Common childhood ocular malignancies include retinoblastoma, rhabdomyosarcoma, and neuroblastoma. Retinoblastoma is the most common intraocular malignancy in childhood, occurring before age 3 in 90% of cases. It is caused by mutations in the RB1 gene and can be hereditary or non-hereditary. Presenting signs include leukocoria, strabismus, and proptosis. Diagnosis involves examination, imaging, and biopsy. Treatment depends on disease extent and may include enucleation, chemotherapy, radiation, and focal therapies like laser or cryotherapy. The goal is to save the child's life, eye, and maximize vision.
This document discusses limbal stem cells, which reside in the basal layer of the palisades of Vogt in the limbus and are responsible for renewing the corneal epithelium every 7 days. It outlines the historical background and relevant anatomy and physiology of limbal stem cell renewal. It also describes limbal stem cell deficiency, including types, clinical manifestations, diagnostic tools, and available treatment options such as conservative treatments and surgical procedures like limbal stem cell transplantation.
Classification Staging Grading in OphthalmologyMeng Hsien Yong
This document discusses various classification and staging systems used in ophthalmology. It covers classifications for corneal and external eye diseases, glaucoma, uveitis, vitreo-retinal diseases, and others. For each condition, it provides details on the classifications used to describe risk factors, pathogenesis, clinical features, severity, investigations, and management approaches. The classifications discussed include international standardized systems as well as other commonly used staging methods.
This document discusses various causes of corneal edema. It begins by explaining that corneal edema can be caused by endothelial dysfunction or situations exceeding the endothelium's barrier and pump capacity. Specific conditions that can lead to corneal edema are then outlined, including persistent epithelial defects, increased intraocular pressure, primary endothelial diseases, Fuch's dystrophy, posterior polymorphous dystrophy, congenital hereditary endothelial dystrophy, iridocorneal endothelial syndrome, and corneal edema induced by cataract surgery or other ocular procedures and injuries. Treatment options are mentioned for selected conditions.
This document discusses corneal collagen cross linking (C3R), a treatment for keratoconus. It begins by describing keratoconus and its symptoms. It then discusses the original C3R protocol developed by Seiler and Spoerl, which involves removing the corneal epithelium, soaking the cornea in riboflavin, and exposing it to UV light. Modifications to the protocol aim to reduce complications by using higher irradiance for less time, different riboflavin delivery methods, and leaving the epithelium intact. Studies show C3R increases corneal collagen bonds and rigidity while halting keratoconus progression in most cases. Contraindications and post-op care are also outlined
Anophthalmia is the absence of the eyeball and can be congenital or acquired. The optimal management of an anophthalmic socket involves maintaining adequate volume with a well-positioned implant, healthy conjunctiva, and symmetric eyelids. Complications after enucleation like enophthalmos, eyelid deformities, and socket contracture can be addressed through procedures like dermis fat grafts, fornix deepening sutures, and implant replacement. Proper prosthesis fitting and care is also important for optimal cosmetic and functional results.
This document discusses various techniques for repairing iridodialysis, which is the separation of the iris from the ciliary body, often caused by trauma. It describes McCannel's suture technique, which uses two double-armed sutures to fixate the peripheral iris to the scleral wall. Other techniques discussed include the hang back technique, sewing machine technique, modified sewing machine technique, cobbler's technique, knotless technique, single suture customized loop technique, and riveting technique. It also presents an alternate iris bypass repair technique that aims to minimize pupil eccentricity and iris clumping by bypassing the iris tissue with sutures.
Limbal Stem Cell Deficiency & its managementKaran Bhatia
1) Limbal stem cells are located in the palisades of Vogt region of the limbus and are responsible for maintaining the normal corneal epithelium. Limbal stem cell deficiency occurs when the source of these cells is damaged, causing severe problems to the ocular surface.
2) Limbal stem cell deficiency can be partial or total, and is classified based on extent and etiology. Common causes include chemical/thermal burns, Stevens-Johnson syndrome, and multiple ocular surgeries.
3) Management is based on the extent and severity of deficiency, and involves steps from conservative treatment to more invasive procedures like limbal stem cell transplantation or keratoprosthesis. The goal is to replace
This document provides information on hereditary macular dystrophies. It discusses several specific conditions including X-linked juvenile retinoschisis, Stargardt's disease, Best disease, and Fundus flavimaculatus. Key points covered include genetics, clinical features, imaging findings, and management for each condition. An anatomical basis for classification of macular dystrophies is also presented.
This document discusses limbal stem cells, which reside in the basal layer of the palisades of Vogt in the limbus and are responsible for renewing the corneal epithelium every 7 days. It outlines the historical background and relevant anatomy and physiology of limbal stem cell renewal. It also describes limbal stem cell deficiency, including types, clinical manifestations, diagnostic tools, and available treatment options such as conservative treatments and surgical procedures like limbal stem cell transplantation.
Classification Staging Grading in OphthalmologyMeng Hsien Yong
This document discusses various classification and staging systems used in ophthalmology. It covers classifications for corneal and external eye diseases, glaucoma, uveitis, vitreo-retinal diseases, and others. For each condition, it provides details on the classifications used to describe risk factors, pathogenesis, clinical features, severity, investigations, and management approaches. The classifications discussed include international standardized systems as well as other commonly used staging methods.
This document discusses various causes of corneal edema. It begins by explaining that corneal edema can be caused by endothelial dysfunction or situations exceeding the endothelium's barrier and pump capacity. Specific conditions that can lead to corneal edema are then outlined, including persistent epithelial defects, increased intraocular pressure, primary endothelial diseases, Fuch's dystrophy, posterior polymorphous dystrophy, congenital hereditary endothelial dystrophy, iridocorneal endothelial syndrome, and corneal edema induced by cataract surgery or other ocular procedures and injuries. Treatment options are mentioned for selected conditions.
