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