PA dr Simon

7/23/2019 PA dr Simon

http://slidepdf.com/reader/full/pa-dr-simon 1/110

The Eyedr. Duti Sriwati Aziz, SpPA

Sub Dep PA RSAL Dr. Ramelan – FK UHT



•Orbita

•Eyelid

•Conjunctiva•Sclera

•Cornea

•Uvea•Retina & vitreuous

•Optic Nerve



ORBITA



Figure 29-1 Anatomy of the eye.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0!:1" #$%

200 'lsevier



•Kelainan :

–Proptosis

–Thyroid ophthalmopathy

–Infeksi

–Neoplasma



1.PROPTOSIS

•Tekanan orbita bola mata

terdorong proptosis

kelopak mata tak tertutup air mata

tak merata kornea kering –Nyeri

–Infeksi



•2 macam :

1.Axial ( directly forward )

2.Positional



•Positional → Medial, inferior o.k teksuperotemporal

–Infeksi → kel.lacrimalis

–Neoplasma →

•Lymphoma

•Pleimorphic adenoma

•Adenoid cystic carcinoma ( Silindroma )



• Axial

–Thyroid ophthalmopathy

–Tumor CNS ( bukan SSP ) →

•Meningioma

•Glioma



2.Thyroid ophthalmopathy

•Axial proptosis

•Grave’s disease

–karena :•Akumulasi extracellular matrix protein

•Fibrosis muskulus rectus



The extraocular muscles are greatly distended in this postmortem dissection of tissuesfrom a patient with thyroid (Graves) ophthalmopathy. Note that the tendons of the

muscles are spared involvement.(Courtesy of Dr. Ralph C. Eagle Jr, Wills Eye Hospital, Philadelphia, PA.)

Downloaded from: Robbins & Cotran Pathologic

Basis of Disease (on 1 November 2005 06:18 AM)© 2005 Elsevier



3.INFEKSI

•Uncontrolled Sinusitis

•Immunosuppressed → mucormycosis

•Diabetes sclerosing•Wegener granulomatosis

•Idiopathic orbital inflammation → orbital

inflammatory pseudotumor



Orbital inflammatorypseudotumor

–Unilateral

–Bilateral

–Seluruh elemen orbita

–Kel lacrimalis → sclerosing dacryoadenitis

–Orbital myositis

–Posterior scleritis



•Mikroskopis :

–Fibrosis

–Radang khronis

•sel plasma, lymphocyte ( germinal centre ),eosinophil

•Lokasi :

–Terbatas di Orbita–Bersamaan dengan keradangan diretroperitoneum, mediastinum, thyroid



In idiopathic orbital inflammation (orbital inflammatory pseudotumor), theorbital fat is replaced by fibrosis.

Note the chronic inflammation, accompanied in this case by eosinophils.

Downloaded from: Robbins & Cotran Pathologic Basis of

Disease (on 1 November 2005 06:18 AM)© 2005 Elsevier



4.Neoplasma

•Vascular :

–Capillary Hemangioma

–Lymphangioma

•Kel. Lacrimal :

–Pleomorfik adenoma

•Dermoid cyst

•Neurilemmoma ( Schwannoma )•Limphoma maligna

•Metastasis ( prostat, neuroblastoma, wilm’s tumor )



EYELID



Downloaded from: Robbins & Cotran Pathologic Basis ofDisease (on 1 November 2005 06:18 AM)

© 2005 Elsevier



•Radang

•Granuloma → chalazion

•Neoplasma



CHALAZION

• Ekstravasasi lipid kejaringan sekitar

–Reaksi granulomatous → Lipogranuloma

–O.k obstruksi sebaceous gland :

•Blepharitis

•Neoplasma



Neoplasma

1.Basalioma ( Basal Cell Ca )

2.Sebaceous Carcinoma

3.Melanoma4.Kaposi sarcoma

Ulcerasi kornea



•Basalioma

–Palpebra inferior

–Chanthus medius

•Sebaceous carcinoma

–≈ chalazion

–Metastase → kelenjar parotis dansubmandibula

–Mortalitas 22%



•Kaposi sarcoma

–Eyelid → Purple hue

–Mucous membran conjuctiva → Bright red

( ≈subconjuctival haemorrhage )

