Post on 17-Feb-2018
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The Eyedr. Duti Sriwati Aziz, SpPA
Sub Dep PA RSAL Dr. Ramelan – FK UHT
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•Orbita
•Eyelid
•Conjunctiva•Sclera
•Cornea
•Uvea•Retina & vitreuous
•Optic Nerve
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ORBITA
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Figure 29-1 Anatomy of the eye.
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•Kelainan :
–Proptosis
–Thyroid ophthalmopathy
–Infeksi
–Neoplasma
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1.PROPTOSIS
•Tekanan orbita bola mata
terdorong proptosis
kelopak mata tak tertutup air mata
tak merata kornea kering –Nyeri
–Infeksi
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•2 macam :
1.Axial ( directly forward )
2.Positional
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•Positional → Medial, inferior o.k teksuperotemporal
–Infeksi → kel.lacrimalis
–Neoplasma →
•Lymphoma
•Pleimorphic adenoma
•Adenoid cystic carcinoma ( Silindroma )
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• Axial
–Thyroid ophthalmopathy
–Tumor CNS ( bukan SSP ) →
•Meningioma
•Glioma
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2.Thyroid ophthalmopathy
•Axial proptosis
•Grave’s disease
–karena :•Akumulasi extracellular matrix protein
•Fibrosis muskulus rectus
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The extraocular muscles are greatly distended in this postmortem dissection of tissuesfrom a patient with thyroid (Graves) ophthalmopathy. Note that the tendons of the
muscles are spared involvement.(Courtesy of Dr. Ralph C. Eagle Jr, Wills Eye Hospital, Philadelphia, PA.)
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3.INFEKSI
•Uncontrolled Sinusitis
•Immunosuppressed → mucormycosis
•Diabetes sclerosing•Wegener granulomatosis
•Idiopathic orbital inflammation → orbital
inflammatory pseudotumor
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Orbital inflammatorypseudotumor
–Unilateral
–Bilateral
–Seluruh elemen orbita
–Kel lacrimalis → sclerosing dacryoadenitis
–Orbital myositis
–Posterior scleritis
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•Mikroskopis :
–Fibrosis
–Radang khronis
•sel plasma, lymphocyte ( germinal centre ),eosinophil
•Lokasi :
–Terbatas di Orbita–Bersamaan dengan keradangan diretroperitoneum, mediastinum, thyroid
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In idiopathic orbital inflammation (orbital inflammatory pseudotumor), theorbital fat is replaced by fibrosis.
Note the chronic inflammation, accompanied in this case by eosinophils.
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4.Neoplasma
•Vascular :
–Capillary Hemangioma
–Lymphangioma
•Kel. Lacrimal :
–Pleomorfik adenoma
•Dermoid cyst
•Neurilemmoma ( Schwannoma )•Limphoma maligna
•Metastasis ( prostat, neuroblastoma, wilm’s tumor )
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EYELID
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•Radang
•Granuloma → chalazion
•Neoplasma
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CHALAZION
• Ekstravasasi lipid kejaringan sekitar
–Reaksi granulomatous → Lipogranuloma
–O.k obstruksi sebaceous gland :
•Blepharitis
•Neoplasma
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Neoplasma
1.Basalioma ( Basal Cell Ca )
2.Sebaceous Carcinoma
3.Melanoma4.Kaposi sarcoma
Ulcerasi kornea
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•Basalioma
–Palpebra inferior
–Chanthus medius
•Sebaceous carcinoma
–≈ chalazion
–Metastase → kelenjar parotis dansubmandibula
–Mortalitas 22%
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•Kaposi sarcoma
–Eyelid → Purple hue
–Mucous membran conjuctiva → Bright red
( ≈subconjuctival haemorrhage )
–Conjuctiva menebal
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CONJUNCTIVA
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•Scarr
•Pinguecula & Pterygium
•Neoplasma
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Conjunctival scarring
•Chlamydia trachomatis
•Caustis alkalis
•Pemphigoid•Iatrogenic
Scarring goblet cairan ulcerasi visi
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3. Pinguecula & Pterygium
•Fibrovascular submucosa
•Pinguecula
–actinic damage
–invasi cornea–Precursor Squamous Cell Ca & Melanoma
•Pterygium
–not invasi cornea–pada submucosa limbus ( solar elastosis )
–Infeksi sekunder → actinic granuloma
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4. Neoplasma
•Dapat CIN ( Conjunctival IntraepithelialNeoplasma )
