retina nss2013

7/23/2019 Retina Nss2013

http://slidepdf.com/reader/full/retina-nss2013 1/46

Vitreo-Retina

Vitreo-Retina Subdivision

Ophthalmology Department

Faculty of Medicine and Health Sciences

Jenderal Soedirman University / Margono Soekarjo General Hospital

7/23/2019 Retina Nss2013


Vitreous

• A water (99%) and Hyaluronic acid &

collagen (1%) mix

• Optically clear, fills centre of globe

• Firm adhesions to optic nerve, peripheral

retina at ora serrata and retinal blood

vessels can produce retinal detachment

when they tear loos

• Normally shrinks somewhat with age

– Sineresis, Posterior vitreous detachment

7/23/2019 Retina Nss2013


Vitreous

• Abnormality

–

Floater / turbidity

• Degeneration, Haemorrhage, infection /

inflammation

• Thin - dense

– Flashes

•

Traction to retina

7/23/2019 Retina Nss2013


Posterior

VitreousDetachment

Traction Vitreous /

Retinal Break

7/23/2019 Retina Nss2013


Retina

Normal retina •

Optic disc

•

Superior temporal arcades

•

Inferior temporal arcades

•

Macula

•

Fovea

7/23/2019 Retina Nss2013


Anatomy

7/23/2019 Retina Nss2013


Anatomy

• Retina layers

7/23/2019 Retina Nss2013


Vision

Biochemistry of Vision:• Visual proteins are based on Vit.A•

Stimulation by light causes abiochemical cascade

•

Electrophysiological changes aretransmitted and modified through the

layers of the retina to the ganglioncells that form the optic nerve

7/23/2019 Retina Nss2013


Vision

Central Vision:• The foveola has the most detailed

vision

•

High density of cones•

Reduction in the inner layers toreduce obstruction to light

•

High (near 1:1) ratio of cones toganglion cells

7/23/2019 Retina Nss2013


Vision

Retinal Pigment Epithelium:

• The RPE provides special metabolic and ionic conditionsnecessary for the rods and cones and is essential fornormal vision

•

Aging changes in the RPE result in Age Related MacularDegeneration

• Highly vascular portion of the uvea

• Supplies the outer retina with much of its metabolic

requirements

7/23/2019 Retina Nss2013


Examination

•

Physical examiantion –

Slit Lamp Biomicrosopic with• Condensing Lens

•

Goldman three mirror – Ophthalmoscope

• Direct

• Indirect

•

Additional examination –

Fundus Photo Color

–

Fundus Fluorescein angiography

–

Ultrasonography

7/23/2019 Retina Nss2013


Goldman Three Mirror Condensing Lens

Slit lamp Biomicroscopic

7/23/2019 Retina Nss2013


Indirect Ophthalmoscope

Direct Ophthalmoscope

7/23/2019 Retina Nss2013


Fundus Fluorescein angiography

7/23/2019 Retina Nss2013


Ultrasonography

7/23/2019 Retina Nss2013


Retinal Abnormality

• Dystrophy

• Degeneration

•

Infection / Inflammation• Vascular

• Detachment

•

Tumor

7/23/2019 Retina Nss2013


Dystrophy

• Retinitis Pigmentosa

• Stargard’s Disease

7/23/2019 Retina Nss2013


Retinitis Pigmentosa

•

Hereditary degeneration

–

Fotoreceptor

• Dysfunction, Loss and atrophy.

•

Autosomal recessive, autosomal dominant,x-linked rescessive and 1/3 no familyhistory

7/23/2019 Retina Nss2013


Retinitis Pigmentosa

•

Symptom :

– Niktalopia

– Constricted visual field

•

Sign : – Bone spicule – like

pigmentation in fundus

– Arteriolar narrowing

•

Treatment

–

Low vision aid

–

No direct medical

treatment

7/23/2019 Retina Nss2013


Stargardt disease

•

Juvenile macular dystrophy•

Gen ABC4R on lp 21-22

• Symptom

–

Presentation on second decades – Gradual impairment of central vision

•

Signs

–

Geographic atrophy

–

Fovea may be normal or non specific

•

Treatment

– Low vision aid

–

No direct medical treatment

7/23/2019 Retina Nss2013


Stargardt disease

7/23/2019 Retina Nss2013


Degeneration

•

Myopic degeneration

• Age related macular degeneration

7/23/2019 Retina Nss2013


Myopic degeneration

•

Pathologic / high Myopia

–

Progressive elongation of the eye

• Thinning RPE and choroid

• > - 6.00 D

•

Axial length > 26 mm

• Liable to glaucoma and cataract

• Treatment

–

Limited to optical correction, intra-ocular pressure

control, and attention to complications that may occur. –

Scleral buckling can prevent axial extension and mayminimize the toll of myopic macular degeneration on

future visual function.

7/23/2019 Retina Nss2013


Myopic degeneration

7/23/2019 Retina Nss2013


ARMD(Age Related Macular Degeneration)

•

The most common cause of central visionloss in persons older than 50 years of agein developed countries.

