RETINA-1

Dr. Gilbert WS Simanjuntak

Bagian IP Mata FK-UKI
SMF IP Mata RS PGI Cikini

Introduction
while they were saying among themselves
it COULD NOT be done,
BEHOLD IT WAS DONE
Helen Keller

Retina

Thin, semitransparent, multilayered sheet of

neural tissue
Lines the inner aspect of the posterior two-thirds
of the wall of the globe
Anterior ending point: ora serrata
The retina and and retinal pigment epithelium are
easily separated: subretinal space

Ten layers of retina, starting from inner aspect:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Internal limiting membrane

Nerve fiber layer
Ganglion cell layer
Inner plexiform layer
Inner nuclear layer (bipolar, amacrine,
horizontal cell bodies)
Outer plexiform layer
Outer nuclear layer of photoreceptor cell nuclei
External limiting membrane
Photoreceptor layer
Retinal pigment epithelium

Sepuluh Lapisan Retina

1. Lp. Epitel pigmen
2. Lp. Batang dan kerucut
3. Membran limitans eksterna
4. Lp. Nukleus luar
5. Lp. Pleksiform luar
6. Lp. Nukleus dalam
7. Lp. Pleksiform dalam
8. Lp. Sel ganglion
9. Lp. Serabut saraf
10.Membran limitans interna

2
3
4

5
6

7
8
9
10

Thickness:
0.1 mm at the ora serrata
0.23 mm at the posterior pole

Area 1.5 mm in diameter, yellowish pigmentation

resulting from the presence of luteal pigment
(xanthophyll): macula

Blood supply from two sources:

Outer third (outer plexiform and outer nuclear layers,
the photoreceptors, and the RPE): choriocapillaris
Inner two-thirds: branches of the central retinal artery

Fovea supplied entirely by the choriocapillaris

Retinal blood vessels non fenestrated
endothelium: inner blood-retinal barrier
RPE: outer retinal-blood barrier

The Vitreous

A clear, avascular, gelatinous body

99% water
1% collagen and hyaluronic acid

Comprises two-thirds of the volume and weight of

the eye
Outer surface: the hyaloid membrane
Vitreous base: firm attachment throughout life to
the pars plana epithelium and the retina
immediately behind the ora serrata
Also attach to the lens capsule and optic disc

Examination

Slitlamp/biomicroscope examination (+60D,

+78D, +90D):

Anterior segment (rubeosis iridis, cataract, etc)

PVD (Weiss ring)
Syneresis
Vitreous hemorrhage
Fibrovascular proliferation

Non-contact vs contact lens

Pupil dilation, topical anestetics, viscous solution
Image resolution

Direct/Indirect

Ophthalmoscope

B-scan Ultrasonography
diagnostic and prognostic, especially in media haze
(corneal scar, small pupil/posterior synechiae, dense
cataract or vitreous opacification)

Fundus Fluorescein Angiography

Electrophysiology Testing

Vitreous Disorders

Vitreous floaters
Asteroid hyalosis: little/no effect upon vision
Acute vitreous collaps: syneresis, photopsia
It should be assumed that patients with new floaters
or photopsia have retinal tears or detachment until
proved otherwise by thorough examination with an
indirect ophthalmoscope

Prolifrative vitreoretinopathy
Vitreous loss due to trauma
Vitritis
Vitrectomy

Color Vision Defects

Intraocular Tumors

Retinal angioma
Vision affected by uxudation or bleeding from the
tumor vessels
Photocoagulation, diathermy or cryotherapy are
treatment modalities

Retinoblastoma
Life-endangering of childhood
The normal retinoblastoma gen, present in every
individual, is a supresor gene or anti-oncogene
Exophytic and/or exophytic, extend through the optic
nerve to the brain
Large tumor: enucleation; small: radiotherapy,
cryotherapy, photocoagulation and/or chemotherapy

Lymphoma
Malignant/choroidal melanoma
Hemangioma
Metastase tumor from kidney, lung and breast

THANK YOU