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GLAUKOMAAKUT & KRONIS
SMF Ilmu Penyakit Mata
RSUD dr. Mohammad Saleh Kota Probolinggo
Fakultas Kedokteran Universitas Wijaya Kusuma Surabaya
Oleh :
Rifqi Ardi Firmansyah, S.Ked.
10700130
Pembimbing :
dr. M. Amarusmana, Sp.M.
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DEFINISI GLAUKOMA
KELAINAN PADA MATA YANG DITANDAI DENGAN :
OPTIK NEUROPATI GLAUKOMA
GAUNG PAPIL ATAU EXCAVATIO PAPIL
DEFEK LAPANG PANDANGAN (KHAS GLAUKOMA)
PENINGKATAN TEKANAN INTRA OKULER (TIO)
MERUPAKAN FAKTOR RESIKO UTAMA
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PENDAHULUAN
• Jumlah P !" Du#"a : $% &u'a
– % m*#+alam" ,*-u'aa#
• U."a Ha/a0a# H"!u0
– Jumlah 0 +lau,1ma
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A2u'* Glau21ma (34 m"ll"1#)
Cl1.* A#+l* Glau21ma
O0*# A#+l* Glau21ma54% (6 m"ll"1#)
7 T1'al Glau21ma ($% m"ll"1#)
78l"#! 9/1m Glau,1ma ($ m"ll"1#)
6 million
60 million
Lim ASM., 2002,
Lim ASM., 2002,
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PENDAHULUAN
6 FAKTOR YANG MEMPENGARUHI TIO
• KECEPATAN PRODUKSI HUMOR AUOS OLEH
8ADAN SILIER
• OUTFLO; HUMOR AUOS MELALUI TRA8ECULAR MESH;ORK<SCHLEMM=S CANAL
SYSTEM
•
TEKANAN VENA<VENA EPISKLERA TER8ANYAK PENINGKATAN TIO DISE8A8KAN :
HAM8ATAN PADA OUTFLO; HUMOR AUOS
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A>u1. Hum1/ D?#am"2.
T*,a#a# I#'/a O,ul*/ TIO
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GAM8AR ALIRAN HUMOR AKUOS
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P/1!u,." Hum1/A>u1. I#@1
P*m-ua#+a#
Ou'@1
Ham-a'a#
8*#!u#+
a#
Pu0"l (8l1, 0u0"l)
Su!u' 8MD
(T*/'u'u0)
T/a-*,ula/m*.h1/,(R1#++a .*m0"')
V*#a E0".,l*/a('*, ↑)
TIO
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PENGUKURAN TIO
• T1#1m*'*/ "#!*#'a." !a/" S2h"1'B
• T1#1m*'*/ a0la#a." !a/" G1l!ma##
•
T1#1m*'*/ #1# ,1#'a, (a"/<0u)• P1/'a-l* *l*2'/1#"2 a00la#a'"1# (21:
T1#10*#)
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PENGUKURAN TIO
• TIO N1/mal –8*/,".a/ :%54 %54 mmH+ –
Ra'a</a'a :454 54 mmH+• TIO T"#++"
– mmH+
• H"01'1#" – $54 mmH+
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• Gam-a/ : P*#+u,u/a# TIO !a# T*h#", P*m*/",.aa#
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PEMERIKSAANLAPANG PANDANGAN
•
Gam-a/
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PEMERIKSAAN KEDALAMANBILIK MATA DEPAN
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PATOGENESIS GLAUKOMA
Gaun Pa!il
K"ma#ian SGR $an A%on SGR
N"uo!a#iO!#i'
Glau'oma
D"("'la!an!an$ana
n
Blo'a$"alian
a%o!la)mi*
TIO
P"(u)i
Ganuanm"'ani)m" "ula)i
T"'anan$aa+
Din$in !"m$aa+ )'l"o#i'
-a)o)!a)m"a'#o ")i'ou#ama
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PEMBAGIAN GLAUKOMA
Glau'oma
Glau'oma)u$u#
#"#u#u!
