Leukemia Retinopathy

Introduction to leukemia retinopathy Leukemia-induced fundus changes, called leukemia retinopathy (leukemicretinopathy). Leukemia patients contain a large number of immature immature cells that can cause fundus changes. It is a spontaneous progressive infinite proliferation of one or more white blood cell components, accompanied by extensive infiltration of bone marrow and other organs, leading to normal hematopoietic failure. Especially in the acute type, it is characterized by retinal vein filling, swelling, segmentation or sausage shape, accompanied by white sheath. At the same time, there are bleeding and exudation in the fundus. According to statistics, there are 1011 to 1012 cancer cells in a leukemia patient. basic knowledge The proportion of sickness: 0.0052% Susceptible people: no specific people Mode of infection: non-infectious Complications: optic disc edema retinal detachment fundus hemorrhage

Causes of leukemia retinopathy

(1) Causes of the disease

A variety of factors can lead to leukemia, such as genetic factors, exposure to chemicals, radiation effects, biological factors (such as viral infections).

(two) pathogenesis

Red blood cells, the degree of reduction of platelet count, the increase of the total number of white blood cells and the proportion of immature white blood cells have a great influence on the fundus changes. The blood picture often fluctuates during the course of leukemia, the edema of the retina is turbid, the veins are dilated, the vein white sheath, various forms of exudation spots, Exudative retinal detachment, optic disc edema, and a large increase in white blood cell count and immature white blood cell ratio is closely related, retinal hemorrhage is associated with anemia, the lower the number of red blood cells, the greater the amount of bleeding, thrombocytopenia, immature leukocytosis on retinal hemorrhage It also has a role, but it has nothing to do with the total number of white blood cells. In general, the factors that cause fundus lesions are acute anemia, whether granulocytic or lymphocytic, mainly anemia; in chronic myeloid leukemia, mainly anemia and immature The white blood cell ratio is highly elevated, and chronic lymphocytic leukemia is mainly anemia, and in some cases, a significant increase in the ratio of immature lymphocytes may also have an effect.

Leukemia retinopathy prevention

prevention

First, eat more natural foods and regular production of foods that have been sanitized, such as: fresh vegetables, grains and so on.

Second, reduce contact with benzene, chronic benzene poisoning mainly damages the human hematopoietic system, causing leukemia, platelet count reduction to induce leukemia, some workers engaged in the production of benzene as chemical raw materials should strengthen labor protection, decoration should be chosen to be harmless to the human body Decoration materials.

Third, try to avoid radiation, personnel engaged in radiation work should do personal protection, infants and pregnant women should avoid contact with excessive emission lines.

According to the statistics of malignant tumors in Shanghai, the incidence of leukemia accounted for the ninth, but in the 1-14 years old group, the first incidence rate was 37.5%; the 15-44 year old group accounted for the third place, the incidence rate was 9.1%. Acute accounted for more than 70%, more than chronic. Among them, acute granulocyte leukemia was the first, acute lymphocyte type was the second, and acute mononuclear type was the least. The annual mortality rate of leukemia is 2 to 4 per 100,000 population in China. Among various malignant tumors, leukemia mortality ranks sixth. Can occur at any age. Men are more common than women, about 2:1. Any leukemia can cause leukemia fundus lesions, mostly involving both eyes, is a common sign of leukemia patients. The incidence of acute cases is high, close to 90%, and the chronic ones are lower, below 70%. The incidence of fundus lesions reported in China is 67% to 89.4%.

Acute leukemia has the highest incidence in childhood, accounting for the first place in various malignant tumors in childhood in China. Young people are second; chronic myelogenous leukemia is more common in young adults aged 20-50; chronic lymphocytic leukemia is more common in elderly people over 50 years old, and monocytic leukemia is more common in middle-aged people.

Leukemia retinopathy complications Complications, optic disc edema, retinal detachment, fundus hemorrhage

Retinal hemorrhage, optic disc edema and exudative retinal detachment.

Leukemia retinopathy symptoms Common symptoms Leukemia cells infiltrate the fundus point or flaming bleeding

1. Fundus manifestations The clinical manifestations of this disease are mostly caused by direct invasion of tumor cells, accompanied by anemia, thrombocytopenia is also a factor causing fundus symptoms, leukemia retinopathy can occur in acute or chronic leukemia, especially in acute cases common.

