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VITREO RETINA

ANATOMY

ANATOMY

ANATOMY

Fisiologi

Visual pathway

(Media refrakta)
Fotoreseptor
Nerve fiber layer
Optic disc
Jalur penglihatan
Korteks penglihatan

Fisiologi

Fotoreseptor

Light impuls nerve impuls


Rod dan cone

Makula

500 nm (blue-green)
430, 530, 575 (blue, green, red)

Cone >>, 1:1 dengan ganglion cell


Central vision, color vision

Peripheral retina

Peripheral vision
Night visio
Rod >>

PEMERIKSAAN

1. Direct ophthalmoscope
2. Indirect ophthalmoscope

PEMERIKSAAN

CONDENSING LENS

PEMERIKSAAN

FUNDUS CAMERA

KELUHAN

Penurunan Visus
Metamorfopsia / mikropsia
Kehilangan lapang pandang
Floaters / flashes
Skotoma relatif

Diseases

Macula
Peripheral retina
Retinal vascular
Tumor

Macula

ARMD

Age related macular degeneration

Macular dystrophies

ARMD

Etiologi : unknown
Risk factor

Caucasian race, female (slightly), family


history, cigarette smoking

Type

Non-exudative

Hard drusen (eosinophilic material between RPE and


Bruchs membrane)

Exudative

Soft drusen
Choroidal neovascularisasi

ARMD

Symptom
Decrease vision
Metamorfopsia

Examination
Amsler grid
Fundus examination
FFA (fundus fluorescein angiography)

ARMD

Treatment

Laser ?
Vitamin / anti-oxidant ?
Monitoring (fundus / amsler grid)

Stargardts disease

Bilateral symetric, autosomal recessive


Yellow-white fleck lession

lipofuscin

Peripheral retina

Retinal detachment

Rhegmatogen

Exudative

Retinal break
Operative : scleral buckle, vitrectomy
Collection fluid
Degeneration, inflammation, infectios
cause

Tractional

Diabetic retinopathy
Operative : scleral buckle, vitrectomy

Vascular

CRVO

BRVO

Branch retina vein occlusion

CRAO

Central retina vein occlusion

Central retina artery occlusion

Diabetic retinopathy
Hypertensive retinopathy

CRVO

Symptom

Sudden visual loss

Complication
Neovascularization
Macular edema

Treatment

Laser

Neovascular / macular edema

CRVO

BRVO

Symptom

Sudden visual loss

Macular edema, macular ischemia and


vitreous hemorrhage

Treatment
Laser
Anticoagulant ?

BRVO

CRAO

Symptom
Amaurosis fugax
Sudden visual loss

Therapy
90 minutes complete occlusion
Paracentesis

intraocluar pressure, perfusion

Inhaled mixture O2 / CO2

CRAO

D.R.

Hyperglycemia
Type I / II (3-5 years after onset)

Refer

I : 3 years
II : difficult to determine the onset

At the time of diagnosis

Type :

NPDR

Nonproliferative DR

Proliferative DR

NPDR

Microaneurysms (MA), hemorrhages (Hem),


hard exudates (HE), cotton wool spots (CWS),
intraretinal microvascular abnormalities
(IRMAs), venous beading (VB) & new vessels
(NV)

New AAO classification CP Wilkinson et al. Ophthalmology


2003; 110: 1677
None
Mild NPDR
MA only
Moderate NPDR
More than MA less than severe
Severe NPDR 4: 2: 1 rule: >20 Hems 4 quads;
Venous bead 2 quads; IRMA 1 quad
PDR
NV or VH

NPDR

TREATMENT:
control of hyperglycemia, hypertension, cholesterol
laser

PDR

Sign :

Neovascularization

Complication
Neovascular glaucoma
Tractional retinal detachment

Treatment

Laser, vitrectomy

PDR

Hypertensive retinopathy

Pathophysiology

In response to arterial hypertension :


Retinal

Choroid
Optic Nerve
Retinopathy

Affected differently

Choroidopathy
Optic disc edema

Supply by difference
system of blood vessel

Hypertensive Retinopathy

Retinal vasculature protected by


metabolic and myogenic mechanism

Increase BP
Autoregulation
Retinal arteriolar constriction

Maintain blood flow despite changes in


perfusion pressure

Hypertensive Retinopathy
Chronic stage

Diffuse narrowing arteriolar


Arteriovenous nicking
Retinal depression sign
precapillary arterial occlusion inner retina infarct

Hypertensive Retinopathy
Acute stage
(rapid rise of BP and arteriolar constriction)

precapillary retinal arterioles occluded

smooth muscle cells necrose


Destroy ability to constrict

Focal vasodilatation
Transmission high BP to endothelium of smaller vessel
Damage endothelium smaller vessel

Leakage plasma and


formed blood

Hypertensive Retinopathy
Acute stage
(rapid rise of BP and arteriolar constriction)

precapillary retinal arterioles occluded

smooth muscle cells necrose

Ischemia

Leakage plasma and


formed blood
Macula

Visual acuity affected

Treatment : control hypertension