–Conjuctiva menebal



CONJUNCTIVA



Downloaded from: Robbins & Cotran Pathologic Basis ofDisease (on 1 November 2005 06:18 AM)

© 2005 Elsevier



•Scarr

•Pinguecula & Pterygium

•Neoplasma



Conjunctival scarring

•Chlamydia trachomatis

•Caustis alkalis

•Pemphigoid•Iatrogenic

Scarring goblet cairan ulcerasi visi



3. Pinguecula & Pterygium

•Fibrovascular submucosa

•Pinguecula

–actinic damage

–invasi cornea–Precursor Squamous Cell Ca & Melanoma

•Pterygium

–not invasi cornea–pada submucosa limbus ( solar elastosis )

–Infeksi sekunder → actinic granuloma



4. Neoplasma

•Dapat CIN ( Conjunctival IntraepithelialNeoplasma )

•CIN + squamous papilloma Humanpapilloma virus 16, 18

•Mucoepidermoid Ca

•Conjunctival nevi melanoma insitu

•Conjunctival melanoma



SCLERA



• Sedikit vascular & fbroblast→ coklat,operasi sukar sembuh

• Rheumatic arthritis Immune complex

deposit necrotizing scleritis• Biru →

– igh intraocular pressure staph!loma

– "steogenesis imper#ecta– $ongenital nevus % nevus o# ota



CORNEA



•Keratitis & ulcer

•Degeneration & distrophy

–Band keratopathies–Keratoconus

–Fuchs endothelial dystrophy

–Stromal dystrophy



Keratitis & Ulcers

•Bakteri, fungal, protozoa, virus ( H.simplex, H. Zoster )

•Aktivasi collagenase epithel &fibroblast

•H. simplex chronis reaksigranulomatous pada Descemet



Chronic herpes simplex keratitis.The cornea is thin and scarred (note the increased number offibroblast nuclei). Granulomatous reaction to Descemet's

membrane (arrows).

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0!:0 #$%

200 'lsevier



Corneal Degeneration & Dystrophies

•Degeneration -bilateral/unilateral

-non-familial

•Dystrophies -bilateral

-hereditary



a.Band keratopathies

•Calcific band keratopathy timbunan kalsium pada lapisanBowman

•Actinic band keratopathy padaultraviolet pengaruh collagen (solarelastosis)



b.Keratoconus

• Penipisan & ectasia corneaprogressive tanpa inflamasi atauvaskularisasi

• Etiologi : unknown

• Biasanya bilateral, ada hubungan dgDown syndrome, Marfan syndrome



Keratoconus.



• The tissue section is stained by periodic acid-Schiff to highlight theepithelial basement membrane (ebm), which is intact.

• Bowman's layer (bl), situated between the epithelial basementmembrane and the stroma (s), is not a basement membrane.

• By tracing Bowman's layer from the right side of thephotomicrograph toward the center, one notices a discontinuity inthis layer, diagnostic of keratoconus.



•Patogenesa :

–Activasi colagenases, gelatinases, matrixmetalloproteinases



Morfologi :

•Cornea menipis, Bowman’s pecah-pecah



c.Fuchs Endothelial Dystrophies

• Ada pada anak-anak / dewasamuda, progressive, autosomalrecessive

• Rasa nyeri karena erosi epitel



d.Stromal Dystrophies

• Ada pada anak-anak / dewasa muda,progressive, autosomal recessive

• Rasa nyeri karena erosi epitel• Keratan sulfat, amyloid pada stromakornea

• Bentuknya ada 3 : Lattice dystrophy Granular dystrophy Avellino dystrophy



ANTERIOR SEGMENT



1. Anatomi Fungsional

•Bag. depan dibatasicornea, lateraldibatasitrabecular messwork, posteriordibatasiiris

