小児白血病の眼症状について

Ocular findings in children with leukemia

　1972年1月より1986年6月までに聖路加国際病院に入院した小児白血病患者100名中眼科を受診した50名（男28名，女22名，1カ月〜17歳）について眼科的検査を行い，眼症状を4種類に分類し調査検討した．眼症状は33名（66％）に認められた．（1）白血病細胞の眼組織浸潤による眼症状9名（18％）；視神経浸潤4名，ぶどう膜浸潤4名，眼窩浸潤1名．（2）造血障害，白血球増多による眼症状12名（24％）；白血病性網膜症10名，結膜下出血2名．（3）中枢神経白血病の部分症としての眼症状14名（28％）；脳神経麻痺症状が多く，顔面神経麻痺が，最も多かった．（4）その他白血病に付随する眼症状14名（28％）；眼感染症5名，白血病治療薬の副作用による眼症状10名であった．死後摘出した眼球10眼（5例）すべてに白血病細胞浸潤を認めた．（1）〜（3）の眼症状を認めた患者の88％は眼症状出現より14カ月以内に死亡している．米国での過去の報告と比較して眼症状は増加している．

We evaluated 50 children with leukemia as to the ocular involvement during the past 14 years 6 months. The ages of the patients averaged 7.2 years. Males and females numbered 28 and 22 each. The series included 35 cases with acute lymphocytic leukemia, 10 acute myelocytic leukemia, 2 acute monocytic leukemia, 2 chronic myelocytic leukemia and 1 erythroleukemia. We detected 33 cases with ocular involvement. Four types could be identified. 1. Leukemic infiltration of ocuar tissues in 9 cases, 18% involving the optic nerve (4 cases), uveal tissue (4) or the orbit (1). 2.

Ophthalmopathy due toleucocytosis or suppressed hematopoiesis in 12 cases, 24% appearing as leukemic retinopathy (10) or subconjunctival hemorrhage (2). 3. Ocular signs of central nervous system leukemia in 14 cases 28%, appearing most frequently as facial nerve palsy. 4. Miscellaneous lesions associated with leukemia in 14 cases, 28%, including side effects of chemothe-rapy (10).

After ocular complications became manifest either as leukemic infiltration, retinopathy, sub-conjunctival hemorrhage, or ocular signes of central nervous system leukemia, death ensued within 17 months in 88% of affected cases. The incidence of ocular involvement in our study are higher than in previous reports from the United States.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(7) : 737-740, 1987