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Pg1}{\bkmkend Pg1}\par\pard\ql \li6410\sb0\sl-241\slmult0 \par\pard\ql\li6410\sb0\sl-241\slmult0 \par\pard\ql\li6410\sb178\sl-241\slmult0 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf2\f3\fs21 Sari Pediatri, Vol. 5, No. 4, Maret 2004: 160 - 164 \par\pard\ql \li1139\sb448\sl-448\slmult0 \up0 \expndtw0\charscalex101 \ul0\nosupersub\cf3\f4\fs38 Konjungtivitis Vernalis \par\pard\ql \li1133\sb0\sl-276\slmult0 \par\pard\ql\li1133\sb139\sl-276\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf4\f5\fs24 Siti Budiati Widyastuti, Sjawitri P. Siregar \par\pard\qj \li1981\sb0\sl-256\slmult0 \par\pard\qj\li1981\sb0\sl-256\slmult0 \par\pard\qj\li1981\ri2061\sb189\sl-256\slmult0 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf5\f6\fs22 Konjungtivitis vernalis (KV) merupakan inflamasi konjungtiva yang bersifat bilateral \up0 \expndtw0\charscalex110 dan rekuren. Kelainan ini ditandai oleh papil cobblestone pada konjungtiva tarsal \up0 \expndtw0\charscalex107 dan hipertrofi papil pada konjungtiva limbus.\ul0\super\cf6\f7\fs20\ul0\super\cf6\f7\fs19 1-5 \ul0\nosupersub\cf5\f6\fs22 Insidens penyakit ini berkisar antara \up0 \expndtw0\charscalex115 0,1-0,5% diantara penyakit mata lainnya dan meningkat terutama pada musim \up0 \expndtw0\charscalex111 kemarau. Penyakit ini umumnya terjadi pada anak berusia antara 3-25 tahun, dan \up0 \expndtw0\charscalex109 lebih sering pada laki-laki.\ul0\super\cf6\f7\fs20\ul0\super\cf6\f7\fs19 1- 5 \par\pard\qj \li1981\ri2068\sb0\sl-260\slmult0\fi0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf5\f6\fs22 Lebih dari sembilan puluh persen pasien KV memiliki riwayat atopi pada dirinya \line \up0 \expndtw0\charscalex107 maupun anggota keluarganya. Patogenesis dan etiologi penyakit ini belum diketahui \line \up0 \expndtw0\charscalex107 dengan pasti. Beberapa peneliti menghubungkan dengan reaksi hipersensitivitas tipe \line \up0 \expndtw0\charscalex108 I dan IV.\ul0\super\cf6\f7\fs20\ul0\super\cf6\f7\fs19 2,4,6-8\ul0\nosupersub\cf5\f6\fs22 Tata laksana adekuat untuk mencegah terjadinya kekambuhan sampai \line \up0 \expndtw0\charscalex108 saat ini belum memberikan hasil yang memuaskan.\ul0\super\cf6\f7\fs20\ul0\super\cf6\f7\fs19 1,6,8-10 \ul0\nosupersub\cf5\f6\fs22 Namun umumnya setelah \par\pard\ql \li1981\sb1\sl-212\slmult0 \up0 \expndtw0\charscalex109 2 sampai 10 tahun akan terlihat resolusi gejala secara spontan.\ul0\super\cf6\f7\fs20\ul0\super\cf6\f7\fs19 4,6,8 \par\pard\qj \li1981\ri2063\sb9\sl-260\slmult0 \up0 \expndtw0\charscalex108 \ul0\nosupersub\cf5\f6\fs22 Tujuan laporan kasus ini untuk membahas diagnosis dan tata laksana konjungtivitis \up0 \expndtw0\charscalex108 vernalis. \par\pard\ql \li1981\sb257\sl-264\slmult0 \up0 \expndtw0\charscalex100 Kata kunci: cobblestone dan hipertrofi konjungtiva, atopi\par\pard\sect\sectd\sbknone\cols3\colno1\colw1807\colsr60\colno2\colw4165\colsr160\colno3\colw5858\colsr160\li1126\sb0\sl-108\slmult0\ql \par\pard\li1126\sb0\sl-108\slmult0\ql \par\pard\li1126\sb0\sl-108\slmult0\ql \par\pard\li1126\sb0\sl-108\slmult0\ql \par\pard\li1126\sb0\sl-108\slmult0\ql {\shp {\*\shpinst\shpleft1078\shptop8011\shpright1961\shpbottom9019\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz10001\shplid10001{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 0}}{\shptxt\pard\plain \qj\sl1046 \li0\ri0 \expndtw0\charscalex98\ul0\nosupersub\cf11\f12\fs90 S{\par}}}}\par\pard\column \qj \li1126\sb0\sl-255\slmult0 \par\pard\qj \li1126\sb0\sl-255\slmult0 \par\pard\qj \li20\ri229\sb181\sl-255\slmult0\fi6 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf9\f10\fs22 eorang anak laki-laki berusia 4 tahun datang \line \up0 \expndtw0\charscalex101 pertama kali ke poliklinik Alergi-Imunologi \line \up0 \expndtw0\charscalex104 Departemen Ilmu Kesehatan Anak (IKA)\par\pard\column \qj \li1126\sb0\sl-255\slmult0 \par\pard\qj \li1126\sb0\sl-255\slmult0 \par\pard\qj \li20\ri1187\sb183\sl-255\slmult0 \up0 \expndtw0\charscalex102 matahari. Gangguan penglihatan disangkal oleh ibu \line \up0 \expndtw-2\charscalex100 pasien. Kemudian pasien berobat ke dokter mata dan \line \up0 \expndtw-4\charscalex100 mendapat obat Fluorometolon + neomisin, tetes mata\par\pard\sect\sectd\sbknone\cols2\colno1\colw6022\colsr160\colno2\colw5858\colsr160\qj \li1126\ri229\sb0\sl-255\slmult0 \up0 \expndtw0\charscalex106 FKUI/RSUPNCM pada tanggal 2 Agustus 2003; \line \up0 \expndtw0\charscalex111 dirujuk dari Bagian Ilmu Penyakit Mata dengan \line \up0 \expndtw-1\charscalex100 diagnosis