(1) Retinal vascular changes: the most common form of venous dilation, accounting for 49.3% ~ 84%, venous distortion, tube diameter can be expanded to several times normal, the ratio of arteriovenous diameter can be 1:2 or even 1:4, Especially at the intersection of arteries and veins, the swelling and tortuous veins are irregular, in the form of segments or sausages. Due to anemia or blood filled with white blood cells, the color of the veins turns yellowish red, even indistinguishable from the arteries. The white sheath is caused by the infiltration of leukemia cells around the blood vessels. The arteries can also be dilated in the late stage. Duke et al. observed the retinal digestive plaque of patients with leukemia and found that 50% of patients with chronic leukemia had microangioma formation in the peripheral retina. The patient is accompanied by peripheral vascular occlusion and neovascularization.

(2) Retinal hemorrhage and exudation: Retinal hemorrhage accounts for the second place in the fundus lesions of leukemia, and there are also statistics that the first place, especially in the acute type, retinal hemorrhage can occur in any part of the fundus, but the most common is located in the posterior pole. Bleeding can be located in the shallow or deep layer of the retina. It can be flaming, linear, point-like, plaque-like or irregular. For example, it is in the shape of a ship in front of the retina. It can enter the vitreous and cover the fundus. Retinal hemorrhage is rare. Occasionally, there is a person who causes retinal detachment. Hemorrhage may have a white heart located in the center, 1/6 to 1/4PD in size, and has different opinions on the source of white heart. Some think that white heart is the accumulation of cell debris, or think Is the accumulation of immature leukemia cells, or is considered to be capillary emboli, retinal exudation is relatively rare, may appear macular sclerosing or cotton-like plaques, the latter may be optic axonal infarction or accumulation by local leukemia cells Caused.

(3) Retinal and choroidal infiltration: due to leukemia cell infiltration in the retina and choroid, retinal edema can occur, the color of the retina changes from normal orange to orange, or even yellowish white, and retinal nodular infiltration occurs mostly in the increase of white blood cell count and Patients with immature white blood cells, mostly fulminant, often die early, so retinal nodular infiltration combined with increased white blood cell count is an indication of poor prognosis. Choroidal leukocyte infiltration is often difficult to see in the fundus, due to leukocyte infiltration of choroidal tissue The thickening, or choroidal capillaries are blocked by infiltration of leukemia cells, disturbing the blood supply of the retinal pigment epithelium, leading to disintegration of the pigment epithelium, resulting in impaired barrier function, and early fluorescein angiography shows a large amount of punctate fluorescein leakage. In some patients with serous retinal detachment, the dye can enter the subretinal space.

(4) optic disc edema: leukemia lesions can invade different parts of the optic nerve. If the leukemia cells infiltrate before the sieve plate, the disc border can be blurred, the optic disc edema can be up to several diopter, accompanied by bleeding, generally less visual decline, such as When the macula is involved, the visual acuity is significantly reduced. For example, after optic nerve involvement in the sieve plate, the visual acuity can also be significantly decreased. The cause of optic disc edema may be caused by leukemia cells infiltrating optic disc tissue and vascular venous return obstruction and ischemia, or by intracranial leukocytes. Infiltration or intracranial hemorrhage caused by increased intracranial pressure.

Leukemia retinopathy is associated with patients with different types and degrees of leukemia, as well as patients with anemia and thrombocytopenia.

2. Leukemia, in addition to the fundus involvement, can extensively invade other tissues of the eye, such as the eyelids, eyelids, iris, cornea, and any other ocular tissue.

(1) Infiltration of eyelids: often occurs in young children, 75% occur within 10 years of age, the average age of domestic reports is 14.2 years old, males are more common than females, males and females are 3:1, can be unilateral or bilateral onset, The incidence of acute granulocytic leukemia is the highest. It used to be called chloromas. It is due to the fact that myeloperoxidase is green. Recently, many leukemia-induced eyelid infiltrations are not green. According to the structure of tumor cells, It is more suitable as granulocytic sarcoma, or myeloid sarcoma. Its clinical features are due to the infiltration of leukemia cells in the sacral tissue, resulting in ocular protrusion, drooping eyelids, conjunctival congestion and edema, and eye movement. Restricted, the gingival margin can touch hard tumors and tenderness after eyeballs. Those with infiltration of the eyelids suggest that the condition is serious, the prognosis is poor, and the mortality rate is high.

(2) iris infiltration: occurs in patients with acute lymphoblastic leukemia, can also occur in granulocyte type or mononuclear type, most of these patients have meningeal infiltration or recurrence cases, iris can be unilateral or bilateral involvement, symptoms Similar to acute iridocyclitis, such as ciliary congestion, pain and shame, anterior chamber may have empyema or hemorrhage, iris infiltration can be divided into diffuse or nodular, diffuse iris color fades, grayish white, forming Iris heterochromia; nodular infiltration is a nodular junction with unclear boundaries, usually located at the edge of the pupil of the iris.