This document discusses corneal collagen cross linking (C3R), a treatment for keratoconus. It begins by describing keratoconus and its symptoms. It then discusses the original C3R protocol developed by Seiler and Spoerl, which involves removing the corneal epithelium, soaking the cornea in riboflavin, and exposing it to UV light. Modifications to the protocol aim to reduce complications by using higher irradiance for less time, different riboflavin delivery methods, and leaving the epithelium intact. Studies show C3R increases corneal collagen bonds and rigidity while halting keratoconus progression in most cases. Contraindications and post-op care are also outlined
Anophthalmia is the absence of the eyeball and can be congenital or acquired. The optimal management of an anophthalmic socket involves maintaining adequate volume with a well-positioned implant, healthy conjunctiva, and symmetric eyelids. Complications after enucleation like enophthalmos, eyelid deformities, and socket contracture can be addressed through procedures like dermis fat grafts, fornix deepening sutures, and implant replacement. Proper prosthesis fitting and care is also important for optimal cosmetic and functional results.
This document discusses various techniques for repairing iridodialysis, which is the separation of the iris from the ciliary body, often caused by trauma. It describes McCannel's suture technique, which uses two double-armed sutures to fixate the peripheral iris to the scleral wall. Other techniques discussed include the hang back technique, sewing machine technique, modified sewing machine technique, cobbler's technique, knotless technique, single suture customized loop technique, and riveting technique. It also presents an alternate iris bypass repair technique that aims to minimize pupil eccentricity and iris clumping by bypassing the iris tissue with sutures.
Limbal Stem Cell Deficiency & its managementKaran Bhatia
1) Limbal stem cells are located in the palisades of Vogt region of the limbus and are responsible for maintaining the normal corneal epithelium. Limbal stem cell deficiency occurs when the source of these cells is damaged, causing severe problems to the ocular surface.
2) Limbal stem cell deficiency can be partial or total, and is classified based on extent and etiology. Common causes include chemical/thermal burns, Stevens-Johnson syndrome, and multiple ocular surgeries.
3) Management is based on the extent and severity of deficiency, and involves steps from conservative treatment to more invasive procedures like limbal stem cell transplantation or keratoprosthesis. The goal is to replace
This document provides information on hereditary macular dystrophies. It discusses several specific conditions including X-linked juvenile retinoschisis, Stargardt's disease, Best disease, and Fundus flavimaculatus. Key points covered include genetics, clinical features, imaging findings, and management for each condition. An anatomical basis for classification of macular dystrophies is also presented.
This document provides guidance on managing failing blebs after glaucoma surgery. It discusses risk factors for bleb failure, the histology of functioning vs failed blebs, typical appearances of failed blebs, identifying the cause of failure as internal or external blockage, and various management techniques. These include increasing digital pressure, medications, laser suture lysis, and bleb needling with or without anti-metabolites like mitomycin C or 5-fluorouracil to restore bleb function and control intraocular pressure. Complications of bleb needling are also reviewed.
This document discusses various conjunctival tumors including benign and malignant/premalignant tumors. Some key points:
- Benign tumors include conjunctival naevus, papilloma, limbal dermoid, dermolipoma, and pyogenic granuloma.
- Malignant/premalignant tumors include primary acquired melanosis (PAM), conjunctival melanoma, ocular surface squamous neoplasia, and Kaposi sarcoma. PAM can progress to conjunctival melanoma in situ or invasive melanoma.
- Conjunctival melanoma often arises from an area of PAM and has a mortality rate up to 30% from metastasis to lymph nodes, lung
A Comparison of The Lateral Tarsal Strip with Everting Sutures and The Quic...Meironi Waimir
Entropion is Inversion or rotation of the margo palpebra towards the eyeball.
Characterized by : Ocular discomfort, epiphora, secondary corneal thinning, vascularization and scarring as well as microbial keratitis and corneal perforation.
This document provides information on lacrimal gland tumors, including:
1) Lacrimal gland tumors typically present with upper eyelid fullness, alteration of the eyelid contour, and downward displacement of the globe. They can be either epithelial or non-epithelial tumors.
2) Epithelial tumors include pleomorphic adenoma (the most common), adenoid cystic carcinoma, and adenocarcinoma. Pleomorphic adenomas are usually benign but can become malignant. Adenoid cystic carcinoma often invades surrounding bone.
3) Treatment involves complete surgical removal with postoperative radiation for malignant or invasive tumors. Prognosis depends on tumor type, with adenocarcinomas having
This presentation describes the nature of amniotic membrane grafts, Indications, and limitations with presentation of two cases of corneal perforations treated with it as a self experience
1. Optical coherence tomography (OCT) uses light interferometry to perform high-resolution, cross-sectional imaging of the retina. It provides quantitative measurements of retinal nerve fiber layer thickness.
2. OCT images are analyzed to detect structural changes in the optic nerve head and retinal nerve fiber layer that can indicate glaucoma, often before visual field defects appear. Parameters like retinal nerve fiber layer thickness, cup-to-disc ratio, and nerve fiber layer deviation maps are used to diagnose and monitor glaucoma progression.
3. Macular ganglion cell complex thickness, which includes the retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer, can also detect early glaucomatous loss
Gonioscopy refers to techniques for examining the anterior chamber angle of the eye to evaluate and classify normal and abnormal angle structures. It involves using specialized lenses and lights to view the iridocorneal angle. There are two main methods: direct gonioscopy uses large contact lenses requiring saline, while indirect uses smaller lenses with mirrors or prisms that utilize tear film. Gonioscopy is used to diagnose angle-closure glaucoma and other conditions by allowing visualization of the trabecular meshwork, scleral spur, and other angle structures. Indentation gonioscopy, where the lens is pressed against the cornea, can differentiate appositional from synechial angle closure. Proper technique and
This document discusses intermediate uveitis (IU), which involves inflammation in the anterior vitreous, pars plana, and peripheral retina. IU accounts for 8-22% of uveitis cases. Clinically, it is characterized by "snowballs" or yellow-white exudates in the peripheral vitreous. Treatment involves topical/periocular steroids initially, with cryotherapy, vitrectomy or immunosuppressants for non-responsive cases. Complications include cystoid macular edema, cataracts, glaucoma, and retinal detachment. Proper diagnosis requires excluding other causes like syphilis, Lyme disease, multiple sclerosis and sarcoidosis.
Malignant glaucoma, also known as aqueous misdirection syndrome, is a secondary glaucoma that occurs when aqueous humor takes an abnormal posterior route behind the lens and vitreous instead of flowing normally through the pupil. It presents with a shallow anterior chamber despite high intraocular pressure. Potential causes include prior eye surgery or laser treatment. Diagnosis involves examining for signs of anterior chamber shallowing and ruling out other conditions. Treatment begins with cycloplegic drugs but may require Nd:YAG laser or vitrectomy if unresponsive. Prognosis depends on severity and underlying anatomy.
