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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. • • • • • • • • 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