PEDS Final - Anterior And Posterior Segment

This retina is avascular because it hasn’t had a chance to develop. Now they are placed in an incubator (O2 rich), the retina undergoes vasoconstriction. Then when it returns to normal room temperature, then that’s going to trigger a vasoproliferation, and that can lead to neovascularization due to change in O2 environment. That neo can further lead to RDs and fibrosis

Option 4 - Best Disease
Option 3 - refers to Infantile GLC
Option 1 - refers to colobomas

Capillary hemangioma is the most likely condition that the child has. Capillary hemangioma is a benign tumor made up of small blood vessels. It commonly appears in infancy and grows rapidly in the first year of life. It is often red or purple in color and can darken when the child cries due to increased blood flow. Capillary hemangiomas typically reach their maximum size by 1-1.5 years of age and then begin to involute, or shrink, with time. The information provided in the question aligns with the characteristics and progression of capillary hemangioma.

Stage I- flat demarcation line that separates vascular and avascular retina. Stage II- Demarcation line is more distinct and now forms an elevated ridge. Stage III- demarcation has neovascularization. Stage IV- partial RD. Stage 5- Complete RD. Plus dz is when there are tortuous and engorged vessels in the posterior pole area. If pt has tortuous vessels it might be noted Stage III with a plus sign next to it
meaning they have plus dz as well.


Option 3 and 4 - Stargardt's Disease

Tapering antibiotics once improvement is seen is not a recommended practice because it can lead to incomplete treatment and potential antibiotic resistance. It is important to complete the full course of antibiotics as prescribed by the healthcare provider to ensure effective treatment and prevent the development of antibiotic-resistant bacteria.

Surgery is considered the definitive treatment for infantile glaucoma, meaning it is the most effective and reliable method to address the condition. While eye drops may be used temporarily to manage symptoms until the surgery can be performed, they are not intended to be a permanent solution. Therefore, the statement that surgery is the definitive treatment for infantile glaucoma and drops are not a permanent treatment is true.

- Polytrim which has Polymycin B covers Gram negative and trimethoprim covers Gram positive so together you have a medication that covers gram negative and positive. Approved for kids 2mo and older. Side effects are rare. Here you can see the dosage for mild infection and moderate to severe infection

- Polysporin: Bacitracin and Polymycin B, because Polymycin B covers Gram (-) bacteria. Combined, this is a pretty good medication that goes against bacterial infection. Dosage is about 3-4 times per day. These medications have ↓cost, little hypersensitivity, and little resistance and low toxicity so it’s pretty good for kids.

- Gentamicin (Aminoglycoside) : safety in neonates not yet established, more toxic questionable for gram positive bacteria

CT scans are no longer done in children with retinoblastoma because they increase the risk of developing a secondary cancer later in life. This is because CT scans use ionizing radiation, which can damage DNA and potentially lead to the development of cancer. Instead of CT scans, the clinic uses a B-Scan, which is also effective at detecting calcium.

The statement contradicts the commonly known fact that bilateral presentation of congenital cataracts is more common than the unilateral presentation. Additionally, while congenital cataracts can have a hereditary component, it is not always the case. Therefore, the correct answer is false.

For babies that don’t have the condition spontaneously resolve by 1yo then what you can do is refer the patient for probing

The Infant Aphakia Treatment Study found that there was no significant difference in visual acuity (VA) at the age of 1 year between children who received intraocular lenses (IOLs) or contact lenses (CLs) for their aphakia. This suggests that both treatment options are equally effective in improving visual outcomes in infants with aphakia.

EOGs and ERGs help differentiate Stargardt’s from Best Dz.
In Stargardt’s pts EOGs are normal, and EOGs are abnormal in Best's Disease

Option1 - Best Disease
Option 2 - Infantile GLC
Option 4 - Retinal coloboma

the dosage Vigamox is TID for 7days and Zymar is Q2H for 2 days and then QID for 5 days. So there’s a loading dosage for Zymar. So for kids you can see that Vigamox is less problematic because you don’t have to put in the drops as frequently as Zymar. Both medications have good Gram positive and negative coverage so that’s a good thing for kids. Vigamox, unlike Zymar, is preservative free and closer to physiological pH and dosage is a little bit less.

