T-Cell Acute Lymphoblastic Leukemia with Massive Vitreo-Retinal Infiltration and Neovascular Glaucoma

Excerpt

A 19-year-old male was referred from Oncology department to evaluate for his rapidly progressive uniocular diminution in vision and ocular pain for past 1-week. His records revealed that he had T-cell acute lymphoblastic leukemia with central nervous system involvement and was on high-dose methotrexate chemotherapy and triple intrathecal therapy (methotrexate, hydrocortisone and cytarabine). Ocular examination showed right eye (RE) vision 20/20 and left eye (LE) no light perception, with intraocular pressures of 14 mmHg and 48 mmHg respectively. Slit-lamp examination of LE showed subtle neovascularisation of iris (Fig. 1a, white arrows), closed angles and cellular infiltration of the anterior vitreous (Fig. 1b, white arrow). Fundus examination showed massive infiltration of retina and optic disc with indiscernible disc borders (Fig. 1c, white arrow). RE was normal. A diagnosis of LE vitreo-retinal leukemic infiltration with neovascular glaucoma was made and proceeded with anterior retinal cryopexy and cyclo-cryotherapy.

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