opt kuliah 17-18 des 2007
TRANSCRIPT
RETINA, VITREOUS, OPTIC NERVERETINA, VITREOUS, OPTIC NERVE
Lecture 6- Central Retinal Vein Occlusion (CRVO)- Branch Retinal Vein Occlusion (BRVO)- Central Retinal Artery Occlusion (CRAO)- Branch Retinal Artery Occlusion (BRAO- Retinal Detachment- Vitreous Hemorrhagic- Optic Neuritis
Lecture 9- Hypertensive Retinopathy - Diabetic Retinopathy
Posterior Segment Disease EvaluationPosterior Segment Disease Evaluation
- Anamnesis- Visual Acuity- Color Vision (Ishihara)- Anterior Segment Evaluation- Posterior Segment Evaluation
. Direct or indirect ophthalmoscope. (Trimiror Funduskopi, Non-kontak Fdkopi).. FFA (Fundus Flourescein Angiography). Visual Field Test. USG (Ultra Sonografi).
ophthalmoscope
Goldmann perimeterNon contact lens 78D
Goldmann three-mirror lens
Normal Fundus
Flourescein Angiography
Ultrasonography (USG)
RETINAL DETACHMENT.RETINAL DETACHMENT.
= Retinal Detachment.= Separation of the sensory retina (photoreceptors and inner tissue layers) from RPE
Three main types :A. Rhegmatogenous Detachment (RD) = >> common exm : myopia, aphakia, Lattice degeneration, trauma, spontaneous.B. Traction Retinal Detachment (TRD) >> Proliferative DR, PVR, ROP, Ocular TraumaC. Serous & Hemorrhagic Retinal Detachment (tear-) Degenerative, inflammatory, infectious dss, Systemic vascular & inflamatory dss
Sign and Symptom
� - Early : Floaters, photopsia.� - Visual Field disturbance. � - Like cover by curtain� - Central Visual Acuity : decrease.
Funduscopy :
� - Retina elevated, bulging, “ blass”, grey color/pale, blood vesel
elevated � - Hole / tear or traction in Vitreous Body
Retinal Detachment Nonrhematogenous
Retinal Detacment rhegmatogenous
RD with fold and traction
Therapy • Hospitalized, bed rest , midriatikum, antiimflamation, Antioksidan • Small Tear : laser fotocoagulation, diatermy, Cryo• Operation ( create adhesion)
Scleral Buckling or pneumatic retinopexy, vitrektomi, endolaser
Prognosis Good : if the tear small and blass not involve the macula
Operation RD
RETINAL VEIN OCLUSIONRETINAL VEIN OCLUSION
2 Type : Central Retinal Vein Occlusion (CRVO) Branch Retinal Vein Occlusion (BRVO)
Cause : - vein compression, arteriosclerosis, Infection
Sign & Symptom : - Sudden painless loss of vision
Funduscopy: - Retinal haemorrhages ; flame shape. - Exudate cotton wool.
Therapy: - careful follow-up, causal, - Local : laser Photocoagulation.
Complication : Rubeosis Iridis (iris new vessel) → Glaucoma Neovascular
CRVO
BRVO
CENTRAL RETINA ARTERY OCLUSIONCENTRAL RETINA ARTERY OCLUSION
Cause : - embolus, arteriosclerosis, Infection
Symptom & Sign : Sudden Painless visual loss(amaurosis fugax)
Visual Acuity : CF~LP, RAPD +
Funduskopi :- retina : Pale (Opacified) - Foveola Red : “cherry red spot’
Therapy: - Immediately : massage eye ball, diamox (I.V). - Anterior Chamber Parasentesis - find the cause.
Complication: - Blind permanently
CRAO hiperemi
CRAO Cherry red spot
VITREOUS HEMORRHAGICVITREOUS HEMORRHAGIC
Definition : Hemorrhage in vitreous body. Cause : - Diabetic retinopathy
- Sensory retina is torn - CRVO / BRVO - Hypertension
Sign & Symptom: - floaters - Visual Loss.
Funduscopy : - Black dot in vitreous body. - Dark
Therapy : - Find the etiology. - Early vitrectomy : TRD involve macula - Conservatively 3 - 6 month.
- Vitrektomy
VITREOUS HEMORRHAGE
VITREOUS HEMORRHAGE
OPTIC NEURITIS
� Variety of causes, >> Demyelination� Retrobulbar neuritits : Normal optic disk
(acute episode)� Papilitis : disc swelling : inflamation nerve
head� Symptom : loss of vision
Demyelinative optic neuritis� Ass. Multiple sclerosis� Color vision, contrast sensitivity: impaired� Pain in eye region, eye movement� Visual field disturbance, >> central scotoma� Pupil Reflek : sluggish, RAPD (asymmetrically
involved)� Papilitis : Hyperemia optic disk, distention of
large veins, blurring disk margin� MRI, CT Scanning
OPTIC NEURITIS
DIFERENTIAL DIAGNOSIS
� Papilitis VS Papiledema (greater elevation of optic nerve, nearly normal VA, Pupil reflek normal, ass. Intracranial pressure, VF intact, enlarge blind spot, >>bilateral
TREATMENT� Steroid (IV, Oral, retrobulbar injection)� Methylprednisolone (ig/d 3 days) followed oral
prednisolone (1 mg/kg/d 11 days) PROGNOSIS� Variety � Improve : 2-3 weeks� Poor : involve optic canal
LECTURE 9HYPERTENSIVE RETINOPATHY
DIABETIC RETINOPATHY
HYPERTENSIVE RETINOPATHY
Deff: Retina and Blood vessel disorder due to Hypertension
Symptom & Sign : Early : no complainLate : Blurr vision ~ blind
FunduscopyNarrowing blood vessel, sclerotic, crossing phenomena.flame shape, Exsudate : dot, hard (punctat) or cotton wool retinal detachment.
CLASSIFICATION Keith - Wagener - Barker (KW).� KW I : Sclerotic, mild narrowing.� KW II : a - v cross, hard eksudat ( ± 20
%)� KW III : Bleeding, soft exsudate� KW IV : KW III + papil edema (± 98 %)
THERAPY : Internal Departement
COMPLICATION : CRVO, BRVO
Hypertensive RetinopathySilver wire
Exsudate
Flame shape hemor
Hypertensive Retinopathy
Hypertensive Retinopathy KW IV
DIABETICDIABETIC RETINOPATHYRETINOPATHY
Deff : Retinopathy cause by Diabetes Melitus. Patient with DM > 5 years 90-95 % will occur DR if DM > 20 th.
Symptom and signBlurr vision ~ grading DRAnterior segment : normal
Funduscopy : microaneurysms, exsudate dot / cotton wool, bleeding spot, PVR, newvessel.
CLASSIFICATION DIABETIC RETINOPATHY.
A. Background D.R = Non Proliferatif D.R (NPDR) mycroaneurysms, exudate(dot) &
bleeding(f lame).
B. PreProliferative : bleeding and exudate more.
C. Proli feratif R.D. (PDR) newvessel on papil, preretina, retina Bleeding and traction in vitreous body
D. Maculopathy D.R edema, exsudate & bleeding in macula.
NONPROLIFERATIVE DIABETIC RETINOPATHY
NPDR
PROLIFERATIVE D.R
Therapy.Antioksidan .Laser photocoagulation
: → hipoksia → newvessel (-).Vitrectomy → traction and bleeding in .vitreous body
Complication.Refraksion error.neovascular Glaucoma .Optic Neuritis
LASER SPOT
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