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TRANSCRIPT
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UVEITIS
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UVEITIS
Dr. Neneng.H,Sp.MBagian Ilmu Kesehatan MataUniversitas Tadulako Palu2017
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ANATOMI Lapisan tengah dinding bola mata,
pigmen + p. darah tdd: iris, korpus siliar, koroid
Iris : - pemisah BMD dg BMB - pupil : mengatur chy
(diafragma) midriasis → m. dilatator pupilae
(n.simpatis) miosis → m. sfingter pupilae ( parasimpatis n.III)
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ANATOMI MATA
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Badan siliar (Korpus siliar) : - mengandung m. siliar
→ akomodasi - epitel (non pigmen)→ prod. HA
Koroid : - antara retina & sklera - mulai ora serata sampai n. optik
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Pembagian Uveitis International Uveitis Study
Group: - U. anterior = iridosiklitis - U. posterior = koroiditis - U. intermediate = pars
planitis - Pan uveitis
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Uveitis : - granulomatous - non granulomatous
Kausa : infeksi, trauma,
neoplastik, autoimun
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GAMBARAN DEMOGRAFI
Dlm 1 th tdp pdrt uveitis 15 per 100.000 org
→ 75% U. anterior 17% U. posterior 8% U.in termediat >> umur 20 – 50 th
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Wanita >> tu pd U. anterior Fak. Resiko : sosek ↓, psikologis (depresi)
imunologik (HLA), AIDS, endokrin (hipotiroid dg uveitis)
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ETIOLOGI1. Inf. Eksogen: inf. Luka perforasi, ulkus
kornea → supuratif 2. Inf. Sekunder : sebaran infeksi dr jar. Mata
lainnya, mis; kornea, sklera, retina3. Inf. Endogen : TBC, GO,sifilis, Virus,
protozoa (Toksoplasmosis)4. Inflamasi alergik: sumber primer berada
dimana saja dlm tubuh mis; gigi, suatu wkt lolos masuk aliran drh shg terbtk respon imun
5. Autoimun→ berhub.dg RA,SLE, Sindr. Bechet’s → HLA B 27
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UVEITIS ANTERIOR = Iridosiklitis- akut- kronik
IRIDOSIKLITIS AKUTGejala :1. Mata merah: inj. Perikornea2. Sakit ; ber(+) jk mata ditekan Rasa skt krn rdg akut disertai spasme iris3. Fotofobi & lakrimasi bila terkena sinar
kuat. Terjadi apabila inflamasi melibatkan
kornea, iris korpus siliar
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4. Visus ↓ : cairan BMD keruh & Keratik Presipitat (KP)
Akomodasi terg3 : jk terjadi siklitis5.Kornea edem, di BMD tdp
penimbunan protein, fibrin,sel rdg → memberikan gbr “flare”,KP, hipopion.
6.Iris: edem, kripte hilang, warna iris suram
7.Pupil miosis, refleks pupil lemah
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8. Iris melekat pd permukaan depan lensa → sinekia posterior, melekat pd perm. dalam kornea→ sinekia anterior Eksudat tertimbun didataran pupil→ oklusi pupil Ujung iris melekat pd permukaan lensa, meliputi seluruh pupil→ seklusi pupil9. Iris bombe→ akbt seklusi pupil→ glaukoma sekunder
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Iridocyclitis with & without hypopion
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Acute iridocyclitis post topical steroid
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Acute HLA-B27
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Flare
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KP
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KP
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Synechiae posterior
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DD Iridosiklitis glaukoma akut akut
Sakit (+) rasa tertkn sakit sekaliVisus ↓ ↓↓Merah Inj. Pc + inj.pc,episkl+Iris warna kabur warna kaburPupil miosis,ireguler
midriasis,oval refleks lmbt refleks (-)TIO awal normal meninggi
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Terapi 1. Atropin 1% 3x1 tts→ melebarkan
pupil melepaskan sinekia,
mengistirahatkan iris & badan siliar, mengurangi sakit akibat spasme iris
2. Steroid; tts mata,subkonj,oral (8-12 tab/hr) atau intravena
3. Terapi spesifik→ kausa 4. Bebat mata 5. Imunosupresif, tu uveitis bilateral &
bandel
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Komplikasi1. Katarak komplikata akbt
