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CALM EYEWITH SLOWLY DECLINE OF VISUALLOSS
Dwi Permana Putra – 1011131066
Tanjungpura University
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Hypertensive Retinopathy
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Hypertensive Retinopathy
• Retinal vascular amage cause !yhypertension
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"linical #ani$estation
• #ost patients are asymptomatic
• %ome presents heaaches an !lurre vision
• &n ophthalmoscopy'
– (enerali)e arteriolar narrowing
– "hanges o$ the arterovenous crossings
– *lame Haemorrhage
– #icroaneurysms
– +,uates
– -rteriolar macroaneurysms – "otton.wool spots
– &ptic isc swelling
– */PT *ocal /ntraretinal Periarterioal Transuates
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(raing o$ Hypertensive Retinopathy2eith an egner "lassi4cation 1535
• Grade I *igure-
• %light narrowing
• /t consists o$ milgenerali)e arteriolarattenuation7 particularlyo$ small !ranches !roaening o$ thearteriolar light re8e,
an vein concealment• asymptomatic
hypertension
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• Grade II *igure 9
• /t comprises mar:egenerali)e narrowingan $ocal attenuationo$ arterioles associatewith e8ection o$ veinsat arteriovenouscrossings %alus; sign
• 9P is higher ansustaine
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• Grade III *igure "
• This consists o$ (rae //changes plus copper.wiring o$arterioles
• !an:ing o$ veins istal to
arteriovenous crossings9onnet sign
• tapering o$ veins on eithersie o$ the crossings (unnsign an right.angle
e8ection o$ veins %alu; ssign
• *lame.shape haemorrhages7cotton.wool spots an hare,uates are also present
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• Grade IV *igureD
• This consists o$ allchanges o$ (rae ///plus silver.wiring o$
arterioles anpapilloeema
• Heaache7 asthenia7loss o$ weight7 yspnea7
visual istur!aces7impairment o$ cariac7cere!ral an renal$unction
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Diagnosis
• history o$ the patients
• ophthalmoscopyirect or inirect
•
#ay reveal ecreaseo$ patient vision7occipital heaachean high 9loopressure
• Physical +,amination
• etect elevation o$!loo pressure
• &phthalmoscopy – (enerali)e arteriolar
narrowing
– "hanges o$ thearterovenous crossings
– *lame Haemorrhage
– #icroaneurysms
– +,uates
– -rteriolar macroaneurysms
–
"otton.wool spots – &ptic isc swelling
– */PT *ocal /ntraretinalPeriarterioal Transuates
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Di
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#anagement
• - major purposes o$ treatment
– prevent7 limit7 or reverse such target organamage !y lowering the patient;s high !loopressure
• =i$estyle changes promote healthy li$estylee,ercise7 consume healthy $oos
• -vice patient to reuce the !loo pressure
–
Ta:ing the meication – Re$erral to meical team %urgical management is
inicate to aress certain seconary causes o$systemic hypertension
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"omplication
• hypertensive retinopathycomplications – venous occlusion !ranch > central
retinal artery
– macular eema
– proli$erative vitreoretinopati
• -ll o$ these changes ultimately leato ecrease visual acuity an!linness
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Retinitis Pigmentosa
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Retinitis Pigmentosa
• Retinitis pigmentosa RP is a groupo$ inherite isorers characteri)e!y progressive peripheral vision loss
an night vision i?cultiesnyctalopia that can lea to centralvision loss
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Pathophysiology
• RP is typically thought o$ as a ro.coneystrophy in which the genetic e$ectscause cell eath apoptosis –
preominantly in the ro photoreceptors – the genetic e$ects
– cone photoreceptors
• RP has signi4cant phenotypic variation
patients with the same genetic mutationcan present with very i
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• Photoreceptors is shortening o$ the ro outersegments loss o$ the ro photoreceptor
occur in mi periphery o$ the retina
Theseregions o$ the retina re8ect the cell apoptosis !yhaving ecrease nuclei in the outer nuclear layer
• the egeneration tens to !e worse in the in$erior
retina
suggesting a role $or light e,posure• The 4nal common pathway in RP is typically eath
