Vitreo - Retina
-
Upload
astrirahma -
Category
Documents
-
view
45 -
download
1
description
Transcript of Vitreo - Retina
VITREO - VITREO - RETINARETINA
ANATOMYANATOMY
ANATOMYANATOMY
ANATOMYANATOMY
Fisiologi Fisiologi
Visual pathwayVisual pathway (Media refrakta)(Media refrakta) FotoreseptorFotoreseptor Nerve fiber layerNerve fiber layer Optic discOptic disc Jalur penglihatanJalur penglihatan Korteks penglihatanKorteks penglihatan
FisiologiFisiologi FotoreseptorFotoreseptor
Light impuls Light impuls nerve impuls nerve impuls Rod dan cone Rod dan cone
500 nm (blue-green)500 nm (blue-green) 430, 530, 575 (blue, green, red)430, 530, 575 (blue, green, red)
Makula Makula Cone >>, 1:1 dengan ganglion cellCone >>, 1:1 dengan ganglion cell Central vision, color visionCentral vision, color vision
Peripheral retinaPeripheral retina Peripheral visionPeripheral vision Night visioNight visio Rod >>Rod >>
PEMERIKSAANPEMERIKSAAN
1. Direct ophthalmoscope
2. Indirect ophthalmoscope
PEMERIKSAANPEMERIKSAAN
CONDENSING LENS
PEMERIKSAANPEMERIKSAAN
FUNDUS CAMERA
KELUHANKELUHAN
Penurunan VisusPenurunan Visus Metamorfopsia / mikropsia Metamorfopsia / mikropsia Kehilangan lapang pandangKehilangan lapang pandang Floaters / flashesFloaters / flashes Skotoma relatifSkotoma relatif
DiseasesDiseases
MaculaMacula Peripheral retinaPeripheral retina Retinal vascularRetinal vascular TumorTumor
Macula Macula
ARMDARMD Age related macular degenerationAge related macular degeneration
Macular dystrophiesMacular dystrophies
ARMDARMD Etiologi : unknownEtiologi : unknown Risk factorRisk factor
Caucasian race, female (slightly), family Caucasian race, female (slightly), family history, cigarette smokinghistory, cigarette smoking
TypeType Non-exudativeNon-exudative
Hard drusen (eosinophilic material between RPE and Hard drusen (eosinophilic material between RPE and Bruch’s membrane)Bruch’s membrane)
ExudativeExudative Soft drusenSoft drusen Choroidal neovascularisasiChoroidal neovascularisasi
ARMDARMD
Symptom Symptom Decrease visionDecrease vision MetamorfopsiaMetamorfopsia
ExaminationExamination Amsler gridAmsler grid Fundus examinationFundus examination FFA (fundus fluorescein angiography)FFA (fundus fluorescein angiography)
ARMDARMD
TreatmentTreatment Laser ?Laser ? Vitamin / anti-oxidant ?Vitamin / anti-oxidant ? Monitoring (fundus / amsler grid)Monitoring (fundus / amsler grid)
Stargardt’s diseaseStargardt’s disease
Bilateral symetric, autosomal recessiveBilateral symetric, autosomal recessive Yellow-white fleck lessionYellow-white fleck lession
lipofuscinlipofuscin
Peripheral retinaPeripheral retina
Retinal detachmentRetinal detachment RhegmatogenRhegmatogen
Retinal breakRetinal break Operative : scleral buckle, vitrectomyOperative : scleral buckle, vitrectomy
ExudativeExudative Collection fluid Collection fluid Degeneration, inflammation, infectiosDegeneration, inflammation, infectios causecause
TractionalTractional Diabetic retinopathyDiabetic retinopathy Operative : scleral buckle, vitrectomyOperative : scleral buckle, vitrectomy
Vascular Vascular CRVOCRVO
Central retina vein occlusionCentral retina vein occlusion BRVOBRVO
Branch retina vein occlusionBranch retina vein occlusion CRAOCRAO
Central retina artery occlusion Central retina artery occlusion Diabetic retinopathyDiabetic retinopathy Hypertensive retinopathyHypertensive retinopathy
CRVOCRVO
SymptomSymptom Sudden visual lossSudden visual loss
ComplicationComplication NeovascularizationNeovascularization Macular edemaMacular edema
TreatmentTreatment LaserLaser
Neovascular / macular edemaNeovascular / macular edema
CRVOCRVO
BRVOBRVO
SymptomSymptom Sudden visual lossSudden visual loss
Macular edema, macular ischemia and Macular edema, macular ischemia and vitreous hemorrhagevitreous hemorrhage
TreatmentTreatment LaserLaser Anticoagulant ?Anticoagulant ?