konjungtivitis vernalis, kemungkinan alergi \line \up0 \expndtw-1\charscalex100 sebagai penyebab. Berdasarkan aloanamnesis dengan \line \up0 \expndtw0\charscalex103 ibu pasien diketahui bahwa sejak 1 tahun yang lalu, \line \up0 \expndtw0\charscalex108 pasien sering mengeluh kedua matanya gatal dan \line \up0 \expndtw-3\charscalex100 terlihat merah. Saat pagi hari terdapat banyak kotoran \line \up0 \expndtw0\charscalex100 mata yang kental dan lengket. Kedua matanya terasa \line \up0 \expndtw-2\charscalex100 sangat gatal sehingga pasien sering menggosok-gosok \line \up0 \expndtw0\charscalex101 matanya, akibatnya mata semakin berair dan merah. \line \up0 \expndtw0\charscalex102 Hal ini bertambah berat saat pasien pulang sekolah \line \up0 \expndtw0\charscalex106 atau setelah bermain di luar rumah di bawah terik\par\pard\ql \li1126\sb0\sl-207\slmult0 \par\pard\ql \li1126\sb0\sl-207\slmult0 \par\pard\ql \li1126\sb100\sl-207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf7\f8\fs18 Alamat korespondensi:\par\pard\ql \li1126\sb23\sl-184\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf8\f9\fs16 Dr Sjawitri P. Siregar, Sp.A(K).\par\pard\qj \li1126\ri256\sb5\sl-209\slmult0 \up0 \expndtw-5\charscalex100 Divisi Alergi Imunologi. Departemen Ilmu Kesehatan Anak FKUI-RSCM. Jl. \up0 \expndtw-4\charscalex100 Salemba no. 6, Jakarta 10430.\par\pard\ql \li1126\sb23\sl-184\slmult0 \up0 \expndtw-4\charscalex100 Telepon: 021- 3161144 Fax.021-3913982.\par\pard\ql \li1126\sb0\sl-184\slmult0 \par\pard\ql \li1126\sb98\sl-184\slmult0 \up0 \expndtw0\charscalex100 Dr. Siti Budiati Widyastuti. PPDS Dep. Ilmu Kesehatan Anak FKUI\par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb59\sl-253\slmult0 \up0 \expndtw0\charscalex110 \ul0\nosupersub\cf1\f2\fs22 160\par\pard\column \qj \li20\ri1187\sb0\sl-256\slmult0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf9\f10\fs22 vitamin A, lodaxamide. Keluhan tersebut berkurang \up0 \expndtw0\charscalex108 untuk sementara, namun timbul kembali. Pasien \up0 \expndtw0\charscalex103 merupakan anak kedua dari tiga bersaudara. Gejala \up0 \expndtw0\charscalex117 atopi pada pasien adalah rinitis alergi, paman \up0 \expndtw0\charscalex106 menderita asma, dan kakak pasien alergi terhadap \up0 \expndtw0\charscalex100 obat kotrimoksasol.\par\pard\qj \li20\ri1187\sb0\sl-256\slmult0\fi422 \up0 \expndtw0\charscalex103 Pemeriksaan fisis saat masuk didapatkan anak \line \up0 \expndtw0\charscalex102 sadar, tidak sesak, tidak sianosis. Berat badan 18 kg \line \up0 \expndtw-3\charscalex100 (P\ul0\sub\cf10\f11\fs19 75-90 \ul0\nosupersub\cf9\f10\fs22 NCHS) dan tinggi badan 102 cm (P\ul0\sub\cf10\f11\fs19 25-50\ul0\nosupersub\cf9\f10\fs22 NCHS). \line \up0 \expndtw-2\charscalex100 Laju denyut nadi sama dengan laju denyut jantung 84 \line \up0 \expndtw0\charscalex103 x/menit, teratur, isi cukup. Laju napas 24 x/menit, \line \up0 \expndtw-1\charscalex100 teratur, suhu aksila 37,2\ul0\super\cf10\f11\fs20\ul0\super\cf10\f11\fs19 o\ul0\nosupersub\cf9\f10\fs22 C. Pada mata kanan dan kiri \line \up0 \expndtw0\charscalex110 tampak konjungtiva tarsalis superior hiperemis, \line \up0 \expndtw0\charscalex102 terdapat hipertropi papil, dan bintik-bintik epitelial, \line \up0 \expndtw-4\charscalex100 tidak terdapat injeksi konjungtiva, ulkus maupun papil \line \up0 \expndtw-3\charscalex100 pada limbus. Pada mata kiri terlihat sikatriks di tengah \line \up0 \expndtw0\charscalex102 kornea. Sklera tidak ikterik, dan pemeriksaan visus \line \up0 \expndtw-4\charscalex100 kedua mata 6/20. Tonsil dan faring tidak ada kelainan. \line \up0 \expndtw0\charscalex104 Pada paru, jantung dan abdomen tidak ditemukan \line \up0 \expndtw0\charscalex101 kelainan. \par\pard\sect\sectd\fs24\paperw12180\paperh15860\pard\sb0\sl-240{\bkmkstart Pg2}{\bkmkend Pg2}\par\pard\ql \li1405\sb0\sl-241\slmult0 \par\pard\ql\li1405\sb0\sl-241\slmult0 \par\pard\ql\li1405\sb178\sl-241\slmult0 \up0 \expndtw0\charscalex104 \ul0\nosupersub\cf2\f3\fs21 Sari Pediatri, Vol. 5, No. 4, Maret 2004\par\pard\sect\sectd\sbknone\cols2\colno1\colw6302\colsr160\colno2\colw5578\colsr160\qj \li1416\sb0\sl-256\slmult0 \par\pard\qj \li1416\ri221\sb248\sl-256\slmult0\fi340 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf12\f13\fs22 Pemeriksaan laboratorium menunjukkan kadar \line \up0 \expndtw0\charscalex101 hemoglobin 11,6 g/dL, leukosit 9.400/mL, eritrosit \line \up0 \expndtw0\charscalex110 4,37 juta/mL, hematokrit 34,2 vol%, trombosit \line \up0 \expndtw0\charscalex101 310.000/mL, hitung jenis: basofil 