Título / Title

RETINAL METASTASIS AS A RECURRENCE OF ACUTE LYMPHOCYTIC LEUKEMIA: A CASE REPORT

Introdução / Purpose

To report a case of metastasis to the retina demonstrating the importance of symptom recognition for early diagnosis.

Material e Método / Methods

Data collection from medical records and test results.

Resultados / Results

D.N.C, male, 34 years old, has presented with decreased visual acuity in the right eye for the past 10 days. He had history of acute lymphoid leukimia (A.L.L) treated for one year with QT and was currently in remission. On examination, visual acuity without correction was 20/25 OD and 20/20 OS. Funduscopy of OD showed optic nerve sweeling 4+/4+ and a inferior temporal subretinal infiltrate near the right arcade. The OD visual field test showed increased blind spot, diffuse reduction of sensitivity with a denser scotoma in the lower nasal region. Optical coherence tomografy (OCT) showed a lesion in the inferior temporal vascular arcade in the inner retina with infiltrates under it and a discrete epiretinal membrane. The patient was referred for a follow-up with an oncologist, underwent a cerebrospinal fluid biopsy, which was inconclusive, and started therapy with intrathecal chemotherapy (MADIT). He returned after 28 days with significant improvement and almost total reduction of the retinal infiltrative lesion and optic disc edema.

Discussão e Conclusões / Conclusion

Metastases to the eye, although rare,are the main cause of malignant intraocular neoplasia in adults. The most common primary sites are breast, lung and digestive tract. Acute Myeloid Leukemia has greater ocular involvement than A.L.L. Tissues affected include: choroid (88%), iris (9%) or ciliary body (2%) and, rarely, the retina. Ophthalmologic involvement may be the first manifestation of the tumor or indicate a recurrence.Manifestations can be divided into 3 groups: leukemic infiltrates; complications secondary to anemia, thrombocytopenia and hyperviscosity; and opportunistic infections (retinitis). In the retina, infiltrates appear as gray-white nodules; in the choroid, isolated or clustered yellow infiltrates. In the optic nerve, it is rare and has a poor prognosis.

Palavras Chave

RETINAL METASTASIS

Area

CLINICAL RETINA