RETINOPATHY

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

!e e"act cause is still unclear

It is belie#ed $

%i&erglyce'ia o#er an e"tended &eriod results
in a nu'ber bioc!e'ical and &!ysiologic
c!anges ((( endot!elial da'age.

Retinal #ascular c!anges $ loss of &ericyte
base'ent 'e'brane t!ic)ening(((co'&ro'ises
ca&illary lu'en((( deco'&ensation of endot!elial
barrier function
Hematologic and biochemical
abnormalitie

Increased &latelet ad!esi#eness

Increaser eryt!rocyte aggregation

Abnor'al seru' li&ids

Defecti#e fibrinolysis

Abnor'al le#els of gro*t! !or'one $ e"
#ascular endot!elial gro*t! factor +,-.F/

Abnor'alities in seru' and *!ole blood
#iscosity
AD!ANCED DIABETIC RETINOPATHY

Ris) factor for $

0ardio#ascular disease

%eart attac)

Stro)e

Diabetic ne&!ro&at!y

A'&utatia

Deat!
C"ASSI#ICATION

1on &roliferati#e diabetic retino&at!y +12DR/ 3
bac) ground diabetic retino&at!y $

4ild

4oderate

Se#ere

,ery se#ere

2roliferati#e Diabetic Retino&at!y $

-arly

%ig! ris)

Ad#anced

4acular ede'a

12DR $ Retinal 'icro#asculer c!anges
li'ited to t!e retina

4icro aneurys'e

Dot 5 blot !e'orr!age

Retinal ede'a

%ard e"udates

Dilatation 5 bleading of t!e #ein

Intraretinal 'icro #ascular abnor'alites +IR4A/

1er#e fiber layer infarct +cotton *ool s&ot/

Areas of ca&illary non &erfussion
RH $ cotton%&ool pot
RD tahap a&al
RD $ mi'roane(rima ) hard e*(date
Gamb+ ,(orein
RD -$ cotton &ool ) #lame haped
RD .
RD . /,(orein0

Affect #isual function t!roug!

0a&illary disease isc!e'ic

,ascular &er'eability ede'a

Diabetic 'acular ede'a

!e 'ost co''on $
6
0ause of ,A
6
0ause focal
6
0ause diffuse

2roliferati#e diabetic retino&at!y +2DR/

-"tra retinal fibro#ascular &roliferation
e"tends beyond t!e I74
RD proli1erati1
12DR

Isc!e'ic retina
Release of #aso &oliferati#e factors
1eo#asculari8ation of t!e retina
o&tic neuro !ead, ant.signal
RD proli1erati1
CO2P"ICATION

Reduced of #isual acuity

,itreous !e'orr!age

raction retinal detac!'ent

1euro#ascular glauco'a
RD proli1+) ablaio
TREAT2ENT

Regulation of blood glucose le#el

7aser &!otocoagulation

,itrecto'y
RD proli1 ) t* laer
HYPERTENSI!E RETINOPATHY

-ffect of syste'ic arterial !y&ertension
to c!ronic retinal #asculari8ation

%y&ertensi#e retino&at!y

%y&ertensi#e c!oroido&at!y

%y&ertensi#e o&tineuro&at!y
HYPERTENSI!E RETINOPATHY /HR0

%y&ertensi#e #ascular c!anges 5 arterio
sclerata #ascular disease
e"&ress in %R.

0lassification of %R, t!e 'odified sc!eir.

.rade 0 $ 1o c!ange +a9# 2 $ :/

.rade ; $ barely table arterial narro*ing a $ #
3 ; $ 2
C"ASSI#ICATION O# HR

.rade 2 $ ob#ious arterial narro*ing *it!
focal irregularities.

0o&&er *ire arteries

Sil#er *ire arteries

<an)ing sign

Salus sign
RH $ croing3G(nn ign
RH $ G(nn phenomen
RH$ g(nn4 copper &ire4 Sal(
RH dg G(nn phenomen
Clai5cation+ cont

.rade : $ grade 2 = retinal !e'orr!ages
and9or e"udate

.rade 4 $ grade : = disc s*elling
Aociated condition

<ranc! retinal artery occlusion +<RA>/

<ranc! retinal #ein occlusion +<R,>/

0entral retinal #ein occlusion +0R,>/

Retinal arterial 'acroaneurys's

2reretinal and #itreous !e'orr!age

-&iretinal 'e'brane
HYPERTENSI!E CHOROIDOPATHY

y&ically occur in young &atients $ *it!
acute !y&ertension e" $

2reecla'&sia, ecla'&sia

2!eoc!ro'acyto'a

Acute renal failure

RH pd HT renal
RH o' HT renal ) edem papil
#(nd(copic 5nding

0!orioca&illaries non&erfusion

%e'orr!ages

Retinal ede'a

Infar) ner#e fiber layer

R2- detac!'ent

Retinal detac!e'ent
RH o' HT renal ) edem papil
H6perteni7e Optic Ne(ropath6

Fla'e(s!a&ed !e'orr!ages around t!e
disc

<lurring of t!e disc 'argin

0ongestion of t!e retinal #ein

Secondary 'acular e"udates
Retinopati angiopati' $ cotton &ool ) ,ame
haped ) dot hemorrhage
Other t6pe o1 retinopath6

7eu)e'ia retino&at!y

!ro'bocyto&enia retino&at!y

Ane'ia retino&at!y
Tromboitopenia
Hemo5lia
"e('emia a'(t
Than' 6o(+++