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Tri RahayuOphthalmology Department
Faculty of Medicine, University Indonesia
Eye Problems II
Chronic visual loss/slow decrease vision
• Cataract
• Glaucoma (chronic: open and closed angle)
• Retinopathies (mainly: diabetic retinopathy)
• Macular Degeneration
(AMD=age-related macular degeneration)
• Others: e.g. retinitis pigmentosa
Cataract
• Definition : Lens opacity• Causes:– Degeneration– Complication of ocular inflammation/
metabolic/drug induced (steroid)– Trauma
• Symptoms : decreased vision, cloudy vision,
CataractSymptoms Early
- no symptoms- fog- glare- difficulty in reading
Late- blur of vision- leucocoria
CataractManagement• Depend on patient’s demand; if interfering
with daily activity: Cataract surgery
• Technique:- Intracapsular Cataract Extraction(ICCE) now rarely done- Extracapsular Cataract Extraction(ECCE)- Phacoemulsification- Small-incision
Glaucoma
• Optic neuropathy, mainly caused by chronic IOP elevation due to increased outflow resistance• visual field defects• 2 types: - open angle glaucoma
- closed angle glaucoma
Glaucoma
Symptoms • IOP > 21 mmHg (normal 10-21)• Open angle: asymptomatic; if there is indicating late stages (frequently bumping, rainbow halo, periocular pain)• Closed angle: predisposition to acute glaucoma• Constricted visual field
Glaucoma
Management• Observation• Glaucoma drugs: - beta-blocker
- acetazolamid - pilocarpine
• Laser (iridotomy, trabeculotomy, trabeculoplasty)• Surgery (iridectomy, trabeculektomy, implant)
Glaucoma
RETINOPATHIES
• Non-inflammatory retina disorders
• 2 most common:
- hypertensive retinopathy
- diabetic retinopathy
Hypertensive retinopathy
• caused by chronic hypertension• depend on onset• - Grade I: narrowing of vessels - Grade II: + narrowing of veins at crossing - Grade III: + intraretinal hemorrhages, exudates - Grade IV: optic disc edema, star figured
macular exudates
Hypertensive retinopathy
Cotton-wool spots and macular star
Disc oedema
Focal Generalized
Arteriolar constriction
Extravascular signs
Flame-shaped retinal haemorrhages
Arteriolosclerosis (A-V changes)
Grading of arteriolosclerosis
Diabetic retinopathy
Complication of diabetes Chronic hyperglycemia damage to microvasculars Chronic visual loss Main cause of blindness in DM 50% of diabetics within 10 yrs will have retinopathy
Mekanisme kebutaan pada diabetic retinopathy
leakage of exudates, lipid and blood to the retina
Macular edeme
Decreased blood flow to the retina
iskemia
neovascularization PDR
-vitreous hemorrhage- Fibrovascular scar- retinal traction
retinal detachment
7
Diabetic retinopathy
7
Normal retina
PDR vitreuous hemorrhage Fibrovascular scar in PDR
Early PDR FFA
NPDR
AMD=age-related macular degeneration
7
• Chronic visual loss caused by changes of the macula
• bilateral
AMD=age-related macular degeneration
7
• Problem world wide
• 4 th in global cause blindness
• Treatment:
- Photodynamic therapy
- Anti-VEGF
- others
Acute (persistent) visual loss/
Sudden decrease vision
• Retinal detachment
• Vitreous hemorrhage
• Retinal vein occlusion
• Retinal artery occlusion
• Optic neuritis
Retinal detachment
• detachment of neurosensory retina from RPE
• mainly caused by retinal breaks
• floaters, photopsia, shadow curtain
retinal detachmentManagement• pneumatic retinopexy• vitreoretina surgery
- Scleral buckling- Vitrectomy
Scleral buckling (SB) Vitrectomy
Vitreous hemorrhage
• Blood in the vitreous
• Rupture of blood vessels
• Cause: trauma, retinal breaks, DM, hypertension
• On examination: fundus reflex absent
• Vitrectomy maybe needed
Oklusi (sumbatan) arteri retina• Sumbatan arteri retina akibat radang / spasme / trombus / melambatnya aliran darah• Mengenai satu mata• Tidak sakit• Berhubungan erat dengan kelainan jantung• Tanda: retina pucat, cherry-red spot
Retinal vein occlusion• Central/branch• Unilateral• Painless• Systemic risk factors• flame-shaped hemorrhages, cotton wool spots
Optic neuritis• inflammation/intoxication/demyelination of the optic nerve• may be accompanied by pain• unilateral• sluggish pupil reflex, RAPD +