- The document discusses the evaluation of proptosis, which is the abnormal forward protrusion of the eyeball. It defines different types of orbital abnormalities and provides the approach to examining a patient with proptosis, including taking a thorough history, performing a local and systemic examination, ordering appropriate imaging and lab tests, and considering histopathological studies if needed. The causes of proptosis can be divided into categories such as inflammatory, mass effect, vascular changes, and infiltrative processes. Key aspects of the evaluation are to determine if the proptosis is unilateral or bilateral and whether there are associated signs and symptoms to suggest an underlying cause.
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
1) A 75-year-old male presented with gradual decreased vision in both eyes over the past 3 years. He has a history of cataracts surgery in both eyes.
2) Examination found posterior capsular opacification in both eyes, worse in the left eye. The left eye also showed an irregular pupil, RAPD, and a dull fundus reflex.
3) The patient underwent YAG capsulotomy in the left eye. At 1-week follow-up, his vision had improved but was still reduced in the left eye, likely due to underlying retinal pathology. He was advised to continue his current prescription and follow-up as needed.
1) Amblyopia is a developmental defect of spatial visual processing in the central visual pathway of the eye that results in poor vision.
2) It is commonly caused by strabismus, unequal refractive errors between the eyes, high refractive errors in both eyes, or obstruction of vision in one eye.
3) Amblyopia is diagnosed through visual acuity testing which shows reduced vision in one eye that is not correctable by glasses alone.
This document provides information on how to evaluate blepharoptosis (drooping of the upper eyelid) clinically. It discusses classifications of ptosis as congenital or acquired. Evaluation involves measuring eyelid positions, assessing levator function and other muscle movements. Tests like phenylephrine, ice and edrophonium help determine the cause. Thorough history, examination and documentation including photographs are needed before considering surgical management of ptosis.
This document discusses various vitreous substitutes and intraocular gases used to replace the vitreous humor after surgery. It describes the anatomy and composition of the natural vitreous and ideal properties for substitutes. Common substitutes discussed include gases like air, sulfur hexafluoride and perfluorocarbons; liquids like silicone oil, perfluorocarbon liquids and semi-fluorinated alkanes; and experimental polymers and implants. The document compares different options and provides details on how each works, associated complications, and appropriate uses.
- Three cases of bilateral corneal opacities are presented
- All cases show central corneal opacity without signs of inflammation or vascularization
- This suggests a diagnosis of corneal dystrophy, which is a hereditary condition causing bilateral corneal opacity that is non-inflammatory in nature
- Corneal dystrophy can be classified anatomically based on the layer of the cornea involved, or by the new IC3D classification system which integrates phenotype, pathology, and genetics
The document discusses the anatomy and surgical applications of the limbus. It defines the limbus as the transitional zone between the cornea and sclera, containing the pathways for aqueous humor outflow. Histologically, it describes how the layers of the cornea and conjunctiva become continuous at the limbus. Surgically, it notes the anterior limbal border, blue limbal zone, mid-limbal line, posterior limbal border, and white limbal zone. The best site for cataract incisions is the mid-limbal line, while anterior or posterior incisions risk damage to underlying structures. The limbus contains stem cells that renew the corneal epithelium.
This document provides guidance on drawing corneal pathology as a method for standardized documentation, follow-up, teaching, and lower cost compared to photography. It outlines color-coding conventions for different corneal features and structures: black for scars, sutures, etc.; blue for edema; yellow for infiltrates; green for defects and staining; red for blood vessels; and brown for pigments. Detailed instructions are given for depicting the frontal and slit views of the cornea, including dimensions, landmarks, and representations of specific conditions. Following a systematic clock-hour approach is emphasized for accurate drawings.
This is a beginner's guide to retinoblastoma. I have briefly covered all the aspects of this most common intraocular tumor of childhood. Hope it will help the undergraduate medical students. Please check out our blog, http://pgblaster.wordpress.com for more presentations and useful stuffs like this one.
Retinoblastoma is a cancer of the retina that develops from mutations in the RB1 gene. It is the most common eye cancer in children. Treatment involves various modalities like chemotherapy, thermotherapy, cryotherapy, brachytherapy, or external beam radiotherapy to preserve vision and the eye if possible. Enucleation is recommended if over 50% of the eye is involved or there is suspicion of extraocular extension. Retinoblastoma management aims to preserve life first, then the eye, and vision.
This document provides guidance on managing failing blebs after glaucoma surgery. It discusses risk factors for bleb failure, the histology of functioning vs failed blebs, typical appearances of failed blebs, identifying the cause of failure as internal or external blockage, and various management techniques. These include increasing digital pressure, medications, laser suture lysis, and bleb needling with or without anti-metabolites like mitomycin C or 5-fluorouracil to restore bleb function and control intraocular pressure. Complications of bleb needling are also reviewed.
This document discusses various conjunctival tumors including benign and malignant/premalignant tumors. Some key points:
- Benign tumors include conjunctival naevus, papilloma, limbal dermoid, dermolipoma, and pyogenic granuloma.
- Malignant/premalignant tumors include primary acquired melanosis (PAM), conjunctival melanoma, ocular surface squamous neoplasia, and Kaposi sarcoma. PAM can progress to conjunctival melanoma in situ or invasive melanoma.
- Conjunctival melanoma often arises from an area of PAM and has a mortality rate up to 30% from metastasis to lymph nodes, lung
A Comparison of The Lateral Tarsal Strip with Everting Sutures and The Quic...Meironi Waimir
Entropion is Inversion or rotation of the margo palpebra towards the eyeball.
Characterized by : Ocular discomfort, epiphora, secondary corneal thinning, vascularization and scarring as well as microbial keratitis and corneal perforation.
This document provides information on lacrimal gland tumors, including:
1) Lacrimal gland tumors typically present with upper eyelid fullness, alteration of the eyelid contour, and downward displacement of the globe. They can be either epithelial or non-epithelial tumors.
2) Epithelial tumors include pleomorphic adenoma (the most common), adenoid cystic carcinoma, and adenocarcinoma. Pleomorphic adenomas are usually benign but can become malignant. Adenoid cystic carcinoma often invades surrounding bone.
