opt kuliah 17-18 des 2007
TRANSCRIPT
![Page 1: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/1.jpg)
![Page 2: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/2.jpg)
RETINA, VITREOUS, OPTIC NERVERETINA, VITREOUS, OPTIC NERVE
Lecture 6- Central Retinal Vein Occlusion (CRVO)- Branch Retinal Vein Occlusion (BRVO)- Central Retinal Artery Occlusion (CRAO)- Branch Retinal Artery Occlusion (BRAO- Retinal Detachment- Vitreous Hemorrhagic- Optic Neuritis
Lecture 9- Hypertensive Retinopathy - Diabetic Retinopathy
![Page 3: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/3.jpg)
Posterior Segment Disease EvaluationPosterior Segment Disease Evaluation
- Anamnesis- Visual Acuity- Color Vision (Ishihara)- Anterior Segment Evaluation- Posterior Segment Evaluation
. Direct or indirect ophthalmoscope. (Trimiror Funduskopi, Non-kontak Fdkopi).. FFA (Fundus Flourescein Angiography). Visual Field Test. USG (Ultra Sonografi).
![Page 4: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/4.jpg)
ophthalmoscope
Goldmann perimeterNon contact lens 78D
Goldmann three-mirror lens
![Page 5: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/5.jpg)
![Page 6: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/6.jpg)
Normal Fundus
![Page 7: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/7.jpg)
Flourescein Angiography
![Page 8: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/8.jpg)
Ultrasonography (USG)
![Page 9: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/9.jpg)
RETINAL DETACHMENT.RETINAL DETACHMENT.
= Retinal Detachment.= Separation of the sensory retina (photoreceptors and inner tissue layers) from RPE
Three main types :A. Rhegmatogenous Detachment (RD) = >> common exm : myopia, aphakia, Lattice degeneration, trauma, spontaneous.B. Traction Retinal Detachment (TRD) >> Proliferative DR, PVR, ROP, Ocular TraumaC. Serous & Hemorrhagic Retinal Detachment (tear-) Degenerative, inflammatory, infectious dss, Systemic vascular & inflamatory dss
![Page 10: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/10.jpg)
Sign and Symptom
� - Early : Floaters, photopsia.� - Visual Field disturbance. � - Like cover by curtain� - Central Visual Acuity : decrease.
![Page 11: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/11.jpg)
![Page 12: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/12.jpg)
![Page 13: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/13.jpg)
Funduscopy :
� - Retina elevated, bulging, “ blass”, grey color/pale, blood vesel
elevated � - Hole / tear or traction in Vitreous Body
![Page 14: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/14.jpg)
Retinal Detachment Nonrhematogenous
![Page 15: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/15.jpg)
Retinal Detacment rhegmatogenous
![Page 16: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/16.jpg)
RD with fold and traction
![Page 17: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/17.jpg)
Therapy • Hospitalized, bed rest , midriatikum, antiimflamation, Antioksidan • Small Tear : laser fotocoagulation, diatermy, Cryo• Operation ( create adhesion)
Scleral Buckling or pneumatic retinopexy, vitrektomi, endolaser
Prognosis Good : if the tear small and blass not involve the macula
![Page 18: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/18.jpg)
Operation RD
![Page 19: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/19.jpg)
RETINAL VEIN OCLUSIONRETINAL VEIN OCLUSION
2 Type : Central Retinal Vein Occlusion (CRVO) Branch Retinal Vein Occlusion (BRVO)
Cause : - vein compression, arteriosclerosis, Infection
Sign & Symptom : - Sudden painless loss of vision
Funduscopy: - Retinal haemorrhages ; flame shape. - Exudate cotton wool.
Therapy: - careful follow-up, causal, - Local : laser Photocoagulation.
Complication : Rubeosis Iridis (iris new vessel) → Glaucoma Neovascular
![Page 20: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/20.jpg)
CRVO
![Page 21: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/21.jpg)
BRVO
![Page 22: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/22.jpg)
CENTRAL RETINA ARTERY OCLUSIONCENTRAL RETINA ARTERY OCLUSION
Cause : - embolus, arteriosclerosis, Infection
Symptom & Sign : Sudden Painless visual loss(amaurosis fugax)
Visual Acuity : CF~LP, RAPD +
Funduskopi :- retina : Pale (Opacified) - Foveola Red : “cherry red spot’
Therapy: - Immediately : massage eye ball, diamox (I.V). - Anterior Chamber Parasentesis - find the cause.
Complication: - Blind permanently
![Page 23: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/23.jpg)
CRAO hiperemi
![Page 24: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/24.jpg)
CRAO Cherry red spot
![Page 25: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/25.jpg)
VITREOUS HEMORRHAGICVITREOUS HEMORRHAGIC
Definition : Hemorrhage in vitreous body. Cause : - Diabetic retinopathy
- Sensory retina is torn - CRVO / BRVO - Hypertension
Sign & Symptom: - floaters - Visual Loss.
