pediatric ophtalmologi-kuliah uncen.ppt
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PEDIATRICPEDIATRIC
OPHTALMOLOGIOPHTALMOLOGI
Dr. Livia, SpMDr. Livia, SpM
SMF I.K. MataSMF I.K. Mata
RS Dian Harapan, JayapuraRS Dian Harapan, Jayapura
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A. EMERIKSAAN MATA
NEONATUS
Tantangan dokter mata, dokter anak, dokter
keluarga
Gjl non spesifik, prkmbngn anak, modifikasi
pemeriksaan Oftalmoskop direk/indirek, portable slit lamp
Fenilefrin 1%; Siklopentolat 0,%; !omatropin
"%; Tropi#amide 0,"% Opti# dis#, makula
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Inspeksi ekstenal
$upil dilatasi" mgg, refleks lambat,
anisokoria 0,mm &"0%
Oftalmoskopik
'uang gelap,pd (()'&, prdr!n retina *0 s/d
+% bbrp minggu kela!iran
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B. EMERIKSAAN MATA ADA
BAYI & ANAK
isus - respon grkn, fiksasi, reaksi pupil, refleks
kon.ergensi, grkn binokuler, prks satu per satu matasatuna diplester, reaksi penolakan,
nistagmus/strabismus2
'efraksi - sikloplegia utk atasi akomodasi, siklopentolat1%" 3 tts*0 mnt sblm pmrksn; inter.al mnt
atropin 4alf mata 1%, "5* 3/!r "5* !r2
60% !iperopia, % miopia,1% emetropia dan 10% ggn
refraksi2
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$emeriksaan segmen anterior dan posterior -
7 Senter, loupe, slit lamp, oftalmoskop
7 T8O, gonioskop
7 'efleks fundus red reflex
7 'efleks fo.ea
7 Fundus perifer
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C. KELAINAN KONGENITAL
82 (O)9 :9T9
79noftalmos
7 oloboma iris, retina, koroid
7 riptoftalmos, nanoftalmos, mikroftalmos
882
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9noftalmia
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riptotalmus
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:ikroftalmia = oloboma iris
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$tosis (ilateral
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$tosis >nilateral
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8882 O'@
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G)9>O:9 O@G
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Glaukoma ongenital
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orektopia
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oloboma >.ea
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2 )
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atarak ongenital
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'i S d
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'iegers Sndrome
(ilateral $eters 9nomal
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(ilateral $eters 9nomal
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882
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(ergmeisters papilla
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832 S9'9F O$T8>S
7 Bipoplasi saraf optikus
7 oloboma sentralis diskus morning glory
syndrome
32
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9bnormalitas saraf optikus
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oloboma 8ris = Saraf Optikus
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ista okular
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)imbal dermoid
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D. EMERIKSAAN BAYI BUTA DGN
HASIL MRKSN MATA &
NEUROLOGIK YG NORMAL
9maurosis kongenital leber
ebutaan korteks
$erlambatan pematangan .isual
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E. MASALAH
2
ASCA LAHIR
5 8nfeksi5 (enda asing
5 'efraksi
5 Strabismus5 'eaksi alergi
5 elainan kongenital
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12 Oftalmia @eonatorum
5 8nf mata (()bktri, .rs, jmr, klamidia, b!n kimia
5 9ntenatal #aretI infeksi genital ibu !ml5 Berpes genital aktifSe#tio Se#area
A. Infeksi Klamidia
Hi 9S plng srg, !r ke s/d 1+, dI pasti bdninklusi, lb! efktf tI eritromisin sistemik drpd tI
topikal
. !rauma kimia
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au a a
5 O/k prk nitrat, biasana pd !r 1 J "
5 Sebaikna Cada! tertutup sekali pakai
5 Hianjurkan eritromisin,tetrasiklin
C. Infeksi akteri
5 (iasana o/k Stap"# "aemop"ilus# streptokok#
neiseria $O# pseudomonasinf pd !r ke " s/d 2
$d inf klamidiaJ $Okedua ortu !rs jg diobati2
%. Infeksi &irus
5 Hitemukan giant sell, bdn inklusi, tI anti .irus
"2 >.eitis pada 9nak
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"2 >.eitis pada 9nak
5 9simptomatik s/d trjd komplikasi, inf !bt, glaukoma,
katarak, keratopati, dll
5 9da !bngn dgn pnkt sistemik lainna mis- T(, rematoidartritis, infeksi lain
5 TI sikloplegik J kortikosteroid topikal
*2 'etinopati $rematuritas5 Fibroplasia retrolental, bilateral, stadium
5 Faktor risiko KK usia gestasi, (()', asidosis, apneu,
septikemia, transfusi dara!
