LEUKOCO

RIA
Diska Astarini
I11109083

DEFINITION
Leukocoria
A white pupillary reflex (leukos:
white, kore: pupil), pink-white, or
yellow-white pupillary reflection.
Normal reflex red reflex

Normal red reflex

Leukocoria bilateral

Leukocoria unilateral

Clinical
differentials?

Leucocoria
TUMOR
Retinoblastoma (most common cause-58%)

DEVELOPMENTAL
Persistent hyperplastic primary vitreous
(2nd most common cause--28%)

Coats disease (16%)

Retrolental fibroplasia (3--5%)

 INFECTION
Larval granulomatosis (16%)

DEGENERATIVE
cataract

TRAUMA
Retinopathy of prematurity (5%)
Long-standing retinal detachment

RETINOBLASTOMA
Retinoblastoma
is
the
most
common intraocular malignant
neoplasm of childhood affecting
1:20,000 to 1:34,000 children.
The
tumor
occurs
most
frequently within the first 2
years of life and may even be
found at birth.
Signs: leukocoria, strabismus,
poor
vision,
spontaneous
hyphema, or a red, painful eye.

RETINOBLASTOMA
A

RETINOBLASTOMA
A

RETINOBLASTOMA
Treatment option:
Intravenous chemotherapy
Enucleation
Radiation therapy
Lasertherapy
Cryotherapy

RETINOBLASTOMA - Chemotherapy

PRETREATMENT

Same lesion after

two cycles of
chemotherapy

TOXOCARIASIS
Toxocariasis

a
nematode
infection (Toxocara canis)
Retinal damage is the result of the
host's
inflammatory
response
(severe eosinophilic reaction) that
becomes granulomatous
The patient may have a history of
contact with puppies or eating
dirt.

TOXOCARIASIS
Present :
Occular symptoms : redness,
photophobia & pain.
Leukocoria, strabismus, decreased
vision, floaters.
Ophthalmic physical examination :
A
large
peripheral
(anterior)
retinal or choroid inflammatory
mass,
associated
with
a
vitreoretinal reaction secondary
retinal detachment.

TOXOCARIASIS

A white intravitreous mass of a

toxocaral eosinophilic granuloma

CATARACT
Cataract any opacity in the lens
Factors : aging, trauma, toxins,
systemic
disease
(such
as
diabetes), smoking, and heredity.
Childhood congenital cataract
sign :
leukocoria
absent red pupillary reflex
abnormal eye movements
(nystagmus)
Strabismus

COATS DISEASE
Congenital
retinal
telangiectasis
(Coats' disease) is an idiopathic
retinal vascular disorder that usually
affects
young
male
patients
unilaterally in their first or second
decade of life. No tumor mass.
Retinal telangiectasia.
Retinal capillary nonperfusion.
Dilated intercapillary spaces.
Lipid exudate.
Subretinal fluid
Retinal detachment

COATS DISEASE
A

A. Coats disease in children

B. vascular
abnormalities
with
aneurysmal
dilatation,
telangiectasia, exudation, and
severe lipid deposition in the

COATS DISEASE - Treatment

Photocoagulation Obliterate
Cryotherapy
telangiectasia
Enucleated
severe

later stage

RETINOPATHY OF PREMATURITY
(ROP)

Retinopathy of
prematurity (ROP) was
formerly known as
retrolental fibroplasia.

Disorder of the
developing retinal
vasculature resulting
from interruption of
normal progression of
newly forming retinal
vessels.

Occurs in the
incompletely

RISK FACTORS

prematurity / low gestational age < 30 weeks

Low birth weight
Hyperoxia / Hypoxia
High Light exposure
Vitamin E deficiency

Postnatal sepsis
Mechanical ventilation

RETINOPATHY
OF PREMATURITY (ROP)
LOCATION
zone 1 centred on
disc, 2x disc
to fovea
distance
zone 2 - outer
limit equator
temporally,
ora nasally
zone 3 temporal
peripheral
crescent

RETINOPATHY
OF PREMATURITY (ROP)
Treatment :
Laser photocoagulation
Cryotherapy
Vitrectomy surgery

STENT HYPERPLASTIC PRIMARY

OUS (PHPV)
Persistent

hyperplastic
primary
vitreous (PHPV) is a congenital
anomaly in which the primary
vitreous fails to regress in utero.
Highly vascular mesenchymal tissue
nurtures the developing lens during
intrauterine life. In PHPV, the
mesenchymal tissue (fibrovascular)
forms a mass behind the lens.
A gray-yellow retrolental membrane
may produce leukocoria, with the
subsequent
suspicion
of

PERSISTENT HYPERPLASTIC
PRIMARY
VITREOUS
(PHPV)
Sign :
Leukocoria
Small eye (microphthalmia)
Episodes of intraocular
(intravitreous) hemorrhage.
Retinal detachment
traction from fibrovascular
mass.

NORRIES DISEASE
Norrie disease, or the progressive
oculoacousticocerebral degeneration
of Norrie, is a rare, X-linked recessive
heritable disorder characterized by
bilateral leukocoria caused by retinal
detachment.
Affected boys classically have a triad
of blindness, deafness, and mental
retardation. Apparent at birth or in
early infancy, the ocular findings
usually progress to phthisis bulbi.

RETINAL DETACHMENT
A
retinal
detachment
(RD)
describes the separation of the
neurosensory retina (NSR) from
the retinal pigment epithelium
(RPE) caused by a breakdown of
the forces that attach the NSR to
the RPE.
Toxocariasis,
PHPV,
Coats disease

ROP,

RETINAL DETACHMENT
Treatment:
Cryotherapy
laser photocoagulation using a
slit-lamp delivery system and
laser using the indirect
ophthalmoscopic delivery system
combined with scleral indentation.

CONCLUSION

THANK
YOU

QUESTION ?