•Lens capsule, sbg basement membranedari epitel lensa

•Anterior segment : cornea, anteriorchamber, posterior chamber, iris, lensa

•Posterior segment : sisa dibelakangnya



Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured ith crypts and folds. Upper right, The normal flo of a!ueous humor. A!ueous

humor, produced in the posterior cham"er, flos through the pupil into the anterior cham"er. The ma#or pathay for the egress of a!ueous humor is through the

tra"ecular meshor$, into %chlemm&s canal. 'inor outflo pathays (u)eoscleral and iris, not depicted* contri"ute to a limited extent to a!ueous outflo. +oer left,

rimary angle closure glaucoma. n anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens "loc$s the passage of a!ueous

humor from the posterior cham"er to the anterior cham"er. ressure "uilds in the posterior cham"er, "oing the iris forard (iris "om"/200* and occluding the

tra"ecular meshor$. +oer right, A neo)ascular mem"rane has gron o)er the surface of the iris, smoothing the iris folds and crypts. 'yofi"ro"lasts ithin the

neo)ascular mem"rane cause the mem"rane to contract and to "ecome apposed to the tra"ecular meshor$ (peripheral anterior synechiae*. utflo of a!ueous humor

is "loc$ed, and the intraocular pressure "ecomes ele)ated.


200 'lsevier












200 'lsevier



2. Cataract

•Cataract yaitu kekeruhan lentikular, dapatacquired/kongenital

•Penyakit-penyakit :

–Systemic (galactosemia, DM, Wilson, Atopic)–Radiation

–Trauma

–Intra ocular•Cataract yg berhubungan usia kekeruhan nukleus



•Pigmen urochrome warna coklat

•Migrasi epitel ke bagian belakang posterior subcapsular cataract

•Cortex lensa mencair morgagniancataract

•Protein berat molekul tinggi yang pecah

dari lensa phacolysis membendungtrabecular meshwork glaucomaphacolytic



3. Segmen anterior dan Glaucoma

•Yaitu kumpulan penyakit ditandai denganperubahan yang jelas dari gangguanpandang & nerve opticum cup

•Biasanya dg peningkatan tekanan intraokular, tetapi dapat juga normal(normal/low tension glaucoma)

•Aqueous humor dibentuk oleh ciliary bodies masuk ke trabecular meshwork












200 'lsevier



Jenis glaucoma :

•Glaucoma sudut terbuka primary

•Glaucoma sudut tertutup secondary



Primary glaucoma sudut terbuka :

•Mutasi padaGLC1A, pada chromosome 1 myocilin

• Jenis glaucoma yg terbanyak



Secondary glaucoma sudut terbuka :

•Phacolysis pada chataract

•Darah (ghost cell glaucoma)•Pigmen iris (pigmentary glaucoma)

•Oxytalan fibers (exfoliation glaucoma)

•Necrotic tumor (melanomalytic glaucoma)



Primary glaucoma sudut tertutup :

•Banyak pada hyperopia

•Terjadi papillary block terjadi iris bombé

•Epitel lensa dapat rusak



Secondary glaucoma sudut tertutup :

•Kelebihan VEGF (Vascular EndothelialGrowth Factor)

•Neovascular glaucoma karena nekrotiktumor

•Endothel cornea berlebihan menutupmeshwork

4Ed hthliti&



4. Endophthalmitis &Panophthalmitis

• Traumatic iridocyclitis

• Infeksi cornea

• Uveitis

• Anterior synechiae iris & trabc. m. Melekat krn

• Posterior synechiae iris & lensa exudate

fibrous metaplasiaanterior subcapsular



%e!uelae of anterior segment inflammation.

This eye as remo)ed for complications of chronic corneal inflammation

(hich cannot "e discerned at this magnification*. The exudate (e* presentin the anterior cham"er ould ha)e "een )isuali3ed at the slit lamp as an

optical 4flare.4 The iris is adherent focally to the cornea, o"structing the

tra"ecular meshor$ (anterior synechia, arro*, and adheres to the lens

(posterior synechiae, arroheads*. An anterior su"capsular cataract (asc*

has formed. The radial folds in the lens are artifacts.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0):2" #$%

200 'lsevier



5xogenous panophthalmitis.