Funduscopy : - Black dot in vitreous body. - Dark
Therapy : - Find the etiology. - Early vitrectomy : TRD involve macula - Conservatively 3 - 6 month.
- Vitrektomy
![Page 26: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/26.jpg)
VITREOUS HEMORRHAGE
![Page 27: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/27.jpg)
VITREOUS HEMORRHAGE
![Page 28: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/28.jpg)
OPTIC NEURITIS
� Variety of causes, >> Demyelination� Retrobulbar neuritits : Normal optic disk
(acute episode)� Papilitis : disc swelling : inflamation nerve
head� Symptom : loss of vision
![Page 29: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/29.jpg)
Demyelinative optic neuritis� Ass. Multiple sclerosis� Color vision, contrast sensitivity: impaired� Pain in eye region, eye movement� Visual field disturbance, >> central scotoma� Pupil Reflek : sluggish, RAPD (asymmetrically
involved)� Papilitis : Hyperemia optic disk, distention of
large veins, blurring disk margin� MRI, CT Scanning
![Page 30: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/30.jpg)
OPTIC NEURITIS
![Page 31: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/31.jpg)
DIFERENTIAL DIAGNOSIS
� Papilitis VS Papiledema (greater elevation of optic nerve, nearly normal VA, Pupil reflek normal, ass. Intracranial pressure, VF intact, enlarge blind spot, >>bilateral
![Page 32: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/32.jpg)
TREATMENT� Steroid (IV, Oral, retrobulbar injection)� Methylprednisolone (ig/d 3 days) followed oral
prednisolone (1 mg/kg/d 11 days) PROGNOSIS� Variety � Improve : 2-3 weeks� Poor : involve optic canal
![Page 33: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/33.jpg)
![Page 34: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/34.jpg)
LECTURE 9HYPERTENSIVE RETINOPATHY
DIABETIC RETINOPATHY
![Page 35: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/35.jpg)
HYPERTENSIVE RETINOPATHY
Deff: Retina and Blood vessel disorder due to Hypertension
Symptom & Sign : Early : no complainLate : Blurr vision ~ blind
FunduscopyNarrowing blood vessel, sclerotic, crossing phenomena.flame shape, Exsudate : dot, hard (punctat) or cotton wool retinal detachment.
![Page 36: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/36.jpg)
CLASSIFICATION Keith - Wagener - Barker (KW).� KW I : Sclerotic, mild narrowing.� KW II : a - v cross, hard eksudat ( ± 20
%)� KW III : Bleeding, soft exsudate� KW IV : KW III + papil edema (± 98 %)
THERAPY : Internal Departement
COMPLICATION : CRVO, BRVO
![Page 37: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/37.jpg)
Hypertensive RetinopathySilver wire
Exsudate
Flame shape hemor
![Page 38: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/38.jpg)
Hypertensive Retinopathy
![Page 39: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/39.jpg)
Hypertensive Retinopathy KW IV
![Page 40: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/40.jpg)
DIABETICDIABETIC RETINOPATHYRETINOPATHY
Deff : Retinopathy cause by Diabetes Melitus. Patient with DM > 5 years 90-95 % will occur DR if DM > 20 th.
Symptom and signBlurr vision ~ grading DRAnterior segment : normal
Funduscopy : microaneurysms, exsudate dot / cotton wool, bleeding spot, PVR, newvessel.
![Page 41: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/41.jpg)
CLASSIFICATION DIABETIC RETINOPATHY.
A. Background D.R = Non Proliferatif D.R (NPDR) mycroaneurysms, exudate(dot) &
bleeding(f lame).
B. PreProliferative : bleeding and exudate more.
C. Proli feratif R.D. (PDR) newvessel on papil, preretina, retina Bleeding and traction in vitreous body
D. Maculopathy D.R edema, exsudate & bleeding in macula.
![Page 42: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/42.jpg)
NONPROLIFERATIVE DIABETIC RETINOPATHY
![Page 43: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/43.jpg)
NPDR
![Page 44: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/44.jpg)
PROLIFERATIVE D.R
![Page 45: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/45.jpg)
Therapy.Antioksidan .Laser photocoagulation
: → hipoksia → newvessel (-).Vitrectomy → traction and bleeding in .vitreous body
Complication.Refraksion error.neovascular Glaucoma .Optic Neuritis
![Page 46: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/46.jpg)
LASER SPOT
![Page 47: Opt kuliah 17-18 des 2007](https://reader036.vdocuments.site/reader036/viewer/2022062600/5889fc371a28ab0f388b59e9/html5/thumbnails/47.jpg)
THANK YOU