I11107014
ANGGI PATRANITA
I11107022
Proliferative retinopathy—spontaneous
rupture of abnormal fragile new vessels that
grow on the retinal surface cause bleeding
into the vitreous cavity. Most common is
proliferative diabetic retinopathy
Retinal detachment—a small retinal blood
vessel may rupture when the retinal break
occurs,bleeding into the vitreous cavity
Trauma
Posterior vitreous detachment can result in
vitreous haemorrhage if,as the vitreous
separates from the retina,it pulls and
ruptures a small blood vessel
Age-related macula degeneration (AMD)—
haemorrhage may occur into the vitreous
from the abnormally weak vessels forming
a subretinal neovascular membrane
The patient complains of a sudden onset of floaters, or
“blobs,” in the vision.
The visual acuity may be normal or, if the haemorrhage is
dense, it may be reduced.
Flashing lights indicate retinal traction and are a dangerous
symptom.
Haemorrhage may occur from spontaneous rupture of
vessels, avulsion of vessels during retinal traction, or
bleeding from abnormal new vessels.
If the patient is shortsighted, retinal detachment is more
likely.
If there is associated diabetesmellitus the patient may have
bled from new vessels and the vitreous haemorrhage may
herald potentially sight threatening diabetic retinopathy.
The visual acuity depends on the extent
of the haemorrhage.
Projection of light is accurate unless the
haemorrhage is extremely dense.
Ophthalmoscopy shows the red reflex to
be reduced; there may be clots of blood
that move with the vitreous
The patient should be referred to an
ophthalmologist to exclude a retinal
detachment.
Underlying causes such as diabetes
must also be excluded.
If a vitreous haemorrhage fails to clear
spontaneously the patient may benefit
from having the vitreous removed
(vitrectomy)
Scleral Buckling, operasi untuk
memperbaiki lepasnya retina
dengan pemasangan pita silicon
yang dijahitkan pada sclera.
Lensectomy, operasi untuk
mengangkat lensa dari mata.
Laser photocoagulation,
pengobatan menggunakan sinar
laser dengan panjang gelombang
tertentu di dalam mata.
Silicone oil, pengisian minyak
silikon untuk menggantikan vitreus
pada beberapa kasus lepasnya
retina. Minyak ini akan dikeluarkan
dari mata dengan operasi
beberapa bulan kemudian.
Central Retina Vein Occlusion
The patient presents with painless loss
of vision, often mixed with sparkles, that
may be sudden or evolve over hours to
days. Systemic hypertension is the most
common cause; hyperviscous and
hypercoagulable states must also be
considered.
Patients may otherwise complain only of a
vague visual disturbance or of field loss
The arteries and veins share a common
sheath in the eye, and venous occlusion
most commonly occurs where arteries and
veins cross, and in the head of the nerve
Thus raised arterial pressure can give rise
to venous occlusion
Visual acuity will not be affected unless
the macula is damaged
Ophthalmoscopy shows characteristic
flame haemorrhages in the affected
areas, with a swollen disc if there is
occlusion of the central vein
Branch Retinal Vein Occlusion (BRVO)
BRVO is a retinal vascular
disease most often related to
hypertension, elevated
lipids/triglyceride/cholesterol,
diabetes, carotid artery
disease, cardiac disease, or
hematologic (blood) disorders.
In BRVO there is an occlusion
of a branch retinal vein by a
compressing, sclerotic retinal
artery. This often leads to
hemorrhage (bleeding), edema
(swelling), or ischemia (poor
circulation) of the retina and
macula with resultant visual
loss.
Central Retinal Vein Occlusion (CRVO)
CRVO is also a retinal vascular
disease but involves occlusion
of the main central retinal vein.
Vascular, hematologic, and
cardiac disease may
predispose individuals to
develop CRVO which leads to
leakage of blood and fluid into
the retina. In many cases the
resultant poor circulation
(ischemia) can lead to
abnormal blood vessel
formation in the iris (rubeosis)
with painful increases in eye
pressure (neovascular
glaucoma).
Hypertension, diabetes mellitus,
hyperviscosity syndromes, and chronic
glaucoma must be identified and treated
if present
Central Retina Artery
the CRA supplies the
superficial nerve fibre
layer and inner two-
thirds of the retina
The choriocapillaris sup-
plies the outer retina
Central Retina Artery Occlusion
The patient complains of a sudden onset
of visual disturbance, often described as
a “greyout” of the vision or as a “curtain”
descending over the vision, in one or
both eyes.
This may be temporary (amaurosis
fugax) if the obstruction dislodges or
permanent if tissue infarction occurs
Causes of retinal arterial occlusion
Emboli
Thrombosis ±atherosclerosis
Congenital thrombophilic states
Acquired thrombophilic states
Vasculitis
Infection
Trauma
Vasospasm
Raised intraocular pressure
Signs
Perform a dilated fundal examination to
detect:
• Cherry red spot at macula.
• Embolus occasionally visible at optic
disc.
• Attenuation of arterioles.
• Retinal pallor.
• Mild disc swelling
Central Retina Artery Occlusion
When the retina
infarcts it becomes
oedematous and
pale and masks the
choroidal circulation
except at the
macula, which is
extremely thin—
hence the “cherry
red spot”
appearance.
Treatment
The aim is to re-establish circulation within the CRA.This is
at-
tempted by:
• Lowering the intraocular pressure (IOP) using:
—acetazolamide 500mg i.v.;
—ocular massage;
—anterior chamber paracentesis (1ml aqueous withdrawn).
• Start cholesterol lowering
statins,e.g.Simvastatin,Atorvastatin.
• Start antiplatelets,e.g.aspirin 300mg stat then 75mg daily or
clopidogrel 75mg daily,within 48hrs.
Prognosis
The prognosis is poor because
irreparable damage to the inner layers of
the retina occurs within one hour.
The prognosis is better where only a
branch of the artery is occluded unless a
macular branch is affected.
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