Pembahasan To Aao Section 12

SOAL DAN PEMBAHASAN TO AAO SECTION 12
4 OKTOBER 2021
1. The most critical and constant finding in retinitis pigmentosa is
a. dense bone-spicule pigmentation in the retinal periphery
b. an abnormality in the rhodopsin gene
c. acquired red-green color deficiency
d. significantly reduced electroretinogram (ERG)
e. small tubular visual fields
Jawaban : D
Retinitis pigmentosa Distrofi sel batang dan sel kerucut
Gejala klinis Niktalopia dan kehilangan lapangan pandangan
Temuan fundus: peneyempitan arteri, dengan atau tanpa papil pucat, perubahan bone spicule-like
pigment yang merupakan deposit pigmen intraretina oleh makrofag yang migrasi ke retina membentuk
sel retina degenerasi. Deposit pigmen retina terjadi di regio outer retinal atrophy (setelah RD atau
retinopathi inflamasi) dan tidak spesifik terhadap retinopathy herediter. Retina perifer dan RPE dapat
atrofi walaupun pimen intraretina tidak ada (RP sine pigmento), dan makula menunjukkan kehilangan
refleks fovea dan irregularitas permukaan pertemuan vitreoretina
a. Dense bone spicule in the retinal periphery → Temuan fundus: peneyempitan arteri, dengan atau
tanpa papil pucat, perubahan bone spicule-like pigment yang merupakan deposit pigmen intraretina oleh
makrofag yang migrasi ke retina membentuk sel retina degenerasi. Deposit pigmen retina terjadi di regio
outer retinal atrophy (setelah RD atau retinopathi inflamasi) dan tidak spesifik terhadap retinopathy
herediter. Retina perifer dan RPE dapat atrofi walaupun pimen intraretina tidak ada (RP sine pigmento),
dan makula menunjukkan kehilangan refleks fovea dan irregularitas permukaan pertemuan vitreoretina
b. An abnormality in the rhodopsin gene → salah krn RP distrofi sel batang dan kerucut
c. Acquired red green color deficiency → salah krn RP gangguan penglihatan saat gelap (skotopik)
d. Significantly reduced ERG → AAO menyatatakan bahwa terdapat pengurangan respon sel batang yg
lebih besar drpd sel kerucut. Gelombang a dan b berkurang karena fotoreseptor terlibat. Signal ERG
bukan merupakan diagnostik tapi menunjukkan disfungsi retina berat
e. Small tubular visual field → RP menunjukkan skotoma parsial hingga penuh di regio midequatorial
yang sering meluas ke perifer meninggalkan hanya lapangan pandangan pulau kecil sentral
2. Which of the following is most characteristic of exudative retinal detachment?

a. shifting fluid
b. tobacco dust
c. fixed folds
d. equatorial traction folds
e. demarcation lines
Jawaban : A
Pembahasan :
Exudative retinal detachment terjadi krn kebocoran pembuluh darah atau RPE rusak, sehingga cairan
mengalir ke subretina. Penyebab adalah neoplasia dan inflamasi. Adanya shifting fluid menunjukkan
adanya exudatif retinal detachment yang besar. Karena cairan subretina respon thd gravitasi, sehingga
mengakibatkan detach pada area retina di mana akumulasi.
3. Which of the following findings constitutes a pertinent clinical feature of neovascular AMD?
a. subretinal fluid
b. geographic retinal pigment epithelium (RPE) atrophy
c. drusen
d. RPE pigmentary changes
Jawaban : A
Pembahasan :
Pada neovaskular AMD adanya CNV merupakan karakteristik khas. Perubahan degeneratif pada
membrana Bruch memberikan kondisi proangiogenik yang dapat menstimulasi neovaskularisasi.
Pembuluh darah baru tda fibroblas yang dapat bocor dan berdarah, sehingga mengganggu arsitektur
normal kompleks RPE dan photoreceptor dengan degenerasi kompleks finrovaskular yang menghasilkan
hipertrophic fibrotic disciform scar. Gejala berupa enurunan visus, metamorfopsia, dan paracentral
scotoma. Tanda berupa subretinal atau inraretinal fluid, exudat dan darah, cincin pigmen atau membran
abu-abi hijau, elevasi RPE irregular, robekan RPE, dan sea fan pattern of subretinal vessel.
