7. Ablasio Retina

ABLASIO RETINA

ROCHASIH MUDJAJANTI

DEFINISI

LEPASNYA LAPISAN RETINA SENSORIS

DARI EPITEL PIGMEN RETINA

KLASIFIKASI

RHEGMATOGENOUS RD –TEAR (+)

TRACTIONAL RD

EXUDATIVE RD

EPIDEMIOLOGI

INSIDENSI – 1 PER 10.000

BERHUBUNGAN DG MIOPIA – 7%

MIOP SEDANG

Teknik pemeriksaan

Indirect Ophthalmoscopy with scleral

indentation

Indirect biomicroscopy

B-scan Ultrasound

Mekanisme ablasio retina

1- Rhegmatogenous RD:

◦ Retinal breaks + accumulation of subretinal

fluid

◦ Retinal breaks result from dynamic

vitreoretinal tractions(PVD) and peripheral

retinal degenerations

Komplikasi PVD

No complications: most of the time

Retinal tears:

◦ 10-15% of cases

◦ Associated with vitreous hemorrhage

◦ U-shaped

◦ Risk of RD is high

Avulsion of retinal blood vessel and

vitreous hemorrhage without tear: rare

Acute posterior vitreous detachment: (a) synchisis; (b) uncomplicated

posterior vitreous detachment; (c) retinal tear formation and vitreous

haemorrhage; (d) avulsion of a retrnal blood vessel and vitreous

haemorrhage

Tipe degenerasi

Lattice Degeneration:

◦ 8% of population

◦ 40% in eyes with RD

◦ Most common among Myopes

◦ Shape: Spindle-shaped areas of thinnig in the

form of a network .

◦ Overlying vitreous is synchitic but

attachments are stronger

Lattice degeneration

MYOPIA & ABLASIO RETINA

over 40% of all RDs occur in myopic eyes.

The higher the refractive error the greater the risk of RD.

The following interrelated factors predispose a myopic eye to RD:◦ Lattice degeneration .

◦ Snailtrack degeneration.

◦ Diffuse chorioretinal atrophy may give rise to small round holes in highly myopic eyes.

◦ Macular holes may give rise to RD in highly myopic eyes.

◦ Vitreous degeneration and PVD are more common.

◦ Vitreous loss during cataract surgery, is associated with about a 15% incidence of subsequent RD in myopic eyes greater than 6D; the risk is even higher if myopia is more than 10D.

◦ Posterior capsulotomy is associated with an increased risk of RD in myopic eyes.

Mekanisme ablasio retina

2-Tractional retinal detachment:

e.g. Diabetic tractional RD

Active vitreous traction

3- Exudative RD: ◦ disorders that disrupt the retinal pigment epithelium and allow

the choroidal fluid to accumulate in the subretinal space

Causes: ◦ Choroidal tumors

◦ Intraocular inflammation

◦ Iatrogenic : RD surgery

◦ Subretinal neovascularizations

Bridging and anteroposterior vltreoretinal traction giving rise to an extensive

tractional retinal detachment in advanced proliferative diabetic retinopathy

Gambaran klinik

Rhegmatogenous RD:

Symptoms: ◦ flashes of light(Photopsia)

◦ Vitreous floaters(ring-shaped, cobweb, and shower of floaters)

◦ Peripheral visual loss: relative scotoma

Signs: ◦ Relative afferent papillary defect

◦ Lower IOP

◦ Vitreous opacities(tobacco dust)

◦ Retinal breaks

◦ Retinal appearance: convex corrugated and undulating surface

Fresh bullous superior retinal detachment

GAMBARAN KLINIK

Tractional RD:

Symptoms: photopsia and floaters are absent, slowly progressive visual field loss

Signs: Concave immobile surface, absent retinal breaks

Exudative retinal detachment:

Symptoms: photopsia is absent but floaters are present(vitritis), visual field loss

Signs: Convex, smooth not corrugated, mobile with shifting of subretinal fluid, absent retinal breaks

Combined Tractional and Rhegmatogenous RD

Choroidal Detachment

Choroidal Detachment

TATALAKSANA

RHEGMATOGEN – SIMPLE SCLERAL BUCKLING, SB + VITREKTOMI, MEMBRAN PEELING, GAS, SILIKON OIL

TRD PADA PDR – LASER FC SEBELUM SB, VITREKTOMI, MEMBRAN PEELING

TRD DG ABLASIO RHEGMATOGEN – SB, VITREKTOMI, MEMBRAN PEELING, GAS

EKSUDATIVA – FFA, USG,ERG,KONSUL SUBBAG LAIN YG TERKAIT, TERAPI PENYAKIT DASAR

PNEUMORETINOPEXY