Retinoblastoma
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This document discusses retinoblastoma, a rare eye cancer that affects children. It is the most common intraocular malignancy in childhood. If untreated, children typically die within 2-4 years of symptoms starting. The document covers epidemiology, genetics, clinical presentation, diagnosis, and management options like chemotherapy, radiation therapy, cryotherapy, laser therapy, and enucleation. Early detection and a multidisciplinary approach can help save the child's life and possibly preserve vision. Prognosis depends on factors like tumor size and extent of spread.
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This document provides guidelines for managing diabetic retinopathy from the International Council of Ophthalmology in 2017. It discusses the epidemiology of diabetic retinopathy, noting that it affects 1 in 3 people with diabetes and is a leading cause of preventable blindness. The pathogenesis involves microvascular changes from prolonged hyperglycemia. Treatment involves optimizing blood glucose and blood pressure control, as well as focal laser treatment, panretinal laser photocoagulation, or anti-VEGF injections depending on the severity of the retinopathy and presence of macular edema. Follow-up examinations are recommended based on the classification and severity of the diabetic retinopathy.
Radiation of eye AND ORBIT
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.
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Retino
- 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
INTERMEDIATE_UVEITIS presentation dhir hospital bhiwani.pptx
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1.Retinoblastoma
2.Persistent hyperplastic primary vitreous (PHPV)
3.Best disease
4.Coats disease
5.Retinopathy of prematurity
6.Stargardts disease
7.Juvenile retinoschisis
8.Familial exudative vitreoretinopathy
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Proliferative vitreoretinopathy
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Retinoblastoma
epidemiology, staging, management of retinoblastoma including local ablative therapy, radiotherapy and chemotherapy
Intermediate uveitis
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.
Sarcoidosis
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1. Optic nerve gliomas and primary orbital lymphoma are rare tumors that can involve the orbit.
2. Optic nerve gliomas typically affect children and are low-grade gliomas, while primary orbital lymphoma can affect a wide age range and are commonly low-grade B-cell lymphomas.
3. Treatment depends on the site and extent of the tumor but may include surveillance, chemotherapy, surgery, radiation therapy, or a combination. The goal is long-term tumor control while preserving vision and cosmesis.
Retinoblastoma
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Retinoblastoma
- 1. RETINA – RETINOBLASTOMA 18th June 2020 May 2020AL KERATITIS DR M SAQUIB MBBS,MS , FSCEH DELHI,FHVDESAI PUNE, EX REGISTRARA JNMCH,AMU CONSULTANT OPHTHALMOLOGIST HOD D/O OPHTHALMOLOGY G.S .MEDICAL COLLEGE Founder sec: MEDICS India , Mail-dms2k5@gmail.com , 9634123800
- 2. • Most common Intraocular Malignancy of the Childhood in all racial group. • Verhoeff -origin from undifferentiated retinal cells, named retinoblastoma in 1900’s. • Untreated children die of their disease within 2-4 year of onset of symptoms . • Strong Tendency to invade Brain via Optic Nerve and Metastatize .