Glau'oma)u$u# T"u'a
Pim"
S"'un$"
Pim"S"'un$"
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GLAUKOMA
SUDUT TERTUTUP
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PEMBAGIAN GLAUKOMASUDUT TERTUTUP
• SUDUT TERTUTUP PRIMER: – AKUT
– SU8AKUT (INTERMITEN)
–
KRONIS• GLAUKOMA SUDUT TERTUTUP PRIMER
• SUDUT TERTUTUP SEKUNDER
• GLAUKOMA SUDUT TERTUTUP SEKUNDER – DENGAN 8LOK PUPIL
– TANPA 8LOK PUPIL
• SINDROMA PLATEAU IRIS
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ETIOLOGI DAN MEKANISMESUDUT TERTUTUP
Ta"'ula m")+/o'
Ii)
T"'anan
l"1"l ana#omi
Ii) Ba$anSili"
L"n)a Po)#"iol"n)a
8l1, Pu0"l Pla'*au I/". Fa,1m1/,
Su-lu,.a." l*#.a
T*, "'/*1u. ,/#
-l1, ."l"*/
M"'ani)m"Po)#"io
M"'ani)m"
An#"io
Tai'
T"'an
SUDUTTERTUTUP
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SUDUT TERTUTUP
• % m*,a#".m* !a.a/ -l1, 0u0"l
•
% m*,a#".m* !a.a/ la"# a'au,1m-"#a."
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SUDUT TERTUTUP
P"$i)!o)i)i Blo' Pu!il
7BMD $an'al
7L"n)a '"$"!an
7L"n)a #"al
U)ia
7BMD $an'al
7L"n)a $"!an
7L"n)a #"al
7Pu!il Mio)i)
3aa'ii)4l"n)a5
Blo' !u!il"la#i(
"#u)an
7Pu!il
$ila#a)i7Pu!ilmio)i)+"a#
7L"n)a
""a''" $"!an
Blo' !u!il
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AKTOR PENETUS BLOK PUPIL
PERUBAHAN
DIAMETER PUPIL
PUPIL DILATASISEDANG
PUPIL KONSTRIKSIHEBAT
LENSABERGERAK KEDEPAN
A,1m1!a."
K*0ala 'u#!u
TERKE3UT,TEGANG, TAKUT,
N7ERI
SINARREMANG4
REMANG
PUPIL SANGATKECIL
AKUOS DARI 8M8SUKAR KE 8MD
MENUMPUK DI8M8
A,'"'a.."m0a'*'",
T1#u. 1'1'
!"la'a'1/
A,'"'a.0a/a."m0a'*'",
T1#u. 1'1'.0h"#+'*/
Pu!il
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Mekanisme sudut tertutup (diambil dari Salmon, 2004)
PATOFISIOLOGI
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SUDUT TERTUTUP
PRIMER
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SUDUT TERTUTUP PRIMER
E0"!*m"1l1+"
U."a L*#.a '*-al
L*#.a ,* !*0a#
M"1.". D*,a!* $< !" #*+a/a -a/a'
D*,a!* 4 !" A."a
D*#+a# 8l1,Pu0"l
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SUDUT TERTUTUP PRIMER
E0"!*m"1l1+"
• S*
– ;a#"'a 6X 0/"a
– O, 8MD a#"'a !a#+,al
• Ra.
– Kul"' 0u'"h: GSTP GS8P :
–
Kul"' h"'am : GSTP .*!","' 1, l*#.a '"0".O'1' .0h"#2'*/ l*mah
– A."a : C"#a5 8"/ma5 S"#+a0u/a : GSTP GS8P
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SUDUT TERTUTUP PRIMER
E0"!*m"1l1+"
• K*la"#a# /*9a,."
– 0a!a h"0*/m*'/10"a
– O, 8MD !a#+,al
• Tu/u#a#
– 8MD !a#+,al 0a!a ,*lua/+a GSTP
• Mu."m – GSTP -a#?a, 0a!a mu."m !"#+"#
Ka/*#a 2aha?a 5 ,a-u' 5 0*/u-aha#2ua2a
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PATOFISIOLOGI STP
P"$i)!o)i)i
BMD $an'alP"n*"#u)
P"ua+an$iam"#"!u!il
Po)i)i
l"n)a '"$"!an
Blo' !u!il!im"
A'uo) $iBMB
T"'an ii)!"i(" '" TM
Su$u##"#u#u!
TIOIi) oman)
Su$u##"#u#u
!
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SUDUT TERTUTUP PRIMER
K"*"!a#an)u$u# #"#u#u!
