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 +