# Clinical characteristics of leukemic optic nerve infiltration in pediatric acute lymphoblastic leukemia: 3 cases and a literature review

## TL;DR

This paper presents three cases of optic nerve infiltration in children with leukemia and reviews how to diagnose and treat this rare but serious condition.

## Contribution

The paper provides a practical framework for managing optic nerve infiltration in pediatric ALL based on new cases and literature.

## Key findings

- Optic nerve infiltration in ALL is a rare but urgent condition requiring early recognition.
- Treatment with chemotherapy and radiation led to varying visual recovery in the cases presented.
- Intensified therapies like CAR T-cell therapy may help in relapse or refractory cases.

## Abstract

Pediatric optic nerve infiltration in acute lymphoblastic leukemia (ALL) is a rare yet critical neuro-ophthalmic emergency, often signaling central nervous system (CNS) involvement or relapse. In this case series we present three cases of optic nerve infiltration in pediatric patients with ALL. The patients underwent systemic chemotherapy, intrathecal chemotherapy, and, in some instances, orbital radiation therapy, leading to varying degrees of visual recovery. In addition to presenting these cases, we review the existing literature and discuss the pathogenesis, clinical features, diagnostic approaches, imaging findings, and treatment strategies for this condition. Based on our cases and prior reports, we outline a practical diagnostic and treatment framework that prioritizes early recognition to reduce the risk of irreversible vision loss. For relapse or refractory disease, intensified therapy may be considered, including chimeric antigen receptor CD19 CAR T-cell therapy and hematopoietic stem cell transplantation. Optic nerve infiltration in ALL requires prompt, coordinated management among hematology, oncology, and ophthalmology specialists. Timely and appropriately intensified treatment may improve visual outcomes and survival.