0%, eosinofil 4%, \line \up0 \expndtw-1\charscalex100 batang 0%, segmen 73%, limfosit 21%, monosit 2%. \line \up0 \expndtw-1\charscalex100 Laju endap darah 12 mm/jam. Pemeriksaan urin dan \line \up0 \expndtw-1\charscalex100 tinja dalam batas normal. Kadar IgE serum 98,2 IU/ \line \up0 \expndtw-6\charscalex100 uL (N serum < 60 IU/uL), kadar IgG serum 2500 mg/ \line \up0 \expndtw0\charscalex106 dL (N 1433-2150 mg/dL), eosinofil total 423/\ul0\nosupersub\cf13\f14\fs22 \ul0\nosupersub\cf12\f13\fs22 l\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 3 \line \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf12\f13\fs22 (N 2 sel eosinofil dengan \line \up0 \expndtw0\charscalex101 pembesaran lensa objektif 40x.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 9,11 \ul0\nosupersub\cf12\f13\fs22 Gambaran histo-\line \up0 \expndtw-1\charscalex100 patologik jaringan konjungtiva pada KV dijumpai sel \line \up0 \expndtw-5\charscalex100 eosinofil, sel mast dan sel basofil. Selain itu juga terjadi \line \up0 \expndtw0\charscalex100 perubahan pada mikrovaskular dari sel endotel serta \line \up0 \expndtw0\charscalex101 ditemukannya deposit jaringan fibrosis, infiltrasi sel \line \up0 \expndtw-5\charscalex100 limfosit dan netrofil.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 4,6\par\pard\ql \li1473\sb4\sl-253\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf12\f13\fs22 Diagnosis ditegakkan berdasarkan gambaran klinis,\par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb202\sl-253\slmult0 \up0 \expndtw0\charscalex110 \ul0\nosupersub\cf1\f2\fs22 162\par\pard\column \qj \li6179\sb0\sl-255\slmult0 \par\pard\qj \li20\ri1190\sb230\sl-255\slmult0\fi0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf12\f13\fs22 adanya riwayat atopi, dan pemeriksaan penunjang.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 2,9 \up0 \expndtw-9\charscalex100 \ul0\nosupersub\cf12\f13\fs22 Hasil uji kulit umumnya positif terhadap alergen tertentu, \up0 \expndtw-9\charscalex100 terutama serbuk bunga, debu rumah, tungau debu rumah; \up0 \expndtw-6\charscalex100 namun kadang-kadang uji kulit dapat memberikan hasil \up0 \expndtw-5\charscalex100 yang negatif.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 8-10\par\pard\qj \li20\ri1189\sb2\sl-255\slmult0\fi340 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf12\f13\fs22 Pada kasus ini terdapat keluhan mata merah, gatal, \line \up0 \expndtw-3\charscalex100 berair, mengeluarkan sekret, dan riwayat atopi berupa \line \up0 \expndtw0\charscalex115 rinitis alergi. Ditemukannya papil \ul0\nosupersub\cf15\f16\fs22 cobblestone\ul0\nosupersub\cf12\f13\fs22 di \line \up0 \expndtw-9\charscalex100 konjungtiva tarsalis superior dan terdapatnya peningkatan \line \up0 \expndtw-2\charscalex100 jumlah eosinofil pada \ul0\nosupersub\cf15\f16\fs22 scraping \ul0\nosupersub\cf12\f13\fs22 konjungtiva merupakan \line \up0 \expndtw0\charscalex105 tanda patognomonik KV. Hasil laboratorium me-\line \up0 \expndtw-10\charscalex97 nunjukkan peningkatan hitung eosinofil total > 300/mm\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 3\ul0\nosupersub\cf12\f13\fs22 . \line \up0 \expndtw-3\charscalex100 Hal ini menunjukkan bahwa pasien mempunyai atopi. \line \up0 \expndtw-10\charscalex97 Pada pasien ini hasil uji kulit positif terhadap debu rumah, \line \up0 \expndtw-1\charscalex100 tungau debu rumah, udang dan kapuk. Hasil uji kulit \line \up0 \expndtw0\charscalex101 positif menunjukkan bahwa pasien telah mengalami \line \up0 \expndtw-8\charscalex100 sensitisasi dengan alergen tersebut, maka perlu dilakukan \line \up0 \expndtw-4\charscalex100 pemeriksaan IgE spesifik untuk memastikan penyebab \line \up0 \expndtw-3\charscalex100 KVnya. Pada kasus ini direncanakan pemeriksaan IgE \line \up0 \expndtw-4\charscalex100 spesifik terhadap debu rumah dan tungau debu rumah \line \up0 \expndtw-8\charscalex100 karena merupakan penyebab tersering. Hasil IgE spesifik \line \up0 \expndtw0\charscalex102 serum terhadap tungau debu rumah pada pasien ini \line \up0 \expndtw0\charscalex104 meningkat. Hal ini menunjukkan bahwa salah satu \line \up0 \expndtw-9\charscalex100 penyebab KV pada pasien ini adalah tungau debu rumah, \line \up0 \expndtw-2\charscalex100 namun tidak dapat disingkirkan penyebab lain berupa \line \up0 \expndtw-7\charscalex100 debu rumah (karena tidak diperiksa) dan faktor fisik lain \line \up0 \expndtw-3\charscalex100 yaitu panas sinar matahari, angin.