BRVOBRVO
CRAOCRAO
SymptomSymptom Amaurosis fugaxAmaurosis fugax Sudden visual lossSudden visual loss
TherapyTherapy 90 minutes complete occlusion90 minutes complete occlusion ParacentesisParacentesis
↓ ↓ intraocluar pressure, ↑ perfusionintraocluar pressure, ↑ perfusion Inhaled mixture O2 / CO2Inhaled mixture O2 / CO2
CRAOCRAO
D.R.D.R.
HyperglycemiaHyperglycemia Type I / II (3-5 years after onset)Type I / II (3-5 years after onset)
Refer Refer I : 3 yearsI : 3 years II : difficult to determine the onsetII : difficult to determine the onset
At the time of diagnosisAt the time of diagnosis
Type :Type : NPDR NPDR
Nonproliferative DRNonproliferative DR Proliferative DRProliferative DR
NPDRNPDR
Microaneurysms (MMicroaneurysms (MAA), hemorrhages), hemorrhages (Hem) (Hem), , hard exudates (HE), cotton wool spots (CWS),hard exudates (HE), cotton wool spots (CWS), intraretinal microvascular abnormalities intraretinal microvascular abnormalities (IRMAs), venous beading (VB)(IRMAs), venous beading (VB) & & new vessels new vessels (NV)(NV)
New AAO classification CP Wilkinson et al. Ophthalmology 2003; New AAO classification CP Wilkinson et al. Ophthalmology 2003; 110: 1677110: 1677 NoneNone Mild NPDRMild NPDR MA onlyMA only Moderate NPDR Moderate NPDR More than MA less than severeMore than MA less than severe Severe NPDR Severe NPDR 4: 2: 1 rule: >20 Hems 4 quads; 4: 2: 1 rule: >20 Hems 4 quads;
Venous bead 2 quads; IRMA 1 Venous bead 2 quads; IRMA 1 quadquad
PDRPDR NV or VHNV or VH
NPDRNPDR
TREATMENT:
• control of hyperglycemia, hypertension, cholesterol
• laser
PDRPDR
Sign :Sign : NeovascularizationNeovascularization
ComplicationComplication Neovascular glaucomaNeovascular glaucoma Tractional retinal detachmentTractional retinal detachment
TreatmentTreatment Laser, vitrectomyLaser, vitrectomy
PDRPDR
Hypertensive retinopathyHypertensive retinopathy
PathophysiologyPathophysiology
In response to arterial hypertension :In response to arterial hypertension :
Affected differently
Supply by difference system of blood vessel
• Retinal• Choroid• Optic Nerve
• Retinopathy
• Choroidopathy
• Optic disc edema
Hypertensive RetinopathyHypertensive Retinopathy Retinal vasculature protected by Retinal vasculature protected by
metabolic and myogenic mechanismmetabolic and myogenic mechanism
Retinal arteriolar constriction
Increase BP
Autoregulation
Maintain blood flow despite changes in perfusion pressure
Hypertensive RetinopathyHypertensive Retinopathy
Chronic stage
• Diffuse narrowing arteriolar
• Arteriovenous nicking
• Retinal depression sign precapillary arterial occlusion inner retina infarct
smooth muscle cells necrose
Hypertensive RetinopathyHypertensive Retinopathy
Acute stage
(rapid rise of BP and arteriolar constriction)
precapillary retinal arterioles occluded
Destroy ability to constrict
• Focal vasodilatation
• Transmission high BP to endothelium of smaller vessel
• Damage endothelium smaller vesselLeakage plasma and
formed blood
smooth muscle cells necrose
Hypertensive RetinopathyHypertensive Retinopathy
Acute stage
(rapid rise of BP and arteriolar constriction)
precapillary retinal arterioles occluded
Leakage plasma and formed bloodIschemia
Macula
Visual acuity affected
Treatment : control hypertension