Anatomi Dan Fisiologi Mata 1

Vitreo - Retina
Vitreous
A water (99%) and Hyaluronic acid & collagen (1%) mix
Optically clear, fills centre of globe
Firm adhesions
optic nerve
peripheral retina at ora serrata
retinal blood vessels
can produce retinal detachment when they tear loos
Normally shrinks : age
Sineresis, Posterior vitreous detachment
Ophthalmology Department
Faculty of Medicine Diponegoro University
Kariadi General Hospital
Vitreous
Abnormality
Floater / turbidity (Thin dense)
Degeneration
Haemorrhage
Infection / inflammation (vitritis)
Flashes
Traction to retina
PVD and retinal break
Retina
Normal retina
Optic disc
Superior temporal arcades
Inferior temporal arcades
Macula
Fovea
Anatomy
Anatomy
Retina layers
Vision
Biochemistry of Vision:
Visual proteins : based on Vitamin A
Stimulation by light : a biochemical cascade
Electrophysiological changes
transmitted and modified through the layers of the retina the
ganglion cells the optic nerve
Central Vision:
The foveola : the most detailed vision
High density of cones
Reduction in the inner layers
reduce obstruction to light
High (near 1:1) ratio of cones to ganglion cells
Vision
Retinal Pigment Epithelium:
The RPE
special metabolic and ionic conditions
the rods and cones for normal vision
Aging changes
Age Related Macular Degeneration
Highly vascular portion of the uvea
Supplies the outer retina
Examination
Physical examiantion
Slit Lamp Biomicrosopic with
Condensing Lens
Goldman three mirror
Ophthalmoscope
Direct
Indirect
Additional examination
Fundus Photo Color
Fundus Fluorescein angiography
Ultrasonography
Goldman Three Mirror Condensing Lens
Slit lamp Biomicroscopic

Indirect Ophthalmoscope
Direct Ophthalmoscope
Fundus Fluorescein angiography
Optical coherence tomography
Ultrasonography
Retinal Abnormality
Dystrophy
Degeneration
Infection / Inflammation
Vascular
Detachment
Tumor
Dystrophy
Retinitis Pigmentosa
Stargardt Disease
Hereditary degeneration
Fotoreceptor
Dysfunction, loss and atrophy optic nerve.
Autosomal recessive
Autosomal dominant
x-linked rescessive
1/3 no family history
Symptom :
Niktalopia
Constricted visual field
Sign :
Bone spicule like
pigmentation in fundus
Arteriolar narrowing
Treatment
Low vision aid
No direct medical treatment
Stargardt disease
Juvenile macular dystrophy
Gen ABC4R on lp 21-22
Symptom
Presentation on second decades
Gradual impairment of central vision
Signs
Geographic atrophy
Fovea may be normal or non specific
Treatment
Low vision aid
No direct medical treatment
Stargardt disease
Degeneration
Myopic degeneration
Age related macular degeneration
Myopic degeneration
Pathologic / high Myopia
Progressive elongation of the eye
Thinning RPE and choroid
> - 6.00 D
Axial length > 26 mm
Liable to glaucoma and cataract
Treatment
Limited to optical correction
Intra-ocular pressure control
Attention to complications that may occur.
Scleral buckling
Myopic degeneration
ARMD
The most common cause of central vision loss
> 50 years of age (developed countries??)
Symptom
- In the early stages
- Central vision may be blurred or distorted, with objects
looking an unusual size or shape and straight lines
appearing wavy or fuzzy (quickly or over several
months).
Dry ARMD
Dry ARMD / non-eksudatif (90%)
Drusen (yellowish deposits of debris in retina)
Geographic Atrophic
Treatment
diet
rich in leafy green vegetables, antioxidants, zinc,
lutein and zeaxanthin.
avoid excessively bright sunlight (ultraviolet (UV)
rays and blue light)
don't smoke
contact a low vision specialist
vision worsens
Wet ARMD
Wet ARMD (10%)
More progressive
Choroidal neovascularization
Treatment
Laser photocoagulation (> 200 um)
Photodynamic therapy
Macular translocation
Sub macular surgery
Dry ARMD
Wet ARMD
Infection / Inflammation
Chorioretinitis toxoplasma (toxoplasmosis)
intracellular protozoan Toxoplasma gondii.
Mammal and bird hosts.
(intermediate host is the cat).
The most frequent causes of retinochoroiditis
75 % the world's general population
possessing some seropositive findings.
Toxoplasmosis
Symptoms
unilateral, mild ocular pain, blurred vision and
new onset of floating spots.
Clinical findings
granulomatous iritis, vitritis, optic disc swelling,
neuroretinitis, vasculitis and retinal vein
occlusion in the vicinity of the inflammation, in
the actively involved eye.
Funduscopically,
active toxoplasmosis :
white-yellow chorioretinal lesions
vitreous cells.
inactive lesions in the fellow eye.
Treatment
Eradicate the parasite
Suppress the inflammatory response.
Classic treatment regimen:
Pyrimethamine
75 mg loading dose, followed by 25mg PO BID
administration
Sulfadiazine
2 g loading dose, then 1g PO QID for 4 to 6 weeks
Concurrent folinic acid
3 mg to 5 mg PO twice weekly
Minimize bone marrow
pyrimethamine toxicity
Treatment
Alternative treatments
Clindamycin
Tetracycline
Trimethoprim
Sulfamethoxazole,
Oral steroid 20 to 80 mg PO
Daily 4 or 6 weeks. (after antibiotic treatment)
Active toxoplasmosis
Inactive toxoplasmosis
Retinal vascular disease
Diabetic retinopathy
Hypertensive retinopathy
Oklusi pembuluh darah retina
Retinopati pada prematur
etc
Diabetic Retinopathy
Hyperglycaemia
Loss of pericyte
Thickening of basement membrane
Alteration of coagulation state
Non-proliferative DR
Microaneurism
Dot & blot intraretinal hemorrhage
Hard exudates
Dilatation and beading of retinal vein
Proliferative DR
Neovascularization
On the disc or else where
Macular Edema
Leakage plasma constituent and fluid in the macula
Diabetic Retinopathy
Treatment
NPDR
Glucose
systemic abnormality control
Hypertension
Dislipidemia, etc
Edema makula
Focal or grid laser photocoagulation
Anti-VEGF
Steroid intra vitreal or sub tenon
PDR
Pan Retina photocoagulation
Vitrectomy
Anti-VEGF
NPDR
PDR
Hypertensive retinopathy
WHO definition
Systolic blood pressure >140 mm Hg
Diastolic blood pressure > 90 mm Hg
HTN can affect
the choroid, retina, and optic nerve
Hypertension can cause:
Cotton Wool Spots
Nerve Fiber Layer micro-infarcts to disruption of
axoplasmic transport
Dot / Blot and flame shaped hemorrhages
Hypertensive Retinopathy
Modified Scheie Classification