!

Symptom! In the early stages! central vision may be blurred or distorted,with objects looking an unusual size or

shape and straight lines appearing wavyor fuzzy (quickly or over several months).

7/23/2019 Retina Nss2013


Dry ARMD

•

Dry ARMD (90%) – Drusen (yellowish deposits of debris in retina)

– Atrophic

•

Treatment –

eat a diet rich in leafy green vegetables,antioxidants,zinc, lutein and zeaxanthin.

– avoid excessively bright sunlight (ultraviolet

(UV) rays and blue light) – don't smoke

– contact a low vision specialist if vision worsens

7/23/2019 Retina Nss2013


Wet ARMD

•

Wet Armd (10%), More progressive – Choroidal neovascularization

• Treatment

–

Laser photocoagulation –

Photodynamic therapy

–

Macular translocation

– Sub macular surgery

7/23/2019 Retina Nss2013


7/23/2019 Retina Nss2013


Infection / Inflammation

•

Chorioretinitis toxoplasma (toxoplasmosis) – intracellular protozoan Toxoplasma

gondii

•

Mammal and bird hosts. – (The most common intermediatehost is the cat).

– It is one of the most frequent causes of

retinochoroiditis in humans, 75 % theworld's general population possessingsome seropositive findings.

7/23/2019 Retina Nss2013


Toxoplasmosis

•

Symptoms –

unilateral, mild ocular pain, blurred vision andnew onset of floating spots.

• Clinical findings

–

granulomatous iritis, vitritis, optic disc swelling,neuroretinitis, vasculitis and retinal veinocclusion in the vicinity of the inflammation, inthe actively involved eye.

–

Funduscopically:

•

active toxoplasmosis presents with white-yellow, choreoretinal lesions and vitreouscells

•

There may be old, inactive lesions in thefellow eye

7/23/2019 Retina Nss2013


7/23/2019 Retina Nss2013


Treatment

•

Alternative treatments• clindamycin, tetracycline, trimethoprim /

sulfamethoxazole,

•

After beginning antibiotic therapy, add oralsteroids at a dose of 20 to 80mg PO dailyfor four or six weeks

7/23/2019 Retina Nss2013


Active toxoplasmosis

Inactive toxoplasmosis

7/23/2019 Retina Nss2013


Retinal vascular disease

•

Diabetic retinopathy• Hypertensive retinopathy

• etc

7/23/2019 Retina Nss2013


Diabetic Retinopathy

•

Hyperglycaemia• Loss of pericyte• Thickening of basement membrane• Alteration of coagulation state

•

Non-proliferative DR – Microaneurism –

Dot & blot intraretinal hemorrhage

– Hard exudates

–

Dilatation and beading of retinal vein

• Proliferative DR – Neovascularization

• On the disc or else where

7/23/2019 Retina Nss2013


Diabetic Retinopathy

•

Treatment – Glucose and other systemic abnormality control –

Laser photocoagulation

– Vitrectomy

7/23/2019 Retina Nss2013


PDR

NPDR

7/23/2019 Retina Nss2013


Hypertensive retinopathy

•

WHO definition – Systolic blood pressure >140 mm Hg

– Diastolic blood pressure > 90 mm Hg

•

HT can affect the choroid, retina, and opticnerve

• Hypertension can cause:

–

Nerve Fiber Layer micro-infarcts, calledCotton Wool Spots - due to disruption ofaxoplasmic transport

– Dot/Blot and flame shaped hemorrhages

7/23/2019 Retina Nss2013


Hypertensive Retinopathy

Modified Scheie Classification – Grade 0 No changes

–

Grade 1 Minimal arteriolar narrowing

–

Grade 2 Obvious arteriolar narrowing withfocal irregularities

–

Grade 3 Grade 2 + retinal hemorrhages and/or exudate

–

Grade 4 Grade 3 + swollen optic nerve(Malignant hypertension)

7/23/2019 Retina Nss2013


Hypertensive Retinopathy

•

Management – Lower the blood pressure gradually to

decrease risk of blindness and stroke

7/23/2019 Retina Nss2013


Grade III

Grade IV

7/23/2019 Retina Nss2013


Retinal Detachment

•

Detachment the nuero-sensory retina fromthe underlying pigment epithelial layer bysubretinal fluid – Exudativa

•

Uveal effusion (infection or inflammation)• Treatment : Underlying disease

–

Rhematogenous• Retinal break

•

Treatment : Scleral Buckling, Vitrectomy – Tractional

• Proliferative DR• Treatment : Vitrectomy

7/23/2019 Retina Nss2013


Rhegmatogen RD

7/23/2019 Retina Nss2013


Tractional RD

Exudative RD

7/23/2019 Retina Nss2013


Tumor

•

Retinoblastoma• Hemangioma choroid• Tumor sub division

7/23/2019 Retina Nss2013


Thank you

retina nss2013

Documents