Optical Coherence Tomography Features of Retinal Leukemic Infiltrates and Their Association With Visual Prognosis

Purpose: To describe the optical coherence tomography (OCT) features of retinal leukemic infiltrates and determine their association with visual and systemic prognosis in leukemic retinopathy. Methods: A retrospective, cross-sectional multicenter study was conducted on patients diagnosed with leukemia from January 2016 to December 2024 who had OCT imaging at presentation. Demographic, clinical, and OCT data were reviewed. Univariate and multivariate regression analyses were performed to identify OCT biomarkers associated with poor visual and systemic outcomes. Results: Seventy-seven eyes of 47 patients (mean age, 41.7 ± 21.75 years; 83% male) were included. Bilateral involvement was present in 70% of patients. Acute lymphocytic leukemia was the most common subtype (53%), followed by chronic myeloid leukemia (25%). Leukemic infiltrates were identified in 39% of eyes, most frequently within the inner retinal layers (70%), with preservation of the retinal pigment epithelium. On univariate regression, cystoid macular edema (CME) (odds ratio [OR], 0.114; 95% CI, 0.014-0.932; P = .043) and ellipsoid zone (EZ) loss (OR, 3.882; 95% CI, 1.289-11.692; P = .016) were significantly associated with visual outcome. Multivariate regression confirmed CME (OR, 0.022; 95% CI, 0.008-0.687; P = .022) and EZ loss (OR, 5.598; 95% CI, 1.571-19.943; P = .008) as independent predictors of poor vision. Infiltrate location, size, and configuration were not associated with visual prognosis. Conclusions: Retinal leukemic infiltrates predominantly involve the inner retinal layers. CME and disruption of the EZ are key OCT biomarkers predictive of poor visual outcome, irrespective of leukemia subtype or infiltrate morphology.