kuliah kelainan lensa 2012 (not mine)
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not mine. credit to owner of this presentation.TRANSCRIPT
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KELAINAN KELAINAN LENSALENSAKemala sayutiKemala sayuti
Bag I K Mata FK.UnandBag I K Mata FK.Unand
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ANATOMI MATAANATOMI MATA
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Anatomi lensaAnatomi lensa Cembung ,tebal 3,5-5 mm, Cembung ,tebal 3,5-5 mm,
D 6,4-9 mm ,D 6,4-9 mm ,Transparan, avaskuler, Transparan, avaskuler,
persyarafan(-) persyarafan(-) .Kapsul ant’or,post’or, .Kapsul ant’or,post’or,
semipermiabel semipermiabel (air,elektrolit),elastis(air,elektrolit),elastis
.Korteks ant’or,post’or.Korteks ant’or,post’or .Nukleus, dewasa keras.Nukleus, dewasa keras .Epitel subkapsul ant’or,1 .Epitel subkapsul ant’or,1
lap sel kuboid,ekuator lap sel kuboid,ekuator (mitosis) serabut (mitosis) serabut lamelar (ukuran lamelar (ukuran >,kelenturan<)>,kelenturan<)
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Komposisi lensaKomposisi lensa• 66 % air,umur >,air <,elastis <(presbiopia)66 % air,umur >,air <,elastis <(presbiopia)• 33 % protein,water soluble (crystalline,81%)33 % protein,water soluble (crystalline,81%) water insoluble (urea soluble/in)water insoluble (urea soluble/in) Mempertahankan transparansiMempertahankan transparansi Umur tua (katarak)Umur tua (katarak) crystalline (51%)crystalline (51%) water insoluble >water insoluble > Bersifat antigenBersifat antigen• Elektrolit , K 120 mM, Na 20 mM, Ca 30 mMElektrolit , K 120 mM, Na 20 mM, Ca 30 mM
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Fungsi lensaFungsi lensa• Refraksi , menfokuskan objek jauh ke Refraksi , menfokuskan objek jauh ke retina.Relaksasi M siliarisretina.Relaksasi M siliaris .Zonula zinn teregang.Zonula zinn teregang .D/ Ant-Post minimal.D/ Ant-Post minimal• Akomodasi, menfokuskan objek dekat ke Akomodasi, menfokuskan objek dekat ke retina.Kontraksi M siliarisretina.Kontraksi M siliaris .Zonula zinn kendor.Zonula zinn kendor .Lensa cembung.Lensa cembung (kapsul elastis,lensa lentur) (kapsul elastis,lensa lentur)
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Angka kebutaan di Angka kebutaan di IndonesiaIndonesia• Survei kesehatan 1993-1996Survei kesehatan 1993-1996• Angka kebutaan 1,5 %Angka kebutaan 1,5 %• Penyebab utama kebutaan :Penyebab utama kebutaan : Katarak : 0,78%Katarak : 0,78% Glaukoma : 0,20%Glaukoma : 0,20% Kelainan refraksi : 0,14%Kelainan refraksi : 0,14% Penyakit(usia >) : 0,38% Penyakit(usia >) : 0,38%
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Pemeriksaan kelainan lensaPemeriksaan kelainan lensa• 1.Uji tajam penglihatan(visus)1.Uji tajam penglihatan(visus)• 2.Pemeriksaan lensa2.Pemeriksaan lensa . Pupil dilebarkan dg midriatikum. Pupil dilebarkan dg midriatikum . Lampu celah(Slit lamp). Lampu celah(Slit lamp) . Oftalmoskop (‘Red reflex’/ refleks . Oftalmoskop (‘Red reflex’/ refleks
fundus )fundus ) . Lup. Lup . Lampu senter . Lampu senter
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Kelainan LensaKelainan Lensa• Katarak : . Kongenital . Polaris ant’or,post’orKatarak : . Kongenital . Polaris ant’or,post’or . Lamellaris(zonularis). Lamellaris(zonularis) . Nuklearis. Nuklearis . Didapat . Senilis(degeneratif). Didapat . Senilis(degeneratif) . Komplikata. Komplikata . Traumatika. Traumatika . Sekunder. Sekunder• Dislokasi : . SublukasiDislokasi : . Sublukasi . Luksasi . Luksasi
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KATARAKKATARAKKriteria lensa katarakKriteria lensa katarak• Perubahan protein Perubahan protein • EdemaEdema• NekrosisNekrosis• Serabut robekSerabut robek• Oxygen uptake <Oxygen uptake <
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Penyebab katarakPenyebab katarak• Kongenital : . HerediterKongenital : . Herediter . Infeksi intra uterin,TORSCH. Infeksi intra uterin,TORSCH . Sindroma,Down S. Sindroma,Down S . Idiopatik. Idiopatik• Didapat : . Umur tua(Age related cataract)Didapat : . Umur tua(Age related cataract) . Infeksi. Infeksi . Metabolik. Metabolik . Toksik . Toksik . Trauma . Trauma