3) Treatment involves complete surgical removal with postoperative radiation for malignant or invasive tumors. Prognosis depends on tumor type, with adenocarcinomas having
This presentation describes the nature of amniotic membrane grafts, Indications, and limitations with presentation of two cases of corneal perforations treated with it as a self experience
1. Optical coherence tomography (OCT) uses light interferometry to perform high-resolution, cross-sectional imaging of the retina. It provides quantitative measurements of retinal nerve fiber layer thickness.
2. OCT images are analyzed to detect structural changes in the optic nerve head and retinal nerve fiber layer that can indicate glaucoma, often before visual field defects appear. Parameters like retinal nerve fiber layer thickness, cup-to-disc ratio, and nerve fiber layer deviation maps are used to diagnose and monitor glaucoma progression.
3. Macular ganglion cell complex thickness, which includes the retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer, can also detect early glaucomatous loss
Gonioscopy refers to techniques for examining the anterior chamber angle of the eye to evaluate and classify normal and abnormal angle structures. It involves using specialized lenses and lights to view the iridocorneal angle. There are two main methods: direct gonioscopy uses large contact lenses requiring saline, while indirect uses smaller lenses with mirrors or prisms that utilize tear film. Gonioscopy is used to diagnose angle-closure glaucoma and other conditions by allowing visualization of the trabecular meshwork, scleral spur, and other angle structures. Indentation gonioscopy, where the lens is pressed against the cornea, can differentiate appositional from synechial angle closure. Proper technique and
This document discusses intermediate uveitis (IU), which involves inflammation in the anterior vitreous, pars plana, and peripheral retina. IU accounts for 8-22% of uveitis cases. Clinically, it is characterized by "snowballs" or yellow-white exudates in the peripheral vitreous. Treatment involves topical/periocular steroids initially, with cryotherapy, vitrectomy or immunosuppressants for non-responsive cases. Complications include cystoid macular edema, cataracts, glaucoma, and retinal detachment. Proper diagnosis requires excluding other causes like syphilis, Lyme disease, multiple sclerosis and sarcoidosis.
Malignant glaucoma, also known as aqueous misdirection syndrome, is a secondary glaucoma that occurs when aqueous humor takes an abnormal posterior route behind the lens and vitreous instead of flowing normally through the pupil. It presents with a shallow anterior chamber despite high intraocular pressure. Potential causes include prior eye surgery or laser treatment. Diagnosis involves examining for signs of anterior chamber shallowing and ruling out other conditions. Treatment begins with cycloplegic drugs but may require Nd:YAG laser or vitrectomy if unresponsive. Prognosis depends on severity and underlying anatomy.
- The document discusses the evaluation of proptosis, which is the abnormal forward protrusion of the eyeball. It defines different types of orbital abnormalities and provides the approach to examining a patient with proptosis, including taking a thorough history, performing a local and systemic examination, ordering appropriate imaging and lab tests, and considering histopathological studies if needed. The causes of proptosis can be divided into categories such as inflammatory, mass effect, vascular changes, and infiltrative processes. Key aspects of the evaluation are to determine if the proptosis is unilateral or bilateral and whether there are associated signs and symptoms to suggest an underlying cause.
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
1) A 75-year-old male presented with gradual decreased vision in both eyes over the past 3 years. He has a history of cataracts surgery in both eyes.
2) Examination found posterior capsular opacification in both eyes, worse in the left eye. The left eye also showed an irregular pupil, RAPD, and a dull fundus reflex.
3) The patient underwent YAG capsulotomy in the left eye. At 1-week follow-up, his vision had improved but was still reduced in the left eye, likely due to underlying retinal pathology. He was advised to continue his current prescription and follow-up as needed.
1) Amblyopia is a developmental defect of spatial visual processing in the central visual pathway of the eye that results in poor vision.
2) It is commonly caused by strabismus, unequal refractive errors between the eyes, high refractive errors in both eyes, or obstruction of vision in one eye.
3) Amblyopia is diagnosed through visual acuity testing which shows reduced vision in one eye that is not correctable by glasses alone.
This document provides information on how to evaluate blepharoptosis (drooping of the upper eyelid) clinically. It discusses classifications of ptosis as congenital or acquired. Evaluation involves measuring eyelid positions, assessing levator function and other muscle movements. Tests like phenylephrine, ice and edrophonium help determine the cause. Thorough history, examination and documentation including photographs are needed before considering surgical management of ptosis.
This document discusses various vitreous substitutes and intraocular gases used to replace the vitreous humor after surgery. It describes the anatomy and composition of the natural vitreous and ideal properties for substitutes. Common substitutes discussed include gases like air, sulfur hexafluoride and perfluorocarbons; liquids like silicone oil, perfluorocarbon liquids and semi-fluorinated alkanes; and experimental polymers and implants. The document compares different options and provides details on how each works, associated complications, and appropriate uses.
- Three cases of bilateral corneal opacities are presented
- All cases show central corneal opacity without signs of inflammation or vascularization
- This suggests a diagnosis of corneal dystrophy, which is a hereditary condition causing bilateral corneal opacity that is non-inflammatory in nature
- Corneal dystrophy can be classified anatomically based on the layer of the cornea involved, or by the new IC3D classification system which integrates phenotype, pathology, and genetics
The document discusses the anatomy and surgical applications of the limbus. It defines the limbus as the transitional zone between the cornea and sclera, containing the pathways for aqueous humor outflow. Histologically, it describes how the layers of the cornea and conjunctiva become continuous at the limbus. Surgically, it notes the anterior limbal border, blue limbal zone, mid-limbal line, posterior limbal border, and white limbal zone. The best site for cataract incisions is the mid-limbal line, while anterior or posterior incisions risk damage to underlying structures. The limbus contains stem cells that renew the corneal epithelium.
This document provides guidance on drawing corneal pathology as a method for standardized documentation, follow-up, teaching, and lower cost compared to photography. It outlines color-coding conventions for different corneal features and structures: black for scars, sutures, etc.; blue for edema; yellow for infiltrates; green for defects and staining; red for blood vessels; and brown for pigments. Detailed instructions are given for depicting the frontal and slit views of the cornea, including dimensions, landmarks, and representations of specific conditions. Following a systematic clock-hour approach is emphasized for accurate drawings.
