Neuro-Ocular manifestations as the primary presenting symptoms of acute promyelocytic leukemia and their outcome:- An experience from a teritiary care centre.

Aim: 1. To highlight the importance of early recognition of neuroocular manifestations in acute promyelocytic leukemia in order to intervene urgently and to prevent additional morbidity and mortality related to the disease. 2. To compare the outcome in patients presenting with neuro-ocular complications versus those patients who had no neuro-ocular complications. Materials and Methods: This study is a retrospective study where in we evaluated 86 cases of acute promyelocytic leukemia diagnosed and treated over a period of 10 years.The evaluation comprised of finding usual symptoms and especially to segregate those cases who had neuroocular manifestations as their primary presenting symptom. Results In our study we found that out of 86 cases of acute promyelocytic leukemia, 16 cases had neuro-ocular manifestations as their primary presenting symptom. Median age in our patients was 33 years with male: female ratio of 0.7:1. 16 cases out of total 86 cases presented with neuro-ocular manifestations. All patients were started on ATRA as per IC-APL 2006 protocol except two patients out who were not eligible for ATRA were put on arsenic trioxide. In addition aggressive supportive care was provided. When we compared patients with neuro-ocular with patients without neuro-ocular manifestations, It was found that overall survival was lower in those who presented with neuro-ocular manifestations as compared to those without neuro-ocular manifestations. The morbiditiy was also more in those with neuroocular manifestations . Conclusion: In all patients presenting with neuroocular bleeds ,acute promyelocytic leukemias should be considered as one of the possibilities. In addition theses patients should be managed more aggressively in terms supportive care.