\par\pard\qj \li20\ri1189\sb2\sl-256\slmult0\fi376 \up0 \expndtw-9\charscalex100 Diagnosis banding KV adalah konjungtivitis alergika \line \up0 \expndtw-5\charscalex100 musiman, keratokonjungtivitis atopik, dan \ul0\nosupersub\cf15\f16\fs22 giant papillary \line \up0 \expndtw0\charscalex105 conjungtivitis\ul0\nosupersub\cf12\f13\fs22 .\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 4,6\ul0\nosupersub\cf12\f13\fs22 Pada konjungtivitis alergi musiman, \line \up0 \expndtw-6\charscalex100 bersifat akut, mereda saat musim dingin, terdapat edem \line \up0 \expndtw-8\charscalex100 konjungtiva, jarang disertai perubahan pada kornea. Pada \line \up0 \expndtw-8\charscalex100 keratokonjungtivitis atopik tidak ada perbedaan usia atau \line \up0 \expndtw-4\charscalex100 jenis kelamin, adanya sekret yang jernih, letak kelainan \line \up0 \expndtw-7\charscalex100 lebih sering di palpebra inferior, tidak terdapat eosinofil \line \up0 \expndtw0\charscalex119 pada \ul0\nosupersub\cf15\f16\fs22 scraping \ul0\nosupersub\cf12\f13\fs22 konjungtiva, Pada \ul0\nosupersub\cf15\f16\fs22 giant papillary \line \up0 \expndtw-5\charscalex100 conjunctivitis \ul0\nosupersub\cf12\f13\fs22 kelainan juga terdapat di konjungtiva tarsal \line \up0 \expndtw-10\charscalex97 superior namun dengan ukuran diameter papila yang lebih \line \up0 \expndtw-1\charscalex100 dari 0,3 mm, penyebab tersering iritasi mekanik yang \line \up0 \expndtw-5\charscalex100 lama terutama karena penggunaan lensa kontak.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 4,6\par\pard\ql \li360\sb2\sl-253\slmult0 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf12\f13\fs22 Pada umumnya KV dapat sembuh sendiri setelah 2\par\pard\qj \li20\ri1190\sb3\sl-255\slmult0 \up0 \expndtw0\charscalex109 - 10 tahun.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 6 \ul0\nosupersub\cf12\f13\fs22 Tujuan pengobatan pada KV untuk \up0 \expndtw-4\charscalex100 menghilangkan gejala dan menghindari efek iatrogenik \up0 \expndtw-1\charscalex100 yang serius dari obat yang diberikan (kortikosteroid). \up0 \expndtw-2\charscalex100 Prinsip pengobatan bersifat konservatif. Tata laksana \up0 \expndtw-4\charscalex100 konjungtivitis vernalis berdasarkan beratnya gejala dan \up0 \expndtw-4\charscalex100 tanda penyakit, yaitu\par\pard\qj \li20\ri1191\sb1\sl-256\slmult0\tx398 \up0 \expndtw-6\charscalex100 1. Terapi utama :\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 \ul0\nosupersub\cf12\f13\fs22 berupa penghindaran terhadap semua \line\tab \up0 \expndtw-5\charscalex100 kemungkinan alergen penyebab.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 5,6 \par\pard\sect\sectd\fs24\paperw12180\paperh15860\pard\sb0\sl-240{\bkmkstart Pg4}{\bkmkend Pg4}\par\pard\ql \li1405\sb0\sl-241\slmult0 \par\pard\ql\li1405\sb0\sl-241\slmult0 \par\pard\ql\li1405\sb178\sl-241\slmult0 \up0 \expndtw0\charscalex104 \ul0\nosupersub\cf2\f3\fs21 Sari Pediatri, Vol. 5, No. 4, Maret 2004\par\pard\sect\sectd\sbknone\cols2\colno1\colw6308\colsr160\colno2\colw5572\colsr160\ql \li1422\sb0\sl-253\slmult0 \par\pard\ql \li1422\sb253\sl-253\slmult0\tx1785 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf12\f13\fs22 2.\tab \up0 \expndtw-2\charscalex100 Terapi topikal\par\pard\qj \li1790\ri225\sb2\sl-256\slmult0\fi1 \up0 \expndtw-9\charscalex100 Pemberian vasokonstriktor topikal dapat mengurangi \line \up0 \expndtw0\charscalex103 gejala kemerahan dan edem pada konjungtiva. \line \up0 \expndtw-8\charscalex100 Namun pada beberapa hasil penelitian menunjukkan \line \up0 \expndtw-7\charscalex100 bahwa penggunaan kombinasi obat vasokonstriktor \line \up0 \expndtw-3\charscalex100 dan antihistamin topikal (vasocon A) mempunyai \line \up0 \expndtw-3\charscalex100 efek yang lebih efektif dibanding pemberian yang \line \up0 \expndtw0\charscalex100 terpisah.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 5,6,8 \ul0\nosupersub\cf12\f13\fs22 Pemberian stabilisator sel mast yaitu \line \up0 \expndtw-7\charscalex100 natrium kromoglikat 2% atau sodium kromolyn 4% \line \up0 \expndtw0\charscalex105 atau iodoksamid trometamin dapat mencegah \line \up0 \expndtw0\charscalex107 degranulasi dan lepasnya substansi vasoaktif, \line \up0 \expndtw0\charscalex110 sehingga dapat mengurangi kebutuhan akan \line \up0 \expndtw-4\charscalex100 kortikosteroid topikal.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 3,5,6,15 \ul0\nosupersub\cf12\f13\fs22 Pemakaian iodoksamid \line \up0 \expndtw0\charscalex113 dikatakan mempunyai efek yang lebih baik \line \up0 \expndtw0\charscalex103 dibandingkan dengan natrium kromoglikat 2% \line \up0 \expndtw-5\charscalex100 maupun sodium kromolyn 4%.