This is a beginner's guide to retinoblastoma. I have briefly covered all the aspects of this most common intraocular tumor of childhood. Hope it will help the undergraduate medical students. Please check out our blog, http://pgblaster.wordpress.com for more presentations and useful stuffs like this one.
Retinoblastoma is a cancer of the retina that develops from mutations in the RB1 gene. It is the most common eye cancer in children. Treatment involves various modalities like chemotherapy, thermotherapy, cryotherapy, brachytherapy, or external beam radiotherapy to preserve vision and the eye if possible. Enucleation is recommended if over 50% of the eye is involved or there is suspicion of extraocular extension. Retinoblastoma management aims to preserve life first, then the eye, and vision.
Retinoblastoma is a rapidly developing cancer of the retina that mostly affects young children. It can be hereditary, arising from a genetic mutation, or non-hereditary. Clinical features include a white pupil reflex or leukocoria. Diagnosis involves eye examination and imaging tests. Treatment depends on tumor stage but may include chemotherapy, radiation therapy, cryotherapy, or eye removal. Close monitoring of family members is needed if hereditary to screen for the condition.
This document discusses retinoblastoma, a rare form of eye cancer that affects children. It is caused by mutations in the RB1 gene and can be hereditary or non-hereditary. Symptoms include white pupil reflex and strabismus. Diagnosis involves examinations like indirect ophthalmoscopy and imaging like ultrasound, CT, and MRI. Treatment depends on tumor staging and may include focal therapies like thermotherapy, chemotherapy, radiation, or enucleation. Prognosis is generally good if caught early but risks include secondary cancers and recurrence so lifelong follow-up is important. Genetic counseling is also critical given hereditary risks for family members.
Retinoblastoma is a rare cancer that affects the retina. It is caused by mutations in the RB1 gene. There are two main types - hereditary retinoblastoma, which requires only one mutation, and sporadic retinoblastoma, which requires two mutations. Symptoms include leukocoria. Diagnosis involves ophthalmoscopy, imaging like ultrasound and MRI, and sometimes biopsy. Treatment depends on factors like tumor size and location, and may include focal therapies like cryotherapy, chemotherapy, external beam radiation, plaque brachytherapy, or enucleation of the eye. Prognosis depends on extent of disease and risk of metastasis.
- Retinoblastoma is a rare cancer that affects the retina in young children. It arises from primitive retinal cells.
- The patient was a 19 month old boy referred for a white pupil in the right eye noticed for 4 months. Examination found a white pupil and squint in the right eye.
- Investigations including ultrasound and MRI confirmed the diagnosis of retinoblastoma in the right eye. The family then took the child to another hospital for further chemotherapy and management.
The document discusses radiotherapy techniques for tumors of the eye and orbit. It covers three main techniques: plaque brachytherapy using radioactive isotopes, external beam radiotherapy, and proton beam radiotherapy. Plaque brachytherapy involves suturing radioactive discs directly on the eyeball for localized tumors. External beam radiotherapy uses photon beams from a linear accelerator to treat larger or multifocal tumors. Proton beam radiotherapy offers dose conformity for tumors near the optic nerve. Key indications and complications of each technique are described for various intraocular and orbital tumors, including retinoblastoma, uveal melanoma, and metastatic lesions.
- Retinoblastoma is a rare cancer that affects the retina, usually in young children under 5 years old. It typically presents as leukocoria (white pupil reflection).
- There are two main types - heritable (genetic) and non-heritable. Heritable retinoblastoma is often bilateral and multifocal due to a germline gene mutation, while non-heritable is typically unilateral from a somatic mutation.
- Treatment aims to cure the disease while preserving vision if possible, and includes chemotherapy, cryotherapy, radiation plaques, enucleation, or external beam radiation depending on tumor size and location. Screening of at-risk children is important for early detection and treatment.
Retinoblastoma for undergraduate MBBS Students.
Covers the basics of Aetiology, Genetics, pathophysiology, clinical features, Classification and management of Retinoblastoma.
Also encompasses salient points for PGMEE
- Retinoblastoma is a rare cancer of the retina that usually develops in young children. It can occur unilaterally or bilaterally.
- If left untreated, it is almost always fatal. Early diagnosis and treatment are important to save the child's life and preserve vision.
- Retinoblastoma is caused by a mutation in the RB1 tumor suppressor gene. It can be inherited or sporadic. Inherited retinoblastoma tends to be bilateral and occur at an earlier age.
- Treatment involves chemotherapy, focal therapies like cryotherapy or photocoagulation, and enucleation depending on severity and chance of vision preservation. The goal is to cure the cancer while minimizing side
Retinoblastoma is a rare eye cancer that affects children. It is caused by mutations in the RB1 tumor suppressor gene. There are two main types - sporadic which occurs spontaneously, and hereditary which is inherited. Treatment depends on tumor size and extent, and may include chemotherapy, laser therapy, cryotherapy, plaque brachytherapy, or enucleation of the eye for large tumors. The goal is to save vision if possible or life if the eye cannot be saved. Screening of family members is important given the hereditary risk.
This document summarizes key information from a presentation on early diagnosis of cancer in neonates and young infants. It discusses how cancer can present non-specifically in infants, with symptoms like lethargy and feeding difficulties. Several common childhood cancers are mentioned, including neuroblastoma, Wilms tumor, retinoblastoma, and leukemia. Challenges in diagnosing and treating neonatal cancer are outlined, such as the need for specialized pathology expertise and reduced chemotherapy doses. The presentation concludes with acknowledgements and a call for improved early diagnosis and shared care models for childhood cancer.
Retinoblastoma is a rare form of eye cancer that affects young children. It occurs when nerve cells in the retina develop genetic mutations causing uncontrolled growth. In about 40% of cases it is inherited from a parent with a faulty gene. Symptoms include a white pupil, eye misalignment, poor vision, and eye swelling/redness. Treatment aims to preserve the child's life, then vision, and minimize side effects. Options include thermotherapy, laser photocoagulation, and cryotherapy. Children also face risks of cancer recurrence or developing other cancers.
Dr. Sharmin Nahar and Dr. Olivia Akhter are presenting a seminar on pediatric hematology and oncology at BSMMU. They discuss the case of a 2-year-old girl admitted with headaches, vomiting, and seizures for the past month as well as left-sided weakness. Imaging shows a mass in the 4th ventricle causing hydrocephalus, possibly an ependymoma or medulloblastoma. They then provide an introduction to brain tumors in children, discussing types, incidence, risk factors, classification, and clinical features. Treatment options for brain tumors including surgery, radiation, and chemotherapy are also summarized.
