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8/17/2019 PSSS Mata Merah Visus Menurun Perlahan

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CALM EYEWITH SLOWLY DECLINE OF VISUALLOSS

Dwi Permana Putra – 1011131066

Tanjungpura University


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Hypertensive Retinopathy


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Hypertensive Retinopathy

• Retinal vascular amage cause !yhypertension


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"linical #ani$estation

• #ost patients are asymptomatic

• %ome presents heaaches an !lurre vision

• &n ophthalmoscopy'

– (enerali)e arteriolar narrowing

– "hanges o$ the arterovenous crossings

– *lame Haemorrhage

– #icroaneurysms

– +,uates

– -rteriolar macroaneurysms – "otton.wool spots

– &ptic isc swelling

– */PT *ocal /ntraretinal Periarterioal Transuates


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(raing o$ Hypertensive Retinopathy2eith an egner "lassi4cation 1535

• Grade I *igure-

• %light narrowing

• /t consists o$ milgenerali)e arteriolarattenuation7 particularlyo$ small !ranches !roaening o$ thearteriolar light re8e,

an vein concealment• asymptomatic

hypertension


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• Grade II *igure 9

• /t comprises mar:egenerali)e narrowingan $ocal attenuationo$ arterioles associatewith e8ection o$ veinsat arteriovenouscrossings %alus; sign

• 9P is higher ansustaine


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• Grade III *igure "

• This consists o$ (rae //changes plus copper.wiring o$arterioles

• !an:ing o$ veins istal to

arteriovenous crossings9onnet sign

• tapering o$ veins on eithersie o$ the crossings (unnsign an right.angle

e8ection o$ veins %alu; ssign

• *lame.shape haemorrhages7cotton.wool spots an hare,uates are also present


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• Grade IV *igureD

• This consists o$ allchanges o$ (rae ///plus silver.wiring o$

arterioles anpapilloeema

• Heaache7 asthenia7loss o$ weight7 yspnea7

visual istur!aces7impairment o$ cariac7cere!ral an renal$unction


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Diagnosis

• history o$ the patients

• ophthalmoscopyirect or inirect

•

#ay reveal ecreaseo$ patient vision7occipital heaachean high 9loopressure

• Physical +,amination

• etect elevation o$!loo pressure

• &phthalmoscopy – (enerali)e arteriolar

narrowing

– "hanges o$ thearterovenous crossings

– *lame Haemorrhage

– #icroaneurysms

– +,uates

– -rteriolar macroaneurysms

–

"otton.wool spots – &ptic isc swelling

– */PT *ocal /ntraretinalPeriarterioal Transuates


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Di


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#anagement

• - major purposes o$ treatment

– prevent7 limit7 or reverse such target organamage !y lowering the patient;s high !loopressure

• =i$estyle changes promote healthy li$estylee,ercise7 consume healthy $oos

• -vice patient to reuce the !loo pressure

–

Ta:ing the meication – Re$erral to meical team %urgical management is

inicate to aress certain seconary causes o$systemic hypertension


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"omplication

• hypertensive retinopathycomplications – venous occlusion !ranch > central

retinal artery

– macular eema

– proli$erative vitreoretinopati

• -ll o$ these changes ultimately leato ecrease visual acuity an!linness


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Retinitis Pigmentosa


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Retinitis Pigmentosa

• Retinitis pigmentosa RP is a groupo$ inherite isorers characteri)e!y progressive peripheral vision loss

an night vision i?cultiesnyctalopia that can lea to centralvision loss


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Pathophysiology

• RP is typically thought o$ as a ro.coneystrophy in which the genetic e$ectscause cell eath apoptosis –

preominantly in the ro photoreceptors – the genetic e$ects

– cone photoreceptors

• RP has signi4cant phenotypic variation

patients with the same genetic mutationcan present with very i


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• Photoreceptors is shortening o$ the ro outersegments loss o$ the ro photoreceptor

occur in mi periphery o$ the retina

Theseregions o$ the retina re8ect the cell apoptosis !yhaving ecrease nuclei in the outer nuclear layer

• the egeneration tens to !e worse in the in$erior

retina

suggesting a role $or light e,posure• The 4nal common pathway in RP is typically eath

o$ the ro photoreceptors that leas to vision loss most ensely $oun in the miperipheral retina7cell loss in this area tens to lea to peripheralvision loss an night vision loss


