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Ocular complications are not uncommon with the use of Vincristine (VCR), but usually consist of ophthalmoplegias. A single case of optic neuropathy, presumably caused by VCR, has been reported in a patient with Hodgkin's disease.' The purpose of this communication is to report two cases of unilateral optic neuropathy in children with acute lymphatic leukemia (ALL) undergoing combined maintenance chemotherapy which included Vincristine.
CASE REPORTS
Patient No. 1
This 7-year-old female was diagnosed as having ALL on September 15, 1972. Initial therapy consisted of L-asparaginase, four weekly doses of Vincristine and 28 days of Prednisone. Remission of the leukemia was achieved. Following central nervous system leukemic prophylaxis with a series of six intrathecal Methotrexate injections, maintenance chemotherapy was begun which consisted of daily six Mercaptopurine (90 mg/sq m/day, po) and Methotrexate (15 mg/sq m/week, po) and every three months Vincristine (2.0 mg/sq m, maximum dose 2 mg given IV weekly x 2 doses) and Predisone (40 mg/sq m/day x 14 days po).
On June 17, 1976, six days following an injection of Vincristine, the patient began to complain of severe right-sided retrobulbar eye pain. Ophthalmologic examination on that day indicated a visual acuity in each eye of 20/25 without refractive correction. There was no evidence of external or internal eye disease. The eye pain subsided over a five-day period. Maintenance chemotherapy was discontinued in October 1977.
At a fol low- up visit on November 28, 1 977, physical examination revealed a visual acuity of 20/70 in the right eye and 20/20 in the left eye. The visual deficit was not improved with refraction. A unilateral color defect was found in the right eye using the pseudoisochromatic color plates. A positive MarcusGunn pupil in the right eye was noted. Amsler grid and tangent screen exam indicated a central scotoma with white test objects. Fundi examination with direct and indirect ophthalmoscopy showed normal optic discs and retina. When seen again one and three months later, the child exhibited no change in these physical findings. Then, on an examination in August 1978, vision in the right eye had spontaneously improved to 20/40 and the previously noted MarcusGunn pupil was absent.
The child had been removed from all leukemic chemotherapy and has remained in a continuous first remission...