Various Types of Neuroleukemia with Optic Nerve Involvement

Neuroleukemia is a severe complication of hemoblastosises characterized by infiltration of blast cells of the meninges, the substance of the brain, cranial and peripheral nerves.The purpose. To analyze the clinical manifestations of leukemia with optic nerve damage in leukemia and malignant lymphomas.Patients and Methods. From January 2016 to January 2020, one center-based non-randomized prospective study was conducted on patients with leukemia and non-Hodgkin’s lymphomas who were treated in the hematology department of MONIKI and made complaints about reduced vision. 26 patients were examined, 4 of them were diagnosed neuroleukosis with leukemic infiltration of the optic nerves: three women aged 41, 44, 46 years and a man aged 50 years.Results. All patients had one common ophthalmological symptom — decreased visual acuity. Complaints of reduced vision in one patient appeared at the onset of the disease, in other patients-during a relapse. The picture of the eye’s fundus in all patients was identical: the optic disk had blurred borders, and elevated above the retina. In the first days, the vascular funnel was viewed, then closed by infiltration. A dense white infiltrate of the peripapillary retina spread over the entire macular area. The retinal veins were sharply dilated of uneven caliber. Along the course of the vessels, there were a large number of different sizes and shapes of hemorrhages. Various types of neuroleukemia with lesion of the optic nerve were described: a combination of focal lesions of the brain and the optic nerve, isolated damage to the optic nerve with blast cytosis in the cerebrospinal fluid (CSF), isolated damage to the intraocular part of the optic nerve without changing the cerebrospinal fluid. In three patients the diagnosis of neuroleukemia exhibited on the basis of changes according to magnetic resonance imaging (MRI) and/or the number of blast cells in punctate liquorologic research. In the fourth patient, in the absence of changes in the liquor and MRI, the diagnosis of leukemic infiltration of the optic nerve was confirmed by data from a cytological examination of a punctate from the peripapillary retina. After the beginning of antitumor treatment, the significant improvement visual acuity and decrease in leukemic infiltrate of the optic disc and retina of the affected eye was noted in all patients.Discussion. Damage of the optic nerve can develop both at the onset of the disease, and relapses of leukemia or aggressive non-Hodgkin’s lymphomas. Leukemic infiltration evolves in all parts of the optic nerve, but more often affects its intraocular portion. The damage to the intraocular part is characterized by the presence of a dense infiltrate both in the area of the papilla and the peripapillary retina.Conclusion. Leukemic infiltration of the optic nerve is manifested by a significant decrease in visual acuity. Careful attention to complaints of reduced vision in patients with leukemia can help to recognize the development of the disease’s debut or its progression. Timely antitumor treatment leads to an improvement in visual acuity and, consequently, an improvement in the quality of life of patients

The Clinical Case of Idiopatic Dilatation of Epibulbal Veins

This publication describes a clinical case of spontaneous subconjunctival hemorrhage in a 15-year-old child on the background of idiopathic local dilatation of epibulbar vessels. Vascular pathology of the orbit and periorbital region is often accompanied by subconjunctival hemorrhages. The aim of the work was to describe a rare clinical case of spontaneous subconjunctival hemorrhage in a child with local idiopathic vasodilation. A complete clinical instrumental study revealed no pathology except the local dilatation of epibulbar vessels. In 6 months after the subconjunctival hemorrhage resorption, the ampoule-shaped expansion of the epibulbar vessels with a wall different from others in color and shape is preserved, which was confirmed by the data of optical coherence tomography (OCT) of the anterior eye segment. When examining patients with spontaneous subconjunctival hemorrhage, especially in childhood, along with pathology of the cardiovascular and circulatory systems, it is necessary to exclude malformations of the vessels of the orbit, periorbital region and anomalies of the epibulbar vessels

The eye status in patients after new coronavirus infection

Rationale: The emerging new coronavirus infection caused by SARS-CoV-2 has resulted in a pandemic. Its clinical manifestations are highly variable and the death rate is high due to rapid progression to acute respiratory distress syndrome. Identified abnormalities of the eye are mainly related to conjunctival injury during manifestation of the disease.Aim: To study the eye abnormalities in patients who have undergone COVID-19.Materials and methods: Ophthalmological examination was performed in 23 patients (6 [26%] men and 17 [74%] women, median age 42.39 years) at days 44 to 85 after manifestation of COVID-19 infection in the Department of Ophthalmology, MONIKI. In addition to the standard ophthalmological examination, all patients were evaluated with optical coherence tomography (OCT), auto fluorescence, contrast and color sensitivity test with different light sources, and tear production assessment.Results: In the late convalescence period there were complaints of dry eyes and abnormal color perception, with visual acuity being unchanged. The OCT assessment the peripapillary retina identified small hyper-reflective foci in the inner layers.Conclusion: Eye disease in patients after COVID-19 is mainly related to the condition of the eye surface, abnormal color perception and abnormal architectonics of the inner retinal layers, which can persist for a long time during convalescence

EYE LESIONS IN SYPHILIS

The paper is focused on diagnosing eye structure lesions in patients with syphilis. Two clinical cases are described: a case of syphilitic uveitis in early syphilis and optic nerve atrophy in late syphilis. The main purpose is to increase the awareness of ophthalmologists about specific eye diseases in syphilis and the need for early detection of such pathologies. For citation: Bokhonovich D.V., Loseva O.K., Ryabtseva A.A., Kovrizhkina A.A., Yudakova V.M., Chernysheva N.V. Eye lesions in syphilis. Russian ophthalmological journal. 2018; 11 (2): 46-53. doi: 10.21516/2072-0076-2018-11-2-46-53 (In Russian)

The First Experience of Creating Registers of Patients with Eye Diseases in Moscow Region

This report is devoted to the problem of absence universal databases of patients with different chronic eye diseases and continuity of these patients between medical organizations. On the basis of MONIKI there has was held a prospective, observational cohort study of patients since 2016, with diagnoses: uveal melanoma — the first group of patients, degenerative States of the optic nerve and retina (multiple sclerosis, glaucoma) — the second group, — and vascular retinal diseases (venous occlusion, diabetic retinopathy) — the third group. There were 114 patients — in the first, 68 — in the second, 92 — in the third. There were developed statistically significant parameters of patients examination, adaptation of registers to application and increase of their efficiency continues to be corrected. All patients underwent standard ophthalmological examination, in addition-gonioscopy, ultrasound (ultrasound) in a and b-scan mode, including ultrasound biomicroscopy (UBM), optical coherence tomography (OCT), fluorescence angiography (FAG), computed tomography (CT) and/or magnetic resonance imaging (MRI) of the orbit. According to the indications, patients were examined by related specialists. For each patient group, prior results were obtained. They were late detection, untimely treatment and referral patients to other medical organizations, which proves the need to systematize patients with various pathologies and the subsequent continuity of medical organizations as for the timely detection of the disease, as for adequate and timely treatment not only at the local, but also at the regional or Federal levels. The integration of patients register with various ophthalmic diseases has a priority course in the development of healthcare in the Moscow region