Ocular manifestations in acute lymphoblastic leukemia: A five-year cohort study of pediatric patients.

Objective: To characterize ocular manifestations (OM) of pediatric patients treating for acute lymphoblastic leukemia (ALL) and to evaluate whether they are associated with well-described predictive risk factors for relapse, protocol (1999 or 2009), gender and cerebrospinal fluid infiltration.

Methods: A prospective cohort study was conducted in children and adolescents with ALL from January 2013 to December 2017. The patients underwent ophthalmologic evaluations before starting treatment (D0), on the eighth day (D8), at the 28th day (D28), and at six months (D6 months). Ocular hypertension (OH) was considered in results above 21 mmHg. Measures of visual acuity <20/40 were considered visual loss (VL).

Results: Fifty-five patients were examined and 18 (32.7%) presented OM, been OH (61.1%), retinal hemorrhage (22.2%) and VL (22.2%) the most frequent finds. A strong association was found between patients with OM and those with a high risk of relapse (p = 0.035, Cramer V = 0.31) and who used the 1999 protocol (p = 0.022, Cramer V = 0.32). The risk of OM in patients from the 1999 protocol was 2.917 (CI = 1.099-7.742), while the risk of relapse it was 0.327 (CI 95% 0.107-0.999).

Conclusions: Patients with ALL have a high incidence of OM due to the treatment and the disease itself, and it may even be asymptomatic and evolve with VL. Of these, we can highlight OH as the most prevalent. Patients submitted to the 1999 protocol and at high risk of relapse are more likely to present OM and these variables are strongly associated.