title: Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India.
abstract: BACKGROUND
  Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse.
  
  
  OBJECTIVE
  This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India.
  
  
  METHODS
  Subjects of leukemia presenting to a tertiary care center in India.
  
  
  METHODS
  A prospective, cross-sectional study looking at the spectrum of ocular manifestations in all inpatients of acute or chronic leukemia.
  
  
  METHODS
  The collected data were analyzed using the Statistical Package for Social Sciences for Windows software, version 16 (SPSS Inc., Chicago, Illinois, USA).
  
  
  RESULTS
  The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%).
  
  
  CONCLUSIONS
  Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular changes are often picked up in asymptomatic patients.
authors.affiliation: Department of Ophthalmology, Christian Medical College, Ludhiana, Punjab, India.
authors.forename: Jacob
authors.initials: J
authors.lastname: Koshy
authors.forename: M Joseph
authors.initials: MJ
authors.lastname: John
authors.forename: Satish
authors.initials: S
authors.lastname: Thomas
authors.forename: Gurvinder
authors.initials: G
authors.lastname: Kaur
authors.forename: Nitin
authors.initials: N
authors.lastname: Batra
authors.forename: Wilson J
authors.initials: WJ
authors.lastname: Xavier
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007938:Leukemia / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012164:Retinal Diseases / Q000453:epidemiology* / Q000209:etiology; D062606:Tertiary Care Centers; D055815:Young Adult