morning discussion leukokoria

8/3/2019 Morning Discussion Leukokoria

1/35

Morning DiscussionMorning Discussion

LeukokoriaLeukokoria

Naila Izzati


2/35

- 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.


3/35


4/35


5/35


6/35

RETINOBLASTOMARETINOBLASTOMA


7/35

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.


8/35

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.


9/35

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.


10/35

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.


11/35

Strabismus+leukokoriaStrabismus+leukokoria


12/35

funduskopyfunduskopy


13/35


14/35

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.


15/35

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.


16/35

CONGENITALCONGENITAL

CATARACTCATARACT


17/35

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


18/35


19/35

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)


20/35

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.


21/35

RETINAL DYSPLASIARETINAL DYSPLASIA


22/35

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.


23/35

OCULAROCULAR

TOXOCARIASISTOXOCARIASIS


24/35


25/35

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.


26/35

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


27/35

RETINOPATY OFRETINOPATY OF

PREMATURITYPREMATURITY


28/35

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


29/35

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


30/35


31/35

PHPV (persistentPHPV (persistenthyperplastichyperplastic primaryprimary

vitreous)vitreous)


32/35

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.


33/35

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


34/35


35/35

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

morning discussion leukokoria

Documents