Note the suppurati)e inflammation "ehind the lens and dran up to the right of

the lens to the cornea, the site of the ound. The central portion of the )itreous

humor as extracted surgically ("y )itrectomy*. Note the adhesions to theDownloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0):2" #$%

200 'lsevier



UVEA



Terdiri dari

–Iris

–Ciliary bodies–Choroid



1. Uveitis

•Adalah proses keradangan khronik darisalah satu atau keseluruhan Uvea

•Misal : juvenile rheumatic arthritis,

segmen anterior/posterior•Biasanya disertai keradangan retina

•Sebabnya :

–Infeksi bakteri ( pneumocystis carnii )–Idiopathic (sarcoidosis) : granulomatous uveitis

–Autoimune (sympathetic ophthalmia)



•Granulomatous Uveitis

–Anterior segment : exudate mutton-fat

–Posterior segment : choroid dan retina

•Toxoplasma infeksi choroid & retina

•Cytomegalovirus retina

•Mycobacterium avium uvea



•Sympathetic ophthalmia

–Bilateral granulomatous inflammation :seluruh uvea

–Pertama didapatkan pada : Louis Braille sel-sel eosinophil

–Terdapat Ag retina 2 minggu beberapa

tahun hypersensitivity delayed



Sympathetic ophthalmia. The granulomatous inflammation depicted herewas identified diffusely throughout the uvea. The uveal granulomas maycontain melanin pigmentand may be accompanied by eosinophils.



2. Neoplasma

Terbanyak metastase ke uvea (choroid)

Uveal nevi & Melanoma

•Melanoma uveal adalah tumor intraocular tersering pada dewasa

•Usia terutama dekade 7

•Nevus choroid sering terjadi, 10% pd Ca•Penyebaran melanoma hematogenous, keliver, 5 YSR 80%



Figure 29-17 U)eal melanoma. A, Fundus photograph from a patient ith a relati)ely flat pigmented lesion of the choroid near the optic

disc. 8, Fundus photograph of the same patient se)eral years later the tumor has gron and has ruptured through 8ruch&s mem"rane.

, :ross photograph of a choroidal melanoma that has ruptured 8ruch&s mem"rane. The o)erlying retina is detached. ;, 5pithelioid

melanoma cells are associated ith an ad)erse outcome. 5, atterns rich in laminin (that are periodic acid-%chiff positi)e* surround

aggregates of melanoma cells these patterns form a 4fluid-conducting meshor$4 in u)eal melanoma and are associated ith an

ad)erse outcome. (A to from Fol"erg <6 athology of the eye-an interacti)e ;-<' program. hiladelphia, 'os"y, 199= 5 from

'aniotis A>, hen ?, :arcia , et al6 ontrol of melanoma morphogenesis, endothelial sur)i)al, and perfusion "y extracellular matrix.

+a" n)est @2(@*6101-1B0, 22.*Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0):2" #$%

200 'lsevier



U)eal melanoma. , :ross photograph of a choroidal melanoma

that has ruptured 8ruch&s mem"rane. The o)erlying retina isdetached. ;, 5pithelioid melanoma cells are associated ith an

ad)erse outcome.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0):2" #$%

200 'lsevier



•Morfologi ada 2 jenis yaitu :

–Spindle sel fusiform, sedikit atypic

–Epitheloid sel spherical, sangat atypic →

prognosa buruk

•Dapat timbul :

–Retinal detachment

–Glaucoma



RETINA & VITREOUS



1. Anatomi Fungsional

•Tidak ada aliran limphetic

•Pigmen epitel retinal asal dari optic vesicle

•Retinal detachment lepasnya neurosensory

retina dg pigmen epitel retina• persistent hyperplastic primary vitreous regresifetal vascular tdk sempurna

•Asteroid hyalosis calcium soap dari debris

vitreus humor•Posterior vitreous detachment posterior facehumor lepas dari retina



Figure 29-1= linicopathologic correlations of retinal hemorrhages and exudates. The location of the hemorrhage ithin the retina

determines its appearance "y ophthalmoscopy. The retinal ner)e fi"er layer is oriented parallel to the internal limiting mem"rane, and

hemorrhages of this layer appear to "e flame-shaped ophthalmoscopically. The deeper retinal layers are oriented perpendicular to the

internal limiting mem"rane and hemorrhages in this location appear as cross-sections of a cylinder or 4dot4 hemorrhages. 5xudates that

originate from lea$y retinal )essels accumulate in the outer plexiform layer.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0):** #$%