o$ the ro photoreceptors that leas to vision loss most ensely $oun in the miperipheral retina7cell loss in this area tens to lea to peripheralvision loss an night vision loss
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+tiology
• Photoreceptor cell eath most o$ thephotoreceptor cells are ros
• #olecular e$ect more than onehunre i
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/ncience
• &ccurs B persons per 1000 o$ theworl population
• -ppears in the chilhoo progressesslowly !linness in avancemile age
• #ale are more commonly a
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"linical *eatures
• 1 isual %ymptoms
• Night bin!ne"" /t is the characteristic$eature an may present several years
!e$ore the visi!le changes in the retinaappear ue to egeneration o$ the ros
• Dark adaptation =ight threshol o$ theperipheral retina is increase the process
o$ ar: aaptation itsel$ is not a
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C *unus "hanges 4g1
• Retinal pigmentary changes these are typically perivascularan resem!le !one corpuscles inshape
• Retinal arterioles are narrowe
an may !ecome threa.li:e inlate stages
• Optic disc !ecomes pale anwa,y in later stages anultimately consecutive opticatrophy occurs *igC
•
Other associated changes whichmay !e seen are colloi !oies7choroial sclerosis7 cystoimacular oeema7 atrophic orcellophane maculopathy
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3 isual *iel "hanges
• Annular or ring-shapedscotoma is a typical $eaturewhich correspons to theegenerate eEuatorial)one o$ retina
• -s the isease progresses7scotoma increasesanteriorly an posteriorlyan ultimately only centralvision is le$t tubular vision
• +ventually even this is alsolost an the patient!ecomes !lin
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Treatment
• Fo e
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-ge.Relate #acular
Degeneration
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• senile macular degeneration
• is a !ilateral isease o$ persons o$B5 years o$ age or oler
• /t is a leaing cause o$ !linness inpopulation a!ove the age o$ 6B years
• /t is o$ two types non#e$%!ati&e an e$%!ati&e
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Ris: *actors
• Hereity
• Futrition
•
%mo:ing• Hypertension
• +,posure to sun light
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"linical types
• 1 on!exudative or atrophi" ARMD
• dry or geographic ARMD 50 percentcases
• causes mil to moerate7 graual losso$ vision
• Patients may complain o$ istorte
vision7 i?culty in reaing ue tocentral shaowing
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• Ophthalmoscopically *ig11C6-
• it is characterise !y
• occurrence o$ rusens colloi!oies
•
pale areas o$ retinal pigmentepithelium atrophy
• irregular or clusterepigmentation
• Drusens appear as smalliscrete7 yellowish.white7 slightly
elevate spots• later stages enlargement o$
the atrophic areas within whichthe larger choroial vessels may!ecome visi!le
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C +,uative -R#D
• Wet or neovascular ARMD 10 rapily progressivemar:e loss o$ vision
• %tages' – %tage o$ rusen $ormation7
– %tage o$ retinal pigmentepithelium RP+ etachment
– %tage o$ "F *ig 11C69
– %tage o$ haemorrhagic
etachment o$ RP+
–
%tage o$ haemorrhagicetachment o$ neurosensoryretina
– %tage o$ isci$orm scarringmacular egeneration
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Diagnosis
• +,amination o$ the macula slitlamp !iomicroscopy with a I50D>IJKD non.contact lens
• undus !uorescein angiographyindocyanine green angiography help in etecting "F in relation to
$oveal avascular )one
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Treatment
• There is no e
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Treatment $or e,uative-R#D
• Argon green-laser photocoagulation is the treatment o$ choice $ore,tra$oveal o$ "F#
• "hotodynamic therapy #"D$% is the treatment o$ choice $or su!$ovealan ju,ta$oveal classic "F# /n PDT7 vertipor4n7 a photosensiti)er orlight activate ye is injecte intravenously The area o$ "F# is thene,pose to light $rom a ioe laser source at a wavelength 6K5 nmthat correspons to a!sorption pea: o$ the ye The light.activate yethen causes isruption o$ cellular structures an occlusion o$ "F# withminimum amage to ajacent RP+7 photoreceptors an capillaries
• $ranspupillary thermotherapy #$$$% with a ioe laser K10 nm may !econsiere $or su!$oveal occult "F# PDT is e4nitely !etter than TTT !ut is very costly
