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FK-UNISA, 13 November 2013

RETINOPATHY

dr. A.M.Ichsan, PhD, SpM


BAGIAN I.K. MATA FK UNHAS
Fundus normal
Papil normal
DIABETIC RETINOPATHY

Frequent cause of blindness in USA,


aged 20 to 64 years
Indonesia blindness due to D.R.
increase
PATHOGENESIS

The exact cause is still unclear


It is believed :
 Hiperglycemia over an extended period results in
a number biochemical and physiologic changes ---
endothelial damage.
 Retinal vascular changes : loss of pericyte
basement membrane thickening---compromises
capillary lumen--- decompensation of endothelial
barrier function
Hematologic and biochemical
abnormalities
Increased platelet adhesiveness
Increaser erythrocyte aggregation
Abnormal serum lipids
Defective fibrinolysis
Abnormal levels of growth hormone : ex
vascular endothelial growth factor (VEGF)
Abnormalities in serum and whole blood
viscosity
ADVANCED DIABETIC RETINOPATHY

Risk factor for :


 Cardiovascular disease
 Heart attack

 Stroke

 Diabetic nephropathy

 Amputatia

 Death
CLASSIFICATION
Non proliferative diabetic retinopathy (NPDR) =
back ground diabetic retinopathy :
 Mild
 Moderate
 Severe
 Very severe
Proliferative Diabetic Retinopathy :
 Early
 High risk
 Advanced
Macular edema
NPDR : Retinal microvasculer changes
limited to the retina
 Micro aneurysme
 Dot & blot hemorrhage
 Retinal edema
 Hard exudates
 Dilatation & bleading of the vein
 Intraretinal micro vascular abnormalites (IRMA)
 Nerve fiber layer infarct (cotton wool spot)
 Areas of capillary non perfussion
RH :
RD tahap awal
RD : mikroaneurisma + hard exudate
Gamb. fluoresin
RD 1: cotton wool + Flame shaped
RD 2
RD 2 (fluoresin)
Affect visual function through
 Capillary disease ischemic
 Vascular permeability edema
Diabetic macular edema
 The most common :
 Cause of VA
 Cause focal

 Cause diffuse
Proliferative diabetic retinopathy (PDR)
Extra retinal fibrovascular proliferation
extends beyond the ILM
RD proliferatif
NPDR

Ischemic retina

Release of vaso poliferative factors

Neovascularization of the retina


optic neuro head, ant.signal
RD proliferatif
COMPLICATION

Reduced of visual acuity


Vitreous hemorrhage
Traction retinal detachment
Neurovascular glaucoma
RD prolif.+ ablasio
TREATMENT

Regulation of blood glucose level


Laser photocoagulation
Vitrectomy
RD prolif + tx laser
HYPERTENSIVE RETINOPATHY

 Effect of systemic arterial hypertension


to chronic retinal vascularization
 Hypertensive retinopathy
 Hypertensive choroidopathy

 Hypertensive optineuropathy
HYPERTENSIVE RETINOPATHY (HR)

Hypertensive vascular changes &


arterio sclerata vascular disease
express in HR.
Classification of HR, the modified
scheir.
 Grade 0 : No change (a/v 2 : 3)
 Grade 1 : barely table arterial narrowing
a:v=1:2
CLASSIFICATION OF HR
Grade 2 : obvious arterial narrowing
with focal irregularities.
 Copper wire arteries
 Silver wire arteries

 Banking sign

 Salus sign
RH : crossing/Gunn sign
RH : Gunn phenomen
RH: gunn, copper wire, Salus
RH dg Gunn phenomen
Classification. cont

Grade 3 : grade 2 + retinal


hemorrhages and/or exudate

Grade 4 : grade 3 + disc swelling


Associated condition

Branch retinal artery occlusion (BRAO)


Branch retinal vein occlusion (BRVO)
Central retinal vein occlusion (CRVO)
Retinal arterial macroaneurysms
Preretinal and vitreous hemorrhage
Epiretinal membrane
HYPERTENSIVE CHOROIDOPATHY

Typically occur in young patients : with


acute hypertension ex :
 Preeclampsia, eclampsia
 Pheochromacytoma

 Acute renal failure


RH pd HT renal
RH ok HT renal + edem papil
Funduscopic findings

Choriocapillaries nonperfusion
Hemorrhages
Retinal edema
Infark nerve fiber layer
RPE detachment
Retinal detachement
RH ok HT renal + edem papil
Hypertensive Optic Neuropathy

Flame-shaped hemorrhages around the


disc
Blurring of the disc margin
Congestion of the retinal vein
Secondary macular exudates
Retinopati angiospastik : cotton wool +
flame shaped + dot hemorrhage
Other types of retinopathy

Leukemia retinopathy
Thrombocytopenia retinopathy
Anemia retinopathy
Trombositopenia
Hemofilia
Leukemia akut