Ghanbari MD 13911210 LCA Infant with normal fundus and low vision LCA Stationary night blindness Achromatopsia Immue retinopathy Development of the Retina T he retina develops over a relatively long period of time beginning from the ID: 389519
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Slide1
Approach to pediatric retinal disease
Ghanbari
MD
1391:12:10Slide2
LCASlide3
Infant with normal fundus and low vision
LCA
Stationary night blindness
Achromatopsia Immue retinopathySlide4Slide5Slide6Slide7Slide8Slide9
Development of the Retina
T
he retina develops over a relatively long period of time beginning from the
early gestational period through the first years of life.Slide10Slide11
Artist’s conception of the perceptual
appearance of a
visual scene for infants of different ages.
(a) Newborn, (b) 1 month, (c) 2 months, (d) 3 months, (e)
6 months,
(
f
) adult. (copyright by Tony Young;
used with permission
)Slide12
Electroretinographic Testing in Infants and Children
ERG can be recorded as in preterm infantsSlide13
Retinopathy of Prematurity (ROP)
Signs and symptoms:
Retinopathy of prematurity (ROP) affects low-birth-weight premature infants and can lead to blindness; the incidence of ROP has increased, as smaller and younger babies are surviving.Slide14
ROP Risk factors
:
Birth before 32 weeks' gestation, especially before 30 weeks
Birth weight of less than 1500 g, especially less than 1250 gPossible risk factors include:
Supplemental oxygen,
H
ypoxemia,
H
ypercarbia
, C
oncurrent illness.Slide15
Treatment of ROP
Cryotherapy
Laser surgery
Scleral buckling
Vitrectomy
Anti-VEGFSlide16
Treatment may also be initiated for the following retinal findings:
Zone 1 ROP - Any stage, with plus disease
Zone 1 ROP - Stage 3, with no plus disease
Zone 2 ROP - Stage 2 or 3, with plus diseaseTreatment should generally be accomplished, when possible, within 72 hours of determination of treatable disease to minimize the risk of retinal detachment. Slide17
An Updated Study of the Use of
Bevacizumab
in
the Treatment of Patients with Prethreshold Retinopathy of Prematurity
in
Taiwan.Slide18
FAMILIAL EXUDATIVE VITREORETINOPATHYSlide19
)
Persistent Hyperplastic Primary Vitreous (PHPVSlide20
A Language for Retinoblastoma:
Guidelines and Standard Operating Procedures
Retinoblastoma is the most common primary malignant intraocular tumor in children.Slide21
International Classification for Intraocular Retinoblastoma
Group A
Small tumors (3 mm across or less) that are confined to the retina and are not near important structures such as the optic disk (where the optic nerve enters the retina) or the
foveola
(the center of vision).
Group B
All other tumors (either larger than 3 mm or small but close to the optic disk or
foveola
) that are still confined to the retina.
Group C
Well-defined tumors with small amounts of spread under the retina (
subretinal
seeding) or into the gelatinous material that fills the eye (vitreous seeding).
Group D
Large or poorly defined tumors with widespread vitreous or
subretinal
seeding. The retina may have become detached from the back of the eye.
Group E
The tumor is very large, extends near the front of the eye, is bleeding or causing glaucoma (high pressure inside the eye), or has other features that mean there is almost no chance the eye can be saved. Slide22
Shields et
al
analyzed 249 eyes with
retinoblastoma treated with intravenous chemoreduction and found
that success
was:
achieved in
of
G
roup A 100%
,
G
roup B 93
%
,
G
roup C 90%,
G
roup
D 47
% eyes
.
A
later study identified treatment success with intra-arterial chemotherapy (IAC) in 100% of group C and D eyes,
and 33
% of group E eyes.Slide23
High-Risk Retinoblastoma Based on
International Classification of
Retinoblastoma: Analysis of 519
Enucleated EyesOn the basis of the ICRB, 17% of group D and 24% of group E eyes are at increased risk
for metastatic
disease. In this study, 8% of patients developed metastasis. There was no metastasis in any
patient classified
with non–high-risk retinoblastoma.Slide24
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