(3) Other rare eye symptoms: It has been reported that leukemia cells infiltrate the cornea to produce corneal ring ulcers, in addition to lacrimal gland enlargement, the vitreous is infiltrated by leukocytes to produce turbidity, and the trabecular meshwork is infiltrated by leukemia cells, causing obstruction of aqueous drainage. In the case of open-angle glaucoma, it has been reported that the anterior segment ischemic.

3. Acute leukemia has an acute onset and rapid progress. Frequently, fever and hemorrhage are the first symptoms. The main cause of fever is infection. The most common sites of bleeding and skin are mucous membranes, such as nosebleeds, bleeding gums, subcutaneous congestion, fundus hemorrhage, such as brain. Bleeding can cause death, and hematuria and blood in the stool can be produced in the late stage. No matter what type of anemia, the patient's appearance is often grayish gray, pale, swollen lymph nodes, and the most common cervical lymph node enlargement, the axillary fossa and the groin are second. The liver and spleen can also be swollen. Other systems such as cardiovascular, respiratory, digestive, neurological and reproductive systems can be affected and produce symptoms such as joint pain, chest and abdomen pain, heartbeat and nerve spasm.

Chronic leukemia has a slow onset and a long course of disease. The systemic symptoms are pale, fatigue, dizziness, abdominal distension, abdominal pain, and diarrhea. It is accompanied by hypothermia, anemia, weight loss, and later bleeding such as nosebleeds, bleeding gums, blood in the stool, etc. Splenomegaly is also the most prominent sign, which can occur early, and the liver and lymph nodes can also be swollen. Regardless of acute or chronic leukemia, the total number of white blood cells in the blood examination is significantly increased, red blood cells and thrombocytopenia are reduced, and the leukocyte system is extremely active in bone marrow examination. And the number of naive cells increased.

Examination of leukemia retinopathy

1. Blood routine and bone marrow puncture can determine the type and pathological condition of leukemia. Regardless of acute or chronic leukemia, the total number of white blood cells in the blood examination is significantly increased, red blood cells and thrombocytopenia are reduced, and the leukocyte system is extremely active in bone marrow examination. The number of primitive and naive cells is very high. increase.

2. Pathological examination The ocular tissues are extensively infiltrated by leukemia cells, some aggregate to form nodules, the vascular lumen is filled with immature white blood cells, capillaries are occluded, white blood cells can also form white sheath around the blood vessels, and digestive patches show capillary walls. The nucleus disappears extensively, loses function, degeneration of nerve fiber layer, gliosis, formation of cystic space in the outer retina, focal disintegration of retinal pigment epithelium, leukocyte infiltration in the optic disc, bleeding in various layers of the retina, choroid due to blood vessels The inner and outer white blood cells infiltrate and can be thickened to 3 to 4 times, and the blood vessel wall becomes thinner and even destroyed.

3. Imaging examination of the head CT or MRI examination to determine whether there is intracranial hemorrhage.

4. Fluorescence angiography In the early retinal infiltration, a large amount of fluorescein point leakage was observed in the early stage.

Diagnosis and differentiation of leukemia retinopathy

Based on laboratory findings, the diagnosis can be determined in conjunction with clinical presentation.

Laboratory inspection:

1. Blood routine and bone marrow puncture can determine the type and pathological condition of leukemia. Regardless of acute or chronic leukemia, the total number of white blood cells in the blood examination is significantly increased, and red blood cells and thrombocytopenia are reduced. Bone marrow examination of the leukocyte system is extremely active and the number of primitive and naive cells is increased.

2. Pathological examination The ocular tissue is aggregated by leukemia cells to form nodules. The vascular lumen is filled with immature white blood cells, capillaries are occluded, and white blood cells can form white sheaths around the blood vessels. The digestive patch showed that the cell wall of the capillary wall disappeared extensively and lost its function. The nerve fiber layer is degenerated and the gliosis is hyperplasia. The outer retina has a cystic space, the retinal pigment epithelium undergoes focal disintegration, the optic disc has leukocyte infiltration, and the hemorrhage is located in various layers of the retina. The choroid can be thickened to 3 to 4 times due to infiltration of white blood cells inside and outside the blood vessel, and the blood vessel wall becomes thinner and even destroyed.

Other auxiliary inspections:

1. Imaging examination of the head CT or MRI examination to determine whether there is intracranial hemorrhage.

2. Fluorescence angiography In the early retinal infiltration, a large amount of early fluorescein point leakage was observed.

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