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Pembagian KatarakPembagian Katarak• Morfologi . Kapsular . NuklearMorfologi . Kapsular . Nuklear . Subkapsular . Lamellar . Subkapsular . Lamellar . Kortikal . Sutural. Kortikal . Sutural• Maturiti . Insipien Maturiti . Insipien . Imatur. Imatur . Matur. Matur .Hipermatur .Hipermatur • Umur .Kongenital .PresenilisUmur .Kongenital .Presenilis . Infantil . Senilis. Infantil . Senilis . Yuvenil . Yuvenil
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Katarak kongenitalKatarak kongenital• Klinis : Lensa keruh (leukokoria)Klinis : Lensa keruh (leukokoria) . Parsial – total. Parsial – total . Unilateral – bilateral. Unilateral – bilateral• Th/ .Indikasi operasi . > 2mmTh/ .Indikasi operasi . > 2mm . Sentral > Operasi segera . Sentral > Operasi segera
. Padat/keruh ( < 2 bl ). Padat/keruh ( < 2 bl ) . Tu/ unilateral . Tu/ unilateral > Mencegah ambliopia deprivasi,supresi> Mencegah ambliopia deprivasi,supresi Penyulit : . Uveitis fakoanafilaktikPenyulit : . Uveitis fakoanafilaktik . Glaukoma sekunder. Glaukoma sekunder . Katarak sekunder . Katarak sekunder
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Katarak pd AnakKatarak pd Anak• Penyebab .KongenitalPenyebab .Kongenital .Didapat .Didapat • Th/ . Tergantung umurTh/ . Tergantung umur . Operasi ,mencegah ambliopia. Operasi ,mencegah ambliopia perbaikan visusperbaikan visus . Follow up (tidak terlalu . Follow up (tidak terlalu
mendesak) mendesak)
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Katarak senilisKatarak senilis• Penyebab kebutaan utama di IndonesiaPenyebab kebutaan utama di Indonesia• Age-related cataractAge-related cataract• Bentuk :Bentuk : . K.Nuklear,. K.Nuklear, Nukleus makin besar,sklerotik,Nukleus makin besar,sklerotik, putih kekuninganan > coklat > k’hitam’putih kekuninganan > coklat > k’hitam’ /K.Nigra, ‘Brunescent nuklear cataract’/K.Nigra, ‘Brunescent nuklear cataract’• .K.Kortikal,.K.Kortikal, Penyerapan air > lensa cembung,miopisasiPenyerapan air > lensa cembung,miopisasi Bentuk .’cuneiform, coronaryBentuk .’cuneiform, coronary• K.Subkapsular post’or/cupuliformK.Subkapsular post’or/cupuliform Std dini K.nuklear,K.kortikal(gamb piring = K.komplikata Std dini K.nuklear,K.kortikal(gamb piring = K.komplikata
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Stadium Katarak SenilisStadium Katarak Senilis• K.Insipien K.Insipien Keruh tdk teratur,kortek ant,postKeruh tdk teratur,kortek ant,post Poliopia,’Shadow test’/Iris shadow (+)Poliopia,’Shadow test’/Iris shadow (+)• K.ImaturK.Imatur Intumesen:Air >,lensa bengkak,kapsul tegang,’Artificial Myopia’Intumesen:Air >,lensa bengkak,kapsul tegang,’Artificial Myopia’ KOA(BMD) dangkal KOA(BMD) dangkal →→ Glaukoma phakomorfik Glaukoma phakomorfik Iris shadow (+)Iris shadow (+)• K.MaturK.Matur Keruh difus,ukuran lensa N’, KOA N’Keruh difus,ukuran lensa N’, KOA N’ Deposit Ca > perkapuran > lensa sangat putihDeposit Ca > perkapuran > lensa sangat putih Iris shadow (-)Iris shadow (-)• K.Hipermatur , K.MorgagniK.Hipermatur , K.Morgagni Korteks m’cair,lensa m’kerut warna kuningKorteks m’cair,lensa m’kerut warna kuning KOA dalamKOA dalam ‘ ‘Shadow test’ pseudo iris shadow (+)Shadow test’ pseudo iris shadow (+) Penyulit : uveitis fakotoksik, glaukoma fakolitikPenyulit : uveitis fakotoksik, glaukoma fakolitik
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Katarak KomplikataKatarak Komplikata• Penyakit intraokulerPenyakit intraokuler . Iridosiklitis,khoroiditis(uveitis ant’or,post’or),. Iridosiklitis,khoroiditis(uveitis ant’or,post’or), . Glaukoma (K.Vogt). Glaukoma (K.Vogt) . Ablasio retina,retinitis pigmentosa,miopia >. Ablasio retina,retinitis pigmentosa,miopia > .Tumor intra okular,iskemia okular.Tumor intra okular,iskemia okular . Paska bedah mata. Paska bedah mata Penyakit sistemikPenyakit sistemik . Diabetes Melitus (K.Diabetes), Galaktosemia. Diabetes Melitus (K.Diabetes), Galaktosemia . Hipoparatiroid,tetani infantil ( Ca<), nutrisi. Hipoparatiroid,tetani infantil ( Ca<), nutrisi . Miotonia distrofi. Miotonia distrofi Rokok Rokok Th/ operasi , visus < , penyulitTh/ operasi , visus < , penyulit