200 'lsevier



2. Retinal Detachment

•Lepasnya neurosensory retina dari pigmenepithelium

•Phlegmatogenous retinal detachment

seluruhnya lepas proliferatif vitreoretinopathy

•Surgical procedure retina pecah

•Non-rhegmatogenous retinal detachment

tanpa pecahnya retina -tumor

-hipertensi



Figure 29-1C <etinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. <etinal detachments are classified "roadly

into non-rhegmatogenous (ithout a retinal "rea$* and rhegmatogenous (ith a retinal "rea$* types. Top, n non-rhegmatogenous retinal detachment, the su"retinal

space is filled ith protein-rich exudate. Note in this s$etch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a

finding that can "e seen in "oth non-rhegmatogenous and rhegmatogenous detachments. 'iddle, osterior )itreous detachment in)ol)es the separation of the posterior

hyaloid from the internal limiting mem"rane of the retina and is a normal occurrence in the aging eye. 8ottom, f, during a posterior )itreous detachment, the posterior

hyaloid does not separate cleanly from the internal limiting mem"rane of the retina, the )itreous humor ill exert traction on the retina hich ill "e torn at this point.

+i!uefied )itreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this s$etch that the photoreceptor outer

segments are intact, suggesting that an acute detachment is "eing illustrated.


200 'lsevier












200 'lsevier



3. Retinal Vascular Disease

•Hypertension

–Arteriolosclerosis

arteriole & vena berjalan bersama, pd tempat

tertentu terdapat cross, pada arteriolosclerosis oclusi vena

–Hipertensi maligna saluran rusak

Elschnig's spots –Occlusion retinal arteriole cytoid bodies cotton wool spots



The retina in hypertension. A,

The all of the retinal arteriole

(arro* is thic$. Note the

exudate (e* in the retinal outer

plexiform layer.


200 'lsevier



Ner)e fi"er layer infarct.

The histology of a cotton-

ool spot-an infarct of the

ner)e fi"er layer of theretina-is illustrated in the

photomicrograph. A focal

swelling of the nerve fiber

layer is occupied by

numerous red to pinkcytoid bodies

(arrowheads), "ul"ous

ends of se)ered axons.

Hemorrhage (arrows)

surrounding the ner)e fi"er

layer infarct as illustrated

here is a )aria"le and

inconsistent finding.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0):** #$%



•Diabetes Mellitus

–Penebalan basement membrane epitel parsplicata

–Microangiopathy retinal :a. Preproliferatifb. Proliferatif

a. Preproliferatif

-basement membrane menebal-pericyte berkurang



The ciliary "ody in chronic

dia"etes mellitus, periodic acid-

%chiff stain. Note the massive

thickening of the basement

membrane of the ciliary body

epithelia, reminiscent of

changes in the mesangium of

the renal glomerulus.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0":01 #$%

200 'lsevier



–Microaneurisma microhemorrhages macular edema gangguan visual

–VEGF, angiogenesis microangiopathy

neovascularization of the disc –Traction retinal detachment rhegmatogenousdetachment

–Neovascular iris neovascular membrane kontraksi adhesi iris dg trabecularmeshwork glaucoma




200 'lsevier

The retina in dia"etes mellitus. A, Note the tangle of a"normal )essels #ust "eneath

the internal limiting mem"rane of the retina on the right half of the photomicrograph("eteen arros*. This is an example of intraretinal angiogenesis $non as

intraretinal microangiopathy (<'A*. Note the retinal hemorrhage in the outer

plexiform layer in the left half of this photomicrograph. phthalmoscopically, this

outer retinal layer hemorrhage ould appear as a 4dot4 hemorrhage



•Retinopathy of prematurity–Genetik susceptible

–Bayi prematur

–VEGF retinal angiogenesis detachment



• Sickle Retinopathy, Retinal Vasculitis,Radiation Retinopathy

a.Non proliferatif (intraretinal angiopathic

changes) b.Proliferatif (retinal neovascularization)

