UVEA

NURHAIDA DJAMIL

FAKULTAS KEDOKTERAN
UNIVERSITAS ISLAM SUMATERA UTARA
MEDAN
2012
ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

Dengan menyebut nama Allah

Yang Maha Pengasih Maha
Penyayang.

ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

UVEITIS
3

The term "uveitis" denotes inflammation

of the iris (iritis, iridocyclitis), ciliary body
(intermediate uveitis, cyclitis, peripheral
uveitis, or pars planitis), or choroid
(choroiditis).
Uveitis may also occur secondary to
inflammation of the cornea (keratitis),
sclera (scleritis), or both (sclerokeratitis).

ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

EPIDEMIOLOGY
4

Uveitis usually affects people 2050 years

of age and accounts for 1020% of cases
of legal blindness in developed countries.
Uveitis is more common in the
developing world than in the developed
countries, due in large part to the greater
prevalence of infections that can affect
the eye, such as toxoplasmosis and
tuberculosis.
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NURHAIDA
DJAMIL

October 30, 2016

PREVALENCE
5

Uveitis is more common in the

developing world than in the developed
countries, due in large part to the
greater prevalence of infections that can
affect the eye, such as toxoplasmosis
and tuberculosis.

ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

SIGNS AND SYMPTOMS

6

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NURHAIDA
DJAMIL

October 30, 2016

ENDOPHTHALMITIS
7

The term refers to intraocular

inflammation
predominantly
involving the vitreous cavity and A/C,
as a result of intraocular colonization
by microrganisms.

ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

PATHOPHYSIOLOGY
8

In 29 43%
of cataract surgery ,
intraocular contamination occurs with
facultative bacteria from ocular surface
without development of endophthalmitis .
Immune privilege mechanisms are
particularly effective in the anterior part
of the eye.
ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

pathophysiology
9

Ocular infection with infectious bacterial load

/with impairment of immune privilege of the
eye ,leads to intense destructive inflammatory
reaction .
( Bact. Toxins ,proteases + intense host
inflammatory response ---------- injury to
retina ,CB, A/S structures .
Intense inflammatory response ----- negative
microbiological studies .

ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

CLASSIFICATION
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1) Endogenous : bacterial / fungal /

parasite.
2) Exogenous :
a) postoperative.
b) post traumatic .
c) Bleb associated .
d) miscellaneous ; e.g. microbial
keratitis ,scleritis (infectious)
ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

INCIDENCE
11

*Post cataract 0.07 0.5 %.

*post PKP 0.11%.
*post PPV 0.05 %.
*Bleb related 0.2 9.6 %.
*traumatic 2.4 8.0 % , up to 40% in rural
areas with IOFB.

ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

SIGNS AND SYMPTOMS

12

*Decrease VA.
*pain.
*A/C reaction +/- hypopyon.
*Vitritis .
*others: lid swelling , discharge ,
C.edema, chemosis.
ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

SOURCE OF INFECTION
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*Mainly eye lids and conjunctiva.

*Other sources : e.g.
- lacrimal drainage syst.
Infections.
- Blephritis.
- infected socket in contralateral
prosthetic eye.
ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

PROPHYLAXIS
14

*Antiseptics: 5% povidone iodine for at

least 3 minutes is the most important
prophylaxis in many studies;
decreasing conj +periorbit.skin flora .

*Single use instruments is always

preferable esp. tubes.

ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

15

*there has been no randomised controlled

studies of preoperative cutting of eye
lashes, available data in the literature
showed no association with the reduction
of the risk of Endoph.
*But taping back of the lashes with adhesive
tape is recommended.
* Treat any underlying predisposing cause
e.g. blephritis.
ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

ANTIBIOTICS
16

Topical antibiotics esp. 4th generation

fluoroquinolones appears to be very
effective in reducing conj. Flora load ,
achieving high concentrations in the in
the A/C.

But no controlled clinical trial prove their

effect in reducing incidence of Endoph.
ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

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ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016

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ENDOPHTHALMITIS

NURHAIDA
DJAMIL

October 30, 2016