•CIN + squamous papilloma Humanpapilloma virus 16, 18
•Mucoepidermoid Ca
•Conjunctival nevi melanoma insitu
•Conjunctival melanoma
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SCLERA
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• Sedikit vascular & fbroblast→ coklat,operasi sukar sembuh
• Rheumatic arthritis Immune complex
deposit necrotizing scleritis• Biru →
– igh intraocular pressure staph!loma
– "steogenesis imper#ecta– $ongenital nevus % nevus o# ota
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CORNEA
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•Keratitis & ulcer
•Degeneration & distrophy
–Band keratopathies–Keratoconus
–Fuchs endothelial dystrophy
–Stromal dystrophy
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Keratitis & Ulcers
•Bakteri, fungal, protozoa, virus ( H.simplex, H. Zoster )
•Aktivasi collagenase epithel &fibroblast
•H. simplex chronis reaksigranulomatous pada Descemet
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Chronic herpes simplex keratitis.The cornea is thin and scarred (note the increased number offibroblast nuclei). Granulomatous reaction to Descemet's
membrane (arrows).
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Corneal Degeneration & Dystrophies
•Degeneration -bilateral/unilateral
-non-familial
•Dystrophies -bilateral
-hereditary
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a.Band keratopathies
•Calcific band keratopathy timbunan kalsium pada lapisanBowman
•Actinic band keratopathy padaultraviolet pengaruh collagen (solarelastosis)
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b.Keratoconus
• Penipisan & ectasia corneaprogressive tanpa inflamasi atauvaskularisasi
• Etiologi : unknown
• Biasanya bilateral, ada hubungan dgDown syndrome, Marfan syndrome
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Keratoconus.
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• The tissue section is stained by periodic acid-Schiff to highlight theepithelial basement membrane (ebm), which is intact.
• Bowman's layer (bl), situated between the epithelial basementmembrane and the stroma (s), is not a basement membrane.
• By tracing Bowman's layer from the right side of thephotomicrograph toward the center, one notices a discontinuity inthis layer, diagnostic of keratoconus.
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•Patogenesa :
–Activasi colagenases, gelatinases, matrixmetalloproteinases
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Morfologi :
•Cornea menipis, Bowman’s pecah-pecah
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c.Fuchs Endothelial Dystrophies
• Ada pada anak-anak / dewasamuda, progressive, autosomalrecessive
• Rasa nyeri karena erosi epitel
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d.Stromal Dystrophies
• Ada pada anak-anak / dewasa muda,progressive, autosomal recessive
• Rasa nyeri karena erosi epitel• Keratan sulfat, amyloid pada stromakornea
• Bentuknya ada 3 : Lattice dystrophy Granular dystrophy Avellino dystrophy
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ANTERIOR SEGMENT
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1. Anatomi Fungsional
•Bag. depan dibatasicornea, lateraldibatasitrabecular messwork, posteriordibatasiiris
•Lens capsule, sbg basement membranedari epitel lensa
•Anterior segment : cornea, anteriorchamber, posterior chamber, iris, lensa
•Posterior segment : sisa dibelakangnya
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Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured ith crypts and folds. Upper right, The normal flo of a!ueous humor. A!ueous
humor, produced in the posterior cham"er, flos through the pupil into the anterior cham"er. The ma#or pathay for the egress of a!ueous humor is through the
tra"ecular meshor$, into %chlemm&s canal. 'inor outflo pathays (u)eoscleral and iris, not depicted* contri"ute to a limited extent to a!ueous outflo. +oer left,
rimary angle closure glaucoma. n anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens "loc$s the passage of a!ueous
humor from the posterior cham"er to the anterior cham"er. ressure "uilds in the posterior cham"er, "oing the iris forard (iris "om"/200* and occluding the
tra"ecular meshor$. +oer right, A neo)ascular mem"rane has gron o)er the surface of the iris, smoothing the iris folds and crypts. 'yofi"ro"lasts ithin the
neo)ascular mem"rane cause the mem"rane to contract and to "ecome apposed to the tra"ecular meshor$ (peripheral anterior synechiae*. utflo of a!ueous humor
is "loc$ed, and the intraocular pressure "ecomes ele)ated.