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 6\par\pard\qj \li1791\ri224\sb0\sl-255\slmult0\fi0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf12\f13\fs22 Pemberian obat antiinflamasi non-steroid topikal \line \up0 \expndtw0\charscalex110 seperti diklofenak, suprofen, flubirofen dan \line \up0 \expndtw0\charscalex101 ketorolak dapat menghambat kerja enzim siklo-\line \up0 \expndtw-1\charscalex100 oksigenase, namun saat ini hanya ketorolak yang \line \up0 \expndtw-3\charscalex100 mendapat rekomendasi dari \ul0\nosupersub\cf15\f16\fs22 Food Drug Administra-\line \up0 \expndtw-4\charscalex100 tion\ul0\nosupersub\cf12\f13\fs22 .\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 6\ul0\nosupersub\cf15\f16\fs22 \ul0\nosupersub\cf12\f13\fs22 Bila obat-obatan topikal seperti antihistamin, \line \up0 \expndtw-10\charscalex97 vasokonstriktor, atau sodium kromolyn tidak adekuat \line \up0 \expndtw-2\charscalex100 maka dapat dipertimbangkan pemberian kortiko-\line \up0 \expndtw0\charscalex104 steroid topikal. Allansmith melaporkan bahwa \line \up0 \expndtw-7\charscalex100 pemberian terapi \u8220?pulse\u8221? dengan deksametason 1% \line \up0 \expndtw-7\charscalex100 topikal, diberikan tiap 2 jam, 8 kali sehari kemudian \line \up0 \expndtw-6\charscalex100 diturunkan secara bertahap selama 1 minggu, dapat \line \up0 \expndtw-9\charscalex100 mengobati inflamasi pada KV, tetapi bila tidak dalam \line \up0 \expndtw0\charscalex105 serangan akut pemberian steroid topikal tidak \line \up0 \expndtw-5\charscalex100 diperbolehkan.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 1 \ul0\nosupersub\cf12\f13\fs22 Saat ini preparat steroid digunakan \line \up0 \expndtw-6\charscalex100 dengan cara injeksi supratarsal pada kasus KV yang \line \up0 \expndtw-2\charscalex100 refrakter.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 5,6 \ul0\nosupersub\cf12\f13\fs22 Siklosporin bekerja menghambat aksi \line \up0 \expndtw-5\charscalex100 interleukin 2 pada limfosit T dan menekan efek sel \line \up0 \expndtw-6\charscalex100 T dan eosinofil, terbukti bermanfaat menurunkan \line \up0 \expndtw-9\charscalex100 gejala dan tanda KV.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 5,6,8\ul0\nosupersub\cf12\f13\fs22 Terapi untuk kasus berulang \line \up0 \expndtw-9\charscalex100 yang tidak dapat diobati dengan natrium kromoglikat \line \up0 \expndtw-3\charscalex100 atau steroid, diberikan siklosporin topikal 2% dan \line \up0 \expndtw-3\charscalex100 mitomisin-C topikal 0,01%.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 3,6-8\par\pard\ql \li1422\sb0\sl-253\slmult0 \par\pard\ql \li1422\sb6\sl-253\slmult0\tx1786 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf12\f13\fs22 3\tab \up0 \expndtw-5\charscalex100 Terapi sistemik\par\pard\qj \li1790\ri225\sb1\sl-256\slmult0\fi1 \up0 \expndtw0\charscalex104 Pengobatan dengan antihistamin sistemik ber-\line \up0 \expndtw-3\charscalex100 manfaat untuk menambah efektivitas pengobatan \line \up0 \expndtw0\charscalex111 topikal. Pemberian aspirin dan indometasin \line \up0 \expndtw-3\charscalex100 (golongan antiinflamasi non-steroid) yang bekerja \line \up0 \expndtw0\charscalex112 sebagai penghambat enzim siklooksigenase \line \up0 \expndtw-6\charscalex100 dilaporkan dapat mengurangi gejala KV.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 5,6 \ul0\nosupersub\cf12\f13\fs22 Kortiko-\line \up0 \expndtw-4\charscalex100 steroid sistemik diberikan bila ada indikasi khusus \line \up0 \expndtw-5\charscalex100 yaitu inflamasi berat pada kornea dan konjungtiva,\par\pard\column \qj \li6468\sb0\sl-256\slmult0 \par\pard\qj \li388\ri901\sb247\sl-256\slmult0 \up0 \expndtw0\charscalex101 bertujuan untuk mencegah kerusakan jaringan.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 6 \up0 \expndtw-9\charscalex100 \ul0\nosupersub\cf12\f13\fs22 Pemberian montelukas dilaporkan dapat mengurangi \up0 \expndtw-1\charscalex100 gejala pada pasien KV yang juga menderita asma \up0 \expndtw-3\charscalex100 atau pada pasien yang mempunyai risiko terhadap \up0 \expndtw0\charscalex114 terapi steroid. Namun hal ini masih dalam \up0 \expndtw-1\charscalex100 perdebatan.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 10 \ul0\nosupersub\cf12\f13\fs22 Efektivitas pemberian imunoterapi \up0 \expndtw-8\charscalex100 sebagai terapi alergi pada mata sampai saat ini belum \up0 \expndtw-5\charscalex100 memberikan hasil yang memuaskan.