Treat Signs of Acute Promyelocytic Leukemia With Urgency

Leukaemia blood cells. Light micrograph of blood cells (mainly B cells, dark purple) in the liver of a patient with lymphocytic leukaemia.
Researchers say ocular involvement occurs in leukemia between 35% 64% of the time.

The following article is a part of conference coverage from the 2021 meeting of the North American Neuro-Ophthalmology Society, being held virtually from February 20 to 23, 2021. The team at Ophthalmology Advisor will be reporting on the latest news and research conducted by these leading experts in neuro-ophthalmology. Check back for more from the NANOS 2021 Meeting.


A case series presented at the North American Neuro-Ophthalmology Society Annual Meeting found that neuro-ophthalmological signs, such as blurred vision, papilledema, optic disc edema, visual field defects, along with retinal hemorrhage, and detachment, should prompt an urgent workup for acute leukemia, specifically acute promyelocytic leukemia (APML). 

The case study included 3 patients between the ages of 24 and 34 years who were all seen in neuro-ophthalmology consultation for vision loss. After their examinations, they were all diagnosed with APML, which is a medical emergency that can rapidly become fatal if left untreated. 

Hemoglobin, white blood cell count, and platelets for each patient were analyzed and their investigations included some combination of MRIs, MRVs, and bone marrow biopsies. 

All 3 patients APML treatment plan included all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), both of which are differentiating agents proven to be lifesaving and have turned APML into one of the most curable adult leukemias. The treatment was well tolerated and 2 out of the 3 patients were reported to be in morphological remission. 

The researchers write that ocular involvement in leukemia has been cited to be between 35% and 64% and should not be overlooked. Also, ocular manifestations of leukemia tend to occur at an advanced stage of disease, and retinal hemorrhage is the most common finding in patients with leukemia. 

Practitioners should be aware of the ocular signs of APML so that they can promptly recognize them and begin an investigation to confirm diagnosis. Rapid treatment with ATRA and ATO can be lifesaving. 

Visit Ophthalmology Advisor’s conference section for complete coverage of the NANOS 2021 Meeting and more.


Paxton A, Micieli J. Rare neuro-ophthalmological presentations of acute promyelocytic leukemia. Presented at: North American Neuro-Ophthalmology Society Annual Meeting; February 20-23, 2021; Poster 6.