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Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured ith crypts and folds. Upper right, The normal flo of a!ueous humor. A!ueous
humor, produced in the posterior cham"er, flos through the pupil into the anterior cham"er. The ma#or pathay for the egress of a!ueous humor is through the
tra"ecular meshor$, into %chlemm&s canal. 'inor outflo pathays (u)eoscleral and iris, not depicted* contri"ute to a limited extent to a!ueous outflo. +oer left,
rimary angle closure glaucoma. n anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens "loc$s the passage of a!ueous
humor from the posterior cham"er to the anterior cham"er. ressure "uilds in the posterior cham"er, "oing the iris forard (iris "om"/200* and occluding the
tra"ecular meshor$. +oer right, A neo)ascular mem"rane has gron o)er the surface of the iris, smoothing the iris folds and crypts. 'yofi"ro"lasts ithin the
neo)ascular mem"rane cause the mem"rane to contract and to "ecome apposed to the tra"ecular meshor$ (peripheral anterior synechiae*. utflo of a!ueous humor
is "loc$ed, and the intraocular pressure "ecomes ele)ated.
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2. Cataract
•Cataract yaitu kekeruhan lentikular, dapatacquired/kongenital
•Penyakit-penyakit :
–Systemic (galactosemia, DM, Wilson, Atopic)–Radiation
–Trauma
–Intra ocular•Cataract yg berhubungan usia kekeruhan nukleus
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•Pigmen urochrome warna coklat
•Migrasi epitel ke bagian belakang posterior subcapsular cataract
•Cortex lensa mencair morgagniancataract
•Protein berat molekul tinggi yang pecah
dari lensa phacolysis membendungtrabecular meshwork glaucomaphacolytic
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3. Segmen anterior dan Glaucoma
•Yaitu kumpulan penyakit ditandai denganperubahan yang jelas dari gangguanpandang & nerve opticum cup
•Biasanya dg peningkatan tekanan intraokular, tetapi dapat juga normal(normal/low tension glaucoma)
•Aqueous humor dibentuk oleh ciliary bodies masuk ke trabecular meshwork
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Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured ith crypts and folds. Upper right, The normal flo of a!ueous humor. A!ueous
humor, produced in the posterior cham"er, flos through the pupil into the anterior cham"er. The ma#or pathay for the egress of a!ueous humor is through the
tra"ecular meshor$, into %chlemm&s canal. 'inor outflo pathays (u)eoscleral and iris, not depicted* contri"ute to a limited extent to a!ueous outflo. +oer left,
rimary angle closure glaucoma. n anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens "loc$s the passage of a!ueous
humor from the posterior cham"er to the anterior cham"er. ressure "uilds in the posterior cham"er, "oing the iris forard (iris "om"/200* and occluding the
tra"ecular meshor$. +oer right, A neo)ascular mem"rane has gron o)er the surface of the iris, smoothing the iris folds and crypts. 'yofi"ro"lasts ithin the
neo)ascular mem"rane cause the mem"rane to contract and to "ecome apposed to the tra"ecular meshor$ (peripheral anterior synechiae*. utflo of a!ueous humor
is "loc$ed, and the intraocular pressure "ecomes ele)ated.