4. What is the most characteristic abnormality that can be seen on fluorescein angiography
(FA) in a patient with CSC?
a. smokestack pattern
b. multifocal hyperfluorescence
c. hyperfluorescent dot
d. lacy hyperfluorescence
Jawaban : A
Central serous chorioretinopathy (CSC)
• menyebabkan pelepasan serosa dari retina yang berhubungan dengan kebocoran RPE
• Hiperpeambilitas choriocapillaritas sekunder
• Idiopatik
• Sering tetjadi pada usia 35-55 tahun
• Laki : Perempuan = 3 : 1
Gejala :
• Penurunan VA mendadak (20/30 – 20/ 200)
• Mikropsia
• Metamorphopsia
• Paracentral scotoma
• Penurunan persepsi warna
• Prolonged after image
retina berhubungan dengan kebocoran pada tingkat epitel pigmen retina (RPE), sekunder
hiperpermeabilitas choriocapillaris,
Angiografi fluorescein
• Dot
• Smokestack
5. 27- year- old woman developed. Nine weeks after surgery, she developed a steroid- responsive
granulomatous uveitis/ endophthalmitis, with a white plaque on her intraocular lens. What would be
the most appropriate management of this condition?
a. injection of vitreous antibiotics
b. sampling of the anterior chamber
c. pars plana vitrectomy (PPV) and partial capsulectomy with intravitreal antibiotic
injection
d. topical antibiotics and steroids
Jawaban : C
Sejarah klinis adalah karakteristik dari Propionibacterium acnes endophthalmitis. meskipun injeksi
antibiotik intravitreous dapat membersihkan infeksi hingga 50%
kasus,
Penatalaksanaan yang tepat adalah pars plana vitrectomy (PPV) dengan partial capsulectomy dan
injeksi antibiotik. Kadang-kadang, pengangkatan lensa intraokular dan seluruh capsular diperlukan
untuk mengobati kondisi secara definitif. Pengambilan sampel bilik mata depan, terutama vitreous,
adalah pendekatan yang biasa untuk identifikasi mikroba penyebab,bukan untuk pengelolaan kondisi.
Namun, karena P acnes adalah mikroaero-bakteri filik, ia mungkin tidak dapat bertahan hidup dalam
suatu kultur kecuali jika kultur tersebut dipertahankan dalam lingkungan rendah oksigen. Dengan
demikian, tingkat kepositifan budaya rendah. Antibiotik topikal dan steroid akan mengobati
gejalanya, tetapi tidak akan membasmi infeksi.
6. The classic indications for pneumatic retinopexy include:

a. retinal breaks that are confined to the inferior 8 clock - hours
b. retinal breaks that are confined to the superior 8 clock- hours
c. uncooperative patient who cant maintain proper positioning
d. multiple ret inal break or multiple breaks more 2 clock- hours
Jawaban : B
Techniques for Surgical Repair of Retinal Detachments
There are 3 surgical techniques for eyes with primary uncomplicat ed rhegmatogenous retinal
detachment:
• pneumatic retinopexy
• scleral buckling
• primary vitrectomy with or without scleral buckling
Pneumatic retinopexy
Penutupan robekan retina debgan menggunakan gelembung gas intraokuler untuk beberapa saat
hingga cairan subretinal di reabsorbsi dan perlengketan chorioretinal pada daerah robekan.
Indikasi klasik untuk pneumatic retinopexy yaitu :

• confidence that all ret i nal breaks have been identified
• retinal breaks that are confined to the superior 8 clock- hour
• a single ret i nal break or multiple breaks within 1–2 clock- hours
• the absence of proliferative vitreoretinopathy (PVR) grade CP or CA
• a cooperative patient who can maintain proper positioning
• clear media
7. A 45-year-old male complains of sudden decreased vision in his right eye for 2 weeks. Visual
acuity is 20/200. His fundus examination, FFA, and OCT are shown in Figures A, B, and C. Which
of the following best represents the pathophysiology of this patient’s condition?
a. Embolic phenomenon
b. Thrombosis at the level of the lamina cribrosa
c. Carotid stenosis
d. Compression of the central retinal vein due to an atherosclerotic arteriole
PEMBAHASAN
AAO 2020-2021. Ch. 5 Retinal Vascular Disease: Diabetic Retinopathy: CRVO. P. 131: In
Fig. 6-9 Moderate to severe non ischemic CRVO.
Pada CRVO, kehilangan penglihatan paling sering terjadi secara tiba-tiba, dengan tingkat
keparahan yang berkisar dari ringan (noniskemik) hingga berat (iskemik). CRVO dianggap tak tentu,
tidak jelas iskemik atau noniskemik; namun, lebih dari 80% mata berkembang menjadi iskemik pada
Central Vein Occlusion Study (CVOS).
