Referat

Ablatio Retina (SKDI 2)

By:
Vivi Yolandha (19360157)

Preceptor:
dr. Rahmat Syuhada, Sp.M (K)
 Introduction

The retina is the neurosensory The human retina is a highly

membrane layer and is the organized structure, consisting
third layer of the eyeball after of layers of cell bodies and
the sclera. synaptic processes.

Retinal detachment is uncommon The removal of the retina or cone

in children, but can sometimes
occur as a result of premature
retinopathy, tumors
(retinoblastoma), trauma, or
myopia.
cells and stems from choroid or
pigment cells will result in
impaired nutritional retinal vessels
which if prolonged will result in
impaired vision function
 Anatomy of the retina
• The retina is a thin sheet of nerve tissue
that is semi-transparent and consists of
several layers that line the inside of the
two-thirds behind the eyeball.

Figure:
Anatomy retina
and normal
retina
Retina layer
 Definition

Retinal detachment is an
abnormality or disease
of the eye where the
retinal sensory layer
(internal photosynthetic
membrane lining
membrane) is detached
from the retinal pigment
epithelium which is
firmly attached to the
choroid.
 Classification
A. Primary Retinal Ablation (Rheugmatogenousa Retinal Detachment) – cause a tear
Pathogenesis
a tear in the retina causes sub-retinal fluid from vitreous synchitis to enter a potential
gap and cause ablation from the inside

Etiology
• Predisposing retinal degenerations
• Aphakia (Endodonesis)
• Trauma

Clinical manifestations
• Floater
• Fotopsia
• The peripheral visual defect then becomes central
Figure.1: Regmatogenous retinal detachment,
Figure.2: Regmatogenous retinal detachment
arrow direction indicates horseshoe tear.
 Classification
B. Retinal Ablation Tractional
Pathogenesis
Caused by the pull of the retina into the vitreous body

Etiology
• Post trauma
• Diabetic retinopathy ploriferative
• Retinopathy of prematurity
• Sickle cell retinopathy

Clinical manifestations
• Decreased visual and visual field
• Vitreoretinal bands appear
 Classification
C. Retinal Ablation Exudative
Pathogenesis
Caused by a buildup of fluid in a potential gap because there are abnormalities in the
epithelial lining of the retinal pigment and choroid without preceded tears

Etiology
• Systemic disease (hypertension, polyarteritis nodosa)
• eye disease (koroiditis, neoplasia)

Clinical manifestations
Visual impairment or visual field without floater and photopsia, the detached area
changes according to position (Shifting fluid).
 Complications

 Early complications after surgery:

Increased IOP, glaucoma, infection, choroidal ablation, failure of retinal attachment,
recurrent retinal detachment.

 Further complications:
Infection, release of buckling material through the conjunctiva or erosion through
the eyeball, vitreous retinopathy proliferative (scar tissue that affects the retina), dipl
opia, refractive errors, astigmatism.
 Diagnosis
Examination:
1. Sharp examination of vision
2. Field of view inspection
3. Check whether there are signs of trauma
4. Check pupillary reaction. Persistent pupillary dilation indicates trauma.
5. Inspection of slit lamp; the anterior segment is usually normal, vitreous examination to look fo
r pigment markings or "tobacco dust", this is a pathognomonic of retinal detachment in 75% of
cases.
6. Check eye pressure.

Check up result:
1. a visual acuity or one of the visual positions deteriorates
2. Fundus reflex shows non-uniform color
3. The retina is raised, looks grayish, sways
4. Sometimes retinal tears can be seen directly on fundoscopic examination
 Diagnosis

Supporting investigation:
1. Laboratory tests are carried out to determine the presence of comorbidities such as diabetes
mellitus.
2. Ultrasound examination is performed if the retina cannot be visualized due to corneal change
s, cataracts, or bleeding.
3. Imaging techniques such as orbital photographs, CT scans, or MRI are not indicated to help
diagnose retinal detachment but can be needed to detect intraocular foreign bodies and tumors.
 Treatment of Retinal Detachment

1. Surgery is the only treatment in rhegmatogenous and tractional cases. treatment

options are scleral bulking or vitrectomy
2. rhegmatogenous case management principles: find all ablation sites and identify
tears, evacuate subretinal fluid, retinal cracks with RPE, chorioretina irritation around
ablation. to provide long-term temponade effects can be used silicon oil or gas.
3. principle of handling tractional cases: remove fibrosis tissue in the vitreous and
Preretina
4. After the patient has vitrectomy accompanied by tamponade gas or silicon oil it is
recommended to head down position.
1. Scleral buckling :
Procedures include localizing the position of the retinal tear, handling the tear with a cryoprobe, and then with
a scleral buckle (belt).

Figure.2: scleral buckling in the patient's

eyes

Figure.1: Silicone sponge is sewn to the eyeball to Figure.3: Emphasis is obtained from a silicone sponge,
compress the sclera above the retinal tear after the retina is now attached again and traction to the retinal
drainage of the subretinal fluid and cryotherapy. tear by vitreous is removed.
2. Retinopeksi pneumatic
The technique for carrying out this procedure is to inject gas bubbles into the vitreous cavity.

Figure: After removal of the vitreous gel in the

subretinal fluid drainage, inert fluorocarbon gas is
injected
into the vitreous cavity.
3. Pars Plana Vitrektomy
How to do this is to make a small incision in the wall of the eyeball and then insert the instruyen
cavum vitreous through the pars plana.

Figure.2: pars plana viterectomy

Fugure.1: Vitrectomy Picture.3: pars plana viterectomy

display where there is a trokar
entry port
 Prognosis

Prognosis depends on the extent of retinal

tear, the interval between ablation, the
diagnosis and the surgical procedure
performed. In high myopia, because there
is retinal degeneration, the prognosis is poor.
“Thank You”