Vascular occlusion : karena -VEGF

-bFGF



•Retinal Artery and Vein Occlusions –Atherosclerosis pd retina trombosis

–Emboli pd retinal karena trombi jantung

infark retina

cherry red spot

–Cherry red spot juga ada padaTay-Sachs andNiemann-Pick

–Dapat menyebabkan glaucoma sudut tertutup



Figure 29-22 The cherry-red spot in Tay-%achs disease. A, Fundus photograph of the cherry-red spot in Tay-%achs disease. 8, hotomicrograph of the

macula in a patient ith Tay-%achs disease, stained ith periodic acid-%chiff to highlight the accumulation of ganglioside material in the retinal

ganglion cells. The presence of ganglion cells filled ith gangliosides outside the fo)ea "loc$s the transmission of the normal orange-red color of the

choroid, "ut a"sence of ganglion cells ithin the fo)ea (to the right of the )ertical "ar* permits the normal orange-red color to "e )isuali3ed, accounting

for the so-called cherry-red spot. (A courtesy of ;r. Thomas A. Deingeist, ;epartment of phthalmology Eisual %cience, Uni)ersity of oa, oa

ity, A 8 originates from the teaching collection of the Armed Forces nstitute of athology.*


200 'lsevier

4. Age Related Macular Degeneration



g g(ARMD)

•Faktor penting yaitu usia•Faktor penentu -rokok

-nutrisi

-vascular•Bruch's membrane

Choriocapillaris

•Ada 2 jenis :a.Atropic ARMD : -branch, membrane

-retinal pigmen epithel

b.Exudative ARMD

visual loss



Figure 29-20 Age-related macular degeneration. A neo)ascular mem"rane is positioned "eteen the retinal pigment epithelium (<5*

and 8ruch&s mem"rane (8'*. Note the "lue discoloration of 8ruch&s mem"rane to the right of the la"el, indicating focal calcification.


200 'lsevier

5Oth ti ld ti



5. Other retinal degeneration

• Retinitis pigmentosa :– Inherited retinal dissorder x linkedrecessive, autosomal recessive / dominant

– Mutasi photoreceptor cell, epitel pigmenretina might blindness

6Rtiiti



6. Retinitis

•Candida

•Cytomegalovirus

7N l



7. Neoplasma

•Retinoblastoma–Dari retinal cell ( neuronal )

–Prognosis tergantung penyebaran o. nerve

choroidal

–40% diturunkan lewat germ line RB allele



Morfologi :

–Sel bulat, kecil, hyperchromatic

–Flexner-Wintersteiner rosettes, fleurettes

–Tingkat deferensiasi tak sesuai prognosis–Therapychemotherapy

laser / cryopexy

–Mutasi ke otak, bone marrow, paru–Ada yang jinak retinocytoma



Figure 29-2B <etino"lastoma. A, :ross photograph of retino"lastoma. 8,

Tumor cells appear )ia"le hen in proximity to "lood )essels, "ut necrosis

is seen as the distance from the )essel increases. ;ystrophic calcification

(dar$ arro* is present in the 3ones of tumor necrosis. Flexner-Dintersteiner rosettes-arrangements of a single layer of tumor cells around

an apparent 4lumen4-are seen throughout the tumor, and one such rosette

is indicated "y the hite arro.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0":01 #$% 200 'lsevier



•Lymphoma–Systemic lymphoma ke uvea (iris, cilliary,choroid)

–Retinal lymphoma sel2 besar lymphoma spt pada otak

pd neurosensory retina dan retinal

pigmen epitel



OPTIC NERVE

1. Anterior Ischemic Optic



pNeuropathy (AION)

•Gangguan vascular

ischemia gangguan penglihatan

optic infarct

•Infeksi arteritis AION

•Emboli/trombosis nonarteritis AION

2Papilledema



2. Papilledema

•Tekanan yg tekanan pd syaraf mata

tekanan pdcerebrospinal

•Tekanan intracranial

–Bilateral papilledema tak adahubungan dengan visual loss



, Normally, the termination of 8ruch&s mem"rane (arrohead* is aligned ith

the "eginning of the neurosensory retina, as indicated "y the presence ofstratified nuclei (arro*, "ut in papilledema, the optic ner)e is sollen, and the

retina is displaced laterally. This is the histologic explanation for the "lurred

margins of the optic ner)e head seen clinically in this condition.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0":0+ #$% 200 'lsevier