Tinin8a !" TIO
B"a#n8a "9ala 8an mun*ul
Lua)n8aTM8an #"#u#u!
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GE3ALA SUDUT TERTUTUPPRIMER
G"9ala : – Hi!""mia )ili"
:
ma#a m"a+:
– Kon"a aa')uam 1i)u)
– Pu!il l"a
– N8"i ma#a :
Gejala + Hiperemia silier +
konjungtiva mata merah +
+ Kornea suram visus
Halo
Atrofi iris sekitar pupil
reflek pupil Pupil le!ar "paralise otot
sfingter pupil#
$%eri mata &an sekitarn%a
'ual( muntah
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SUDUT TERTUTUP PRIMER;STP<
STP Su- a,u' STP ,/1#".STP a,u'
7E0".1!* TIO ↑7Pu0"l l*-a/
7PSO : N
7 TIO ↑7Pu0"l : N
7PSO : N
7 TIO ↑ ↑ ↑7Pu0"l l*-a/
7PSO : N
Glau,1ma STP (GSTP)
GSTP
!+# +*&ala
GSTP
!+# +*&ala /"#+a#
GSTP
'a#0a +*&ala
7 TIO ↑ ↑7Pu0"l : l*-a/
7PSO : Gau#+
7 TIO ↑ 7Pu0"l : N
7PSO : Gau#+
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SUDUT
TERTUTUPPRIMER AKUTSTP AKUT
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SUDUT TERTUTUP PRIMERAKUT
G*&ala : – TIO
– K1/#*a *!*ma • V".u. 5 hal1
• Su/am
– 8MD !a#+,al
– Pu0"l l*-a/5 l1#&1#+5 /*@*,. <
– Pa0"l .a/a9 10'",: #1/mal a'au *!*ma
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SUDUT TERTUTUP
PRIMER AKUTD"a+#1.a :
– TIO ↑↑
– Su!u' 8MD '*/'u'u0
– Pu0"l l*-a/
– PSO : #1/mal
P*#a'ala,.a#aa# :
– P*/'1l1#+a# 0*/'ama
– P*/'1l1#+a# .*la#&u'#?a
– P*#2*+aha# 0a!a 9*ll1 *?*
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PENATALAKSANAAN STP AKUT
P*/'1l1#+a#0*/'ama
P*/'1l1#+a#.*la#&u'#?a
P*#2*+aha#
Tu/u#,a# TIO
8u,a .u!u'?+ '*/'u'u0
Su01/'"9 C*+ah.u!u'm*#u'u0
ula#+H"0*/1.m1'",
Ham-a' 0/1!u,."a>u1.
M"1'",um
H"0*/1.m1'",
Ham-a'0/1!u,." a>u1.
A#'" #?*/"
A#'" *m*'",
A#'" /a!a#+
C*+ah .u!u' m*#u'u00a!a 9*l1 *?*
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PENATALAKSANAAN STP AKUT
P*/'1l1#+a# 0*/'ama : Tu/u#,a# TIO• H"0*/1.m1'", -"la TIO .a#+a' '"#++"
– Gl".*/"# : +/,+ 88 !alam 4% la/u'a# – Ma##"'1l : < 34 +/,+ -- "3
• Ku/a#+" 0/1!u,." hum1/ a,u1. : – A22*'aB1lam"!* 4%% m+ 0*/ 1al – T"m1l1l %54 '10",al !! – 8/"#B1lam"!* '10",al !! –
D1/B1lam"!* '10",al !! – 8/"m1##"!"#* %54 < 5 '10",al !!
