Penyakit Mata Kering

7/23/2019 Penyakit Mata Kering

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Penyakit Mata kering : Sebuah tinjauandari pendekatan diagnosis dan terapiHui Lin, MD, PhD; Samuel C. Yiu,MD, PhD

Journal of Ophthalmology(2014)28, 173-181



Abstrak • penyakit mata yang umum yang

menyebabkan mata menjadi tidaknyaman, gangguan penglihatan dan berakibat pada kualitas hidup

Kata Kunci• mata kering, penyakit permukaan

okuli, gangguan penglihatan,

pendekatan diagnosis



penyakit yangmultia!torial dari

air mata danpermukaan okuli

kisaran pre"alensi

berkisar darisekitar #$ sampailebih dari %#$ dikelompok usia yang

berbeda&beda

Pengantar



Klasifikasi

'lasiikasi etiopatogenesis (modiikasi dari laporan )**+ D-S.



Penilaian Diagnosis

ri/ayat danpemeriksaan

0ear break&uptime

pe/arnaanpermukaan

okuli denganloresin



Evaluasi Subjektif

1ejala dan ri/ayat pasien mata kering ber"ariasi

ering kurangnya korelasi antarakeparahan gejala dan tanda&tanda matakering



Evaluasi Objektif

0ear break&up time(2%$

pe/arnaankornea(3#$

penilaianilm airmata (+4$

pe/arnaankonjungti"a

(+5$

uji S!hirmer(#5$



-"aluasidengan

0eknologi



Osmolaritas air mata

• osmolaritas 6%*3 m7sms 8 lmerupakan indikator matakering ringan

• 6 %9) m7sms 8 l indikasi

mata kering sedang sampai berat

:ilaiindikator

• 0itik depresi pembekuan(PD

• 0ekanan uap• kondukti"itas listrik atau

impedans

Cara ukurosmolaritas

air mata

<<osmolaritas airmata tidak dapat

digunakan sebagai

satu&satunyaindikator penyakit

mata kering<<



Penilaian stabilitas air mata

• dasar diagnosismata kering

• Tear Break-upTme

• non&in"asiTear Break-upTme (:=>?0

• :=>?0 dapatdiukur dengan

topograikornea,intererometri,aberrometry,penilaianungsional

ketajaman "isual, danmikroskop!onfo!al



rpotensi digunakan

untuk e"aluasi yang tepat danobjekti ilm air

mata

untuk mengukurpenyebaran ilm air

mata ke atas danstabilitas

'e!epatan partikelilm air mata

diukur sebagaisebuah penilaian

hidrodinamika airmata dengan

mela!ak

pergerakanrelekti partikeldalam ilm air

mata

Sebuah program

menentukan

ke!epatan daripartikel saatmereka melintasike atas di ilm air

mata

dapat berpotensidigunakan untuk

e"aluasi klinis daristabilitas ilm airmata yang lebih

tepat dan objekti.

Penilaian partikel film air mata



Sistem analisis topografi

Sistem topograi kornea

seperti 0MS&9 dan

"ideokeratos!opy

dengan ke!epatan tinggi

(HS@ menggantikan

keratometers untuk

menge"aluasi indeks

keteraturan permukaan(SA=, danindeks

asimetri permukaan

(SB=

pola topograi dapatdigunakan untukmenge"aluasiketeraturan permukaan

kornea dan stabilitasilm air mata



Aberrometri"a#efront a$errometry memungkinkan penilaian non&in"asi dari gangguan "isual yang disebabkan oleh penyimpangan susunan yang lebih tinggi yang

timbul dari ketidakstabilan ilm air mata dan $reak-up

Perubahan pada "olume air mata dan

dinamikanya

pola

karakteristik dimata normal

dan mata kering

Pemberian perlahan&lahanair mata buatan telahterbukti mengurangi

penyimpangan dalam matakering ketika pengukurandiambil setelah beberapa

detik

untuk mendeteksi matakering dan untuk

memantau eekti"itaspengobatan



Ketajaman fungsional visual

pasien denganmata kering

mungkin memilikimasalah mengaturpandangan yang

jelas ketikamenatap

@B adalahukuran

ketajaman "isual selama

mata terbukatanpa berkedip.

@B menurunse!ara signiikanpada pasien mata

kering sindromnon&Sjgren (:SS

dan Sjgrensyndrome (SS

sistem terbaru pengukuran terus menerus @B (@BM, :=D-', 1amagori,

epang telah dikembangkan, yang memungkinkan ketajaman "isusmonokuli terus menerus selama %* detik tanpa kedipan.

berguna untuk menge"aluasi pasien dengan ketidakstabilanair mata dan telah dilaporkan bah/a penilaian berkorelasi dengan 0>?0



Tomografi

koherensi optik

• Segmen anteriortomograi koherensi

optik (7C0 dapatmengukurketebalan lapisanair mata danparameter menis!usair mata yangmenunjukkan total "olume air mata

Microskopconfocal non-

kontak

• Sebuah non&kontak,tan%em&&!annng mikroskop !ono!almenunjukkangambar real-tme telah digunakanoleh beberapapeneliti mengamatiilm air mata



Evaluasi permukaanmata dan peradangan

Mikroskop !ono!al

Mi!rokop kornea!ono!al in "i"o(=@CM adalahsebuah no"el,

nonin"asi, alat&resolusi tinggi yang

memungkinkanpen!itraan kornea

pada tingkat sel danmemberikan gambar

yang sebandingdengan metode

histokimia.