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+tiology

• Photoreceptor cell eath most o$ thephotoreceptor cells are ros

• #olecular e$ect more than onehunre i


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/ncience

• &ccurs B persons per 1000 o$ theworl population

• -ppears in the chilhoo progressesslowly !linness in avancemile age

• #ale are more commonly a


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"linical *eatures

• 1 isual %ymptoms

• Night bin!ne"" /t is the characteristic$eature an may present several years

!e$ore the visi!le changes in the retinaappear ue to egeneration o$ the ros

• Dark adaptation =ight threshol o$ theperipheral retina is increase the process

o$ ar: aaptation itsel$ is not a


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C *unus "hanges 4g1

• Retinal pigmentary changes these are typically perivascularan resem!le !one corpuscles inshape

• Retinal arterioles are narrowe

an may !ecome threa.li:e inlate stages

• Optic disc !ecomes pale anwa,y in later stages anultimately consecutive opticatrophy occurs *igC

•

Other associated changes whichmay !e seen are colloi !oies7choroial sclerosis7 cystoimacular oeema7 atrophic orcellophane maculopathy


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3 isual *iel "hanges

• Annular or ring-shapedscotoma is a typical $eaturewhich correspons to theegenerate eEuatorial)one o$ retina

• -s the isease progresses7scotoma increasesanteriorly an posteriorlyan ultimately only centralvision is le$t tubular vision

• +ventually even this is alsolost an the patient!ecomes !lin


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Treatment

• Fo e


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-ge.Relate #acular

Degeneration


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• senile macular degeneration

• is a !ilateral isease o$ persons o$B5 years o$ age or oler

• /t is a leaing cause o$ !linness inpopulation a!ove the age o$ 6B years

• /t is o$ two types non#e$%!ati&e an e$%!ati&e


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Ris: *actors

• Hereity

• Futrition

•

%mo:ing• Hypertension

• +,posure to sun light


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"linical types

• 1 on!exudative or atrophi" ARMD

• dry or geographic ARMD 50 percentcases

• causes mil to moerate7 graual losso$ vision

• Patients may complain o$ istorte

vision7 i?culty in reaing ue tocentral shaowing


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• Ophthalmoscopically *ig11C6-

• it is characterise !y

• occurrence o$ rusens colloi!oies

•

pale areas o$ retinal pigmentepithelium atrophy

• irregular or clusterepigmentation

• Drusens appear as smalliscrete7 yellowish.white7 slightly

elevate spots• later stages enlargement o$

the atrophic areas within whichthe larger choroial vessels may!ecome visi!le


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C +,uative -R#D

• Wet or neovascular ARMD 10 rapily progressivemar:e loss o$ vision

• %tages' – %tage o$ rusen $ormation7

– %tage o$ retinal pigmentepithelium RP+ etachment

– %tage o$ "F *ig 11C69

– %tage o$ haemorrhagic

etachment o$ RP+

–

%tage o$ haemorrhagicetachment o$ neurosensoryretina

– %tage o$ isci$orm scarringmacular egeneration


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Diagnosis

• +,amination o$ the macula slitlamp !iomicroscopy with a I50D>IJKD non.contact lens

• undus !uorescein angiographyindocyanine green angiography help in etecting "F in relation to

$oveal avascular )one


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Treatment

• There is no e


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Treatment $or e,uative-R#D

• Argon green-laser photocoagulation is the treatment o$ choice $ore,tra$oveal o$ "F#

• "hotodynamic therapy #"D$% is the treatment o$ choice $or su!$ovealan ju,ta$oveal classic "F# /n PDT7 vertipor4n7 a photosensiti)er orlight activate ye is injecte intravenously The area o$ "F# is thene,pose to light $rom a ioe laser source at a wavelength 6K5 nmthat correspons to a!sorption pea: o$ the ye The light.activate yethen causes isruption o$ cellular structures an occlusion o$ "F# withminimum amage to ajacent RP+7 photoreceptors an capillaries

• $ranspupillary thermotherapy #$$$% with a ioe laser K10 nm may !econsiere $or su!$oveal occult "F# PDT is e4nitely !etter than TTT !ut is very costly

• &urgical treatment in the $orm o$ su!macular surgery to remove "F#an macular translocation surgery are !eing evaluate

