copy of oklusi avrs
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oklusi AVRSTRANSCRIPT
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Oklusi arteri dan vena Oklusi arteri dan vena retina sentralisretina sentralis
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OKLUSI ARTERI RETINA SENTRALIS
Def : hambatan aliran darah arteri ke retina
Etiologi :• sering oleh trombosis yg berhub dgn aterosklerosis di dekat
lamina kribrosa.• Emboli pd byk kasus (20 % dr seluruh mata dgn OARS)• Peny jantung (infark miokard, PJR)• Peny aterosklerosis karotis.• Peny vaskuler sistemik (hipertensi, aterosklerosis, giant cell
arthritis)• Hiperviskositas darah• Trauma (fraktur tlg pjg emboli lemak)• Kontrasepsi oral• Peny. sistemik (DM, sifilis)
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Gambaran klinik: - Gejala subyektif : visus hilang-timbul (amourosis fugax) - Gejala obyektif : Pupil refleks , anisokoria
Funduskopi : - retina pucat cherry red spot (reflex merah dr p.drh koroid di bwh fovea yg kontras dgn retina sekitarnya yg pucat) - papil pucat, batas kabur, atropi - retina milky white appearance (retina berwarna kelabu spt susu) - boxcar phenomenon (arteri sgt menciut, mengempes tanpa darah, kdng terputus-putus) - tiny thread like (p.drh kolaps, mengecil spt benang & halus) - neovaskularisasi iris tjd pd 18% akut OARS 1-12 mgg set
OARS; rata2 : 4 - 5 mgg.
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• Setelah bbrp minggu : - atrofi papil dgn batas tegas - edem menghilang - arteri menciut & tampak
sbg garis-garis putih
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Diagnosis berdasarkan : - anamnesis - gambaran klinikPenanganan:• ≠ memuaskan masih dipertanyakan• Menurunkan TIO :
Massage bola mata emboli lepas Parasentesis BMD Anastesi retrobulba
T/ inhalasi (95% Oksigen dicampur dgn 5% CO2)• asetazolamid oral & aspirin.
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Prognosis• Tergantung : - kausa - derajat obstruksi lamanya oklusi
menetap Komplikasi : glaukoma neovaskuler
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OKLUSI VENA RETINA SENTRALIS
Def : hambatan aliran darah vena dari retina
Etiologi : - arteriosklerosis & hipertensi - trombus peny jantung, DM - perubahan viskositas darah
Gambaran fundus khas berupa dilatasi dan berkelok-keloknya p. drh vena, edema papil N.optik, perdarahan intraretina dan edema retina.
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• Ada 2 klasifikasi OVRS yi
1. noniskemik , btk lbh ringan kadang dikenal sbg partial, perfused atau retinopati venus statis.
2. iskemik, khas plng sdkt area yg terkena 10 DD, dgn FFA kapiler retina nonperfusi di pole posterior shg dikenal juga sbg nonperfused, complete atau hemorrhagic.
• Mekanisme diduga tjd trombosis di posterior pd lamina kribrosa menyebabkan turbulensi, kerusakan endotel dan pbtk thrombus
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NONISKEMIK OVRS. - p. drh dilatasi ringan dan berkelok-kelok pd semua
cab VRS - perdarahan retina btk dot dan flame shape di semua
kuadran. - edema makula dgn penurunan visus dgn atau tanpa
edema papil. - FFA: waktu sirkulasi retina memanjang dgn pecahnya
permeabilitas kapiler ttp daerah nonperfusi sedikit. - Jarang tjd neovask di segmen ant.
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ISKEMIK OVRS.
- perdarahan lbh ekstensif di 4 kuadran dan edema retina.
- ada dilatasi vena dan cotton wool spot. - FFA: kapiler nonperfusi luas, perpanjangan sirkulasi intraretina. - Prognosis biasanya jelek. - Neovask. iris > 60%, tjd 3 – 5 bln ssdh onset. - Defek aferen pupil (pupil Markus Gunn)
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• Gambaran klinik: # Subyektif : - visus bertahap - mata merah - fotofobia - nyeri # Obyektif : Flame shape hemorrhage
Vena retina kongesti & berkelok- kelokPerdarahan pd membran hyaloid & vitreusNeovaskularisasi di sekitar n.optik & irisDefek lapang pandang sesuai cabang oklusi
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Diagnosis• Anamnesis : KU, rwyt.pykt sistemik• gejala klinik : - funduskopi - FFA• Lab mendukung peny sistemik
Evaluasi : - TIO - Gonioskopi - FFA
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Penanganan :
• Kausal, tdk ada t/ efektif utk noniskemik OVRS.• Fotokoagulasi utk edema makula.• Kortikosteroid & terapi utk me(-) adhesi platelet.
Komplikasi• Trombotik glaukoma (glaukoma sekunder)• Retinal detachment
Prognosis• Komplikasi jelek
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