CRVO noniskemik (ringan), kadang-kadang disebut sebagai partial, perfused, or venous stasis
retinopathy, ditandai dengan ketajaman visual 20/200 atau lebih baik, defek pupil aferen ringan atau
tidak ada, dan perubahan visual field ringan. Oftalmoskopi menunjukkan dilatasi ringan dan
tortuosity semua cabang vena retina sentral serta perdarahan berbentuk dot dan flame-shaped
hemorrhages di semua kuadran retina.
Studi histologis menunjukkan bahwa sebagian besar bentuk CRVO memiliki mekanisme
utama: thrombosis of the central retinal vein at or posterior to the level of the lamina cribrosa.
Dalam beberapa kasus, arteri retina sentralis yang menebal dapat menimpa vena retina sentral,
menyebabkan turbulensi, kerusakan endotel, dan pembentukan trombus. Ketika trombosis lebih
anterior, lebih sedikit kolateral yang tersedia, menghasilkan iskemia yang lebih besar.
Gambar pada soal merupakan gambaran CRVO noniskemik sedang hingga berat. Fig A,
Ultra-wide-field fundus photograph noniskemik sedang hingga berat, atau perfusi, CRVO pada mata
dengan ketajaman visual 20/80. Dilatasi vena retina dan perdarahan retina terdapat pada keempat
kuadran. Cotton-wool spotsdapat dilihat di dekat optic nerve head. Fig B, Gambar fluorescein
angiography diambil pada 1 menit, 8 detik menunjukkan perfusi yang relatif intak dari retinal
capillary bed, tetapi tampak dilatasi pembuluh darah dan peripheral leakage dari pembuluh darah
besar. Ada beberapa area nonperfusi kapiler di makula superior. Fig C, Pemindaian SD-OCT
menunjukkan severe cystoid retinal edema dengan serous foveal detachment. Setelah 2,5 tahun
pengobatan anti-VEGF bevacizumab, pasien mempertahankan ketajaman visual 20/40.
8. The fundus appearance seen in the above figure can’t be found in what condition listed below…
a. diabetic retinopathy
b. radiation retinopathy
c. proliferative vitreoretinopathy
d. hypertensive retinopathy
PEMBAHASAN
Review Questions in Ophthalmology. 3rd edition Copyright. 2015. Wolters Kluwer Health.
Pada soal 140.
a. diabetic retinopathy: Pemeriksaan fundus dilatasi harus mencakup pemeriksaan makula,
microaneurysms, hemorrhage, hard exudates, cotton wool spots, retinal swelling (DME). Diskus
optikus dan area di sekitarnya (satu diameter diskus) harus diperiksa untuk mengetahui adanya
pembuluh darah baru yang abnormal (neovaskularisasi diskus, NVD), optic nerve head pucat atau
perubahan glaukomatous. Retina juga harus diperiksa untuk mengetahui adanya pembuluh darah
baru yang abnormal (neovaskularisasi di tempat lain (NVE).
b. Radiation retinopathy adalah komplikasi yang dapat diprediksi setelah terpapar sumber radiasi
apa pun. Dihipotesiskan bahwa sensitivitas diferensial antara sel endotel dan perisit adalah hasil
dari paparan langsung sel endotel terhadap oksigen ambien tinggi dan zat besi yang ditemukan
dalam darah yang menghasilkan radikal bebas dan menyebabkan kerusakan membran sel.
Kerusakan ini menyebabkan oklusi kapiler dan pembentukan mikroaneurisma. Iskemia retina dari
daerah non-perfusi retina akhirnya menyebabkan edema makula, neovaskularisasi, perdarahan
vitreous, dan ablasi retina traksi.
c. proliferative vitreoretinopathy: menghasilkan proliferasi seluler pada permukaan retina dan
bukan makulopati eksudatif dengan edema, seperti yang dapat dilihat pada tiga kondisi lainnya.
Proliferative vitreoretinopathy komplikasi utama dari ablasi retina rhegmatogenous (RRD),
proses abnormal dimana proliferatif, membran seluler kontraktil terbentuk di vitreous dan di kedua
sisi retina, mengakibatkan ablasi retina traksi dengan lipatan retina. Kondisi ini tentu
mengakibatkan traksi retina (terutama grade C atau lebih tinggi) yang memerlukan vitrektomi
untuk mencapai reattachment retina. Robekan retina multipel dan dialisis retina (terutama tanpa
detasemen retina terkait) biasanya diobati dengan laser atau demarkasi kriopeksi. Perdarahan
vitreous yang tidak mempengaruhi aksis visual mungkin hanya memerlukan observasi atau
pengobatan pada kondisi yang mendasarinya (seperti retinopati diabetik proliferatif), tergantung
pada gangguan terkait.
d. hypertensive retinopathy: dapat menyebabkan oklusi pembuluh darah retina utama seperti cabang
arteri retinal, arteri retina sentralis, vena retina cabang dan vena retina sentralis. Retinopati
hipertensi didiagnosis berdasarkan gambaran klinisnya pada pemeriksaan funduskopi dilatasi dan
hipertensi yang menyertainya.
