Differentials Of Leukocoria PDF

DIFFERENTIALS OF LEUKOCORIA 23  WHAT IS LEUKOCORIA? -appearance of white pupil typically seen in flash photography 24 LEUKOCORIA DIFFERENTIALS o Strabismus...

DIFFERENTIALS OF LEUKOCORIA 23  WHAT IS LEUKOCORIA? -appearance of white pupil typically seen in flash photography 24 LEUKOCORIA DIFFERENTIALS o Strabismus o Myelinated NFL o Anisometropia o Coloboma o Congenital Cataract o Retinopathy of prematurity o Persistent Fetal Vasculature o Incontinentia Pigmenti o Retinoblastoma o Cytomegalovirus o Retinal Detachment o Norrie’s disease o Coats disease o Morning glory disc anomaly o Toxocariasis o Toxoplasmosis 25  Etiology Prevalence: unknown = inherited = syndrome/systemic- related Unilateral cases mostly unknown etiology CONGENITAL Inherited: usually bilateral with no systemic conditions CATARACT Intrauterine infections PHPV (and other ocular abnormalities) Metabolic disorders Chromosome abnormalities and syndromes Trauma Drugs 26 SIGNS/SYMPTOMS Opacity of lens at birth May be… Isolated or associated with systemic Leukocoria condition Congenital or acquired Inherited or Nystagmus – one or both eyes sporadic Unilateral or bilateral Strabismus Partial or complete Deprivation Amblyopia if >3mm Stable or progressive No APD 27 TREATMENT Cataract Extraction Within days to weeks Treat amblyopia following surgery Contact lenses – SilSoft (B&L) vs. IOL* Glaucoma Investigate and diagnose possible etiology, treat or refer for any underlying disorders If cataract not visually significant – monitor 28  INFANT APHAKIATREATMENT STUDY (IATS) Unilateral Cataract CL vs. IOL VA checked at 1 y/o and 4.5 y/o No significant difference in vision between groups at either age About half of children in both groups were able to get 20/200 or better in treated eye More complications in IOL group, required more surgeries About 1/3 of both groups developed glaucoma or were suspects Most surgeons prefer CL Cost: surgery with IOL implant is 7% more expensive, however patient costs are more than double in the CL group -this study looked at infants with aphakia wearing a CL or putting an IOL and wanted to see what happened with any complications -end result: vision was the same in both conditions but wasn’t 20/20 -most surgeons will choose the CL route 29  PERSISTENT HYPERPLASTIC PRIMARY VITREOUS (PHPV) o Failure of primary vitreous to regress o Usually unilateral o Fibrous tissue adhering to back of lens o Often vascularized o Can cause vascular traction o Shallow anterior chamber o Microphthalmos o Cataract o Persistent hyaloid artery -failure of the hyaloid system during embryology -in some kids there is failure of apoptosis due to a genetic abnormality so there’s no regression of the system -typically the child will have poor vision 30 31  PHPV TREATMENT Surgical Visual Outcomes Cataract extraction with IOL Vitrectomy 20/50 or better à 12.6% Removal of embryonic remnants 20/70 to 20/200 à 11.5% Conservative 20/300 to LP à 46% No surgery, poor visual NLP à 29.9% prognosis -LP: light perception 32 RETINOBLASTOMA Most common pediatric neoplasm Hereditary in 25% of cases à bilateral Presenting signs: Leukocoria (56%) Strabismus (20%) Red painful eye with glaucoma (7%) Poor vision (5%) 33  RETINOBLASTOMA Genetic counseling Treatment Chemotherapy Intra-arterial chemotherapy Radiation therapy Laser therapy Cryotherapy Enucleation Often fatal if tumor spreads beyond the eye -pic shows intra arterial chemotherapy to directly give chemotherapy to the one eyeball that has tumor 34 RETINAL DETACHMENT Most common cause within the pediatric population is trauma Other causes: o Proliferative retinopathy o Myopia o Aphakia o ROP o Lattice 35 36  COAT’S DISEASE Peripheral retinal telangiectasia with associated exudation Can lead to serous retinal detachment May present as leukocoria in young children More common in males Usually unilateral -usually happens in boys -lots of exudation in the eye -idiopathic and not systemic -also termed xanthocroia 37 7 Y0 M WITH NON- SPEAKING AUTISM, C/O LONGSTANDING CLXT 38  TOXOCARIASIS Caused by ingestion of Toxocara canis/catii parasite Retinal granuloma associated with severe inflammation Unilateral No effective treatment -when the worm dies, your body responds with inflammation 39 THE CULPRITS 40  MYELINATED NERVE FIBERS o Superficial, white retinal lesion with feathery borders o Unilateral but can be bilateral o Vision loss uncommon, unless macula is affected o If VA is decreased, high myopia is often present o Produces scotoma -if there is vison loss it may be due to lots of area of myelination 41 MYELINATED NFL 42  COLOBOMA Incomplete closure of embryonic optic fissure Most commonly located in inferior nasal part of optic disc Amount of vision loss depends on size and location Increased risk of retinal detachment over coloboma Part of CHARGE -can have a eyelid coloboma as well in superficial eyelid -those who have retinal coloboma have an increased chance of having retinal detachment -CHARGE à Coloboma, Heart defects, Atria, Retardation of Growth, Ear development 43 COLOBOMA 44 COLOB OMA 45