leukocoria differential diagnosis differential diagnosis

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Page 1: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS
Page 2: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

LEUKOCORIA

Page 3: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

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

Page 5: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

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

Page 10: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

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

Page 14: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

AETIOLOGY

INBORN ERRORS OF METABOLISM 10%

GALACTOSEMIA MANNOSIDOSIS FABRY’S DISEASE

ASSOCIATED WITH OCULAR ANOMALIES 05%

MICROPHTHALMIA ANIRIDIA COLOBOMA

Page 15: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

AETIOLOGY

CHROMOSOMAL ABNORMALITIES 03%

DOWN’S SYNDROME TURNER SYNDROME TRISOMY 13 & 18

BIRTH TRAUMA 02%

Page 16: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

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)

Page 33: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

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

Page 34: LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

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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THANK YOU