9. The following statement is incorrect about the disease that has fundus appearance as the picture
above:
a. The EOG is pathologic in affected patients and carriers.
b. Peripheral visual fields, ERG, and dark adaptation testing are normal.
c. It is autosomal dominant.
d. It has a poor visual prognosis.
PEMBAHASAN
AAO 2020-2021. Ch. 13. Hereditary Retinal and Choroidal Dystrophies. In : Best Disease or
Best Vitelliform Dystrophy. P.271
Dari tampilan fundus, dikaitkan dengan Best disease (vitelliform macular dystrophy).
Individu yang terkena Best disease, lesi makula berkembang menjadi gambaran seperti kuning telur
(vitelliform) pada masa kanak-kanak, yang akhirnya rusak, meninggalkan tampilan atrofi geografis
berbintik-bintik Di akhir perjalanan penyakit, atrofi mungkin sulit dibedakan dari jenis degenerasi
makula atau distrofi lainnya. Beberapa pasien (sampai 30% dalam beberapa seri) memiliki lesi
vitelliform ekstrafoveal di fundus. Penampilan makula di semua tahap menipu, karena kebanyakan
pasien mempertahankan ketajaman visual yang relatif baik selama perjalanan penyakit.
Bahkan pasien dengan lesi makula “scrambled- egg” biasanya memiliki ketajaman visual dari 20/30
hingga 20/60.
Respon ERG secara khas normal, tetapi hasil elektrookulogram (EOG) hampir selalu
abnormal, bahkan pada individu yang “unaffected”, asymptom yang memiliki varian genetik
penyebab tetapi memiliki fundus yang tampak normal. Kenaikan ringan EOG biasanya sangat
berkurang atau tidak ada. Sebelum melakukan EOG untuk menyingkirkan penyakit lain, dokter
harus memastikan bahwa full-field ERG normal. Studi genetik molekuler mendeteksi carriers.
Penyakit autosomal dominant maculopathy disebabkan oleh mutasi pada gen BEST1 (VMD2).
10. Pada hypertensive optic neuropathy gejala klinis yang dapat terlihat adalah:
(dr. Amanda)
a. papillary flame- shaped hemorrhages
b. batas optic nerve head menjadi kabur
c. eksudat makula
d. optic nerve head edem
e. semua benar
Jawaban : E
(AAO 12 HAL.123)
Pasien dengan optik neuropati hipertensi sekunder ke severe menunjukkan :
• linear peripapillary flame- shaped hemorrhages
• blurring of the optic nerve head margins
• florid optic nerve head edema with secondary retinal venous stasis
• macular exudates
11. Di bawah ini yang bukan faktor resiko terjadinya dry AMD adalah :
a. penyakit jantung dan pembuluh darah
b. kebiasaan merokok
c. jenis kelamin perempuan lebih sering terjadi
d. penyakit yang sama dalam keluarga
e. semua benar
Jawaban : E
Dry AMD : Nonneovaskular AMD
Faktor resiko AMD
• age (10% of people over the age of 65 years and 25% over the age of 75 years have AMD)
• Additional risk factors : female sex, hypertension, hypercholesterolemia, cardiovascular disease,
higher waist- to- hip ratio in men, positive family history, cigarette smoking, elevated levels of C-
reactive protein and other inflammatory markers, hyperopia, and light iris color.
12. Apa gen yang paling sering menyebabakan / bertanggungjawab untuk terjadinya age related
macular disease? (dr. Amanda)
a. ARMS2 and CFH
b. CFI and ARMS2
c. CFI and CFH
d. APOE and ARMS2
Jawaban : A
Gen yg paling sering menyebabkan AMD adalah CFH (1q31) dan ARMS2 (10q26).
CFI dan APOE juga berhubungan dengan AMD, namun bukan yang paling sering menyebabkan AMD.