This document discusses intraventricular tumors, which can be primary or secondary lesions originating from structures adjacent to the brain ventricles. The most common intraventricular tumors include ependymoma, subependymoma, choroid plexus tumors, and meningiomas. Imaging is important for diagnosis but cannot distinguish tumor types. Surgical resection is often recommended but carries risks due to the tumors' locations near critical structures. The prognosis depends on tumor grade, with low-grade lesions having better outcomes than high-grade gliomas or metastases.
This document discusses different types of cataracts, including congenital and acquired cataracts. It describes various causes of congenital cataracts including genetic mutations, metabolic disorders, infections, and chromosomal abnormalities. Congenital cataracts affect approximately 0.03% of newborns and are a leading cause of childhood blindness. The document also discusses different types of cataracts including nuclear, lamellar, and cerulean cataracts. It provides information on diagnosing and treating pediatric cataracts through surgery and preventing amblyopia.
This document provides information on retinoblastoma, a rare eye cancer that affects children. It is the most common primary intraocular tumor in childhood. Key points include that it can be hereditary or sporadic, presents most often as leukocoria, and if left untreated can be fatal. Treatment options described are various localized therapies as well as enucleation if needed. Differential diagnoses discussed include persistent hyperplastic primary vitreous, retinopathy of prematurity, ocular toxocariasis, and Coats' disease.
Similar to Common childhood ophthalmic malignancy - Dr Elias (20)
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
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3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
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10. Describe the Cheyne-Stokes breathing
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2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
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Common childhood ophthalmic malignancy - Dr Elias
1. Common childhood ophthalmic malignancy
Elias T - R-II
JUDO, June 2021
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2. Out lines
• Introduction
• Retinoblastoma
• Rhabdomyosarcoma
• Neuroblastoma
• Capillary hemangioma
• Others to discus
• References
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3. Introduction
Several benign and malignant ocular tumors can occur in childhood
Tumors in the ocular region can lead to loss of vision, loss of the eye
In the case of malignant neoplasms - loss of life
It is important to recognize childhood ocular tumors early
To have diagnostic studies done and manage appropriately
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4. 7/3/2021 common childhood tumors - elias 4
“If most solid tumors of childhood
are indeed correctly
attributable to mutations in germ
and/or somatic cells …
then childhood cancer cannot be
prevented. … the main
effort against childhood cancer
must be that of early
diagnosis and treatment”
A. G. Knudson Jr, 1976
5. Retinoblastoma
• The most common primary intraocular malignancy in childhood.
• Accounts for about 3% of all childhood cancers
• Incidence: 1 in 14, 000 to 1 in 20, 000 live births.
• Bilateral in 30-40% of cases.
• 40% of the case is heritable.
• No gender or racial variation
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6. Cont.…
• Occurs equally in right and left eyes
• 90% occurs before 3 years.
• Eighth most common childhood cancer
• Mean age at diagnosis depends on family history and the laterality
– patients with a known family history of retinoblastoma: 8 months
– patients with bilateral disease: 12 months
– patients with unilateral disease: 24 months
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7. Genetic Counseling
• Mutation in the RB1 located on the long arm of chromosome 13 at locus 14
(13q14).
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8. Cont.…
• Protein (pRB) that binds various cellular proteins to suppress cell
growth
• RB1 is a recessive oncogene at cellular level
• Mutations of RB1 alleles result in cancer only in developing retina; other
cell types die by apoptosis in absence of RB1
• Primitive retinal cells disappear within first few years of life so RB is
seldom seen after 3 or 4 years of age
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9. Pathogenesis of RB
• Arises from undifferentiated retinoblasts of inner layer of optic cup
• Before its differentiation to PHR
• Immunohistochemistry - neuron-specific enolase, ROS specific S-
antigen & rhodopsin. IPRrBP – Secreted by tumor cell
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10. Hereditary
• One of Knudson’s 2 hits occur prior to conception
• 40% of RB is hereditary type of RB
• The risk of the Knudson’s second hit/new mutation is extremely
high (therefore RB is inherited as AD trait with 90% penetrance)
• There is risk of bilateral RB (as all cells have inherited one mutant
allele)
• There is risk of non-ocular malignancies elsewhere (as all cells
have one mutant allele)
• Age of presentation: 12 months
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11. Non-hereditary
• Both of Knudson’s 2 hits occur after conception
• Both alleles are normal after fertilization, but two or more
subsequent spontaneous mutations inactivate both alleles
• 60% of RB is nonhereditary type of RB
• No risk of bilateral RB
• No risk of non-ocular malignancies elsewhere
• Age of presentation: 24 months
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21. Evaluation
• Complete physical examination
• EUA
• The intraocular pressure and corneal diameter of both eyes should
be measured
• The location of all tumors in each eye should be clearly documented
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22. Cont.…
• A funduscopic examination is performed with indirect
ophthalmoscopy and gentle scleral depression to the ora serrata.
• Small retinoblastoma lesions may appear as translucent flat or
dome shaped lesions
• As the tumors increase in size, they often take on a white or
off-white, chalky color
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23. Morphologic feature
• Early retinoblastoma is a solitary or multifocal, well-circumscribed,
translucent intraretinal mass
• As the disease advances,
• Tumor becomes more pink in color,
• With dilated feeding blood vessels,
• Exhibit one of three main growth patterns
• Exophytic ,endophytic and diffuse infiltrating retinoblastoma
• Trilateral retinoblastoma??
• SPONTANEOUSLY ARRESTED®RESSED TUMORS and RETINOCYTOMA??
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25. Histopathology
Composed of small basophilic cells (Retinoblasts) with large hyperchromatic
nuclei and scanty cytoplasm
Many retinoblastomas are undifferentiated but varying degrees of differentiation
are characterized by the formation of rosettes
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30. Treatment
• Aims of management
• First goal to save life
• Second goal to save eye
• Third goal to maximize vision
• Oncologists, pediatric ophthalmologists, geneticists, genetic
counselors, pediatric oncologists, and radiation oncologists
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32. Enucleation
• The tumor involves more than 50% of the globe
• Orbital or optic nerve involvement is suspected
• Anterior segment involvement is present
• Neovascular glaucoma is present
• The affected eye has limited vision potential
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33. Laser Therapy
• Argon 532um
• Power 250-300mw and duration 300-500ms.
