بنام خداوند بخشنده مهربان
Gh.Naderian M.D Isfahan University of Medical Scinces
Department of Opthalmology
leukocoria
Leukocoria
•Definition : A white pupillary reflex
•Leukocoria in a child requires urgent attention , primarily because in most patients with retinoblastoma it is the
first sign noticed .
•Secondarily , a white pupil indicates a severely amblyopiogenic condition , which may be treatable .
•Anatomic location is important in the diffential diagnosis of Leukocoria .
•Normally , only the lens is found immediately behind the pupil , so an opacity here indicates a cataract .
•Advanced cases of persistent hyperplastic primary vitreous (PHPV)/persistent fetal vasculature (PFV) can also present with a posterior or total cataract.
•A cataract dose not exclude other causes of leukocoria . Therefore thoroughly examine the remainder of the eye.
•Cells or clumps in the vitreous indicate hemorrhage , infection , or tumor.
•Calcium in a retinal mass is highly typical for retinoblastoma, although not entirely pathognomic .
•Chorioretinal colobomas vary from very small to encompassing most of the fundus and optic nerve.
•Causes of Retinal Detachment in Children
•■ Retinopathy of prematurity•■ Systemic diseases•Incontinentia pigmenti•Familial exudative vitreoretinopathy•■ Trauma•■ Toxocara•■ Coat’s disease
Work –up
1- History 2- Complete ocular examination 3- B Scan ultrasonoghraphy 4- Intravenous fluorescein angiogram (coats disease , ROP, retinoblastoma )5- CT or MRI 6- Serum ELISA7- Anterior chamber paracentesis 8-EUA
NOTE :
•Anterior chamber paracentesis in a patients with a retinoblastoma can possibly led to tumor cell dissemination