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Katarak TraumatikaKatarak Traumatika• Lensa keruh k/ trauma Lensa keruh k/ trauma
tumpul(‘vissius ring’),tajam, radiasi, tumpul(‘vissius ring’),tajam, radiasi, kimia, IOFB, metallosis(siderosis, kimia, IOFB, metallosis(siderosis, calcosis), listrikcalcosis), listrik
• ‘ ‘ Monokular katarak’Monokular katarak’• Penyulit : Glaukoma,uveitisPenyulit : Glaukoma,uveitis• Th/ Visus < , penyulit Th/ Visus < , penyulit
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Katarak SekunderKatarak Sekunder• ‘‘After cataract’After cataract’• Pos-op operasi ECCE,/fakoemulsifikasiPos-op operasi ECCE,/fakoemulsifikasi• ‘‘Wedl /bladder’ cell Wedl /bladder’ cell → Soemmering ring → → Soemmering ring →
‘Elschnig pearls’‘Elschnig pearls’ • Penebalan kapsul posteriorPenebalan kapsul posterior• Th/ . Visus <,penyulitTh/ . Visus <,penyulit . Kapsulektomi post. Kapsulektomi post . Laser. Laser
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Operasi KatarakOperasi Katarak• Indikasi :. Tajam penglihatan(visus)Indikasi :. Tajam penglihatan(visus) . Penyulit. Penyulit• Anestesi: . Lokal , GA (anak, takut,neurosis)Anestesi: . Lokal , GA (anak, takut,neurosis)• Tehnik : . ICCETehnik : . ICCE . ECCE. ECCE . Fakoemulsifikasi. Fakoemulsifikasi• Persiapan : Visus,anel test (+)Persiapan : Visus,anel test (+) infeksi (-), TIO Ninfeksi (-), TIO N Keadaan umum Keadaan umum
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Extracapsular cataract extraction1. Anterior capsulotomy
2. Completion of incision
3. Expression of nucleus
4. Cortical cleanup
6. Polishing of posterior capsule, if appropriate
5. Care not to aspirate posterior capsule accidentally
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8. Grasping of IOL and coating with viscoelastic substance
Extracapsular cataract extraction ( cont. )
7. Injection of viscoelastic substance
9. Insertion of inferior haptic and optic
11. Placement of haptics into capsular bag
10. Insertion of superior haptic
12. Dialling of IOL into horizontal position
and not into ciliary sulcus
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AFAKIAAFAKIA• Lensa tidak adaLensa tidak ada• Iris trimulans,KOA(BMD) dalamIris trimulans,KOA(BMD) dalam• Umum’ hipermetrop +10D,Add+3D(Ako-)Umum’ hipermetrop +10D,Add+3D(Ako-)• Afakia monokuler Afakia monokuler →→ anisometropia anisometropia• Penatalaksanaan :Penatalaksanaan : . Tes toleransi. Tes toleransi . Kaca mata. Kaca mata . Lensa kontak. Lensa kontak . IOL /peudofakia. IOL /peudofakia
(P = A – 2,5 L – 0,9 K )(P = A – 2,5 L – 0,9 K )
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Dislokasi LensaDislokasi Lensa• Subluksasi lensaSubluksasi lensa Sebagian zonula zinn putus/lemahSebagian zonula zinn putus/lemah Penyebab : Kel’ kongenital(sindroma Penyebab : Kel’ kongenital(sindroma Marfan,Marscesani)Marfan,Marscesani) Kel’ didapat (trauma)Kel’ didapat (trauma) Keluhan : miopia,astigmat,diplopiaKeluhan : miopia,astigmat,diplopia Penyulit : GlaukomaPenyulit : Glaukoma Th/ : Koreksi km max,operasi ekstraksi Th/ : Koreksi km max,operasi ekstraksi
lensa(glaukoma)lensa(glaukoma)
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Dislokasi LensaDislokasi Lensa• Luksasi lensa Luksasi lensa Luksasi anterior . Visus <,lensa di Luksasi anterior . Visus <,lensa di
COA,glaukoma COA,glaukoma kongestif kongestif . Operasi ekstraksi lensa (TIO < ). Operasi ekstraksi lensa (TIO < ) Luksasi posterior . Visus <,lensa di C Luksasi posterior . Visus <,lensa di C
vitreus,uveitis vitreus,uveitis fakotoksik fakotoksik Glaukoma Glaukoma
fakolitik ,hipermetropia fakolitik ,hipermetropia +10D+10D
.Th/ Ekstraksi lensa(penyulit), .Th/ Ekstraksi lensa(penyulit), Th ( - ) (absorpsi) Th ( - ) (absorpsi)
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