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Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured ith crypts and folds. Upper right, The normal flo of a!ueous humor. A!ueous
humor, produced in the posterior cham"er, flos through the pupil into the anterior cham"er. The ma#or pathay for the egress of a!ueous humor is through the
tra"ecular meshor$, into %chlemm&s canal. 'inor outflo pathays (u)eoscleral and iris, not depicted* contri"ute to a limited extent to a!ueous outflo. +oer left,
rimary angle closure glaucoma. n anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens "loc$s the passage of a!ueous
humor from the posterior cham"er to the anterior cham"er. ressure "uilds in the posterior cham"er, "oing the iris forard (iris "om"/200* and occluding the
tra"ecular meshor$. +oer right, A neo)ascular mem"rane has gron o)er the surface of the iris, smoothing the iris folds and crypts. 'yofi"ro"lasts ithin the
neo)ascular mem"rane cause the mem"rane to contract and to "ecome apposed to the tra"ecular meshor$ (peripheral anterior synechiae*. utflo of a!ueous humor
is "loc$ed, and the intraocular pressure "ecomes ele)ated.
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Jenis glaucoma :
•Glaucoma sudut terbuka primary
•Glaucoma sudut tertutup secondary
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Primary glaucoma sudut terbuka :
•Mutasi padaGLC1A, pada chromosome 1 myocilin
• Jenis glaucoma yg terbanyak
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Secondary glaucoma sudut terbuka :
•Phacolysis pada chataract
•Darah (ghost cell glaucoma)•Pigmen iris (pigmentary glaucoma)
•Oxytalan fibers (exfoliation glaucoma)
•Necrotic tumor (melanomalytic glaucoma)
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Primary glaucoma sudut tertutup :
•Banyak pada hyperopia
•Terjadi papillary block terjadi iris bombé
•Epitel lensa dapat rusak
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Secondary glaucoma sudut tertutup :
•Kelebihan VEGF (Vascular EndothelialGrowth Factor)
•Neovascular glaucoma karena nekrotiktumor
•Endothel cornea berlebihan menutupmeshwork
4Ed hthliti&
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4. Endophthalmitis &Panophthalmitis
• Traumatic iridocyclitis
• Infeksi cornea
• Uveitis
• Anterior synechiae iris & trabc. m. Melekat krn
• Posterior synechiae iris & lensa exudate
fibrous metaplasiaanterior subcapsular
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%e!uelae of anterior segment inflammation.
This eye as remo)ed for complications of chronic corneal inflammation
(hich cannot "e discerned at this magnification*. The exudate (e* presentin the anterior cham"er ould ha)e "een )isuali3ed at the slit lamp as an
optical 4flare.4 The iris is adherent focally to the cornea, o"structing the
tra"ecular meshor$ (anterior synechia, arro*, and adheres to the lens
(posterior synechiae, arroheads*. An anterior su"capsular cataract (asc*
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5xogenous panophthalmitis.
Note the suppurati)e inflammation "ehind the lens and dran up to the right of
the lens to the cornea, the site of the ound. The central portion of the )itreous
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UVEA
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Terdiri dari
–Iris
–Ciliary bodies–Choroid
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1. Uveitis
•Adalah proses keradangan khronik darisalah satu atau keseluruhan Uvea
•Misal : juvenile rheumatic arthritis,
segmen anterior/posterior•Biasanya disertai keradangan retina
•Sebabnya :
–Infeksi bakteri ( pneumocystis carnii )–Idiopathic (sarcoidosis) : granulomatous uveitis
–Autoimune (sympathetic ophthalmia)
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•Granulomatous Uveitis
–Anterior segment : exudate mutton-fat
–Posterior segment : choroid dan retina
•Toxoplasma infeksi choroid & retina
•Cytomegalovirus retina
•Mycobacterium avium uvea
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•Sympathetic ophthalmia
–Bilateral granulomatous inflammation :seluruh uvea
–Pertama didapatkan pada : Louis Braille sel-sel eosinophil
–Terdapat Ag retina 2 minggu beberapa
tahun hypersensitivity delayed
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Sympathetic ophthalmia. The granulomatous inflammation depicted herewas identified diffusely throughout the uvea. The uveal granulomas maycontain melanin pigmentand may be accompanied by eosinophils.
