Search

The authors present the youngest reported child with proliferative sickle retinopathy. A 3-year, 6-month-old boy presented with leukocoria in the left eye, left esotropia, and dense free-floating white vitreous cells obscuring the fundus, suspicious for endophytic retinoblastoma. Ultrasonography depicted dense debris in the vitreous with no distinct calcific echo or retinal mass. Transcorneal, transzonular fine-needle aspiration biopsy of the vitreous confirmed the presence of dehemoglobinized vitreous red blood cells without tumor. The opposite eye showed peripheral retinal pigment epithelial proliferation and fibrosis with angiographic peripheral ischemia. Hemoglobin electrophoresis disclosed sickle trait (AS). The findings were classified as proliferative sickle cell retinopathy with vitreous hemorrhage in the left eye and non-proliferative sickle cell retinopathy in the right eye. Leukocoria generally raises warnings for retinoblastoma, but can also reflect chronic vitreous hemorrhage., (Copyright 2011, SLACK Incorporated.)

The aim of this study was to establish the causes of leukocoria in pediatric patients in a tertiary hospital environment. All patients younger than 10 years who presented with leukocoria between January 1, 1999, and December 31, 2000, were included in the study; 39 (55%) patients were boys and 32 (45%) patients were girls. Sixty percent of the patients who presented with leukocoria had congenital cataract (18% unilateral and 42% bilateral). Other causes included retinoblastoma (11% unilateral and 7% bilateral), retinal detachment (2.8% unilateral and 1.4% bilateral), bilateral persistent hyperplastic primary vitreous (4.2%), and unilateral Coats' disease (4.2%). Leukocoria in children demands immediate attention because a significant number of children have pathology that either threatens life or causes permanent visual disability.

We examined a 14-year-old girl with bilateral hyperplastic persistent pupillary membranes, present since birth, with poor visual acuity. The membranes were excised surgically; visual acuity improved. Extensive persistent pupillary membranes can be removed safely by surgical methods if they are large enough to obscure the pupillary axis and affect visual acuity.

Two patients with small pupils developed endophthalmitis following cataract surgery during which the small pupils were managed by sector iridectomy and closed with a polypropylene suture. Prior studies have reported that implantation of intraocular lenses (IOLs) with haptics made of polypropylene is associated with a higher risk of postoperative endophthalmitis than the use of IOLs with polymethylmethacrylate haptics. Endophthalmitis in the two patients reported herein was managed successfully without removal of the polypropylene suture; vision returned to 20/60 in one patient and 20/30 in the other patient. Iris retractors may represent a faster and safer alternative management option for small pupils than sector iridectomy closed with a polypropylene suture.