7. Ablasio Retina
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Transcript of 7. Ablasio Retina
ABLASIO RETINA
ROCHASIH MUDJAJANTI
DEFINISI
LEPASNYA LAPISAN RETINA SENSORIS
DARI EPITEL PIGMEN RETINA
KLASIFIKASI
RHEGMATOGENOUS RD –TEAR (+)
TRACTIONAL RD
EXUDATIVE RD
EPIDEMIOLOGI
INSIDENSI – 1 PER 10.000
BERHUBUNGAN DG MIOPIA – 7%
MIOP SEDANG
Teknik pemeriksaan
Indirect Ophthalmoscopy with scleral
indentation
Indirect biomicroscopy
B-scan Ultrasound
Mekanisme ablasio retina
1- Rhegmatogenous RD:
◦ Retinal breaks + accumulation of subretinal
fluid
◦ Retinal breaks result from dynamic
vitreoretinal tractions(PVD) and peripheral
retinal degenerations
Komplikasi PVD
No complications: most of the time
Retinal tears:
◦ 10-15% of cases
◦ Associated with vitreous hemorrhage
◦ U-shaped
◦ Risk of RD is high
Avulsion of retinal blood vessel and
vitreous hemorrhage without tear: rare
Acute posterior vitreous detachment: (a) synchisis; (b) uncomplicated
posterior vitreous detachment; (c) retinal tear formation and vitreous
haemorrhage; (d) avulsion of a retrnal blood vessel and vitreous
haemorrhage
Tipe degenerasi
Lattice Degeneration:
◦ 8% of population
◦ 40% in eyes with RD
◦ Most common among Myopes
◦ Shape: Spindle-shaped areas of thinnig in the
form of a network .
◦ Overlying vitreous is synchitic but
attachments are stronger
Lattice degeneration
MYOPIA & ABLASIO RETINA
over 40% of all RDs occur in myopic eyes.
The higher the refractive error the greater the risk of RD.
The following interrelated factors predispose a myopic eye to RD:◦ Lattice degeneration .
◦ Snailtrack degeneration.
◦ Diffuse chorioretinal atrophy may give rise to small round holes in highly myopic eyes.
◦ Macular holes may give rise to RD in highly myopic eyes.
◦ Vitreous degeneration and PVD are more common.
◦ Vitreous loss during cataract surgery, is associated with about a 15% incidence of subsequent RD in myopic eyes greater than 6D; the risk is even higher if myopia is more than 10D.
◦ Posterior capsulotomy is associated with an increased risk of RD in myopic eyes.
Mekanisme ablasio retina
2-Tractional retinal detachment:
e.g. Diabetic tractional RD
Active vitreous traction
3- Exudative RD: ◦ disorders that disrupt the retinal pigment epithelium and allow
the choroidal fluid to accumulate in the subretinal space
Causes: ◦ Choroidal tumors
◦ Intraocular inflammation
◦ Iatrogenic : RD surgery
◦ Subretinal neovascularizations
Bridging and anteroposterior vltreoretinal traction giving rise to an extensive
tractional retinal detachment in advanced proliferative diabetic retinopathy
Gambaran klinik
Rhegmatogenous RD:
Symptoms: ◦ flashes of light(Photopsia)
◦ Vitreous floaters(ring-shaped, cobweb, and shower of floaters)
◦ Peripheral visual loss: relative scotoma
Signs: ◦ Relative afferent papillary defect
◦ Lower IOP
◦ Vitreous opacities(tobacco dust)
◦ Retinal breaks
◦ Retinal appearance: convex corrugated and undulating surface
Fresh bullous superior retinal detachment
GAMBARAN KLINIK
Tractional RD:
Symptoms: photopsia and floaters are absent, slowly progressive visual field loss
Signs: Concave immobile surface, absent retinal breaks
Exudative retinal detachment:
Symptoms: photopsia is absent but floaters are present(vitritis), visual field loss
Signs: Convex, smooth not corrugated, mobile with shifting of subretinal fluid, absent retinal breaks
Combined Tractional and Rhegmatogenous RD
Choroidal Detachment
Choroidal Detachment
TATALAKSANA
RHEGMATOGEN – SIMPLE SCLERAL BUCKLING, SB + VITREKTOMI, MEMBRAN PEELING, GAS, SILIKON OIL
TRD PADA PDR – LASER FC SEBELUM SB, VITREKTOMI, MEMBRAN PEELING
TRD DG ABLASIO RHEGMATOGEN – SB, VITREKTOMI, MEMBRAN PEELING, GAS
EKSUDATIVA – FFA, USG,ERG,KONSUL SUBBAG LAIN YG TERKAIT, TERAPI PENYAKIT DASAR
PNEUMORETINOPEXY