Download - Morning Discussion Leukokoria
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Morning DiscussionMorning Discussion
LeukokoriaLeukokoria
Naila Izzati
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- Leukokoria (white pupil) can be defined byabnormal pupilary light reflex that usuallyresulted from intraocular abnormality.
- Itis more commonly seenin children. One-half ofthe cases is caused byRetinoblastoma. Therefore routine screeningshould be done in children < 2 years old.
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RETINOBLASTOMARETINOBLASTOMA
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y Primary eye tumor that commonly affectedchildren.
y Itis a rapidly developing cancer whichdevelops inthe cells of retina.
y Inthe developed world, Rb has one ofthe
best cure rates ofall childhood cancers (95-98%), with more thannine out of every tensufferers survivinginto adulthood.Retinoblastomais a very treatable cancer.
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y Retinoblastomais caused by a mutationin
agene controlling cell division, causingcells to grow out of controland becomecancerous.
y In most ofthe cases the mutationispresentin several family members.
y The cancer generally affects children
under the age of 6. Itis most commonlydiagnosed in childrenaged 1 - 2 years.
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Endophytic growthy E
ndophytic growth occurs whenthe tumorbreaks throughthe internallimitingmembrane and has an ophthalmicappearance ofawhite-to-cream massshowing either no surface vessels or small
irregular tumor vessels
Exophytic growthy Exophytic growth occurs inthe subretinal
space. This growth patternis oftenassociated with subretinal fluidaccumulationand retinal detachment.
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SymptomsSymptoms
y One or both eyes may be affected.They pupil may appear white or have white spots.
y Other symptoms caninclude:y Crossed eyesy Double visiony Eyes that do notalign
y Eye painand rednessy Poor visiony Differing iris colors in each eyey Ifthe cancer has spread, bone painand other
symptoms may occur.
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Strabismus+leukokoriaStrabismus+leukokoria
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funduskopyfunduskopy
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TreatmentT
reatment
y Treatment options depend uponthe size and locationofthe tumor.
y Smalltumors may be treated by laser surgery orcryotherapy.
y Radiationis used for bothlocaltumor and for largertumors.
y Chemotherapy may be needed ifthe tumor hasspread beyond the eye.
y The eye may need to be removed (a procedure calledeucleation)ifthe tumor does not respond to other
treatments. In some cases, it may be the firsttreatment.
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PrognosisPrognosis
y Ifthe cancer has not spread beyond the
eye, almostall patients can be cured. Acure, however, may require aggressivetreatmentand even removal ofthe eye inorder to be successful.
y Ifthe cancer has spread beyond the eye,the likelihood ofa cure is lower anddepends onhowthe tumor has spread.
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CONGENITALCONGENITAL
CATARACTCATARACT
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y A congenital cataract is clouding ofthelens ofthe eye, thatis presentat birth.
y The number of people bornwith cataractsis low. In most patients, no specific cause
can be found.P
ossible causes ofcongenital cataracts include the following:
y Chondrodysplasia syndrome
y Congenital rubella
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SymptomsSymptoms
y Cloudiness ofthe lens thatlooks like awhitespotinan otherwise normally dark pupil --
often obvious at birthwithout special viewingequipment
y Failure ofaninfantto show visualawareness
ofthe world around him or her (if cataractspresentin both eyes)
y Nystagmus (unusual rapid eye movements)
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TreatmentTreatment
y In some cases, congenital cataracts are mild anddo notaffect vision, and these cases require no
treatment.
y Moderate to severe cataracts thataffect visionwill require cataract removal surgery, followed byplacement ofanartificialintraocular lens (IOL).Patchingto force the child to use the weaker eye
may be required to preventamblyopia.
y Treatment for any underlying disorder may alsobe needed.