Cryotherapy
• Destruction of the cellular membranes during freeze-thaw cycle
• Vaso-occulsion
• Laser is chosen for posterior tumors, cryoablation for more anterior
tumors.
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34. External Beam Radiotherapy
• In the mid-1900s, EBRT became the main alternative to enucleation for
salvaging eyes with RB
• EBRT is associated with second cancers, mainly in the field of
irradiation and with facial cosmetic problems
• In recent years, there has been a trend toward avoiding both
enucleation and EBRT when possible
• Because RB tumors are responsive to radiation, EBRT has become a
salvage technique, when chemotherapy has failed
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35. Chemo treatment from INCTR-03-05 RB protocol
• Based on PE, diagnostic work-up, consider the following scenarios:
– Intraocular disease without buphthalmos
– Intraocular disease with buphthalmos
– Extraocular/orbital disease
– Extraorbital (metastatic) disease
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36. .
7/3/2021 36
• Intraocular Disease without Buphthalmos
– Upfront enucleation – removing 0.8 to 1 cm of ON
– Review of pathology
– Risk factors: involvement of choroid (massive), sclera
or episcleral vessels, optic nerve beyond lamina
cribrosa, anterior chamber/ciliary body
– If NO risk histology – no additional therapy
– If YES risk histology – adjuvant chemotherapy
• 3 courses of VCE and 3 courses (VCyD)
or
• 6 courses of VCyD if carboplatinum and etoposide are not
available.
common childhood tumors - elias
37. ‘
7/3/2021 37
• Intraocular Disease with Buphthalmos
– Delay enucleation to avoid rupture and suboptimal optic
nerve resection
– Preoperative chemotherapy:
• 2 courses of VCE or
• 2 courses of VCyD if VCE not available
– Enucleation
– Postoperative chemotherapy
• To complete a total of 6 courses ;3 courses of VCE and 3
courses of VCR/CYC/DOX (VCyD) or
• 6 courses of VCyD if carboplatinum and etoposide are not
available
common childhood tumors - elias
38. .
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• Extraocular/Orbital Disease
– Treatment ; chemotherapy+ enucleation+ orbital irradiation
if possible.
• Chemotherapy 4 courses VCE and 4 courses VCyD for a total of 8
cycles (4 VCE and 4 VCyD).
– Start chemotherapy with standard regimen: give 2 or 3
courses of VCE (or VCyD if VCE not available).
– If good response, proceed with enucleation.
– Complete postoperative chemotherapy for a total of 8
courses.
• Consolidate with orbital Radiation Therapy (45 Gy) to orbit up to
optic chiasm if RT is available
• Extraorbital (metastatic) disease;Palliation
common childhood tumors - elias
39. 7/3/2021 39
Chemotherapy Regimens
• If carboplatin is available , standard regimen ;VCE(
vincristine, carboplatin&etoposide)
• If carboplatin is not available , can use VCyD( vincristine
,cyclophosphamide & doxorubicin)instead,
• Cycles can be given every 21 or 28 days
• Cotrimoxazole -5 mg /kg orally daily for 3 consecutive
days per week through entire chemotherapy protocol and
for 12 weeks after the end of therapy
• Criteria for initiation of each cycle
1. ANC > 750/mm3and recovering
2. Platelets > 75,000/mm3 and recovering
3. Normal serum creatinine for age
5. SGPT/SGOT < 2.5 times upper limit of normal
common childhood tumors - elias
40. Follow-up
• Patients with treated RB and siblings at risk need to be followed
• After initial treatment, re-examine patient 3–6 weeks later:
• Active tumor on treatment requires follow-up every 3 weeks
• If tumor is obliterated, follow-up 6–12 weeks later
• 3-monthly until 2 years post-treatment, then 6 monthly until 6 years of
age, then yearly for life
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41. Prognosis
• Location (most important factor):
• 95% 5-year survival if intraocular tumor
• Less than 50% 5-year survival with extraocular
extension/optic nerve involvement
• Tumor size and grade
• Iris rubeosis
• Bilateral tumors (risk of second malignancy)
• Age of patient (older is worse)
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42. Second cancer in RB patients
• Osteogenic sarcoma is the most common cancer
• Pineoblastoma, ectopic intracranial RB (trilateral RB) is common up to 2 years
after diagnosis of RB
• Beyond 2 years after diagnosis of RB
• Bony and soft tissue sarcomas (Ewing’s tumor, chondrosarcoma,
rhabdomyosarcoma)
• Skin tumors (malignant melanoma, sebaceous cell CA, squamous cell CA)
• Neuroblastoma, medulloblastoma, leukemia
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43. Natural history of RB
• Intra-retinal tumor
• Angiogenesis with feeder artery and draining vein.
• Loss of cellular adhesion and begin to seed into the vitreous (endophytic)
and subretinal spaces (exophytic with RD)
• Invasion of the choroid and optic nerves and into the brain Continued
growth may induce glaucoma
• Ruptures the globe and see into the orbit or periorbital tissue.
• Distant metastasis is rare nowadays.
• Spontaneous regression in 5%
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44. Orbital Rhabdomyosarcoma
• The most common primary orbital malignant tumor in children
• Rhabdomyosarcomas arise from undifferentiated pluripotential
mesenchymal cell not from extraocular muscle
• 3.4 % of all childhood malignancies
• The average age of onset is 7-8 years, but it can occur at any age.
• No racial predisposition
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45. Cont.…
• The orbit is the origin of 10% of RMS;
• 25% of these tumors arise elsewhere in the head and neck,
• 90% diagnosed before age 16 yrs
• RMS in infancy is more aggressive and carries a poorer prognosis
• Can primarily involve orbit, eyelid, conjunctiva & uveal tract
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47. Embryonal RMS
• Most common (85 %) & good prognosis.
• Elongated cell with centrally located hyperchromatic nucleus
surrounded by eosinophilic cytoplasm.
• Cross-striations are seen in 50- 60%.
• Commonly arise in superior nasal quadrants
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48. Alveolar RMS
• Least common & carries worst prognosis.
• Consists of eosinophilic rhabdomyoblasts that are loosely adherent
within thin hyalinized CT septa.