• T*,a# R*a,." /a!a#+ – S'*/1"! '10",al
PENATALAKSANAAN STP
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PENATALAKSANAAN STPAKUT
P*/'1l1#+a# .*la#&u'#?a : -u,a .u!u'• M*l*0a.,a# -l1, 0u0"l : H"0*/1.m1'",
V1lum* "'/*1u. m*#+*2"l l*#.a '*/'a/", ,*01.'*/"1/ -l1, 0u0"l l*0a. a,u1. !a/" 8M8,* 8MD '*,a# "/". ,* 01.'*/"1/ .u!u''*/-u,a
• M*m-ua' lu-a#+ 0a!a "/". 0*/"9*/ :"/"!*,'1m" 0*/"9*/ (IP) !*#+a# 2a/a : – La.*/ : la.*/ PI
– 8*!ah : -*!ah IP
A,u1. !a/" 8M8 lu-a#+ IP 8MD T*,a#"/". ,* 01.'*/"1/ .u!u' '*/-u,a
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O0*/a'1/ D/3 Nu/a.".5 S0M %43%3%%
I)I*KTO'I P)IF)
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IRIDEKTOMI PERIER
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N$7AG La)" Ii$"*#om8 4Lun#=> T+"*ni?u" ;S#a" @<
N$7AG La)" Ii$"*#om8 4Lun#=> T+"*ni?u" ;S#a" 2<
Gam-a/ : La.*/ I/"!*,'1m"P*/"9*/
M*la#2a/,a# al"/a# a,u1. m*lalu" lu-a#+ 0a!a "/".,* 8MD
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Aa+am>) Aon La)"Ii$"*#om8 T/o4S#"!
T"*+ni?u"4o)) S"*#ion -i"/o( i)# Bun.
Aa+am>) Aon La)"Ii$"*#om8 T/o4S#"!
T"*+ni?u"4o)) S"*#ion -i"/
o( S"*on$ Bun.
Gam-a/ : La.*/ I/"!*,'1m" P*/"9*/
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DIAGNOSA 8ANDING
STP AKUTSTP Akut Keratitis Iritis Akut
Kornea Suram Infiltrat Jerni
!M" "an#kal $ormal $ormal
Pupil Midriasis $ormal Miosis
TI% Tin##i $ormal $ormal&renda
'iperemia Konun#tia *Silier
Silier Silier
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SUDUT TERTUTUPPRIMER AKUT
STP A,u'
8*/la#+.u#+
lama
TIO lama
M"u)a'PSO
Gaun !a!ilD"("' la!an!an$anan
Glau,1maSTP !*#+a#
+*&ala
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GLAUKOMA SUDUT
TERTUTUP PRIMERDENGAN GE3ALA
GLAUKOMA STP DGN GEJALA
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GLAUKOMA STP
DENGAN GE3ALAGEJALA :
– TIO
– IRIS ATROFI – PUPIL LE8AR
– PSO : GAUNG : EXCAVATIO
–
DEFEK LAPANG PANDANGAN GLAUKOMA
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GLAUKOMA STP
DENGAN GEJALAPENATALAKSANAAN :
• TURUNKAN TIO
– TIMOLOL %54 DD
– 8ETAXOLOL %54 DD
– 8RINQOLAMIDE DD
– DORQOLAMMIDE DD
– 8RIMONIDINE %54 DD
GLAUKOMA STP
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GLAUKOMA STPDENGAN GE3ALA
PENATALAKSANAAN :
• 8EDAH FILTRASI TRA8EKULEKTOMI – KARENA SUDUT TERTUTUP LAMA
TRA8EKULAR MESH;ORK RUSAK FILTRASI(<)
– CARA :
MEM8UAT HU8UNGAN LANGSUNG DENGAN
8MD MELALUI LU8ANG PADA TRA8EKULARMESH;ORK KE RONGGA DI 8A;AHKONJUNGTIVA
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SUDUT
TERTUTUPSEKUNDERSTS
S
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SUDUT TERTUTUPSEKUNDER
STS KARENA 8LOK PUPIL SEKUNDER :
– RADANG IRIS (IRITIS IRIDOSIKLITIS)
• PRODUK RADANG PELEKATAN TEPI IRIS PADAPUPIL DENGAN LENSA : SINEKIA POSTERIOR
• SINEKIA POSTERIOR TOTALIS SEKLUSIO PUPIL 8LOK PUPIL
– LENSA INTUMESEN ( FAKOMORFIK)
– SU8LUKSASI LENSA ANTERIOR
• APOSISI LENSA DENGAN IRIS PADA PUPIL 8LOKPUPIL
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S+"+T T-T+T+P SK+$"-