5 Skrining pada usia +0 mgg "5 + mgg stl! l!r bai dgn
(() L 100 gr 0% ##lomdril
5 Std 888 krioterapi atau fotokoagulasi
+ Gl k k it l
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+2 Glaukoma kongenital
5 Hpt berdiri sendiri atau bersama pen2lain
5 Srg bilateral, fotofobia, lakrimasi, kekeru!an kornea,megalokornea, T8O
5 (uftalmos
2 )eukokoriaatarak, retinoblastoma, retinopati prematuritas,
korpus .itreum primer !iperplastik persisten
' ti bl t
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2 'etinoblastoma
5 M s/d 0% mun#ul pd * t!n pertama
5 *0% bilateraltmr gns fotoreseptor retina, jrg tapifatal
5
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'
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HH2 Fibroplasia retrolental, $B$, #oats,
endoftalmitis, displasia retina
5 T3-
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KELAINAN LENSA
KATARAK5 9mbliopia
5 1 - "0 kela!iran !idup
Morfologi Infantile katarak
5 @uklear katarak
5 ortikal katarak
5 )amelar/4onular katarak
Anterior Katarak
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Anterior Katarak
5 9nterior polar katarak- kena kapsul dan korteks,
lokasi sentral, ke#il, non progressif, .isus normal,btk piramid / #one
Poterior Katarak
5 $osterior lentikonus, $B$, astigmatisma,ambliopia
5 $osterior subkapsular
5 $osterior #orteks
9nterior polar katarak
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9nterior polar katarak
atarak nuklear
t k l l
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atarak lamelar
)entikonus posterior
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)entikonus posterior
atarak subkapsularis posterior
!entuk lain katarak
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!entuk lain katarak
92 ?!ristmas tree #atara#t
:otoni# dstrop!, Bpoparat!roidis$seudo!popara!roidism
(2 ?erulean ?atara#t
(lue dot #atara#t, HoCn sndrome, bilat
?2 :embranous #atara#t
Trauma, intrauterin infeksi
H2 >nilateral #atara#t
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F2 ?atara#t dan infantile Glaukoma
Lowes Syndrome-
O#ulo#erebrorenal sndrome, katarak, glaukoma,pertumbu!an terlambat, !potonia, gangguan ginjal,
amino a#iduria
Rubella syndrome-Gangguan jantung, pendengaran, retardasi mental,
strabismus, mikroptalmus, kornea keru!, glaukoma,
katarak bilateral
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Terapi Katarak
Strategi- segera membersi!kan media refraksi
untuk #ega! ambliopia ire.ersibel
>nilateral #at K mgg, bilateral #at K 10 mgg
" bln pertamanistagmus, strabismus,ambliopia
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isus-*mm kekeru!an #entral, fiksasi
Gerakan mata 'efleks fundus, .isus "0 / M0
Teknik Operasi-
5 Tidak perlu ekspresi nukleus5 Tidak perlu $!akoemulsif
5 apsulotomi anterior, #utting, aspirasi / irigasi
#orteks / nukleus, epitel dibaCa! kaps ant
$ost #apsulotomi
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p
5 >sia "5* t!n8O)
5 ?utting / su#tion
5 ontraindikasi 8??