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RETINAL DYSPLASIARETINAL DYSPLASIA
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y Retinal dysplasiais a retinal malformationwhichis characterized by Rosette formation,
retinal foldingand retinal detachment
y Often diagnosed in children below 1 y.opresentingwith congenital pink or white
retrolental membrane ina microcephalic eye,witha shallowanterior chamber andelongated ciliary processes.
y Bilateralinvolvement may be associated with
Norrie disease, Patau and Edwardsyndromes.
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OCULAROCULAR
TOXOCARIASISTOXOCARIASIS
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y Toxocariasis is caused by infestationwithToxocara canis, a commonintestinal
roundworm of dogs and cats.
y Ingestion of soil or food contaminated withova shed inthe faeces
y Affectliver, lungs, skin, brainand eyes->OLM
y Death ofthe larvainitiate inflmmatoryreaction -> usually unilateral
y Treatment for OLM:Peri-ocular or systemiccorticosteroid injection,Vitrektomy.
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y Ocular larva migrans Clinical manifestation:x Reduce visionx Leukocoria
x Strabismus
x Paininthe eye
x Endophtalmitis
x Uveitis
x Vitreus abses
x Optic neuritis
Rarely found
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RETINOPATY OFRETINOPATY OF
PREMATURITYPREMATURITY
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y Retinopati proliferatif
y Preterm baby terpapar oksigen jenuh
konsentrasi tinggiy History of prematur, berat lahir rendah
y Retina : tidak ada pembuluh darah sampai usia gestasi 4 bulan
Pembuluh darah berkembang dari diskus optikus ke
perifer Mencapai perifer bagian nasal usia gestasi 8 bulan
Mencapai perifer bagian temporal 1 bulan setelahkelahiran
Vaskularisasi retina bagian temporal yangtidak komplit rentan terhadap kerusakan yang disebabkan olehoksigen
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Screening : Born < 36 weeks Oxygen exposure
Body weight < 1500gram
Treatmenty Ablasio retinaimatur avaskuler
Crioterapy
Laser photocoagulationy Scleral Buckling
With or without vitrektomi pars plana For traction retinalablation Improvementin visionnot quite statisfactory
y Vit E
Protect spindle cell from free radical
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PHPV (persistentPHPV (persistenthyperplastichyperplastic primaryprimary
vitreous)vitreous)
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y Kegagalan regresi vitreus primery Sangat menyerupai retinoblastomay
Untuk membedakannya dilakukan CT scan: tidak terdapat kalsifikasi dan terdapathipoplastik bola mata pada mata yangterkena
y Hasil CT scan : infiltrasi jaringan lunak pada badan kaca
jaringan lunak retrolental ketiadaan kalsifikasi abnormal dalam orbita Microphthalmus retrohyaloid layered blood hipervaskularisasi badan kaca.
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Tipe :
y PHPV anterior Mikroftalmus 90% unilateral Retrolental mass, elongated cilliary process melibatkan kapsul posterior katarak
Tatalaksana :x Pengangkatan retrolental mass, cataractous lens
y PHPV posterior Jarang white dense opaque membrane, prominent non-
opaque retinal fold keluar dari diskus optikus keretina perifer Terbanyak : inferior
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THANK YOUTHANK YOU
Refferences
y Fredrick DR. Special subjects of pediatric interest. In: Vaughan D,
Asbury T, Riordan-EvaP, editors. General ophthalmology. 15th ed.Stanford: Prentice HallInternational. 1999. pp.336-8.y Alex V. Levin MD, MHSc, FRCSC Department of Ophthalmology
The Hospital for Sick Children University of Torontoy Jack J. Kanski, Clinical Ophthalmology: A systematic approach,
5th Edition.y Smirniotopoulos JG, Bargallo N, Mafee MF. Differential diagnosis
ofleukokoria: radiologic-pathologic correlation. RadioGraphics1994; 14(9): 1059-79.y Harper RA, Shock JP. Lens. In: Riordan-EvaP, Whitcher JP,
editors. Vaughan & Asburys General Ophthalmology. 2004.Boston: McGrawHill. p:174-7