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‫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.
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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 ELISA
7- Anterior chamber paracentesis
8-EUA
NOTE :
• Anterior chamber paracentesis
in a patients with a
retinoblastoma can possibly led
to tumor cell dissemination