Systematic review and meta-analysis finds high prevalence of ocular manifestations in leukemia patients
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Key Takeaway
Consider routine ophthalmic screening in patients with leukemia given the 42% prevalence of ocular manifestations.
This systematic review and meta-analysis evaluated the prevalence of ocular manifestations in patients with leukemia, including 1016 patients across included studies. The primary outcome was overall ocular manifestations, with a pooled prevalence of 42% (logit event rate: -0.3307; 95% CI: -0.456 to -0.206; P < 0.0001). Secondary outcomes included retinal hemorrhage (13%-15%), retinal infiltration (3%), and retinal vein occlusion (1.2%). The analysis for retinal infiltration showed low heterogeneity (I^2 = 10.2%), while retinal vein occlusion had no heterogeneity (I^2 = 0%).
The authors note an association between retinal vein occlusion and leukemia, but caution that this is not necessarily causal. Limitations of the meta-analysis were not explicitly reported, but the findings are based on pooled observational data. The authors emphasize the importance of routine ophthalmic screening, including fundus examination, OCT, and OCTA, as integral components of leukemia management.
For clinicians, this review highlights that ocular involvement is common in leukemia and may be underrecognized. While the evidence is observational, the high prevalence supports a low threshold for ophthalmologic evaluation in patients with leukemia. Further research is needed to clarify the clinical impact of screening on outcomes.
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View Original Abstract ↓
PURPOSE: To evaluate the association between retinal vein occlusion and leukemia.
METHODS: A comprehensive literature search was conducted across PubMed, Google Scholar, ScienceDirect, Scopus, and Cochrane Library from inception to October 20, 2025, following PRISMA guidelines and a registered PROSPERO protocol (CRD420251134924). Observational studies reporting ocular findings in leukemia were included. Data extraction and risk of bias assessment were performed independently using the JBI and ROBINS-I tools. Pooled effect sizes were calculated using Comprehensive Meta-Analysis (CMA v4.0), expressed as logit event rates with 95% confidence intervals. Case reports were narratively summarized but excluded from quantitative synthesis.
RESULTS: Eight studies encompassing 1,016 participants were included in the meta-analysis. The pooled logit event rate for overall ocular manifestations was -0.3307 (95% CI: -0.456 to -0.206; P < 0.0001), corresponding to a prevalence of 42%. Retinal hemorrhage was the most frequent finding (logit = -1.90; 13%-15%), followed by retinal infiltration (logit = -3.55; 3%) and retinal vein occlusion (logit = -4.41; 1.2%). Heterogeneity was low for infiltration (I 2 = 10.2%) and retinal vein occlusion (I 2 = 0%).
CONCLUSION: Ocular involvement occurs in nearly half of patients with leukemia, with retinal hemorrhages and microvascular compromise as dominant manifestations. Although retinal vein occlusion is rare, it signifies advanced hematologic derangement. These findings highlight the importance of routine ophthalmic screening including fundus examination, OCT, and OCTA-as integral components of leukemia management for early detection, systemic correlation, and vision preservation.
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