Introduction: Visual impairment as the initial symptom of leukemia is rare. Although retinal involvement during leukemia is frequent, a leukemic macular 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 hemorrhage 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 as T-cell-type acute lymphocytic leukemia (ALL). Chemotherapy was given immediately and general improvement of ALL was observed. Eleven months after the 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 paramacular pigment clumping.
Conclusion: Because of the differentiated and improved therapy schemata available now, e.g., the ALL-BFM 95 protocol, ALL can be cured more frequently. The prognosis, however, is essentially dependent on early diagnosis. By being familiar with the corresponding ocular findings, an ophthalmologist can contribute to this.