13. Findings in Stargardt disease may include all of the following:
a. RPE atrophy in the macula
b. yellow flecks in the peripheral retina
c. yellow flecks in the macula
d. All above is true
Jawaban : D
Pembahasan :
Stargardt disease is the most common juvenile macular dystrophy and a common cause of central vision
loss in adults younger than 50 years. The classic Stargardt phenotype is characterized by a juvenile-onset
foveal atrophy surrounded by discrete, yellowish, round or pisciform flecks at the level of the RPE. If
the flecks are widely scattered throughout the fundus with central sparing, the condition, which used to
be referred to as fundus flavimaculatus, is now known to result from mutations in the same genes and
can be present in families with the classic Stargardt phenotype. On fluorescein angiography, 80% or
more of patients with Stargardt disease have a “dark choroid,” or, in other words, blocking of choroidal
fluorescence that highlights the retinal circulation. Fundus autofluorescence imaging is a more reliable
means of demonstrating elevated background autofluorescence and characteristic findings, including
peripapillary sparing of the RPE changes, central macular hypoautofluorescence, and, over time, an
outward expanding pattern of hyperautofluorescent flecks, which leave hypoautofluorescent areas in
their wake. Full-field ERGs are not diagnostic for this condition; however, individuals with significantly
abnormal responses generally have more severe and progressive disease.
14. Exudative detachments occur in all of the following conditions:

a. Vogt Koyanagi Harada (VKH) syndrome
b. CMV retinitis
c. toxemia of pregnancy
Jawaban : D
Pembahasan :
VKH syndrome → Fluorescein angiography studies can be particularly helpful in monitoring disease
activity and often show multiple RPE leaks in the areas of detachment, a finding referred to as the
“starry night” or “Milky Way” sign. A “sunset glow” fundus appearance can be seen due to choroidal
depigmentation as the uveitis subsides.
CMV retinitis → Patients with CMV retinitis typically present with floaters or decreased visual acuity.
Clinically, CMV retinitis has a characteristic appearance that consists of opacification
of the necrotic retina, typically along retinal vessels and often with areas of hemorrhage. Periphlebitis
and even “frosted branch” angiitis may be prominent features. The degree of vitreous inflammation is
highly variable. Early CMV retinitis may resemble the cotton-wool spots associated with HIV-related
retinopathy. Although the diagnosis is often made clinically, polymerase chain reaction (PCR)–based
analysis of ocular fluids may be diagnostic in unclear cases.
Toxemia in pregnancy → Exudative detachment a rare but severe acute complication of toxemia of
pregnancy, is a manifestation of acute ischemic infarction of the choroid associated with severe
hypertension
15. All of the following about retinopathy in shaken baby syndrome are true:
a. Intraretinal and preretinal hemorrhages are present.
b. Similar to central retinal vein occlusion (CRVO), Purtscher retinopathy, and Valsalva Retinopathy
c. May also have VH
Jawaban : D
Pembahasan :
Abusive head trauma (formerly known as shaken baby syndrome). The typical baby with abusive head
trauma is almost always younger than 1 year and is frequently younger than 6 months. Ocular signs
include :
- retinal hemorrhages and cotton-wool spots
- retinal folds
- hemorrhagic schisis cavities
They can begin to resolve very rapidly. The retinopathy may resemble that observed in Terson syndrome
or central retinal vein occlusion, neither of which is common in infants. Retinal hemorrhages may be
caused by trauma, but they are not usually associated with typical accidents, such as falls in the home.
Vitrectomy for vitreous hemorrhage should be considered if amblyopia is likely to occur but may be
deferred if a bright-flash ERG response shows loss of the b-wave, which is indicative of extensive
retinal damage. Fluorescein angiography shows attenuated vasculature and avascularity of the periphery.
16. What diagnostic device is used for the evaluation of contrast sensitivity?
a. Pelli-Robson test
b. Anomaloscope
c. Farnsworth- Munsell 100- hue test
d. Ishihara plates
Jawaban : A
(A) . The Pelli- Robson test mea sures contrast sensitivity using a single, large letter size (20/60
optotype), with contrast varying across groups of letters. Patients read the letters, starting with the
highest contrast and continue until they are unable to read 2 or 3 letters in a single group. The subject is
assigned a score based on the contrast of the last group in which 2 or 3 letters were correctly read. The
Pelli- Robson score is a logarithmic mea sure of the subject’s contrast sensitivity. The anomaloscope,
Farnsworth- Munsell 100- hue test, and Ishihara plates are all used to evaluate color vision, not contrast
sensitivity.