-"aluasi kelenjar

meibomM1D adalah

penyebab palingumum dari mata

kering karenae"aporasi

Meiboskopi

Meibograi

Meibometri

Pe/arnaan kornea

dan konjungti"amerupakan prosedur

in"asi yangmemungkinkan

penilaian kerusakanpermukaan okuli

dengan

menanamkanpe/arna sepertinatrium luores!ein,

ro&e $engal , ataul&&amne hijau.

'esan sitologikonjungti"a atau

sikat sitologiPenelitian telah

menunjukkan bah/asitokin =L&9a, =L&9bmatang, dan =L&9Aa

ditemukan dalampersentase yang lebih

tinggi dari spesimensitologi konjungti"adari mata dengan SS,

daripada yang berasal dari mata

normal



Testes lain

• m e n g u k u r p e n y e r a p a n l u o r e s ! e i n d i p u s a t k o r n e a d a n d i a n g g a p s e n s i t i

m e n g u k u r i n t e g r i t a s e p i t e l

luorophotometri



Pengobatan



Perawatan anti-inflamasi

Siklosporin B

bereek imunosupresi dan anti&inlamasimelalui beberapa jalur

Steroid

Sering di kombinasidengan CSB

Steroid topikal jugadigunakan untuk

meredam peradanganpada permukaan okuli

pada mata kering,

rekuensi dosis tinggi

dapat meningkatkaneisiensi pengobatan,

beberapa pasienmengalami eek tidak

nyaman

memblokadesiklooksigenase,

produksi prostaglandindari asam arakidonat

dan stimulasiapoptosis dari limosit



Aeseptor untuk androgen,estrogen, progesteron,dan prolaktin telahdiidentiikasi dalam beberapa jaringan mata,termasuk kelenjarlakrimal dan kelenjarmeibom

pengolesan androgentopikal dan hormonsteroid estrogen selama%&5 bulan juga telahditemukan untukmenunjukkan perbaikanklinis

0erapihormonal

antibioti! makrolid(aEitromisin danturunannya tetrasiklin(tetrasiklin,doFy!y!line,danmino!y!line memiliki bahan imunomodulator

untuk mengurangiperadangan permukaanmata dan menormalkanproduksi lemak olehkelenjar meibom

sangat berguna dalammata kering sekunderkarena rosa!ea okuli dan blepharitis

Bntibiotik



Perawatan tambahan

Bsam Lemak-sensial (-Bs

• 7mega&% (asamala&linolenatdan omega&4(asam linoleat

• sebagian besar buktimenunjukkanomega&%, dapat

mengurangikeparahan matakering

aktorpertumbuhansara (:1

• untukmeningkatkansensiti"itaspermukaan mata,menghambatreaksi inlamasidan mengaturproduksi lapisanair mata

• penggunaan :1eksogen mungkin bermanaatdalammemulihkan

kerusakanpermukaan okuli

Serum autologus

• Butologus danserum tali pusarmengandungEat&Eat yangmendukungprolierasi,dierensiasi, danpematangan dari

epitelpermukaan mata

yang normal



Perawatan tambahan

• P e n g g u n a a n a k u p u n k t u r s e b a g a i p e n g o b a t a n u n t u k p e n y a k i t m a t a d i d a s a r k a n

p a d a k l a i m b a h / a a k u p u n k t u r m e m o d u l a s i s i s t e m s a r a o t o n o m d a n s i s t e m k e k e b a l a n t u b u h

akupuntur



Pembedahan

S u m b a t a n p u n ! t a l

• S u m b a t a n p u n ! t a l m e n g u r a n g i d r a i n a s e , m e n j a g a a i r m a t a d a n m e m p e r p a n j a n g e e k p e l u m a s

P r o s e d u r k e l e n j a r l u d a h

• k e l e n j a r l u d a h s u b m a n d i b u l a r k e d a e r a h t e m p o r a l d a n i m p l a n d a r i d u k t u s " h a r t o n k e o r n i k s a t a s

• P a r a p a s i e n m e l a p o r k a n r a s a s u b j e k t i l e g a d a r i g e j a l a m a t a k e r i n g s e g e r a s e t e l a h o p e r a s i .

S u b k u t a n e u s a b d o m i n a l

p o m p a & / a d u k a i r m a t a b u a t a n • P o m p a / a d u k a i r m a t a b u a t a n d i s a r a n k a n o l e h ' u r u $ e u n t u k p e n g o b a t a n m a t a k e r i n g y a n g p a r a h



Kesimpulan

Pada kesimpulan, pemahaman patogenesis dan responseluler tertentu yang terlibat dalam berbagai bentukmata kering dapat mengakibatkan pengembangan

strategi pengobatan lainnya untuk manajemen yanglebih baik dan hasil jangka panjang. >ukti peradangan yang berimplikasi pada patogenesis mata kering telah

membuka jalan baru untuk pengobatan gangguankompleks ini. Pengembangan pilihan pengobatan

tambahan dalam bentuk senya/a menargetkankomponen tertentu seperti penghalang epitel, sarakornea, konjungti"a sel goblet, atau sel&sel imun dan

sitokin yang terlibat dalam reaksi inlamasi okular akanmemberikan harapan bagi jutaan orang yang setiap hari

mengalami kondisi merugikan ini.



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