If the patient's redness and discharge have improved but the itching persists, the best next step in treatment would be to consider using a mild steroid in addition to the combination drops (Patanol or Pataday). If the condition is severe, a stronger steroid like PredForte can be used on a frequent basis. It is important to follow up with the patient later in the day or the next day to monitor their progress.

The given answer is not a characteristic of Rhabdomyosarcoma because it does not present with a rapid onset of bilateral proptosis. Rhabdomyosarcoma is a type of cancer that commonly occurs in children and is characterized by the rapid growth of malignant cells in the soft tissues, such as muscles. It typically presents as a mass or swelling in the head or neck area, but can also occur in other parts of the body. While it can cause proptosis or bulging of the eyes, it does not usually manifest as a rapid onset of bilateral proptosis.

The brother of Vigamox is Moxeza, the benefit is that it’s approved for kids as young as 4mo compared to Vigamox. The concentration is the same but the carrier for Moxeza allows for the drop to stay in the eye for a longer period of time, that’s why the dosaging is only 2x per day compared to 3x per day for Vigamox.

Propanolol - was an oral treatment and we can't prescribe this

There’s a lot of treatment options that are available in order to medically manage these patients. Steroids used to used frequently in the past and they can be administered orally if the tumor is very
large in size. They can be administer intralesionally, so if it’s a smaller tumer then via injection, the steroid can be administered. There were a few doctors that tried topical administration of steroids to see if that would help regression of the tumor and it actually was found not to be very successful. So it’s usually giving via injection or orally. With steroids there are complications, so weight gain, behavior changes, GI upset, as well as a lot of other things that are items to worry about with a steroid administration. Laser or an excision type of a procedure has also been done in the past. So more recently Oral propanolol and Topical Timolol has been in the research as a method of treatment for capillary hemangiomas.

Neurofibromatosis is not a differential diagnosis for Leukocoria because it is a genetic disorder that causes tumors to grow on nerves, while Leukocoria is a symptom characterized by a white reflection in the eye. The other options listed, such as Coloboma, Persistent hyperplastic primary vitreous (PHPV), Coat's Disease, and Retinopathy of Prematurity (ROP), are all potential causes of Leukocoria.

Unilateral cases of RB are not normally caught at 7 months, while bilateral cases are not normally caught at 24 months. The statement is false because the age at which RB is caught can vary and is not specific to unilateral or bilateral cases.

Aniridia is a genetic disorder characterized by the absence of the iris in the eye. It is commonly associated with the development of posterior polar cataracts. These cataracts form at the back of the lens and are often located in the central area. The presence of aniridia increases the likelihood of developing posterior polar cataracts, making it the most associated type of congenital cataract in individuals with this condition.

Anisometropia refers to a condition where there is a significant difference in the refractive power between the two eyes. Anterior Polar cataract is most associated with Anisometropia because it occurs in the front portion of the lens, causing a significant difference in the refractive power between the affected eye and the unaffected eye. This difference in refractive power can lead to anisometropia, resulting in unequal focusing abilities between the two eyes.

The onset of symptoms is much later in life vs. with retinoblastoma we said that shows up between 7 or 8 months of age up to about 2 years of age when that condition typically presents.

Microphthalmia/Microcornea - in nuclear cataract and persistend hyperplastic primary vitreous
Iris neovascularization and corneal edema, Lipids/proteins in the aqueous chamber - Coat's disease

The family history of glaucoma is not a factor to consider for surgical intervention. Factors to consider for surgical intervention typically include the location of the condition, the appearance of strabismus or nystagmus, and the density of the cataract. However, a family history of glaucoma does not directly impact the decision for surgical intervention.

Option 4 - Lamellar cataract
Option 2: RB

Coats - Tx dependent on stage , refer at stage 2