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2. Neoplasma
Terbanyak metastase ke uvea (choroid)
Uveal nevi & Melanoma
•Melanoma uveal adalah tumor intraocular tersering pada dewasa
•Usia terutama dekade 7
•Nevus choroid sering terjadi, 10% pd Ca•Penyebaran melanoma hematogenous, keliver, 5 YSR 80%
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Figure 29-17 U)eal melanoma. A, Fundus photograph from a patient ith a relati)ely flat pigmented lesion of the choroid near the optic
disc. 8, Fundus photograph of the same patient se)eral years later the tumor has gron and has ruptured through 8ruch&s mem"rane.
, :ross photograph of a choroidal melanoma that has ruptured 8ruch&s mem"rane. The o)erlying retina is detached. ;, 5pithelioid
melanoma cells are associated ith an ad)erse outcome. 5, atterns rich in laminin (that are periodic acid-%chiff positi)e* surround
aggregates of melanoma cells these patterns form a 4fluid-conducting meshor$4 in u)eal melanoma and are associated ith an
ad)erse outcome. (A to from Fol"erg <6 athology of the eye-an interacti)e ;-<' program. hiladelphia, 'os"y, 199= 5 from
'aniotis A>, hen ?, :arcia , et al6 ontrol of melanoma morphogenesis, endothelial sur)i)al, and perfusion "y extracellular matrix.
+a" n)est @2(@*6101-1B0, 22.*Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 1 November 200 0):2" #$%
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U)eal melanoma. , :ross photograph of a choroidal melanoma
that has ruptured 8ruch&s mem"rane. The o)erlying retina isdetached. ;, 5pithelioid melanoma cells are associated ith an
ad)erse outcome.
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•Morfologi ada 2 jenis yaitu :
–Spindle sel fusiform, sedikit atypic
–Epitheloid sel spherical, sangat atypic →
prognosa buruk
•Dapat timbul :
–Retinal detachment
–Glaucoma
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RETINA & VITREOUS
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1. Anatomi Fungsional
•Tidak ada aliran limphetic
•Pigmen epitel retinal asal dari optic vesicle
•Retinal detachment lepasnya neurosensory
retina dg pigmen epitel retina• persistent hyperplastic primary vitreous regresifetal vascular tdk sempurna
•Asteroid hyalosis calcium soap dari debris
vitreus humor•Posterior vitreous detachment posterior facehumor lepas dari retina
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Figure 29-1= linicopathologic correlations of retinal hemorrhages and exudates. The location of the hemorrhage ithin the retina
determines its appearance "y ophthalmoscopy. The retinal ner)e fi"er layer is oriented parallel to the internal limiting mem"rane, and
hemorrhages of this layer appear to "e flame-shaped ophthalmoscopically. The deeper retinal layers are oriented perpendicular to the
internal limiting mem"rane and hemorrhages in this location appear as cross-sections of a cylinder or 4dot4 hemorrhages. 5xudates that
originate from lea$y retinal )essels accumulate in the outer plexiform layer.
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2. Retinal Detachment
•Lepasnya neurosensory retina dari pigmenepithelium
•Phlegmatogenous retinal detachment
seluruhnya lepas proliferatif vitreoretinopathy
•Surgical procedure retina pecah
•Non-rhegmatogenous retinal detachment
tanpa pecahnya retina -tumor
-hipertensi
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Figure 29-1C <etinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. <etinal detachments are classified "roadly
into non-rhegmatogenous (ithout a retinal "rea$* and rhegmatogenous (ith a retinal "rea$* types. Top, n non-rhegmatogenous retinal detachment, the su"retinal
space is filled ith protein-rich exudate. Note in this s$etch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a
finding that can "e seen in "oth non-rhegmatogenous and rhegmatogenous detachments. 'iddle, osterior )itreous detachment in)ol)es the separation of the posterior
hyaloid from the internal limiting mem"rane of the retina and is a normal occurrence in the aging eye. 8ottom, f, during a posterior )itreous detachment, the posterior
hyaloid does not separate cleanly from the internal limiting mem"rane of the retina, the )itreous humor ill exert traction on the retina hich ill "e torn at this point.
+i!uefied )itreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this s$etch that the photoreceptor outer
segments are intact, suggesting that an acute detachment is "eing illustrated.