17. A patient develops branch retinal vein occlusion (BRVO) at a site other than an arteriovenous
crossing. What under lying etiology should be considered?
a. hypertension
b. embolus
c. vasculitis
d. glaucoma
Jawaban : C
(C) . In branch ret i nal vein occlusion (BRVO), obstruction of the vein occurs most commonly at an
arteriovenous crossing, where thickening of the arterial wall compresses the adjacent vein within a
common adventitial sheath. When the occlusion does not occur at an arteriovenous crossing, the
possibility of an under lying retinochoroiditis or ret i nal vasculitis should be considered. Hypertension
and glaucoma are risk factors for BRVO but not implicated in occlusion at sites other than arteriovenous
crossings. An embolus may cause a ret i nal artery occlusion but not a retinal vein occlusion.
18. What identifiable preoperative feature is a contraindication to retrobulbar anesthesia?

a. axial high myopia
b. older age
c. use of continuous positive airway pressure (CPAP) at night
d. obesity
Jawaban : A
(A) . Axial high myopia is a risk factor for ocular perforation with a retrobulbar injection. It is a relative,
not an absolute, contraindication. Older age is not a contraindication to retrobulbar anesthesia injection.
Use of continuous positive airway pressure (CPAP) is a relative contraindication to general anesthesia,
not retrobulbar anesthesia, because laryngeal swelling following intubation may necessitate
hospitalization for postanesthesia observation. Because obesity may make endotracheal intubation more
difficult, the use of retrobulbar anesthesia would be favored.
19. Seorang pasien laki-laki 30 tahun datang ke IGD dengan keluhan penglihatan mata kiri kabur
setelah kecelakaan sepeda motor 5 jam sebelum masuk RS. Pada pemeriksaan oftalmologi didapatkan
visus 20/200, funduskopi didapatkan sheenlike retinal whitening, cherry-red spot. Apa diagnosis pada
pasien ini?
a. Retinal Detachment
b. Choroidal Hemorrhage
c. Commotio Retina
d. Macular Hole
Jawaban : C
Pembahasan : AAO 2020-2021 chapter 18 p.353
Diagnosis pada kasus ini Commotio Retina
Istilah commotio retinae mengacu pada kerusakan pada lapisan luar retina yang disebabkan oleh
“shock waves “ / (gelombang kejut) yang melintasi mata dari tempat benturan setelah trauma
tumpul. Pemeriksaan oftalmoskopi: menunjukkan pemutihan retina (sheenlike retinal whitening )
seperti kemilau yang muncul beberapa jam setelah cedera (Gambar dibawah). sheenlike retinal
whitening ini paling sering terjadi di kutub posterior tetapi juga dapat ditemukan di perifer.
Temuan spektral-domain optical coherence tomography (SD-OCT) menunjukkan bahwa bagian
utama gangguan adalah pada lapisan fotoreseptor dan epitel pigmen retina (RPE), menghasilkan
kekeruhan / opasifikasi retina yang dapat diamati. Dengan keterlibatan foveal, cherry-red spot
mungkin muncul karena sel-sel yang terlibat dalam pemutihan yg tidak ada di foveola. Commotio
retinae di kutub posterior dapat menurunkan ketajaman visual hingga serendah 20/200. Pemuliha n
visual bertahap dapat terjadi jika tidak ada makula pigmen epiteliopati terkait, ruptur koroid, atau
pembentukan lubang makula/macular hole.
20. A-40 years old man came to outpatient clinic with chief complaint sudden onset of blurred vision,
micropsia, metamorphopsia, paracentral scotoma, and decrease color vision. From ophthalmology
examination found visual acuity 20/30. There is an elevation in macular region, flourescein
angiography shows leaks from the RPE that may appear as the "smokestack" form. This patient has a
hypertension and cushing syndrome. What is the diagnosis of this patient?
a. Polypoidal Choroidal Vasculopathy
b. Central Serous Chorioretinopathy
c. Giant Cell Arteritis
d. CNV
Jawaban : B
Pembahasan : AAO 2020-2021 Chapter9 p189-195
Pada kasus ini diagnosisnya adalah Central Serous Chorioretinopathy
CSC terjadi terutama pada orang berusia antara 35 dan 55 tahun, dengan laki-laki lebih banyak
dibandingkan pada perempuan dengan rasio 3:1; saat ini tidak ada statistik yang dapat diandalkan yang
menunjukkan adanya hubungan dengan ras. Pasien dengan CSC menggambarkan berbagai gejala,
termasuk sudden onset of blurred or dim vision /penglihatan kabur atau redup yang tiba-tiba, mikropsia,
skotoma paracentral metamorphopsia, penurunan penglihatan warna, dan prolonged afterimages.