Grade 0 No changes
Grade 1 Minimal arteriolar narrowing
Grade 2 Obvious arteriolar narrowing with focal
irregularities
Grade 3 Grade 2 + retinal hemorrhages and / or
exudate
Grade 4 Grade 3 + swollen optic nerve (Malignant
hypertension)
Hypertensive Retinopathy
Management
Lower the blood pressure gradually to
decrease risk of blindness and stroke
Grade III
Grade IV
Retinal vessel occlusion
Vena
Central (CRVO)
Cabang (BRVO)
Arteri
Central (CRAO)
Cabang (BRAO)
CRAO
Symptom
Acut severe loss of vision
Amaurosis fugax penglihatan kabur hilang timbul
Sign
RAPD
Pale / ischaemic retina
Cerry red spot
4-6 weeks : optic disc pale
Risk factor
Hypertension
Dislipidemia
Hemorrhelogy abnormality
GCA
Treatment
No effective therapy
90 minutes irreversible
Ocular massage
Paracintesis
Carbogen inhalasion
CRAO
Pale / ischaemic retina
Cerry red spot
CRVO
Symptom
Acut severe loss of vision
Pain less
Sign
RAPD
Retinal and vitrous hemorrhage
Macular edema and NVG
Optic disc edema
Risk factor
Hypertension
Dislipidemia
Hemorrhelogy abnormality
GCA Ophthalmology Department
CRVO
Treatment
No effective therapy
Laser photocoagulation
CRVO
ROP (Retinopathy of Prematurity)
A disease that occurs in premature infant and affect the blood vessel of
the developing retina
Vascular shunts
Neovascularization
Tractional retinal detachment
A major cause of Blindness and Visual Impairment in premature
infant.
Fortunately
Regression : 80 %
Progression : 20 %
25 % poor visual outcome despite current treatment
Screening at first 1 month
NORMAL VASCULAR DEVELOPMENT
IN UTERO ENVIRONMENT
1 2 months
After birth
8 months
4 months
Avascular zone Hypoxia Physiologic VEGF

Retinopathy of Prematurity
Avascular zone
Hyperoxia
Down regulated
VEGF
Decrease normal
Vascularization
Hypoxia
Up regulated
VEGF
Neovascularization
Stage 1, distinct demarcation line
Stage 2, ridge between the avascular

and vascularized retina
Stage 3, ridge with extraretinal proliferation
Stage 4, subtotal retinal detachment

4a. macula involvement (-)
4b. macula involvement (+)
ROP
Treatment
Threshold :
Laser photocoagulation, cryotherapy or anti-
VEGF
Retinal detachment
Vitrektomi
Retinal Detachment
Detachment the nuero-sensory retina from the
underlying pigment epithelial layer by
subretinal fluid
Exudativa
Uveal effusion (infection or inflammation)
Treatment : Underlying disease
Rhematogenous
Retinal break
Treatment : Scleral Buckling, Vitrectomy
Tractional
Proliferative RD
Treatment : Vitrectomy
Rhegmatogen RD
Tractional RD
Exudative RD
Tumor
Retinoblastoma
Hemangioma choroid
Tumor sub division
Thank you

Anatomi Dan Fisiologi Mata 1

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Anatomi Dan Fisiologi Mata 1

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Vitreo - Retina

Slit lamp Biomicroscopic

Modified Scheie Classification

Avascular zone Hypoxia Physiologic VEGF

Stage 2, ridge between the avascular

Stage 4, subtotal retinal detachment

Laser photocoagulation, cryotherapy or anti-

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