leukocoria
DESCRIPTION
LEUKOCORIA. DIFFERENTIAL DIAGNOSIS. LEUKOCORIA. Congenital Cataract Retinoblastoma Retinopathy of Prematurity Persistent Hyperplastic Primary Vitreous Retrolental Fibroplasia Toxocariasis Toxoplasmosis Incontinentia pigmenti Retinal Detachment Cytomegalovirus Retinitis. - PowerPoint PPT PresentationTRANSCRIPT
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LEUKOCORIA
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DIFFERENTIAL DIAGNOSIS
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LEUKOCORIA Congenital Cataract Retinoblastoma Retinopathy of Prematurity Persistent Hyperplastic Primary
Vitreous Retrolental Fibroplasia Toxocariasis Toxoplasmosis Incontinentia pigmenti Retinal Detachment Cytomegalovirus Retinitis
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RETINAL DETACHMENT WITH A MITTENDORF SPOT
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PERSISTENT HYPERPLASTIC PRIMARY VITREOUS
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TOXOPLASMOSIS
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RETROLENTAL FIBROPLASIA
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CONGENITAL CATARACT
An opacity in the crystalline lens, present at the time of birth or appears with in first three months of life
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TYPES OF CATARACT
CONGENITAL 80-90%
TRAUMATIC 10-20%
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SURGICAL ANATOMY
Clear Healthy Young Crystalline Lens
4-5mm
9-10mm
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INCIDENCE
Constitutes 20% of treatable blindness in the world
Occurs in 1 in 250 live births Maybe unilateral or bilateral
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AETIOLOGY
IDIOPATHIC 35% HEREDITARY
25% INTRA-UTERINE CAUSES
20% MATERNAL INFECTIONS MALNUTRITION PREMATURITY DRUG INDUCED
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AETIOLOGY INBORN ERRORS OF METABOLISM
10% GALACTOSEMIA MANNOSIDOSIS FABRY’S DISEASE
ASSOCIATED WITH OCULAR ANOMALIES 05%
MICROPHTHALMIA ANIRIDIA COLOBOMA
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AETIOLOGY
CHROMOSOMAL ABNORMALITIES 03%
DOWN’S SYNDROME TURNER SYNDROME TRISOMY 13 & 18
BIRTH TRAUMA 02%
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STRUCTURE OF AN INFANT LENS
Embryonic Nucleus
Foetal Nucleus Infantile
Nucleus Cortex Capsule
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EMBRYONAL NUCLEAR CATARACT
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NUCLEAR CATARACT
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CORTICAL CATARACT
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CORONARY CATARACT
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LAMELLAR (ZONULAR) CATARACT
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SUTURAL (STELLATE) CATARACT
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ANTERIOR CAPSULAR CATARACT
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ANTERIOR POLAR CATARACT
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POSTERIOR POLAR CATARACT
cornealens
Aqueous
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CLINICAL FEATURES
White pupillary reflex Poor Visual Acuity Nystagmus
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CLINICAL EVALUATION Purpose: To know:
1. Cataract density2. Type of cataract3. Condition of retina and optic nerve4. Any associated ocular anomaly
Steps: 1. Torch examination 2. Examination under Anesthesia
– Ophthalmoscopy direct / indirect
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PAEDIATRIC CONSULTATION
– Dysmorphic features or suspicion of associated systemic diseases
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LABORATORY INVESTIGATIONS
TORCH screening Blood Complete picture Blood Glucose levels Urine:
Routine examination Reducing substances
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VISUAL FUNCTION EVALUATION
Visual Acuity– Follows light or not– Colour targets– Reaction to occlusion
Pupillary Reflexes Fixation Reflex Visual Evoked Responses (VER)
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RETINOBLASTOMA
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MANAGEMENT
SURGERY is the only solution whenever indicated
INDICATIONS OF SURGERY
– Very Dense Cataract – Moderately Dense Cataract – Mild Cataract (Central)
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SURGICAL TECHNIQUES BEFORE 18 MONTHS
–Lensectomy with Anterior Vitrectomy
– Simple Lens Aspiration AFTER 18 MONTHS
– Extracapsular Cataract Extraction with Posterior Chamber IOL
– Phacoemulsification with Posterior Chamber IOL
– Secondary IOL
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LID SPECULUM INSERTED
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BRIDLE SUTURE
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INCISION
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METICULOUS DRAPPING
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ANTERIOR CAPSULOTOMY
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LENS ASPIRATION
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ANTERIOR VITRECTOMY
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WOUND CLOSURE
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STITCHES APPLIED
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MANAGEMENT OF APHAKIA
SPECTACLES (Bilateral Aphakia) CONTACT LENSES (Before 2
years / Unilateral aphakia) INTRAOCULAR LENS
IMPLANTATION (18 months onwards)
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PROGNOSIS Encouraging results in bilateral
cases (before 03 months)
Not very encouraging results in unilateral cases unless the cataract is removed very early, with in first few weeks of life
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PROGNOSIS
Visual morbidity may result from deprivation amblyopia, refractive amblyopia, glaucoma (10% post surgical removal), squint, secondary cataract and retinal detachment
Mental retardation, deafness, kidney disease, heart disease, and metabolic disorders may be part of the presentation
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