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GLAUKOMA SUDUT
TERBUKA
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PEM8AGIAN GLAUKOMA
SUDUT TER8UKA• HIPERTENSI OKULI SUDUT TER8UKA
PRIMER
• SUDUT TER8UKA SEKUNDER
• NORMAL TENSION GLAUKOMA
• GLAUKOMA SUDUT TER8UKA PRIMER
• GLAUKOMA SUDUT TER8UKA SEKUNDER
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SUDUT TERBUKA
SUDUT TER8UKA
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SUDUT TER8UKA
P/"m*/ S*,u#!*/
7 T/a-*,ulum
7 R1#++a.*m0"'
7 E#!1'*l
7 Ka#al S2hl*mm
7 M*#u'u0
7 Va,u1l*
7 K*la"#a# '*/&a!" !" !alamma'a
7K*la"#a# a'au+a#++ua# 0a!a'/a-Ka#al S2hl*mm
7 K*la"#a# ?a#+ '*/&a!" !"lua/ ma'a
7 T*,a#a# *#a
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HIPERTENSI OKULI SUDUT
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HIPERTENSI OKULI SUDUTTERBUKA PRIMER ;HTO
STP<
• TERDAPAT <% PADA POPULASI % THN
• KE8ANYAKAN TIDAK MENJADI GLAUKOMA
• GAM8ARAN KLINIS : – TIO MMHG –
PSO : NORMAL – LAPANG PANDANGAN : NORMAL – SUDUT TER8UKA
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HIPERTENSI OKULI SUDUTTERBUKA PRIMER ;HTO
STP<
• PENATALAKSANAAN : –
TURUNKAN TIO 8ILA : – TIO 6% MMHG
– RI;AYAT KELUARGA GLAUKOMA
– FAKTOR RESIKO (DM5 HIPERTENSI5PENY KARDIOVASKULER)
– RAS
– USIA
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R1#++a T/a- M*.h1/, Ka#al S2hl*mm
T*/'u'u0M*#?*m0"'
P*m-ua#+a#
T/a-*,ula/ < U*a.,l*/a
TIO ↑
8*/la#+.u#+ lama
Gau#+ 0a0"lD*9*, la0a#+0a#!a#+a#
Glau,1ma Su!u' T*/-u,a
P/"m*/ S*,u#!*/
GS8P GS8S
S8P HTOS8S
AUOUS HUMOR
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AUOUS HUMOR
AUOUS HUMOR
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AUOUS HUMOR
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GLAUKOMA SUDUT
TERBUKA PRIMERGSBP
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GLAUKOMA SUDUTTERBUKA PRIMER
EPIDEMIOLOGI :
– USIA : PREVALENSI TINGGI PADA USIA
TETAPI DAPAT TERJADI PADA ANAK DE;ASA
MUDA – SEX : TIDAK ADA PER8EDAAN
– RAS : PREVALENSI TINGGI PADA KULIT HITAM
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GLAUKOMA SUDUT
TERBUKA PRIMEREPIDEMIOLOGI
– KELAINAN REFRAKSI : 8ANYAK PADA MYOPIA
– KETURUNAN : MELALUI TRANSMISI POLIGENIK
ATAU MLTIFAKTORIALDILAPORKAN 4<4% KASUS GS8P KETURUNAN
– FAKTOR SISTEMIK : DM
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GLAUKOMA SUDUT
TERBUKA PRIMER• GAM8ARAN KLINIS :
– TIDAK ADA KELUHAN
–
NYERI MATA (<) – VISUS SENTRAL 8AIK
– HIPEREMIA (<)
– KORNEA JERNIH
– PUPIL NORMAL
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GLAUKOMA SUDUT
TER8UKA PRIMER• GAM8ARAN KLINIS :
– MATA TAMPAK NORMAL
– PENDERITAPUN MERASA MATANYA NORMAL – KECUALI PADA STADIUM LANJUT LAPANG
PANDANGAN SUDAH SANGAT SEMPIT
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GLAUKOMA SUDUT
TER8UKA PRIMER
• DIAGNOSA :
– TIO MMHG
– SUDUT TER8UKA
– PSO : GAUNG
– DEFEK LAPANG PANDANGAN GLAUKOMA
PENATALAKSANAAN GSBP
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PENATALAKSANAAN GSBP
↓ TIO ↑ P*/9u." PSO
↑ Ou'@1 ↓ I#@1
6 P"l"ha#
O-a'<1-a'a#
La.*/ 8*!ahl'/a."
