuity in OD was finger-counting at 1 m and near vision was less than N36. Anterior segment examination was normal, except for the presence of relative afferent pupillary defect in OD. Fundus examination showed optic disc oedema, peripapillary and vitreous haemorrhage, dilated and tortuous veins over the disc and presence of subretinal infiltrates and subretinal fluid around the optic disc. Clinical picture was suggestive of leukaemic infiltration of the optic nerve head. Cytological analysis of the cerebrospinal fluid did not show any abnormal cells or blasts .Vitreous biopsy from OD was suggestive of leukaemic infiltration. After radiotherapy, the leukaemic infiltrates regressed and visual acuity improved to 6/6, N6 in OD.

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  • Contributors SBS has contributed in the preparation of the manuscript. TK has contributed in preparing the manuscript and acquisition of data. KU has contributed in the manuscript preparation and management of patient. BN has contributed in planning the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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