Retina - 1
-
Upload
ghanirahmani -
Category
Documents
-
view
253 -
download
1
description
Transcript of Retina - 1
![Page 1: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/1.jpg)
![Page 2: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/2.jpg)
Retina
• Merupakan 2/3 bagian dari dinding dalam bola mata
• Lapisan transparan, tebalnya kira-kira 1 mm
• Terdiri dari 3 macam sel syaraf (neuron) yang berestafet dalam meneruskan impuls penglihatan
![Page 3: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/3.jpg)
![Page 4: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/4.jpg)
Urutan sel dari luar(sklera) ke dalam (vitreus):
• Sel-sel fotoreseptor : conus dan bacillus• Sel horisontal dan sel bipolar• Sel ganglion
Ketebalan retina terdiri dari:3 lapisan berisi nukleus 2 lapisan berisi sinaps akson neuron-neuron tersebut2 lapisan membrana limitan1 lapis serabut syaraf, merupakan akson neuron ke-31 lapis epitel pigmen retina
![Page 5: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/5.jpg)
Vaskularisasi retina:
Neuron terluar: khoriokapiler
2 neuron lebih dalam: a retina sentralis
![Page 6: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/6.jpg)
![Page 7: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/7.jpg)
![Page 8: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/8.jpg)
![Page 9: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/9.jpg)
Topografi retina:
Retina polus posterior:Papil syaraf optik
Makula dengan fovea
Pembuluh darah:Arteri
Vena
Ekuator
Retina perifer : di depan ekuator
![Page 10: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/10.jpg)
![Page 11: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/11.jpg)
Diabetic Retinopathy
• Wanita 62 tahun, obese, dengan DM 8 tahun, tidak terkendali.
• Kedua mata kabur. OD kabur sudah beberapa tahun
• OS kabur kira-kiara 3 bulan ini
• VOD : 1/300
• VOS : 3/60
![Page 12: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/12.jpg)
• Diagnosa :– OD: Retinopati DM Proliferativa dengan
perdarahan vitreus– OS Retinopati non proliferative berat dengan
kemungkinan iskemik makula.
• Prognosis ad visam :– buruk untuk kedua mata
![Page 13: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/13.jpg)
Retinopati Diabetes?:
• Perubahan pada retina
• Dapat tanpa gejala , dapat menimbulkan gangguan penglihatan sampai kebutaan
• Terjadi pada 60 % penderita Diabetes > 15 tahun
• Di AS setiap tahun > 8000 penderita Diabetes menjadi buta karena retinopati DM
![Page 14: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/14.jpg)
– Sebagian besar kebutaan karena Retinopati DM dapat dicegah :
• Fotokoagulasi laser yang tepat waktu
– Kenyataannya : sebagian besar penderita datang terlambat
![Page 15: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/15.jpg)
Apakah Retinopati Diabetes ?
• Perubahan retina karena :
• 1. Kebocoran pembuluh darah halus
![Page 16: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/16.jpg)
• 2. Sumbatan pembuluh darah halus di retina
![Page 17: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/17.jpg)
• 3.pembentukan pembuluh darah baru yang rapuh
![Page 18: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/18.jpg)
• Kebocoran/kenaikan permeabilitas kapiler:– Hilangnya sel perisit
– Hiangnya sel endotel
Akibatnya:Edema retina
Hard Exudate
Perdarahan retina
![Page 19: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/19.jpg)
Sumbatan pembuluh darah di retina:Shunt
Terbentuk pembuluh darah neovaskuler:
Perdarahan vitreus
Jaringan fibrous
Ablasi retina
![Page 20: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/20.jpg)
![Page 21: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/21.jpg)
![Page 22: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/22.jpg)
![Page 23: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/23.jpg)
![Page 24: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/24.jpg)
Oklusi Vena Retina
• Laki-laki, 52 tahun, perokok berat, hipertensi.
• Penglihatan mata kanan seperti tertutup kabut di bagian tengah
• Tak terasa sakit, tidak merah
• Pemeriksaan: VOD : 5/60 ; VOS 6/6
![Page 25: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/25.jpg)
![Page 26: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/26.jpg)
Oklusi vena retina
• Faktor predisposisi:– Usia– Hipertensi– Diskrasia darah– Glaukoma– Kelainan kongenital– Periphlebitis– Hipermetropia
![Page 27: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/27.jpg)
Oklusi vena retina
• Oklusi vena tekanan vena & kapiler naik Stagnasi aliran darah hipoksia kerusakan sel endotel kapiler ekstra vasasi tekanan ekstra vaskuler naik stagnasi dst
• Akibat : – Perdarahan retina– Edema retina
![Page 28: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/28.jpg)
Oklusi cabang vena retina
• Prognosis:– 6 bl, 50% membentuk kolateral– Visus tergantung pada:
• Lokasi vena yg tersumbat• Integritas kapiler perifovea
– Komplikasi:• Edema makula • Neovaskularisasi iris glaukoma neovaskuler
![Page 29: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/29.jpg)
![Page 30: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/30.jpg)
Oklusi vena sentralis retina
• 2 macam gambaran klinik:– Tipe iskemik– Tipe non iskemik
• Tipe iskemik:– Penurunan visus berat– Refleks pupil negatif
• Komplikasi:– glaukoma neovaskuler– Edema makula kistoid
• Gambaran fundus:
![Page 31: Retina - 1](https://reader031.fdocument.pub/reader031/viewer/2022031720/55cf9157550346f57b8ccd8e/html5/thumbnails/31.jpg)
Oklusi vena retina sentralis
• Tipe non iskemik:– Penurunan visus tidak berat
• Komplikasi:– Jarang timbul glaukoma neovaskuler– Kadang berubah menjadi tipe iskemik