Vitreoretina

Iwan Sovani,Arief K, Erwin,Rova

Retina Sub-department
Dept. of Ophthalmology Faculty of Medicine
Unpad
Cicendo Eye Hospital Bandung
Anatomi Retina
SKLERA

KHOROID

RPE

RETINA
Neurosensoris
 10 lapisan Retina
1. Lapisan epitel pigmen
2. Lapisan sel batang & kerucut
3. Membran Limitans External
4. Lapisan Inti luar
5. Lapisan pleksiform luar
6. Lapisan Inti Dalam
7. Lapisan Pleksiform Dalam
8. Lapisan Sel Ganglion
9. Lapisan Serabut syaraf
10.Membran Limitans Internal
Gejala-gejala pada penyakit Retina
Buta Senja
Ganguan penglihatan perifer
Gangguan penglihatan Sentral
Gangguan penglihatan warna
Metamorphopsia
Micropsia
Macropsia
Photopsia
Muscae volitantes (floaters)
Tanpa adanya Gejala
 Pemeriksaan
Visus
Adaptasi Gelap
Penglihatan Warna (Ishihara)
Lapang Pandang :
confrontation test
Goldmann perimetry
Bjerrum tangent screen
Octopus perimetry
Ophthalmoskopi:
direct ophthalmoscopy
indirect ophthalmoscopy
biomicroscopy + contact/non contact lens
DIRECT
OPHTHALMOSCOPY
Binocular Indirect
Ophthalmoscopy

Binocular stereopsis
25 degrees field of view
Inverted real image
Good alignment of light
beam, lens, pupil,
oculars for sharp image
DIRECT

INDIRECT
1. Slit-lamp Indirect
Ophthalmoscopy
Non Contact
Inverted real
image
Magnification
depends on
lens used
 Pemeriksaan Khusus

Angiografi Fluoresein Fundus(FFA)

Ultrasonography (USG)
Optical Coherence Tomography (OCT)
Electroretinography (ERG)
Pemeriksaan funduskopi mata:
Pemeriksaan USG Mata :
Pemeriksaan OCT :
Pemeriksaan Lapang pandang:
Pemeriksaan ERG:
Pemeriksaan OCT :
Penyakit Retina yang perlu diketahui
Ablasio Retina
Oklusi Arteri Retina
Oklusi Vena Retina
Diabetic retinopathy
Hypertensive retinopathy
AMD (Age Related Macular
Degeneration)
 Ablasio Retina
ablasio retina =
Pelepasan retina

Lap. Neurosensoris
terlepas dari
Lap. RPE
 Ablasio Retina

KLASIFIKASI :
AR.Rhegmatogen

Robekan Retina

AR.Eksudatif
Tumor/inflamasi

AR.Traksi
Fibrosis
vitreous/PVR
 Ablasio retina

GEJALA SUBYEKTIF :
Photopsia, floaters
Bayangan hitam /gordyn
Mulainya dari perifer
Penurunan visus
pada makula atau perdarahan
vitreous
Metamorphopsia
Sudah mengenai makula (detached)
 Ablasio Retina
Gejala Obyektif
Penurunan tekanan
bolamata
Mata tenang
Funduskopi;
Retina yang

lepas terangkat,
berwarna keabu-
abuan
Retinal Tears

Cryo/ Laser
Prophylaxis
 Ablasio Retina

Terapi :
AR.Rhegmatogen Operasi

AR.Traksi
AR.Eksudatif terhadap
penyebab primer
Operasi
Vitreoretina
Sutureless
23G/25G/27G
 Oklusi Arteri Retina
A.Retina tersumbat oleh embolus.
Gejala : Penurunan visus mendadak tanpa
sakit
Ada 2 tipe:
Oklusi A Retina Sentral (CRAO)

Sumbatan terjadi dibelakang lamina

cribrosa
Oklusi A.Retina Cabang (BRAO)

Sumbatan terjadi didepan lamina cribrosa

 Retinal Artery
Occlusion
Penyebab :
Arteriosclerosis
Hypertension
Carotid arterial disease
Diabetes mellitus
Valvular heart disease
Others: oral contraception, trauma,
coagulopathy, toxoplasmosis, etc.
 Retinal Arterial
Occlusion
Gejala klinis:
Penurunan visus mendadak (HM - LP)