Ketajaman visual berkisar antara 20/20 hingga 20/200, tetapi pada kebanyakan pasien, visus lebih baik
dari 20/30. Penurunan ketajaman visual seringkali dapat ditingkatkan dengan koreksi hiperopia. Pada
manifestasi akut, retina memiliki elevasi bulat atau oval di daerah makula; sering melibatkan fovea.
Angiografi fluoresen menunjukkan kebocoran dari RPE yang mungkin muncul di awal urutan
angiografi, sebagai dot (bentuk "titik/dot") atau sebagai tree-shaped movement di ruang subretina
(“Smokestack form”/ bentuk "tumpukan asap") .Dalam beberapa keadaan, kebocoran yang kuat dapat
menyebabkan pengendapan bahan subretina berwarna putih keabu-abuan yang umumnya diyakini
sebagai fibrin. Pada CSC kronis, RPE menunjukkan pigmentasi granular; angiografi fluorescein
menunjukkann banyak kebocoran kecil, terkadang tidak mencolok; dan ada widespread shallow
detachment yang meluas dengan area atrofi fotoreseptor.
Seperti disebutkan, CSC dikaitkan dengan stres dan dengan kepribadian yang tegang/tense dan
didorong, berhubungan dg sistemik termasuk hiperkortisolisme endogen (sindrom Cushing), hipertensi,
sleep apnea, penggunaan obat psikofarmakologis, dan kehamilan. Penggunaan kortikosteroid sistemik
dikaitkan dengan CSC, tetapi anehnya, penggunaan kortikosteroid intraokular tampaknya tidak terkait
dengan kondisi tersebut.
Teratment
CSC bersifat destruktif dan oleh karena itu dapat menyebabkan skotoma yang signifikan secara visual.
CNV sekunder terjadi segera setelah operasi pada hingga 2% mata yang telah diobati dengan
fotokoagulasi. Fotokoagulasi laser tidak terkait dengan penurunan tingkat kekambuhan.
Terapi fotodinamik Verteporfin (PDT) mengurangi atau menghilangkan cairan subretina dan dikaitkan
dengan beberapa komplikasi, yang paling umum adalah atrofi, yang terjadi pada sekitar 4% pada mata
yang dirawat. Kekambuhan setelah PDT jarang terjadi. Laser fotokoagulasi tidak berpengaruh pada
ketebalan koroid, sedangkan PDT menurunkan ketebalan dan mengurangi hiperpermeabilitas pembuluh
darah koroid. Penggunaan antagonis reseptor mineralokortikoid seperti eplerenone atau spironolactone
dikaitkan dengan resolusi cairan subretina pada sekitar 25% pasien yang diobati, tetapi terapi ini belum
menjadi subjek uji coba secara acak.
21. A-55 years old man has history of hypertension for 10 years with no adequate medication. He
complaint blurred vision but no significant. Posterior segment examination in both eyes shows
obvious arterial narrowing with focal irregularities, blot hemorrhages, venous beading, and soft
exudates. What is the diagnosis of this patient?
a. Hypertension choroidopathy
b. Hypertensive retinopathy
c. Hypertensive optic neuropathy
d. Branch Retinal Vein Occlusion
Jawaban : B
(AA0 2021 Chapter 6 p122)
Classification of Hypertensive Retinopathy:
Grade 0 No changes
Grade 1 Barely detectable arterial narrowing
Grade 2 Obvious arterial narrowing with focal irregularities
Grade 3 Grade 2 plus retinal hemorrhages and/or exudates
Grade 4 Grade 3 plus optic nerve head swelling
22. Vitreous attaches to the internal limiting membrane (ILM) of the retinal surface via what 2
primary adhesion molecules?
a. fibronectin and laminin
b. fibronectin and integrin
c. fibronectin and connectin
d. laminin and connectin
Jawaban : A
Vitreous menempel pada interal limiting membrane (ILM) dari permukaan retina terutama melalui
fibronektin dan laminin. Molekul integrin telah terbukti menginduksi pelepasan vitreous posterior,
bukan memfasilitasi perlekatan. Molekul connectin tampaknya tidak memainkan peran penting dalam
adhesi vitreoretinal.