eksudasi & perlengketan lensa& iris
2. Glaukoma sekunder akbt sinekia ant, sinekia post.
3. Radang berlanjut → Endoftalmitis, panoftalmitis
4. Ablasi retina→ fibrosis CV5. Pd keadaan kronik : edema
makula, degenerasi
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Uveitis menurut klinis & patologi : U. non granulomatosa - merup. Rx hipersensitivitas - tidak ditemukan kuman patogen & respon thd pemberian steroid. - Gambaran klinis inflamasi> sering uvea ant iridosiklitis U. granulomatosa - gbr patologis pd uvea post (koroiditis) - bersifat kronis - terdpt nodul kecil pd iris, sel-sel di BMD
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Pem. Laboratorium Pada iridosiklitis (uveitis ant ) non granulomatous perlu diketahui
kausa, untuk itu perlu pemeriksaan thd : - tuberkulosis - histoplasmosis - uji fiksasi, komplemen dan - uji rx. hipersensitivitas
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UVEITIS SPESIFIK
1. Ankylosing spondilitis - Gej. Klinik bervariasi - Berhub. dg HLA B 27 sekitar 10-60% - pdrt ankylosing spondilitis terdpt iridosiklitis non granulomatous akut /
kronik - Sering rekuren→ kerusakan permanen - Pemeriksaan : X-ray spina lumbosakral Faktor reumatoid
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Ankylosing spondylitis, acute unilateral iridocyclitis
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Juvenile RA, chronic iridocyclitis
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Ankylosing spondylitis
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2. Iridosiklitis heterokromik (Fuchs)
- Kausa tdk diketahui - Depigmentasi lap. pigmen iris &
Korp.Siliar (tanda atrofi iris) - Unilateral, jarang bilateral - Iridosiklitis kronis tanpa gej. khas merah (-) - Jarang terjadi sinekia
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Fuchs heterochromic iridocyclitis
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3. Pars planitis= U. Intermediat - Titik2 spt melayang2→ Muscae Volitantes - Bilateral, tanda inflam. tdk jelas → tdk disadari pdrt - Gejala uveitis ant. yg ringan - Katarak subkapsul post. - Kausa ? - R/ : Kortikosteroid
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4. Lens induced uveitis - Autoimun sekunder thd Ag lensa - Protein lensa keluar (katarak traumatik, katarak hipermatur) →Ag→ inflamasi - Mata merah, nyeri, pupil miosis, visus ↓ tanda-tanda iridosiklitis - R/: Kortikosteroid topikal,sistemik atropin ED - Komplikasi: Glaukoma sekunder - Inflamasi tenang → eksraksi lensa
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5. Oftalmia simpatika - Uveitis granulomatosa bilateral terjd post trauma tembus di korpus siliar - Inflamasi lbh dulu pd exciting eye diikuti sympathizing eye) - Terjadi 10 hr – 50 thn post trauma → >> pd 4 – 8 mgg - Kronik eksaserbasi berulang
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Sympathetic ophthalmia
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6. Bechet’s syndrom - Iridosiklitis berat, rekuren,
hipopion - Ulserasi mukosa konj., oral,
genital - Rekuren pd org dws → visus
hilang - Kausa ? Berhub. dg HLA – B5 - R/: Spesifik tdk ada Steroid Imunosupresan
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Behcet syndrome,hypopion
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UVEITIS POSTERIOR(KOROIDITIS)
1. Toksoplasmosis - 7 – 15% dr semua uveitis - Kausa: toksoplasma gondi
(kucing) - Klinis : retinokoroiditis exudatif
fokal - D/ : Gambaran fundus Dye test Sabin-Feldman ELISA
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Toxoplasma
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2. Toksokariasis- toxocara canis (anjing)
3. Kandidiasis- Candida albicans
4. ARN (Acute Retinal Necrosis)
5. Retinitis Citomegalovirus- pd pdrt HIV
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PANUVEITIS 1. Sarcoidosis 50% sarcoidosis disertai uveitis bentuk iridosiklitis granulomatous 2. Tuberkulosis merupakan Uveitis kronis 3. VKH Syndrom - >> org Asia - Bilateral, kronik granulomatous mrp oftalmia simpatika - Koroiditis exudatif, vitreus keruh - Ablasi retina exudatif - R/ spesifik (-), steroid imunosupresi
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Sarcoidosis, KP & iridocyclitis
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Acut tuberculous uveitis with hypopion
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VKH syndrome, vitiligo (skin & perilimbal)
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