Retinopati 306j46

RETINOPATHY

HABIBAH S. MUHIDDIN BAGIAN I.P. MATA FK UNHAS

Fundus normal

Papil normal

DIABETIC RETINOPATHY Frequent cause of blindness in USA, aged 20 to 64 years Indonesia blindness due to D.R. increase

PATHOGENESIS The exact cause is still unclear It is believed : 



Hiperglycemia over an extended period results in a number biochemical and physiologic changes --endothelial damage. Retinal vascular changes : loss of pericyte basement membrane thickening---compromises capillary lumen--- decompensation of endothelial barrier function

Hematologic and biochemical abnormalities Increased platelet adhesiveness Increaser erythrocyte aggregation Abnormal serum lipids Defective fibrinolysis Abnormal levels of growth hormone : ex vascular endothelial growth factor (VEGF) Abnormalities in serum and whole blood viscosity

ADVANCED DIABETIC RETINOPATHY

Risk factor for : Cardiovascular disease  Heart attack  Stroke  Diabetic nephropathy  Amputatia  Death 

CLASSIFICATION Non proliferative diabetic retinopathy (NPDR) = back ground diabetic retinopathy :    

Mild Moderate Severe Very severe

Proliferative Diabetic Retinopathy :   

Early High risk Advanced

Macular edema

NPDR : Retinal microvasculer changes limited to the retina        

Micro aneurysme Dot & blot hemorrhage Retinal edema Hard exudates Dilatation & bleading of the vein Intraretinal micro vascular abnormalites (IRMA) Nerve fiber layer infarct (cotton wool spot) Areas of capillary non perfussion

RH :

RD tahap awal

RD : mikroaneurisma + hard exudate

Gamb. fluoresin

RD 1: cotton wool + Flame shaped

RD 2

RD 2 (fluoresin)

Affect visual function through Capillary disease ischemic  Vascular permeability edema 

Diabetic macular edema 

The most common : Cause of VA  Cause focal  Cause diffuse 

Proliferative diabetic retinopathy (PDR) Extra retinal fibrovascular proliferation extends beyond the ILM

RD proliferatif

NPDR Ischemic retina Release of vaso poliferative factors Neovascularization of the retina optic neuro head, ant.signal

RD proliferatif

COMPLICATION Reduced of visual acuity Vitreous hemorrhage Traction retinal detachment Neurovascular glaucoma

RD prolif.+ ablasio

TREATMENT Regulation of blood glucose level Laser photocoagulation Vitrectomy

RD prolif + tx laser

HYPERTENSIVE RETINOPATHY  Effect of systemic arterial hypertension

to chronic retinal vascularization Hypertensive retinopathy  Hypertensive choroidopathy  Hypertensive optineuropathy 

HYPERTENSIVE RETINOPATHY (HR) Hypertensive vascular changes & arterio sclerata vascular disease express in HR. Classification of HR, the modified scheir. Grade 0 : No change (a/v 2 : 3)  Grade 1 : barely table arterial narrowing a:v=1:2 

CLASSIFICATION OF HR Grade 2 : obvious arterial narrowing with focal irregularities. Copper wire arteries  Silver wire arteries  Banking sign  Salus sign 

RH : crossing/Gunn sign

RH : Gunn phenomen

RH: gunn, copper wire, Salus

RH dg Gunn phenomen

Classification. cont Grade 3 : grade 2 + retinal hemorrhages and/or exudate Grade 4 : grade 3 + disc swelling

Associated condition Branch retinal artery occlusion (BRAO) Branch retinal vein occlusion (BRVO) Central retinal vein occlusion (CRVO) Retinal arterial macroaneurysms Preretinal and vitreous hemorrhage Epiretinal membrane

HYPERTENSIVE CHOROIDOPATHY

Typically occur in young patients : with acute hypertension ex : Preeclampsia, eclampsia  Pheochromacytoma  Acute renal failure 

RH pd HT renal

RH ok HT renal + edem papil

Funduscopic findings

Choriocapillaries nonperfusion Hemorrhages Retinal edema Infark nerve fiber layer RPE detachment Retinal detachement

RH ok HT renal + edem papil

Hypertensive Optic Neuropathy

Flame-shaped hemorrhages around the disc Blurring of the disc margin Congestion of the retinal vein Secondary macular exudates

Retinopati angiospastik : cotton wool + flame shaped + dot hemorrhage

Other types of retinopathy Leukemia retinopathy Thrombocytopenia retinopathy Anemia retinopathy

Trombositopenia

Hemofilia

Leukemia akut