Visual impairment as the initial symptom of acute lymphatic leukemia of the T-cell type

Introduction: Visual impairment as the initial symptom of leukemia is rare. Although retinal involvement during leukemia is frequent, a leukemic macul ar lesion is an exception. Case report: A 5 1/2-year-old female child, pale and with a general feeling of illness complained about bilateral reduced vision for 3 days. Binocular visual acuity in reading distance was 0.4. Anterior segment and optic disc were inconspicuous. The macula in both eyes displayed a preretinal hemorrh age in the form of a spot with red, yellow and clear layers lying on top of one another. After a hematological examination the illness was diagnosed a s T-cell-type acute lymphocytic leukemia (ALL). Chemotherapy was given imme diately and general improvement of ALI was observed. Eleven months after th e first presentation visual acuity of the right eye was 0.7 and of the left eye 0.3. The central lesion was completely resorbed and revealed paramacul ar pigment clumping. Conclusion: Because of the differentiated and improved therapy schemata ava ilable now, e.g., the ALL-BFM 95 protocol, ALL can be cured more frequently . The prognosis, however, is essentially dependent on early diagnosis. By b eing familiar with the corresponding ocular findings, an ophthalmologist ca n contribute to this.