title: Unilateral Eye Findings: A Rare Herald of Acute Leukemia.
abstract: OBJECTIVE
  Unilateral choroidal infiltration as the initial manifestation of leukemic relapse in adults is rare, particularly after an extended period of remission. This report describes this unique ophthalmic presentation, highlights the associated diagnostic challenges, and reviews the literature.
  
  
  METHODS
  Two cases are described and an extensive literature review was conducted.
  
  
  RESULTS
  A 59-year-old male with acute lymphoid leukemia, in remission for 18 months, presented with unilateral scleritis, exudative retinal detachment, and choroidal thickening. A 57-year-old male with a history of acute myeloid leukemia, in remission for 4 years, presented with unilateral choroidal thickening leading to secondary angle closure. In both cases, there was a significant lag from the onset of eye symptoms to establishing a systemic diagnosis of acute leukemia, leading to a delay in definitive systemic treatment, despite a high suspicion of disease based on ophthalmic findings.
  
  
  CONCLUSIONS
  These two cases illustrate the fundus findings consistent with leukemic choroidal infiltration that can represent the first sign of relapsed leukemia. The successful treatment of these patients hinges on collaboration between ophthalmologists and oncologists to optimize patient outcomes, highlighting the need for both groups to be aware of this rare ophthalmic presentation.
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Mass., USA.
authors.forename: Avni V
authors.initials: AV
authors.lastname: Patel
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Mass., USA; Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Mass., USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Miller
authors.affiliation: Department of Hematology/Oncology, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Mass., USA.
authors.forename: Rajneesh
authors.initials: R
authors.lastname: Nath
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass., USA.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Shih
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Mass., USA; Department of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, Mass., USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Yoon
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Mass., USA; Department of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, Mass., USA.
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Freitag
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Mass., USA; Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Boston, Mass., USA.
authors.forename: George
authors.initials: G
authors.lastname: Papaliodis
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Mass., USA; Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, Mass., USA.
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Mass., USA; Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Mass., USA.
authors.forename: Dean
authors.initials: D
authors.lastname: Eliott
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Mass., USA; Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Mass., USA.
authors.forename: Ivana K
authors.initials: IK
authors.lastname: Kim
keywords: Choroidal infiltration; Leukemia; Ocular manifestations of leukemia; Ocular oncology; Radiation