Retina Nss2013
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Transcript of Retina Nss2013
7/23/2019 Retina Nss2013
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Vitreo-Retina
Vitreo-Retina Subdivision
Ophthalmology Department
Faculty of Medicine and Health Sciences
Jenderal Soedirman University / Margono Soekarjo General Hospital
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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
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Vitreous
• Abnormality
–
Floater / turbidity
• Degeneration, Haemorrhage, infection /
inflammation
• Thin - dense
– Flashes
•
Traction to retina
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Posterior
VitreousDetachment
Traction Vitreous /
Retinal Break
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Retina
Normal retina •
Optic disc
•
Superior temporal arcades
•
Inferior temporal arcades
•
Macula
•
Fovea
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Anatomy
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Anatomy
• Retina layers
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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
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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
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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
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Examination
•
Physical examiantion –
Slit Lamp Biomicrosopic with• Condensing Lens
•
Goldman three mirror – Ophthalmoscope
• Direct
• Indirect
•
Additional examination –
Fundus Photo Color
–
Fundus Fluorescein angiography
–
Ultrasonography
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Goldman Three Mirror Condensing Lens
Slit lamp Biomicroscopic
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Indirect Ophthalmoscope
Direct Ophthalmoscope
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Fundus Fluorescein angiography
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Ultrasonography
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Retinal Abnormality
• Dystrophy
• Degeneration
•
Infection / Inflammation• Vascular
• Detachment
•
Tumor
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Dystrophy
• Retinitis Pigmentosa
• Stargard’s Disease
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Retinitis Pigmentosa
•
Hereditary degeneration
–
Fotoreceptor
• Dysfunction, Loss and atrophy.
•
Autosomal recessive, autosomal dominant,x-linked rescessive and 1/3 no familyhistory
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Retinitis Pigmentosa
•
Symptom :
– Niktalopia
– Constricted visual field
•
Sign : – Bone spicule – like
pigmentation in fundus
– Arteriolar narrowing
•
Treatment
–
Low vision aid
–
No direct medical
treatment
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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
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Stargardt disease
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Degeneration
•
Myopic degeneration
• Age related macular degeneration
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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.
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Myopic degeneration
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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).
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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
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Wet ARMD
•
Wet Armd (10%), More progressive – Choroidal neovascularization
• Treatment
–
Laser photocoagulation –
Photodynamic therapy
–
Macular translocation
– Sub macular surgery
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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.
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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
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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
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Active toxoplasmosis
Inactive toxoplasmosis
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Retinal vascular disease
•
Diabetic retinopathy• Hypertensive retinopathy
• etc
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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
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Diabetic Retinopathy
•
Treatment – Glucose and other systemic abnormality control –
Laser photocoagulation
– Vitrectomy
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PDR
NPDR
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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
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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)
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Hypertensive Retinopathy
•
Management – Lower the blood pressure gradually to
decrease risk of blindness and stroke
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Grade III
Grade IV
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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
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Rhegmatogen RD
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Tractional RD
Exudative RD
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Tumor
•
Retinoblastoma• Hemangioma choroid• Tumor sub division
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Thank you