An infant present with bilateral white pupillary reflex. On slit lamp examination a zone of opacity is observed arround the fetal nucleus with spoke like radial opacities. The most likely diagnosis is-
**Core Concept**
The question describes a characteristic appearance of the cornea in an infant, which is a specific manifestation of a congenital condition. The presence of a zone of opacity around the fetal nucleus along with spoke-like radial opacities is a classic sign of a corneal anomaly. This condition requires a detailed understanding of corneal development and anatomy.
**Why the Correct Answer is Right**
The described appearance is consistent with a congenital corneal defect known as _Peter's anomaly_. This condition is characterized by a central corneal opacity that involves the entire thickness of the cornea, with spoke-like radial opacities emanating from the center. The opacity often involves the fetal nucleus, which is the central part of the cornea that develops from the embryonic lens. The spoke-like opacities are thought to result from the abnormal development of the corneal stroma and endothelium. The condition is often associated with other systemic anomalies and may be related to a genetic mutation.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not accurately describe the characteristic appearance of Peter's anomaly. While corneal scars can result from various causes, the specific pattern of spoke-like radial opacities around the fetal nucleus is not typical of other corneal conditions.
**Option B:** This option is incorrect because it does not accurately describe the characteristic appearance of Peter's anomaly. While corneal leukoma can result from various causes, the specific pattern of spoke-like radial opacities around the fetal nucleus is not typical of other corneal conditions.
**Option C:** This option is incorrect because it does not accurately describe the characteristic appearance of Peter's anomaly. While corneal dystrophies can result in opacities, the specific pattern of spoke-like radial opacities around the fetal nucleus is not typical of other corneal dystrophies.
**Option D:** This option is incorrect because it does not accurately describe the characteristic appearance of Peter's anomaly. While corneal scars can result from various causes, the specific pattern of spoke-like radial opacities around the fetal nucleus is not typical of other corneal conditions.
**Clinical Pearl / High-Yield Fact**
Peter's anomaly is a rare congenital condition that often requires surgical intervention to restore vision. It is essential to recognize the characteristic appearance of the cornea in infants with Peter's anomaly to provide prompt and effective treatment.
**Correct Answer: C. Congenital Corneal Ectasia with Peter's anomaly.**