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Figure 29-1C <etinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. <etinal detachments are classified "roadly
into non-rhegmatogenous (ithout a retinal "rea$* and rhegmatogenous (ith a retinal "rea$* types. Top, n non-rhegmatogenous retinal detachment, the su"retinal
space is filled ith protein-rich exudate. Note in this s$etch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a
finding that can "e seen in "oth non-rhegmatogenous and rhegmatogenous detachments. 'iddle, osterior )itreous detachment in)ol)es the separation of the posterior
hyaloid from the internal limiting mem"rane of the retina and is a normal occurrence in the aging eye. 8ottom, f, during a posterior )itreous detachment, the posterior
hyaloid does not separate cleanly from the internal limiting mem"rane of the retina, the )itreous humor ill exert traction on the retina hich ill "e torn at this point.
+i!uefied )itreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this s$etch that the photoreceptor outer
segments are intact, suggesting that an acute detachment is "eing illustrated.
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Figure 29-1C <etinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. <etinal detachments are classified "roadly
into non-rhegmatogenous (ithout a retinal "rea$* and rhegmatogenous (ith a retinal "rea$* types. Top, n non-rhegmatogenous retinal detachment, the su"retinal
space is filled ith protein-rich exudate. Note in this s$etch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a
finding that can "e seen in "oth non-rhegmatogenous and rhegmatogenous detachments. 'iddle, osterior )itreous detachment in)ol)es the separation of the posterior
hyaloid from the internal limiting mem"rane of the retina and is a normal occurrence in the aging eye. 8ottom, f, during a posterior )itreous detachment, the posterior
hyaloid does not separate cleanly from the internal limiting mem"rane of the retina, the )itreous humor ill exert traction on the retina hich ill "e torn at this point.
+i!uefied )itreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this s$etch that the photoreceptor outer
segments are intact, suggesting that an acute detachment is "eing illustrated.
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3. Retinal Vascular Disease
•Hypertension
–Arteriolosclerosis
arteriole & vena berjalan bersama, pd tempat
tertentu terdapat cross, pada arteriolosclerosis oclusi vena
–Hipertensi maligna saluran rusak
Elschnig's spots –Occlusion retinal arteriole cytoid bodies cotton wool spots
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The retina in hypertension. A,
The all of the retinal arteriole
(arro* is thic$. Note the
exudate (e* in the retinal outer
plexiform layer.
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Ner)e fi"er layer infarct.
The histology of a cotton-
ool spot-an infarct of the
ner)e fi"er layer of theretina-is illustrated in the
photomicrograph. A focal
swelling of the nerve fiber
layer is occupied by
numerous red to pinkcytoid bodies
(arrowheads), "ul"ous
ends of se)ered axons.
Hemorrhage (arrows)
surrounding the ner)e fi"er
layer infarct as illustrated
here is a )aria"le and
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•Diabetes Mellitus
–Penebalan basement membrane epitel parsplicata
–Microangiopathy retinal :a. Preproliferatifb. Proliferatif
a. Preproliferatif
-basement membrane menebal-pericyte berkurang
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The ciliary "ody in chronic
dia"etes mellitus, periodic acid-
%chiff stain. Note the massive
thickening of the basement
membrane of the ciliary body
epithelia, reminiscent of
changes in the mesangium of
the renal glomerulus.