Segmen anterior mata tenang

Funduskopi:

cherry-red spot (greyish pale retina

except at the fovea)
Arteri/vena mengecil
 Retinal Arterial
Occlusion
Oklusi A.Retina Cabang
Bila tidak kena makula, visus relatif stabil
Retina pucat pada area oklusi

Komplikasi:
Papil atropi
NVI + NVG

Prognosis:
Jelek, perbaikan visus apabila :

1. Onset oklusi 1 2 jam

2. Oklusi sementara (spasm),
3. Adanya arteri Silioretina
 CRAO

BRAO
 Oklusi Vena Retina
Penurunan visus mendadak tanpa sakit.
2 tipe :
Sentral (CRVO)

occlusion behind lamina cribrosa

Cabang (BRVO)

occlusion in front of lamina cribrosa

RVO 4-5 x lebih sering daripada RAO

 Oklusi Vena Retina

PENYEBAB :
hypertension & arteriosclerosis (60%)
Common adventitial sheath at a-v crossing.

Sclerosis --> vein compressed --> slowed

flow --> thrombus --> occlusion
open angle glaucoma (40-70%)
hyperviscosity (polycythemia, hyperli-
pidemia, leukemia, etc)
thromblophlebitis
etc.
 Oklusi Vena Retina

GEJALA KLINIS :
Penurunan visus mendadak
Segmen anterior mata tenang
funduskopi :
dilated and tortuous vein
edema, hemorrhage, soft exudate
KOMPLIKASI :
NVG
30-35% of CRVO, 1-3 months after
onset
 CRVO

BRVO
 Diabetic Retinopathy
Kelainan retina karena mikroangiopati
Biasanya hampir selalu bilateral
Faktor resiko :
Lamanya menderita :

5 -10 tahun : 27%

10-15 tahun : 71%
15-30 tahun : 95%
Kontrol metabolik
Faktor lain: hipertensi,hamil,ginjal,anemia
 How does Diabetic retinopathy
cause blindness ?

Diabetes Retina:
Microangiopathy -microvascular occlusion
-microvascular leakage

Good Vision
Diabetic
Retinopathy

Poor Vision
 Diabetic Retinopathy
Gejala klinis :
microaneurysm
retinal hemorrhage
hard exudate
soft exudate
retinal edema
collateral vessels (IRMA-IntraRetinal
Microvasular Abnormalities)
venous beading
CNPA (Capillary Non Perfusion Area)
neovascularization & gliosis
 Mild NPDR

Photo

FFA
Severe NPDR

Venous Beading
 NVD

PDR

Severe PDR
Advanced PDR
Extensive Avascular Fibrosis
Advanced PDR
 Diabetic Retinopathy
Treatment
Pharmaceutical Therapy
Laser Photocoagulation
Intravitreal Triamcinolone
(IVTA)
Intravitreal Anti VEGF
Operative
 PRP
PRP

FOCAL
 Retinopati Hipertensi
Kelainan retina karena hipertensi dan
arteriosklerosis.
Perubahan karena hipertensi :
arteriole attenuation
focal constriction/spasm
hemorrhage and exudate
papil edema
Perubahan karena arteriosklerosis :
changes in arteriole light reflex
changes in a-v crossing
 Retinopati hipertensi

Perubahan retina karena hipertensi :

arteriole attenuation
normal A:V ratio 2:3 or 3:4

attenuation < 3:4 (e.g. 1:2, 1:3)

focal constriction

hemorrhage

hard exudate

soft exudate

papil edema
 Attenuation
Focal Spasm
Venous Indentation

Hypertensive
Retinopathy
 Hypertensive
CWS Retinopathy
Hemorrhage

Papil Edema
 Retinopati hipertensi

Terapi :
Terhadap hipertensinya

hypertensive signs may disappear;

sclerotic signs persist
papil edema, focal constriction quickly
disappear
hemorrhage, soft exudate disappear
within several weeks-months
hard exudate disappear within 4-6
months or more
 AMD
(Age-related Macular Degeneration)
WHAT IS AMD ?
 PREVALENCE

Western countries: Leading cause of visual loss

in people over 60 yrs old
Prevalence increases with age:
55-64 16.8%
65-74 25.6%
75 30-42%
Non-exudative 90%
Exudative 10% (Visual loss 88%)
SYMPTOMS of ARMD ?
How AMD is detected ? ( SCREENING )
CICENDO EYE HOSPITAL RETINA TEAM