3. Glaucomatous optic nerve



pdamage

•Normal tension glaucoma ada mutasi padagene optineurin

•Morfologi

–Ganglion sel berkurang, lapisan serat syaraf tipis–N. opticus menjadi cupped & atrofi

–Glaucoma timbul bila ada atrofi disertai cupping

–Pada anak, intraocular pressure buphthlalmos,

megalocornea–Sclera tipis, staphyloma (elastic sclera)

–Edematous cornea, degeneratif pannus



Figure 29-2= The retina and optic ner)e in glaucoma. A, The normal retina is illustrated in the left panel, and the retina in long-standing glaucoma is in

the right panel. 8oth pictures ere ta$en at the same magnification. Note that the full thic$ness of the glaucomatous retina is captured (right*, hereas

only a portion of the normal retina (left* can "e seen-a reflection of the thinning of the retina in glaucoma. n the glaucomatous retina, the areas

corresponding to the ner)e fi"er layer (NF+* and ganglion cell layer (:* are atrophic the inner plexiform layer (+* is la"eled for a point of reference.

8, :laucomatous optic ner)e cupping results, in part, from loss of retinal ganglion cells, the axons of hich populate the optic ner)e. , The arros

point to the dura of the optic ner)e. Notice the ide su"dural space, a result of atrophy of the su"stance of the optic ner)e. The degree of cupping on

the surface of the ner)e is stri$ing in this eye, hich as remo)ed "ecause of complications of long-standing glaucoma.




Figure 29-2= The retina and optic ner)e in glaucoma. A, The normal retina is illustrated in the left panel, and the retina in long-standing glaucoma is in

the right panel. 8oth pictures ere ta$en at the same magnification. Note that the full thic$ness of the glaucomatous retina is captured (right*, hereas

only a portion of the normal retina (left* can "e seen-a reflection of the thinning of the retina in glaucoma. n the glaucomatous retina, the areas

corresponding to the ner)e fi"er layer (NF+* and ganglion cell layer (:* are atrophic the inner plexiform layer (+* is la"eled for a point of reference.

8, :laucomatous optic ner)e cupping results, in part, from loss of retinal ganglion cells, the axons of hich populate the optic ner)e. , The arros

point to the dura of the optic ner)e. Notice the ide su"dural space, a result of atrophy of the su"stance of the optic ner)e. The degree of cupping on

the surface of the ner)e is stri$ing in this eye, hich as remo)ed "ecause of complications of long-standing glaucoma.


4OpticNeuropathylain



4. Optic Neuropathy lain

•Inherited : Leber hereditary opticneuropathy

•Sekunder :

–Defisiensi mutational : tobacco – alcoholamblyopia

–Toxin : methanol

5OpticNeuritis



5. Optic Neuritis

•Yaitu demyelinization nerve opticus

•Sebab utama : multiple sclerosis

•Dengan pengobatan bisa sembuh



Phthisis bulbi

•Trauma

•Radang intra ocular atrophic phthisis

•Retinal detachment bulbi



hthisis "ul"i. The eye is small and internally disorgani3ed. Thetension exerted on this hypotonic eye "y the extraocular muscles

contri"utes to a s!uare rather than round shape. Note the atrophic

optic ner)e and the presence of intraocular "one posteriorly and

anteriorly.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0":0+ #$%

200 'lsevier



Morfologi :•Exudate -ciliochoroidal effusion

•Darah -cyclitic membrane

-retinal detachment-optic atrofi

-intraocular bone metaplasia

osseous dari epitel pigmenretina

-sclera tebal

TERIMAKASIH



TERIMA KASIH

•SELAMAT BELAJAR

•SEMOGA LULUS UJIAN

PA dr Simon

Documents

Transcript of PA dr Simon