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–Microaneurisma microhemorrhages macular edema gangguan visual
–VEGF, angiogenesis microangiopathy
neovascularization of the disc –Traction retinal detachment rhegmatogenousdetachment
–Neovascular iris neovascular membrane kontraksi adhesi iris dg trabecularmeshwork glaucoma
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The retina in dia"etes mellitus. A, Note the tangle of a"normal )essels #ust "eneath
the internal limiting mem"rane of the retina on the right half of the photomicrograph("eteen arros*. This is an example of intraretinal angiogenesis $non as
intraretinal microangiopathy (<'A*. Note the retinal hemorrhage in the outer
plexiform layer in the left half of this photomicrograph. phthalmoscopically, this
outer retinal layer hemorrhage ould appear as a 4dot4 hemorrhage
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•Retinopathy of prematurity–Genetik susceptible
–Bayi prematur
–VEGF retinal angiogenesis detachment
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• Sickle Retinopathy, Retinal Vasculitis,Radiation Retinopathy
a.Non proliferatif (intraretinal angiopathic
changes) b.Proliferatif (retinal neovascularization)
Vascular occlusion : karena -VEGF
-bFGF
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•Retinal Artery and Vein Occlusions –Atherosclerosis pd retina trombosis
–Emboli pd retinal karena trombi jantung
infark retina
cherry red spot
–Cherry red spot juga ada padaTay-Sachs andNiemann-Pick
–Dapat menyebabkan glaucoma sudut tertutup
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Figure 29-22 The cherry-red spot in Tay-%achs disease. A, Fundus photograph of the cherry-red spot in Tay-%achs disease. 8, hotomicrograph of the
macula in a patient ith Tay-%achs disease, stained ith periodic acid-%chiff to highlight the accumulation of ganglioside material in the retinal
ganglion cells. The presence of ganglion cells filled ith gangliosides outside the fo)ea "loc$s the transmission of the normal orange-red color of the
choroid, "ut a"sence of ganglion cells ithin the fo)ea (to the right of the )ertical "ar* permits the normal orange-red color to "e )isuali3ed, accounting
for the so-called cherry-red spot. (A courtesy of ;r. Thomas A. Deingeist, ;epartment of phthalmology Eisual %cience, Uni)ersity of oa, oa
ity, A 8 originates from the teaching collection of the Armed Forces nstitute of athology.*
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4. Age Related Macular Degeneration
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g g(ARMD)
•Faktor penting yaitu usia•Faktor penentu -rokok
-nutrisi
-vascular•Bruch's membrane
Choriocapillaris
•Ada 2 jenis :a.Atropic ARMD : -branch, membrane
-retinal pigmen epithel
b.Exudative ARMD
visual loss
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Figure 29-20 Age-related macular degeneration. A neo)ascular mem"rane is positioned "eteen the retinal pigment epithelium (<5*
and 8ruch&s mem"rane (8'*. Note the "lue discoloration of 8ruch&s mem"rane to the right of the la"el, indicating focal calcification.
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5Oth ti ld ti
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5. Other retinal degeneration
• Retinitis pigmentosa :– Inherited retinal dissorder x linkedrecessive, autosomal recessive / dominant
– Mutasi photoreceptor cell, epitel pigmenretina might blindness
6Rtiiti
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6. Retinitis
•Candida
•Cytomegalovirus
7N l
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7. Neoplasma
•Retinoblastoma–Dari retinal cell ( neuronal )
–Prognosis tergantung penyebaran o. nerve
choroidal
–40% diturunkan lewat germ line RB allele
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Morfologi :
–Sel bulat, kecil, hyperchromatic
–Flexner-Wintersteiner rosettes, fleurettes
–Tingkat deferensiasi tak sesuai prognosis–Therapychemotherapy
laser / cryopexy
–Mutasi ke otak, bone marrow, paru–Ada yang jinak retinocytoma
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Figure 29-2B <etino"lastoma. A, :ross photograph of retino"lastoma. 8,
Tumor cells appear )ia"le hen in proximity to "lood )essels, "ut necrosis
is seen as the distance from the )essel increases. ;ystrophic calcification
(dar$ arro* is present in the 3ones of tumor necrosis. Flexner-Dintersteiner rosettes-arrangements of a single layer of tumor cells around
an apparent 4lumen4-are seen throughout the tumor, and one such rosette
is indicated "y the hite arro.
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•Lymphoma–Systemic lymphoma ke uvea (iris, cilliary,choroid)
–Retinal lymphoma sel2 besar lymphoma spt pada otak
pd neurosensory retina dan retinal
pigmen epitel
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OPTIC NERVE
1. Anterior Ischemic Optic
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pNeuropathy (AION)
•Gangguan vascular
ischemia gangguan penglihatan
optic infarct
•Infeksi arteritis AION
•Emboli/trombosis nonarteritis AION
2Papilledema
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2. Papilledema
•Tekanan yg tekanan pd syaraf mata
tekanan pdcerebrospinal
•Tekanan intracranial
–Bilateral papilledema tak adahubungan dengan visual loss
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, Normally, the termination of 8ruch&s mem"rane (arrohead* is aligned ith
the "eginning of the neurosensory retina, as indicated "y the presence ofstratified nuclei (arro*, "ut in papilledema, the optic ner)e is sollen, and the
retina is displaced laterally. This is the histologic explanation for the "lurred
margins of the optic ner)e head seen clinically in this condition.