• Only 30% show cross striations.
• Usually originates within inferior orbit.
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49. Botyroid RMS
• Considered as variant of embryonal RMS
• Appears as fleshy grape-like or papillomatous mass
• It is not found in the orbit as a primary tumor
• Occurs as a secondary invader from the PNS or from the conjunctiva
• Cluster of tumor cells arranged in a loose syncytium
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50. Pleomorphic RMS
• Very rare & common in adult.
• Has best prognosis
• Cells are straplike or rounded, and cross-striations are easily
visualized with trichrome stain.
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51. Clinical feature
• Acute, rapidly progressive proptosis with an absence of pain – typical
CF
• Proptosis (80%–100%)
• Globe displacement (80%)
• Blepharoptosis (30%–50%)
• Conjunctival and eyelid swelling (60%)
• Palpable mass (25%)
• Pain (10%)
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52. Work up
• US - well circumscribed, heterogenous, irregular mass with low to medium echogenicity
• CT- well circumscribed, homogenous, soft tissue mass isodense as compared to muscles calcification
• MRI - T1 weighted – Isointense to EOM & hypointense to orbital fat
T2 weighted - Hyperintense to orbital fat & EOM
• Immunohistochemical –Ab to desmin, actin,myoD1,myoglobin, vimentin
• Biopsy
• Systemic evaluation
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53. .
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Treatment
• Ultimate diagnosis of RMS requires biopsy for histopathologic
evaluation
• Treatment modalities
• surgery,
• irradiation and
• Chemotherapy
IRSG postsurgical staging system
• Group I: localized disease, completely resected (excisional biopsy)
• Group II: microscopic disease remaining after biopsy
• Group III: gross residual disease remaining after biopsy
• Group IV: distant metastasis present at onset
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54. 7/3/2021 54
• Group I ;chemotherapy only: VA (vincristine and actinomycin)
• Group II; chemotherapy(vincristine + actinomycin D) & radiotherapy
• Group III; chemotherapy (vincristine + actinomycin D
+cyclophosphamide /ifosfamide / etoposide) & radiotherapy
• Group IV - palliative care
common childhood tumors - elias
55. Prognosis
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• 94% and 74% ; 5-year survival for embryonal & alveolar
variants respectively
• Infants - more aggressive & survival rates of 54%
• Confined to orbit - survival rate is 90%
• Bone destruction & extension beyond orbit →survival rate
65%
common childhood tumors - elias
56. Follow up
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• Look for side effects of radiotherapy, recurrence & secondary
tumors
• MRI - at 3mo intervals, with decreasing frequency until 5
years after treatment
• Ocular examination - every 3–4 months & after first year
every 4–6 months for several years and then yearly
common childhood tumors - elias
57. Metastatic tumor
• Metastatic neoplasms to orbit
• Predominated by small, round, blue-cell tumors.
• Neuroblastoma
• Ewing’s sarcoma
• Wilms tumor
• Leukemia
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58. Neuroblastoma
• Neuroblastoma is one of the most common childhood cancers
• The most frequent source of childhood orbital metastasis (89% of cases).
• Arise from primitive neural cells (neural crest cells)
• Adrenal gland or the sympathetic ganglion chain in the retroperitoneum or
mediastinum.
• 20% of all patients with neuroblastoma show clinical evidence of orbital
involvement,
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59. Cont…
• Incidence 1 per 1000 live births
• Accounts for 10% of all pediatric malignancy.
• The mean age at diagnosis - 2 years
• 90% are diagnosed by 5 years of age.
• Inherited as AD
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60. Histopathology
• Soft, friable, bluish mass; small round cells that resemble lymphocytes
• Specks of calcium and areas of necrosis are seen.
• Disproportionately large darkly staining nuclei & scanty cytoplasm.
• Electron microscopy reveals neurosecretory tubules
• In 1° tumors there is differentiating neuroblasts with a rosette
formations is seen (Homer Wright rosettes).
• Once tumor metastasizes - neural differentiation lost
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61. • Immunohistochemical markers
• NB84, neuron-specific enolase (NSE), S-100, Synaptophysin &
Chromogranin.
• >90% of affected children excrete catecholamine by products.
• Homovanillic acid (HVA)
• Vanillylmandelic acid (VMA) in urine.
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63. Investigation
• UA - Homovanillic acid (HVA) and Vanillylmandelic acid (VMA)
• US
• Plain abd XR and CXR
• CT
• MRI
• CBC, RFT,LFT
• BMA and Biopsy
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65. Treatment
• Stage 1,2 & 4-S
– Surgery alone
– Chemotherapy indicated
• Reccurence
• Unfavorable histology
• Stage 3 & 4
– Neoadjuvant chemotherapy
– Followed by surgery
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66. Chemo agent
• Combination of drugs :
– Cyclophosphamide (Cy)
– Carboplatin(C)
– Cisplatin
– Vincristine (V)
– Doxorubicin (D)
– Etoposide(E)
– Topotecan(T)
• Most common combination used – (CCyDE)
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67. RT
• 1500cGy in children & 4000cGy in patients older than 10years.
• Used for localized tumor
• Shrink tumors before surgery.
• As treatment regimen (along with high-dose chemotherapy) before
a stem cell transplant.
• Relieves pain
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68. • Stage 1 - 5 year survival rate >98%
• Stage 2 & 3 - 5 year survival rate 90 to 95%
• Stage 4 - 5 year survival rate 40 to 50%
• Stage 4-S - 5 year survival rate >90%
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69. Leukemia
• Acute in 95%
• ALL>AML
• Responsible for 30% all childhood malignancy
• Most common ocular manifestation is leukemic retinopathy ( retinal hg)
• Ocular involvement highly corelate CNS involvement
• Anterior segment - HI, KPs, hyphemia, pseudo hypopyon, glaucoma
• Choroid ……..
• Optic nerve …..
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70. References
• Pediatric Ophthalmology & Strabismus, BCSC, Section 6, 2019-2020
• Ryan’s retina 6th edition (2017)
• Duane`s Ophthalmology, 2012
• Yanoff & Duker Ophthalmology, 5th ed
• J.J. Kanski. Clinical Ophthalmology, A Systematic Approach, 8th ed.
• INCTR-USA protocol for the treatment of children with
Retinoblastoma in Ethiopia
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