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 6\par\pard\ql \li6468\sb0\sl-253\slmult0 \par\pard\ql \li20\sb6\sl-253\slmult0\tx394 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf12\f13\fs22 4.\tab \up0 \expndtw-6\charscalex100 Terapi suportif \ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 5,6\par\pard\ql \li20\sb4\sl-253\slmult0\tx394 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf12\f13\fs22 -\tab \up0 \expndtw-5\charscalex100 Desensitisasi dengan alergen inhalan.\par\pard\ql \li20\sb2\sl-253\slmult0\tx394 \up0 \expndtw-3\charscalex100 -\tab \up0 \expndtw0\charscalex104 Kompres dingin pada mata dan menggunakan\par\pard\ql \li388\sb4\sl-253\slmult0 \up0 \expndtw-3\charscalex100 kacamata hitam.\par\pard\ql \li20\sb3\sl-253\slmult0\tx394 \up0 \expndtw-3\charscalex100 -\tab \up0 \expndtw-3\charscalex100 Tetes mata artifisial dapat melarutkan alergen dan\par\pard\ql \li388\sb2\sl-253\slmult0 \up0 \expndtw-5\charscalex100 berguna untuk mencuci mata\par\pard\ql \li20\sb4\sl-253\slmult0\tx394 \up0 \expndtw-3\charscalex100 -\tab \up0 \expndtw-8\charscalex100 Klimatoterapi seperti pendingin udara di rumah atau\par\pard\ql \li388\sb2\sl-253\slmult0 \up0 \expndtw-5\charscalex100 pindah ke tempat berhawa dingin.\par\pard\ql \li6468\sb0\sl-253\slmult0 \par\pard\ql \li20\sb6\sl-253\slmult0\tx394 \up0 \expndtw0\charscalex105 5.\tab \up0 \expndtw-7\charscalex100 Terapi bedah\par\pard\qj \li388\ri901\sb2\sl-256\slmult0\fi0 \up0 \expndtw-4\charscalex100 Terapi bedah yang dapat dilakukan adalah otograf \up0 \expndtw0\charscalex103 konjungtiva dan krio terapi, namun kelemahan \up0 \expndtw0\charscalex103 kedua terapi ini dapat menyebabkan terjadinya \up0 \expndtw0\charscalex119 sikatriks, trikiasis, defisiensi air mata dan \up0 \expndtw-8\charscalex100 entropion.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 6,10 \ul0\nosupersub\cf12\f13\fs22 Keratotomi superfisial dapat dilakukan \up0 \expndtw-4\charscalex100 untuk reepitelisasi kornea.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 6\par\pard\qj \li388\ri901\sb0\sl-255\slmult0\fi0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf12\f13\fs22 Tata laksana yang diberikan pada pasien ini adalah \line \up0 \expndtw-1\charscalex100 menghindari penyebab dengan cara mengurangi \line \up0 \expndtw0\charscalex115 frekuensi bermain di luar rumah, menjaga \line \up0 \expndtw-3\charscalex100 kebersihan lingkungan, memakai kacamata hitam, \line \up0 \expndtw-8\charscalex100 diberikan kortikosteroid topikal, stabilisator sel mast \line \up0 \expndtw-1\charscalex100 (iodoksamid) topikal, dan terapi sistemik berupa \line \up0 \expndtw0\charscalex100 antihistamin, dan kortikosteroid. Kortikosteroid \line \up0 \expndtw-7\charscalex100 topikal dan sistemik diberikan karena saat ini pasien \line \up0 \expndtw-2\charscalex100 termasuk dalam derajat penyakit sedang ke berat. \line \up0 \expndtw0\charscalex100 Penggunaan stabilisator sel mast perlu diberikan \line \up0 \expndtw-5\charscalex100 dalam jangka panjang (4-6 bulan) untuk mencegah \line \up0 \expndtw-5\charscalex100 kekambuhan.\par\pard\qj \li388\ri900\sb2\sl-255\slmult0\fi0 \up0 \expndtw0\charscalex101 Komplikasi yang timbul dapat diakibatkan oleh \line \up0 \expndtw-1\charscalex100 perjalanan penyakitnya atau efek samping peng-\line \up0 \expndtw-6\charscalex100 obatan yang diberikan. Bila proses penyakit meluas \line \up0 \expndtw-7\charscalex100 ke kornea, dapat terjadi parut kornea, astigmatisme, \line \up0 \expndtw0\charscalex111 keratokonus, dan kebutaan.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 4,16 \ul0\nosupersub\cf12\f13\fs22 Penggunaan \line \up0 \expndtw-5\charscalex100 kortikosteroid jangka panjang dapat menyebabkan \line \up0 \expndtw-4\charscalex100 glaukoma, katarak dan infeksi bakteri sekunder.\ul0\super\cf14\f15\fs20\ul0\super\cf14\f15\fs19 3 \line \up0 \expndtw-8\charscalex100 \ul0\nosupersub\cf12\f13\fs22 Komplikasi yang terjadi pada pasien ini yaitu adanya \line \up0 \expndtw0\charscalex103 bintik-bintik epitelial di kornea dan sikatriks di \line \up0 \expndtw0\charscalex100 tengah kornea mata kiri yang disebabkan karena \line \up0 \expndtw0\charscalex105 pasien sering menggosok-gosok matanya. Hal \line \up0 \expndtw-1\charscalex100 tersebut dapat mengakibatkan terjadi penurunan\par\pard\ql \li10694\sb0\sl-253\slmult0 \par\pard\ql \li4246\sb206\sl-253\slmult0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf1\f2\fs22 163 \par\pard\sect\sectd\fs24\paperw12180\paperh15860\pard\sb0\sl-240{\bkmkstart Pg5}{\bkmkend Pg5}\par\pard\ql \li7382\sb0\sl-241\slmult0 \par\pard\ql\li7382\sb0\sl-241\slmult0 \par\pard\ql\li7382\sb198\sl-241\slmult0 \up0 \expndtw0\charscalex104 \ul0\nosupersub\cf2\f3\fs21 Sari Pediatri, Vol. 5, No. 4, Maret 2004\par\pard\sect\sectd\sbknone\cols2\colno1\colw6027\colsr160\colno2\colw5853\colsr160\qj \li1142\sb0\sl-256\slmult0 \par\pard\qj \li1510\ri225\sb227\sl-256\slmult0 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf12\f13\fs22 visus. Hasil pemeriksaan visus pada pasien ini \line \up0 \expndtw0\charscalex100 belum dapat disimpulkan karena saat ini kondisi \line \up0 \expndtw0\charscalex109 mata pasien sedang dalam keadaan akut. Se-\line \up0 \expndtw0\charscalex106 harusnya kejadian tersebut dapat dicegah bila \line \up0 \expndtw0\charscalex105 pasien atau orangtuanya mendapat penjelasan \line \up0 \expndtw-3\charscalex100 tentang cara menghindari komplikasi penyakitnya \line \up0 \expndtw-2\charscalex100 sejak awal.\par\pard\qj \li1142\ri224\sb0\sl-255\slmult0\fi340 \up0 \expndtw0\charscalex112 Walaupun penyakit ini termasuk \ul0\nosupersub\cf15\f16\fs22 self-limiting\ul0\nosupersub\cf12\f13\fs22 , \up0 \expndtw0\charscalex103 namun bila proses keratokonjungtivitis tidak dapat \up0 \expndtw-1\charscalex100 teratasi maka prognosisnya menjadi buruk.\par\pard\ql \li1142\sb0\sl-276\slmult0 \par\pard\ql \li1142\sb221\sl-276\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf16\f17\fs24 Daftar Pustaka\par\pard\ql \li1142\sb0\sl-218\slmult0 \par\pard\ql \li1142\sb34\sl-218\slmult0\tx1534 \up0 \expndtw0\charscalex110 \ul0\nosupersub\cf17\f18\fs18 1.\tab \up0 \expndtw0\charscalex103 Allansmith MR. Vernal conjungtivitis. Dalam: Tasman\par\pard\qj \li1142\ri246\sb0\sl-210\slmult0\fi397\tx1539\tx1530 \up0 \expndtw0\charscalex104 W, Jaeger EA, penyunting. Duane\u8217?s Clinical Ophthal-\line \tab \up0 \expndtw0\charscalex102 mology. Philadelphia: Lippincott Ra-Ven, 1997. h. 1-8. \line \up0 \expndtw0\charscalex110 2. \tab \up0 \expndtw0\charscalex101 Wright KW. Vernal conjungtivitis. Dalam: Wright KW,\par\pard\qj \li1539\ri247\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex109 Buckley EG, Del Monte MA, penyunting. Pediatric \line \up0 \expndtw0\charscalex100 Ophthalmology and Strabismus. St Louis: Mosby, 1995.\par\pard\ql \li1539\sb2\sl-210\slmult0 \up0 \expndtw0\charscalex108 h. 285-6.\par\pard\ql \li1142\sb0\sl-209\slmult0\tx1534 \up0 \expndtw0\charscalex110 3.\tab \up0 \expndtw0\charscalex113 Pucci N, Novembre E, Cianteronia, Lombardi E,\par\pard\qj \li1539\ri248\sb2\sl-210\slmult0 \up0 \expndtw0\charscalex110 Bernardini R, Caputo R, dkk.Efficacy and safety of \up0 \expndtw-1\charscalex100 cyclosporin eyedrops in vernal keratoconjunctivitis. Ann \up0 \expndtw0\charscalex104 Allergy Asthma Immunol 2002;89:298-303.\par\pard\ql \li1142\sb1\sl-209\slmult0\tx1534 \up0 \expndtw0\charscalex110 4.\tab \up0 \expndtw0\charscalex110 Majmuder PA. Conjunctivitis allergic. Didapat dari\par\pard\qj \li1539\ri249\sb0\sl-210\slmult0 \up0 \expndtw0\charscalex114 URL:http//{\field{\*\fldinst {HYPERLINK "http://www.emedicine.com/" }}{\fldrslt {\ul0\nosupersub\cf17\f18\fs18 www.emedicine.com}}}\ul0\nosupersub\cf17\f18\fs18 pada tanggal 16 \up0 \expndtw0\charscalex103 Agustus 2003.\par\pard\ql \li1142\sb0\sl-209\slmult0\tx1534 \up0 \expndtw0\charscalex110 5.\tab \up0 \expndtw-1\charscalex100 Bielory L. Allergic and immunology disorders of the eye.\par\pard\qj \li1539\ri248\sb2\sl-209\slmult0 \up0 \expndtw0\charscalex109 Part II: ocular allergy.J Allergy Clin Immunol 2000; \up0 \expndtw0\charscalex109 106:805-16.\par\pard\ql \li1142\sb0\sl-209\slmult0\tx1534 \up0 \expndtw0\charscalex111 6.\tab \up0 \expndtw0\charscalex109 Bonini S, Bonini S, Schiavone M, dkk : Conjuntival\par\pard\qj \li1539\ri247\sb2\sl-209\slmult0 \up0 \expndtw0\charscalex104 Hyperres Ponsivenes To Ocular Histamine Challenge \line \up0 \expndtw0\charscalex105 In Patients With Vernal Conjunctivitis. J Allergy Clin \line \up0 \expndtw0\charscalex103 Immunol 192 ; 89:103-7. Dikutip dari Lee Y, Raizman \line \up0 \expndtw0\charscalex126 MB. Vernal conjunctivitis. Dalam: Bielory L, \line \up0 \expndtw0\charscalex102 penyunting. Immunology and Allergy Clinics of North \line \up0 \expndtw0\charscalex105 America. Philadelphia: WB Saunders company, 1997.\par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb0\sl-253\slmult0 \par\pard\ql \li1133\sb68\sl-253\slmult0 \up0 \expndtw0\charscalex110 \ul0\nosupersub\cf1\f2\fs22 164\par\pard\column \ql \li6187\sb0\sl-218\slmult0 \par\pard\ql \li6187\sb0\sl-218\slmult0 \par\pard\ql \li417\sb48\sl-218\slmult0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf17\f18\fs18 h. 33-52.