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3. Glaucomatous optic nerve
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pdamage
•Normal tension glaucoma ada mutasi padagene optineurin
•Morfologi
–Ganglion sel berkurang, lapisan serat syaraf tipis–N. opticus menjadi cupped & atrofi
–Glaucoma timbul bila ada atrofi disertai cupping
–Pada anak, intraocular pressure buphthlalmos,
megalocornea–Sclera tipis, staphyloma (elastic sclera)
–Edematous cornea, degeneratif pannus
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Figure 29-2= The retina and optic ner)e in glaucoma. A, The normal retina is illustrated in the left panel, and the retina in long-standing glaucoma is in
the right panel. 8oth pictures ere ta$en at the same magnification. Note that the full thic$ness of the glaucomatous retina is captured (right*, hereas
only a portion of the normal retina (left* can "e seen-a reflection of the thinning of the retina in glaucoma. n the glaucomatous retina, the areas
corresponding to the ner)e fi"er layer (NF+* and ganglion cell layer (:* are atrophic the inner plexiform layer (+* is la"eled for a point of reference.
8, :laucomatous optic ner)e cupping results, in part, from loss of retinal ganglion cells, the axons of hich populate the optic ner)e. , The arros
point to the dura of the optic ner)e. Notice the ide su"dural space, a result of atrophy of the su"stance of the optic ner)e. The degree of cupping on
the surface of the ner)e is stri$ing in this eye, hich as remo)ed "ecause of complications of long-standing glaucoma.
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Figure 29-2= The retina and optic ner)e in glaucoma. A, The normal retina is illustrated in the left panel, and the retina in long-standing glaucoma is in
the right panel. 8oth pictures ere ta$en at the same magnification. Note that the full thic$ness of the glaucomatous retina is captured (right*, hereas
only a portion of the normal retina (left* can "e seen-a reflection of the thinning of the retina in glaucoma. n the glaucomatous retina, the areas
corresponding to the ner)e fi"er layer (NF+* and ganglion cell layer (:* are atrophic the inner plexiform layer (+* is la"eled for a point of reference.
8, :laucomatous optic ner)e cupping results, in part, from loss of retinal ganglion cells, the axons of hich populate the optic ner)e. , The arros
point to the dura of the optic ner)e. Notice the ide su"dural space, a result of atrophy of the su"stance of the optic ner)e. The degree of cupping on
the surface of the ner)e is stri$ing in this eye, hich as remo)ed "ecause of complications of long-standing glaucoma.
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4OpticNeuropathylain
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4. Optic Neuropathy lain
•Inherited : Leber hereditary opticneuropathy
•Sekunder :
–Defisiensi mutational : tobacco – alcoholamblyopia
–Toxin : methanol
5OpticNeuritis
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5. Optic Neuritis
•Yaitu demyelinization nerve opticus
•Sebab utama : multiple sclerosis
•Dengan pengobatan bisa sembuh
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Phthisis bulbi
•Trauma
•Radang intra ocular atrophic phthisis
•Retinal detachment bulbi
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hthisis "ul"i. The eye is small and internally disorgani3ed. Thetension exerted on this hypotonic eye "y the extraocular muscles
contri"utes to a s!uare rather than round shape. Note the atrophic
optic ner)e and the presence of intraocular "one posteriorly and
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Morfologi :•Exudate -ciliochoroidal effusion
•Darah -cyclitic membrane
-retinal detachment-optic atrofi
-intraocular bone metaplasia
osseous dari epitel pigmenretina
-sclera tebal
TERIMAKASIH
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TERIMA KASIH
•SELAMAT BELAJAR
•SEMOGA LULUS UJIAN