• "harmacologic modulation with antiangiogenic agent li:e inter$eronal$a.C57 an inhi!itor o$ vascular enothelial growth $actor +(*


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+ye /nto,i4cation


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/ntrouction

• The to,ic retinopathies $orm aiverse group o$ conitions thatresult $rom retinal amage cause !y

systemically aministere rugs

• relatively rare particularly when$eatures o$ !ilateral pigmentary

istur!ance or retinal crystaleposition are present


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"H=&R&LU/F+ -FD

HMDR&AM"H=&R&LU/F+

• "hloroEuine was populari)e 4rst $or theprophyla,is an treatment o$ malaria

• as an e


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• The ea'ie"t $unus are irregularityin the macular pigmentation an!lunting o$ the $oveal re8e,

• the central irregular pigmentation may!ecome surroune !y a concentric)one o$ hypopigmentation7 usuallyhori)ontally oval an more prominent

in$erior to the $ovea *igure 1• This paracentral epigmentation results

in the classical !ull;s.eye maculopathy

• continue e,posure to the rug generali)e pigmentary changes

• En!#"tage appearance may !einistinguisha!le $rom that o$ a cone.ro ystrophy7 with peripheral pigmentirregularity an !one spicule $ormation7vascular attenuation7 an optic iscpallor


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Thioria)ine

• antipsychotic rug

• -$ter C wee:s !lurring7nyctalopia7 an a !rownish visualiscoloration

• vision was normal to pro$ounlyreuce

• $unus coul appear normal change a couple o$ wee:s

• Pigment granularity evelopeposterior to the eEuator

• geographic areas o$ epigmentationan loss o$ choriocapillaris

evelope *igC• /$ the rug was withrawn early

a$ter the onset o$ symptoms7 thepatients usually reporteimprovement in vision


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Fiacin

• nicotinic aci7 vitamin 96 to lower

serum cholesterol

• patients who ta:e 1B g or more ailyevelop maculopathy Rarely

• central visual changes in wee:s ormonths a$ter the initial aministration

o$ the rug• Reuction in visual acuity is usually

mil to moerate

• The patients evelop a !ilateralmaculopathy that has the clinicalappearance o$ cystoi macular eema7!ut there is no ye lea:age or

accumulation with 8uoresceinangiography

• &ptical coherence tomography &"Treveals the presence o$ cystoi spacesin the inner nuclear an outerple,i$orm layers *ig3


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Tamo,i$en

• Tamo,i$en is a nonsteroialestrogen antagonist !reastcancer

• Retinopathy was 4rst escri!eamong women treate with morethan 1K0 mg>ay $or longer than a

year• These patients usually ha a

symptomatic ecrease in vision

• The characteristic $unus 4ningswere small7 white7 re$ractileeposits in the inner retina

• -ssociate pigmentary irregularity *igN

• *luorescein angiographyemonstrate macular eema inmost cases


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De$ero,amine

• De$ero,amine mesylate is a chelatingagent use to remove to,ic levels o$heavy metals $rom the !oy

• reuce iron levels in patients withtrans$usion.epenent anemia an totreat aluminum to,icity "hronic Renal

• The onset o$ visual symptoms occur

a$ter long e,posure• Patients usually complain o$ !lurre

vision7 nyctalopia7 color visiona!normalities7 or visual 4el restriction

• the $unus may appear normal or su!tlepigment

• "olor vision is $reEuently a!normal7

typically with a tritan yschromatopsia• The maculopathy may progress

evelop into coarse macular pigmentarychanges *igB occasionally7peripheral pigmentary clumping


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Dianosine

• Dianosine is an antiretroviral rug human immunoe4ciency virus in$ection

• &$ N3 chilren receiving ianosine$ollowe prospectively7 3 Jevelope an asymptomatic peripheralretinal egeneration 4rst note a$ter 5–15 months o$ therapy

• The 4nings consiste o$ small7 sharplyemarcate areas o$ retinal an retinalpigment epithelial atrophy aroun themiperiphery *ig 6

• isual acuity remaine normal in allpatients

• &ne patient who was a!le to unergo

relia!le testing emonstrate milrestriction o$ the peripheral visual 4el

• "linical 4nings inclue normal visualacuity7 4el e$ects7 an a!normalelectro.oculogram +&(


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