Adult T-Cell LeukemiaPresenting with Episcleritis andSecondary Glaucoma

摘要

Adult T-cell leukemia (ATL) results from infection by the human T-cell lymphotrophic virus type 1 (HTLV-1), and the major ocular manifestations are opportunistic infection and infiltrative lesions by leukemic cells. Episcleritis is a rare ocular manifestation of ATL.We treated an ATL patient who presented with episcleritis and the complication of secondary glaucoma.A 64-year-old woman had suffered for 1 month from headaches and conjunctivitis in both eyes that were resistant to the 0.02% fluorometholone and levofloxacin administered at her neighborhood eye hospital (Fig. la, b). Elevation of intraocular pressure (IOP) in both eyes was found on reekamination. Three days later, she was referred to our hospital. At our initial examination, her visual acuity was 1.0 OU. IOP was 38 mmHg OD and 43 mmHg OS. The conjunctival and episcleral vessels were moderately dilated (Fig. la, b). There was no proptosis, and the eye movements were full. The anterior chamber of both eyes showed normal depth and no inflammatory cells. Gonioscopy showed no abnormalities in either eye. The vitreous, retina, and optic disc of both eyes were normal. The patient had no significant medical history. Goldmann perimetry showed no scotoma and no constriction of the visual fields. From these findings, we suspected that she was a steroid responder with episcleritis and carotid cavernous fistula.