- 3. EPIDEMIOLOGY & PATHOGENESIS • Incidence 1: 15000-20000 live birth . • Age – 1 year to 6 year • Median Age 12 Month in Bilateral • 24 Month in Unilateral • Sex – Male = Female • Race- Rare in Negros than Whites • Unilateral – 60-70%- Multifocal • Bilateral – 30 % - Single Tumor
- 4. GENETICS • Non Heritable ( 90%) -Sporadic- Somatic (60%) ,Germline (30%) Unilateral – 70% • Heritable ( 10%) - Familial - Bilateral – 67% • In Almost all cases of Retinoblastoma ,loss or inactivation of both normal alleles of the Retinoblastoma genes. • DNA sequence localized to a small segment of the long arm (the q14 region) of chromosome 13
- 5. Malignant Proliferation of immature Retinal Neural Cells ,Small round cell with large Nuclei .Small Round Blue Cell Tumor ( Nuclear Layer of Retina) FLEXNER-WINTERSTEINER ROSETTES HOMER –WRIGHT ROSEETTES . Area of Necrosis and Calcification Photoreceptor Differentiation of Individual Retinoblast (Fleurettes)
- 7. CLINICAL FEATURE • Leukokoria - 56% • Strabismus -20% • Painful Red Eye-07% • Diminution Of Vision -05% • Excessive Tearing • Buphthalmos • Corneal Clouding • Iris Discoloration
- 8. • Painful Red Eye- Acute secondary Glaucoma • Intraocular inflammation • Orbital cellulitis • Proptosis , • Conjuctiva – Congested • Pseudohypopyon • Spontaneous Hyphema
- 9. PRESENTATION White round oval dome shaped retinal masses Attract retinal BVs Very small tumors - Translucent thickenings Larger tumors- non rhegmatogenous RD Tumors – extend via RPE- exophytic - into vitreous - endophytic -generalised thickening-Infiltrating Retinoblastoma Ocassionally stops progressing-Retinoma Severe necrosis-Phthisis
- 10. • Vision • Retinoscopy • Squint • Ophthalmoscopy – Distant Direct • Indirect • B SCAN • CT SCAN • MRI
- 11. White Eye Reflex Proptosis
- 12. RETINOBLASTOMA , RETINOMA RETINOMA- spontaneously arrested retinoblastoma Limited vascularity Greyish-white Speckled Surrounding chorio-retinal atrophy RPE hypertrophy
- 15. PRDIFFERENTIAL DIAGNOSIS Pseudoglioma OGNOSTIC FACTORS • Differential Diagnosis of Leukokoria • Coats’ disease • Persistent hyperplastic primary vitreous • Ocular toxocariasis • retinopathy of prematurity • Familial exudative vitreoretinopathy • Incontinentia pigmenti retinopathy • Norrie’s disease
- 16. DIAGNOSIS • Examinatioon Under Anaesthesia – • Mydriasis with Atropine , I.O.P- Neovascular Glaucoma ,Corneal Diameter • X Ray – Orbit –Calcification • Lactate Dehydrogenase (LDH)– Level –Increased • CT – Bright on CT scan Infiltrating Retinoblastoma-tumor multicentricity , extensive seeding into vitreous • MRI – Most useful for evaluating sellar/parasellar Rule out- ectopic intracranial RB Studying optic nerve & soft tissues • Lumbar Puncure for CSF analysis • Bone Marrow Aspiration or Biopsy
- 17. Imaging In Retinoblastoma CT Scan B Scan
- 19. MANAGEMENT • Primary goal-save life • Salvage of the organ and function-secondary and tertiary • Multidisciplinary approach • Individualised –depends on • 1. Age • 2. Laterality • 3. Location • 4. Staging • 5. Systemic condition • 6. Overall progression • 7. Cost effectivene
- 20. TREATMENT TREATMENT OPTIONS FOR INTRAOCULAR RETINOBLASTOMA • Intravenous chemotherapy • Enucleation Radiation therapy • • External beam radiation therapy • • Plaque radiotherapy Laser therapy • • Photocoagulation • • Transpupillary thermotherapy (TTT) Cryotherapy Observation (for spontaneously arrested retinoblastoma, retinoma
- 21. Enucleation : Advanced Unilateral Retinoblastoma or B/L advanced • Intravenous Chemotherapy : Bilateral Retinoblastoma or Unilateral in salvagable • CEV-Carboplatine ,Etoposide , Vicristine .3-4 Week Cycles • In Extraocular Extension cases • Ophthalmic Artery Infusion Chemotherapy : Central Ret • Peri ocular Chemotherapy : Posterior subtenon’s Injection of Chemo agents. • Intravitreal Chemo ;
- 22. Cryotherapy : Trans scleral Cryotherapy .Focal therapy for Targeted mass. • LASER THERAPY : Photocoagulation: Argon Laser • Transpupillary Thermotherapy ( TTT) Infra Red Laser Beam • External Beam Radiation Therapy ( EBRT ) – Regress Vascularised RB • Plaque Radiation Therapy : • Iodine 125 Surgical Implantation ,2-5 days • Large but Localised RB.
- 23. Prognosis • 2-4 Year after diagnosis if Untreated Died . • Small to Medium size tumor ,NO seeding salvage with useful vision. • Prognostic Factors: Optic Nerve invasion • Choroidal invasion • Trans scleral tumor extension into orbit • Classification : • Reese-Ellsworth System • International classification of Intraocular Retinoblastoma( ICIR)