Systematic review and meta-analysis finds high prevalence of ocular manifestations in leukemia patients

PURPOSE: To evaluate the association between retinal vein occlusion and leukemia. METHODS: A comprehensive literature search was conducted across PubMed, Google Scholar, ScienceDirect, Scopus, and Cochrane Library from inception to October 20, 2025, following PRISMA guidelines and a registered PROSPERO protocol (CRD420251134924). Observational studies reporting ocular findings in leukemia were included. Data extraction and risk of bias assessment were performed independently using the JBI and ROBINS-I tools. Pooled effect sizes were calculated using Comprehensive Meta-Analysis (CMA v4.0), expressed as logit event rates with 95% confidence intervals. Case reports were narratively summarized but excluded from quantitative synthesis. RESULTS: Eight studies encompassing 1,016 participants were included in the meta-analysis. The pooled logit event rate for overall ocular manifestations was -0.3307 (95% CI: -0.456 to -0.206; P < 0.0001), corresponding to a prevalence of 42%. Retinal hemorrhage was the most frequent finding (logit = -1.90; 13%-15%), followed by retinal infiltration (logit = -3.55; 3%) and retinal vein occlusion (logit = -4.41; 1.2%). Heterogeneity was low for infiltration (I 2 = 10.2%) and retinal vein occlusion (I 2 = 0%). CONCLUSION: Ocular involvement occurs in nearly half of patients with leukemia, with retinal hemorrhages and microvascular compromise as dominant manifestations. Although retinal vein occlusion is rare, it signifies advanced hematologic derangement. These findings highlight the importance of routine ophthalmic screening including fundus examination, OCT, and OCTA-as integral components of leukemia management for early detection, systemic correlation, and vision preservation.