Fa,'1/ ?+ ha/u.!"0*/ha'",a# :
7 S'a!"um +lau,1ma7 T"#++"#?a TIO7 K1#!"." 0*#!*/"'a:
7U."a7P*,*/&aa#7P*#?3 S".'*m", :
CV5 /*.0 '/a2'7 K*mam0ua# 0
m*maham" Glau,
!a# 0*#a#+a#a##?a
Fa,'1/ /*.",1:7 T*,a#a# !a/ah ↓
7Va.1.0a.m*7S,l*/1'", 0!
Kal"'a. H"!u0 P*#!*/"'a
PENATALAKSANAAN GSBP
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PENATALAKSANAAN GSBP
O-a'<1-a'a# :• M*#*,a# 0/1!u,." hum1/ a,u1.
– 8/"#B1lam"!* !!
– D1/B1lam"!!* !!
– T"m1l1l %54 !!
– 8*'a1l1l %54 !!
– 8/"m1#"!"#* %54 !!
•
M*#"#+,a',a# Ou'@1 m*ll TM – P"l12a/0"#* !!
(,1#'/a,." 1'1' ."l"*/ /1#++a TM '*/-u,a
– 8"ma'10/1.' %5%6 !!
PENATALAKSANAAN GSBP
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PENATALAKSANAAN GSBP
O-a'<1-a'a# :• M*#"#+,a',a# 1u'@1 m*ll U*a.,l*/a
– La'a#10/1.' %5%%4 !!
– 8/"m1#"!"#* %54 !!
– U#10/1.'1#* %5 !!
– T/a10/1.' %5%% !!
– 8"ma'10/1.' %5%6 !!
PENATALAKSANAAN GSBP
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PENATALAKSANAAN GSBP
La.*/ u#'u, GS8P
• La.*/ T/a-*2ul10la.'? (LTP)
– La.*/ 0a!a '/a-*,ulum m*.h1/,
– T*/&a!" 0*#+,*/u'a# ,1m01#*# ,1la+*#
• E9*, m*,a#", /1#++a '/a-*,*l '*/-u,a
• R*.01# .*lul*/ -aha# a,.'/a .*lul*/
!a/" '/a-*,*l '*/-ua#+ '*/-u,a
T-A!K+.KT%MI
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T-A!K+.KT%MI
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Gam-a/ : '/a-*,ul*,'1m"
/.A+K%MA S+"+TT-!+KA P-IM-
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SUDUT TERBUKA
SEKUNDER
SUDUT TER8UKA SEKUNDER
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SUDUT TER8UKA SEKUNDER
K1#!"." .*,u#!*/• D"!alam ma'a
– M*m-/a# -/1a.,ul*/ 0a!a 0*/mu,aa#'/a-*,ulum m*.h1/,
• 8*/a.al !a/" #*1a.,ul*/ 0a!a "/".(/u-*1.". "/"!".) TIO↑ Glau,1ma#*1a.,ul*/ 0a!a .'a!"um .u!u' '*/-u,a
– E!*ma '/a-*,*l a,"-a' :
• Ra!a#+ : "/"'".5 .,l*/"'".
• T/auma 'um0ul5 '/auma al,al"
SUDUT TER8UKA SEKUNDER
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SUDUT TER8UKA SEKUNDER
•
D" !alam -1la ma'a – O-.'/u,." /1#++a '/a-*,*l 1l*h :
• S*l !a/ah m*/ah ,a/*#a '/auma
• S*l /a!a#+ ,a/*#a "/"'".
•M1l*,ul 0/1'*"# l*#.a 0a!a ,a'a/a,h"0*/ma'u/ +lau,1ma 9a,1l"'",
– Ga#++ua# 9u#+." '/a-*,*l a,"-a' .'*/1"!'10",al
•
D" lua/ -1la ma'a – K*la"#a# ?+ m*#?*-a-,a# '*,a#a# *#a
*0".,l*/a
• C1 : 1-.'/u,." *#a5 .'ula a/'*/" *#a
KOMPLIKASI
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KOMPLIKASI
PROGNOSIS
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PROGNOSIS
• 8a", +lau,1ma a,u' 2*0a''*/!*'*,." !a# m*#!a0a' '*/a0" ?a#+.*.*+*/a mu#+,"#
• P*#a#+a#a# *0".1!* a,u' ?a#+'*/lam-a' a,a# m*#?*-a-,a#,*-u'aa# 0*/ma#*#
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