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

THANK YOU