B-cell acute lymphoblastic leukemia with ophthalmic manifestations supported by live-cell cytology – A series of three cases

Leukemia patients may experience a broad range of eye-related symptoms, some of which can cause significant vision loss. These ocular manifestations may arise either from the direct invasion of leukemic cells or as secondary effects due to blood-related abnormalities. In this report, we describe three known cases of B-cell acute lymphoblastic leukemia identified in a tertiary care center in North-Eastern India during 2024. The patients presented with various eye findings, including chemosis, hypopyon, papilledema, retinochoroidal thickening, optic disc hemorrhages, and Roth’s spots. Clinical and blood test data from all patients were collected prospectively. Tests included peripheral blood smear analysis and live-cell cytology with fluorescent staining to monitor the behavior and activity of leukemic blast cells in real time. Routine eye examinations should be considered essential for all leukemia patients, as ocular signs may be detected even in those without any eye-related symptoms.