\par\pard\ql \li20\sb0\sl-209\slmult0\tx421 \up0 \expndtw0\charscalex111 7.\tab \up0 \expndtw0\charscalex102 Foundation of the American Academy of ophthalmol-\par\pard\qj \li417\ri1204\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex106 ogy clinical approach to immune-related disorders of \up0 \expndtw0\charscalex104 the external eye. Dalam: Thomas JL, Thomas AD, M. \up0 \expndtw0\charscalex104 Gilbert, penyunting. External disease and cornea. San \up0 \expndtw0\charscalex107 Fransisco: Foundation of the American Academy of \up0 \expndtw0\charscalex108 Ophthalmology; 2001. h. 194-7.\par\pard\ql \li20\sb1\sl-210\slmult0\tx421 \up0 \expndtw0\charscalex109 8.\tab \up0 \expndtw0\charscalex101 Katelaris CH. Ocular allergy: Implications for the clini-\par\pard\qj \li417\ri1204\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex112 cal immunologist. Allergy Asthma Immunol 2003; \up0 \expndtw0\charscalex108 90:23-7\par\pard\ql \li20\sb2\sl-210\slmult0\tx422 \up0 \expndtw0\charscalex122 9.\tab \up0 \expndtw0\charscalex116 Bonini S. Vernal keratoconjunctivitis revisited: a\par\pard\qj \li417\ri1208\sb0\sl-210\slmult0 \up0 \expndtw0\charscalex111 case series of \up0 \expndtw0\charscalex116 195 patients with long-term follow \up0 \expndtw0\charscalex114 up. Ophthalmol 2000; 107:1157-63.\par\pard\ql \li20\sb1\sl-209\slmult0\tx423 \up0 \expndtw0\charscalex120 10.\tab \up0 \expndtw0\charscalex120 Lambiase A, Bonini S, Rasi G, Coassin M,\par\pard\ql \li417\sb0\sl-209\slmult0 \up0 \expndtw0\charscalex112 Bruscolini A, Bonini S. Montelukast, a leukotriene\par\pard\qj \li417\ri1204\sb2\sl-210\slmult0 \up0 \expndtw0\charscalex113 receptor antagonist, in vernal keratoconjunctivitis \up0 \expndtw0\charscalex116 associated with asthma. Arch Ophthalmol 2003; \up0 \expndtw0\charscalex115 121:615-20\par\pard\ql \li20\sb1\sl-209\slmult0\tx422 \up0 \expndtw0\charscalex120 11.\tab \up0 \expndtw0\charscalex109 D\u8217?Ermo F, Bonini S, Todini V. Inflamatory cells in\par\pard\ql \li417\sb1\sl-210\slmult0 \up0 \expndtw0\charscalex119 conjungtiva scrapings of patient with vernal\par\pard\qj \li417\ri1203\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex120 conjungtivitis. Dalam: Secchi AG, Fregona IA, \up0 \expndtw0\charscalex117 penyunting. Modern trends in Immunology and \up0 \expndtw0\charscalex119 Immunopathology of the eye. Milano: Masson; \up0 \expndtw0\charscalex117 1989. h. 395-8.\par\pard\ql \li20\sb1\sl-210\slmult0\tx422 \up0 \expndtw0\charscalex120 12.\tab \up0 \expndtw0\charscalex110 Allansmith MR, Hahn GS, Simon MA. Tissue, tear\par\pard\ql \li417\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex105 and serum IgE concentration in vernal conjungtivitis.\par\pard\ql \li417\sb0\sl-209\slmult0 \up0 \expndtw0\charscalex113 Am J Ophthalmol 1976; 81:506-11.\par\pard\ql \li20\sb2\sl-210\slmult0\tx422 \up0 \expndtw0\charscalex120 13.\tab \up0 \expndtw0\charscalex117 Kresno SB. Penyakit Alergi. Dalam: Kresno SB,\par\pard\ql \li417\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex119 penyunting. Imunologi: diagnosis dan prosedur\par\pard\ql \li417\sb1\sl-210\slmult0 \up0 \expndtw0\charscalex115 laboratorium. Jakarta: FKUI, 1991. h. 133-43.\par\pard\ql \li20\sb1\sl-209\slmult0\tx422 \up0 \expndtw0\charscalex120 14.\tab \up0 \expndtw0\charscalex118 Munazir Z, Suyoko D. Reaksi Hipersensitivitas.\par\pard\qj \li417\ri1204\sb0\sl-210\slmult0 \up0 \expndtw0\charscalex109 Dalam: Arwin A, Corry SM, penyunting. Buku Ajar \line \up0 \expndtw0\charscalex115 Alergi Imunology Anak. Jakarta: BP IDAI, 1997.\par\pard\ql \li417\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex116 h. 78-94.\par\pard\ql \li20\sb1\sl-210\slmult0\tx422 \up0 \expndtw0\charscalex120 15.\tab \up0 \expndtw0\charscalex112 Leonardi. A, Borghesan F, Avarello A, Plebani M,\par\pard\ql \li417\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex122 Secchi AG. Effect of iodoxamide and sodium\par\pard\qj \li417\ri1204\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex110 cromoglycate on tear eosinophil cationic protein in \line \up0 \expndtw0\charscalex110 vernal keratoconjunctivitis. Br J Ophthalmol 1997; \line \up0 \expndtw0\charscalex117 81:23-6.\par\pard\ql \li20\sb1\sl-210\slmult0\tx421 \up0 \expndtw0\charscalex107 16.\tab \up0 \expndtw-1\charscalex100 Tobbara KF. Ocular complications of vernal keratocon-\par\pard\ql \li417\sb1\sl-209\slmult0 \up0 \expndtw0\charscalex103 junctivitis. Can J Ophthalmol 1999; 34:88-92 \par\pard\sect\sectd\fs24}