Iris involvement in leukaemia.

Involvement of the eye and the adnexa in leukaemia is not uncommon, and one half of patients can expect involvement at some stage of the disorder. The literature contains numerous reports of these conditions and a wide range ofocular structures may be affected, but iris involvement is relatively rare. Allan and Straatsma (i 96 I) found two cases out of 76 with eye involvement studied pathologically after death and Auvert, Hurel, and Theron (I968) found three out of I43 cases of leukaemia studied pathologically. The clinical picture has been well described by Duke-Elder (1966). Iris infiltration may be either nodular or diffuse. Nodules are ill defined and extend up to the pupil margin. Diffuse infiltration gives rise to iris discolouration and heterochromia. Vascular congestion is common and rupture leads to hyphaema and bloodstaining. Leukaemic cells in the aqueous are deposited as keratic precipitates and hypopyon which is greyish white. There may be hyphaema overlying hypopyon and it is not surprising that secondary glaucoma is a frequent sequel. A similar picture may occur in the reticuloses. Reese (I 963) found three cases out of I71 with iris involvement. We have found only thirteen cases of iris involvement reported in any detail in the literature, mostly American and French.* Of these, four were cases of leukaemia and nine of reticulosis, such as malignant lymphoma and reticulum-cell sarcoma. No detailed report was found in the British literature. It is proposed to describe in detail the case of a child with bilateral iris involvement in acute lymphoblastic leukaemia and to discuss the significant features in conjunction with thirteen previously published cases.