Ocular manifestations and factors associated with haematological malignancies at two tertiary hospitals in Tanzania

Abstract

Backgroud: Ocular involvement in haematological malignancy may profoundly affect the visual outcome of
survivors, although little about this is known in our setting. Haematological malignancies include lymphoma,
leukemia, and multiple myeloma. Ocular manifestations may be the initial diagnostic symptoms or the earliest identifiers for relapse or progression of haematological malignancies. Ocular involvement can result from direct malignant infiltration or indirect sequel of haematological cellular derangement.
Objective: This study aims to determine the burden of ophthalmic manifestations, describe the manifestations and the factors associated with haematological malignancies among patients attending Muhimbili National Hospital (MNH) and Ocean Road Cancer Institute (ORCI) in Dar es Salaam.
Methods: Hospital-based cross-sectional study at MNH and ORCI from June 2021 to January 2022. Patients who met the inclusion criteria were recruited consecutively. Data analysis was done with SPSS version 23.
Results: A total of 99 patients with haematological malignancies were recruited, 61.6% were males. The age
range was 2 to 77 years with a mean age of 29 years. Two-thirds (61.6%) of the participants had ophthalmic
manifestations. Posterior segment manifestations were the most common with roth spots (31.1%) and
intraretinal haemorrhage (21.0%) as the most frequent presentations. Vision-threatening manifestations such as sub-hyaloid haemorrhage and optic nerve swelling were present in 6.7% and 11.1% of patients respectively. Direct infiltration was present in 15.15% of the patients. Low haemoglobin level was the statistically significant factor associated with ocular involvement among the study participants.
Conclusion: The prevalence of ophthalmic manifestations of haematological malignancies at MNH and ORCI
was significantly high. Roth spots and intraretinal haemorrhages were the most common manifestations. Direct malignant ocular infiltrations were present in a few patients. Patients with haemoglobin level of 8g/dl or less had four times increased odds of having ocular manifestations. A comprehensive ophthalmic exam needs to be done for all patients with haematological malignancies for early detection and intervention.