LEUKOCORIA DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

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  • LEUKOCORIA
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  • DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS
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  • LEUKOCORIA Congenital Cataract Congenital Cataract Retinoblastoma Retinoblastoma Retinopathy of Prematurity Retinopathy of Prematurity Persistent Hyperplastic Primary Vitreous Persistent Hyperplastic Primary Vitreous Retrolental Fibroplasia Retrolental Fibroplasia Toxocariasis Toxocariasis Toxoplasmosis Toxoplasmosis Incontinentia pigmenti Incontinentia pigmenti Retinal Detachment Retinal Detachment Cytomegalovirus Retinitis Cytomegalovirus Retinitis
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  • 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 An opacity in the crystalline lens, present at the time of birth or appears with in first three months of life
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  • TYPES OF CATARACT CONGENITAL 80-90% CONGENITAL 80-90% TRAUMATIC 10-20% TRAUMATIC 10-20%
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  • SURGICAL ANATOMY SURGICAL ANATOMY Clear Healthy Young Crystalline Lens 4-5mm 9-10mm
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  • INCIDENCE Constitutes 20% of treatable blindness in the world Constitutes 20% of treatable blindness in the world Occurs in 1 in 250 live births Occurs in 1 in 250 live births Maybe unilateral or bilateral Maybe unilateral or bilateral
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  • AETIOLOGY IDIOPATHIC 35% IDIOPATHIC 35% HEREDITARY 25% HEREDITARY 25% INTRA-UTERINE CAUSES 20% INTRA-UTERINE CAUSES 20% MATERNAL INFECTIONS MATERNAL INFECTIONS MALNUTRITION MALNUTRITION PREMATURITY PREMATURITY DRUG INDUCED DRUG INDUCED
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  • AETIOLOGY INBORN ERRORS OF METABOLISM 10% INBORN ERRORS OF METABOLISM 10% GALACTOSEMIA GALACTOSEMIA MANNOSIDOSIS MANNOSIDOSIS FABRYS DISEASE FABRYS DISEASE ASSOCIATED WITH OCULAR ANOMALIES 05% ASSOCIATED WITH OCULAR ANOMALIES 05% MICROPHTHALMIA MICROPHTHALMIA ANIRIDIA ANIRIDIA COLOBOMA COLOBOMA
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  • AETIOLOGY CHROMOSOMAL ABNORMALITIES 03% CHROMOSOMAL ABNORMALITIES 03% DOWNS SYNDROME DOWNS SYNDROME TURNER SYNDROME TURNER SYNDROME TRISOMY 13 & 18 TRISOMY 13 & 18 BIRTH TRAUMA 02% BIRTH TRAUMA 02%
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  • STRUCTURE OF AN INFANT LENS Embryonic Nucleus Embryonic Nucleus Foetal Nucleus Foetal Nucleus Infantile Nucleus Infantile Nucleus Cortex Cortex Capsule 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 cornea lens Aqueous
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  • CLINICAL FEATURES CLINICAL FEATURES White pupillary reflex White pupillary reflex Poor Visual Acuity Poor Visual Acuity Nystagmus Nystagmus
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  • CLINICAL EVALUATION Purpose: To know: Purpose: To know: 1.Cataract density 2.Type of cataract 3.Condition of retina and optic nerve 4.Any associated ocular anomaly Steps: Steps: 1. Torch examination 1. Torch examination 2. Examination under Anesthesia 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 TORCH screening Blood Complete picture Blood Complete picture Blood Glucose levels Blood Glucose levels Urine: Urine: Routine examination Routine examination Reducing substances Reducing substances
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  • VISUAL FUNCTION EVALUATION Visual Acuity Visual Acuity Follows light or not Colour targets Reaction to occlusion Pupillary Reflexes Pupillary Reflexes Fixation Reflex Fixation Reflex Visual Evoked Responses (VER) Visual Evoked Responses (VER)
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  • RETINOBLASTOMA
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  • MANAGEMENT SURGERY is the only solution whenever indicated INDICATIONS OF SURGERY INDICATIONS OF SURGERY Very Dense Cataract Moderately Dense Cataract Mild Cataract (Central)
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  • SURGICAL TECHNIQUES BEFORE 18 MONTHS BEFORE 18 MONTHS Lensectomy with Anterior Vitrectomy Simple Lens Aspiration AFTER 18 MONTHS AFTER 18 MONTHS Extracapsular Cataract Extraction with Posterior Chamber IOL Phacoemulsification with Posterior Chamber IOL Secondary IOL
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  • 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) 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 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 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 Mental retardation, deafness, kidney disease, heart disease, and metabolic disorders may be part of the presentation
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  • THANK YOU