• &urgical treatment in the $orm o$ su!macular surgery to remove "F#an macular translocation surgery are !eing evaluate
• "harmacologic modulation with antiangiogenic agent li:e inter$eronal$a.C57 an inhi!itor o$ vascular enothelial growth $actor +(*
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+ye /nto,i4cation
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/ntrouction
• The to,ic retinopathies $orm aiverse group o$ conitions thatresult $rom retinal amage cause !y
systemically aministere rugs
• relatively rare particularly when$eatures o$ !ilateral pigmentary
istur!ance or retinal crystaleposition are present
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"H=&R&LU/F+ -FD
HMDR&AM"H=&R&LU/F+
• "hloroEuine was populari)e 4rst $or theprophyla,is an treatment o$ malaria
• as an e
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• The ea'ie"t $unus are irregularityin the macular pigmentation an!lunting o$ the $oveal re8e,
• the central irregular pigmentation may!ecome surroune !y a concentric)one o$ hypopigmentation7 usuallyhori)ontally oval an more prominent
in$erior to the $ovea *igure 1• This paracentral epigmentation results
in the classical !ull;s.eye maculopathy
• continue e,posure to the rug generali)e pigmentary changes
• En!#"tage appearance may !einistinguisha!le $rom that o$ a cone.ro ystrophy7 with peripheral pigmentirregularity an !one spicule $ormation7vascular attenuation7 an optic iscpallor
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Thioria)ine
• antipsychotic rug
• -$ter C wee:s !lurring7nyctalopia7 an a !rownish visualiscoloration
• vision was normal to pro$ounlyreuce
• $unus coul appear normal change a couple o$ wee:s
• Pigment granularity evelopeposterior to the eEuator
• geographic areas o$ epigmentationan loss o$ choriocapillaris
evelope *igC• /$ the rug was withrawn early
a$ter the onset o$ symptoms7 thepatients usually reporteimprovement in vision
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Fiacin
• nicotinic aci7 vitamin 96 to lower
serum cholesterol
• patients who ta:e 1B g or more ailyevelop maculopathy Rarely
• central visual changes in wee:s ormonths a$ter the initial aministration
o$ the rug• Reuction in visual acuity is usually
mil to moerate
• The patients evelop a !ilateralmaculopathy that has the clinicalappearance o$ cystoi macular eema7!ut there is no ye lea:age or
accumulation with 8uoresceinangiography
• &ptical coherence tomography &"Treveals the presence o$ cystoi spacesin the inner nuclear an outerple,i$orm layers *ig3
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Tamo,i$en
• Tamo,i$en is a nonsteroialestrogen antagonist !reastcancer
• Retinopathy was 4rst escri!eamong women treate with morethan 1K0 mg>ay $or longer than a
year• These patients usually ha a
symptomatic ecrease in vision
• The characteristic $unus 4ningswere small7 white7 re$ractileeposits in the inner retina
• -ssociate pigmentary irregularity *igN
• *luorescein angiographyemonstrate macular eema inmost cases
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De$ero,amine
• De$ero,amine mesylate is a chelatingagent use to remove to,ic levels o$heavy metals $rom the !oy
• reuce iron levels in patients withtrans$usion.epenent anemia an totreat aluminum to,icity "hronic Renal
• The onset o$ visual symptoms occur
a$ter long e,posure• Patients usually complain o$ !lurre
vision7 nyctalopia7 color visiona!normalities7 or visual 4el restriction
• the $unus may appear normal or su!tlepigment
• "olor vision is $reEuently a!normal7
typically with a tritan yschromatopsia• The maculopathy may progress
evelop into coarse macular pigmentarychanges *igB occasionally7peripheral pigmentary clumping
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Dianosine
• Dianosine is an antiretroviral rug human immunoe4ciency virus in$ection
• &$ N3 chilren receiving ianosine$ollowe prospectively7 3 Jevelope an asymptomatic peripheralretinal egeneration 4rst note a$ter 5–15 months o$ therapy
• The 4nings consiste o$ small7 sharplyemarcate areas o$ retinal an retinalpigment epithelial atrophy aroun themiperiphery *ig 6
• isual acuity remaine normal in allpatients
• &ne patient who was a!le to unergo
relia!le testing emonstrate milrestriction o$ the peripheral visual 4el
• "linical 4nings inclue normal visualacuity7 4el e$ects7 an a!normalelectro.oculogram +&(
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Than: Mou
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