23. What percentage of cones overall reside outside the foveal region?
a. 30%
b. 50%
c. 70%
d. 90%
Jawaban : D
Pembahasan:
Densitas dan distribusi fotoreseptor bervariasi dengan lokasi topografi. Di fovea, cones sebagian besar
peka terhadap warna merah dan hijau, dengan kepadatan melebihi 140.000 cones/mm2. Foveola tidak
memiliki rods. Fovea hanya berisi fotoreseptor, rods dan cones, dan prosesus sel Muller. Jumlah
fotoreseptor cone menurun dengan cepat jauh dari fovea, meskipun 90% dari cones secara keseluruhan
berada di luar daerah fovea. Kepadatan rods juga menurun menuju pinggiran.
24. What noninvasive diagnostic test is most specific for detecting retinal pigment epithelial (RPE)
cell death?
a. fundus autofluorescence (FAF)
b. fluorescein angiography
c. fundus photography
d. optical coherence tomography angiography (OCTA)
Jawaban : A
Pembahasan:
Fundus autofluorescence (FAF) adalah cara yang cepat, non-kontak, dan non-invasif untuk mencitrakan
fluorofor di fundus okular. Cahaya eksitasi dimasukkan ke mata, dan fluoresensi dari fluorofor intrinsik
dideteksi dengan mengecualikan pencitraan cahaya eksitasi itu melalui penggunaan filter penghalang.
Sumber utama autofluoresensi dari fundus adalah lipofuscin di epitel pigmen retina (RPE). Jika sel RPE
mati, lipofuscin yang terkandung di dalamnya hilang, mengakibatkan hilangnya autofluoresensi. Area
ini tampak gelap dalam gambar autofluoresensi. Prinsip ini dapat digunakan untuk memantau tidak
adanya sel RPE pada atrofi geografis, suatu manifestasi degenerasi makula terkait usia (AMD)
noneksudatif. Fotografi fundus tidak spesifik untuk mendeteksi kematian sel RPE. Optical coherence
tomography angiography (OCTA) adalah teknik noninvasif yang memperoleh informasi angiografi
volumetrik tanpa menggunakan pewarna, dan gambar pleksus vaskular individu dari retina bagian
dalam, luar retina, dan choriocapillaris. Angiografi fluorescein adalah tes diagnostik invasif, terutama
digunakan untuk pencitraan pembuluh darah retina.
25. What diagnostic device is used for the evaluation of contrast sensitivity?
a. Pelli-Robson test
b. anomaloscope
c. Farnsworth-Munsell100-huetest
d. Ishihara plates
The Pelli- Robson test mea sures contrast sensitivity using a single, large letter size (20/60 optotype), with
contrast varying across groups of letters. Patients read the letters, starting with the highest contrast, and
continue until they are unable to read 2 or 3 letters in a single group. The subject is assigned a score based
on the contrast of the last group in which 2 or 3 letters were correctly read. The Pelli- Robson score is a
logarithmic measure of the subject’s contrast sensitivity. Thus, a score of 2 means that the subject could
read at least 2 of the 3 letters with a contrast of 1% (contrast sensitivity = 100%, or log10 2). That is, a
score of 2.0 indicates normal contrast sensitivity of 100%. A Pelli- Robson contrast sensitivity score of
less than 1.5 is consistent with visual impairment, and a score of less than 1.0 represents visual disability.
AAO Chapter 3 hal 56
26. In a premature infant born at 29 weeks’ gestation, what is the appropriate time for the initial
screening examination for retinopathy of prematurity (ROP)?
a. at birth
b. 1–3 weeks after birth
c. 4–6 weeks after birth
d. no examination indicated
All infants with a birth weight of less than 1500 g or a gestational age of 30 weeks or less should be
screened. In addition, infants with a birth weight between 1500 g and 2000 g or a gestational age greater
than 30 weeks, with an unstable clinical course, and who are believed to be at high risk by their attending
pediatricians or neonatologists should be screened. The first examination should generally be performed
between 4 and 6 weeks of postnatal age or, alternatively, between 31 and 33 weeks’ postconceptional or
postmenstrual age, whichever is later. AAO Chapter 8 hal 182
27. A 45-year-old man presents with recent left-eye decreased vision, vitreous cells, optic pal- lor,
retinal arteriolar narrowing, and diffuse RPE pigment loss and clumping. The ERG demonstrates
normal responses in the right eye and severely subnormal a- and b-wave amplitudes with delayed
latencies in the left eye. What is the most likely cause?
a. P23H mutation in the rhodopsin gene
b. virus
c. fungus
d. nematode
Diffuse unilateral subacute neuroretinitis (DUSN) is a rare condition that typically occurs in other wise
healthy, young patients and is caused by the presence of a mobile subret i nal nematode. Prompt diagnosis
and treatment of the condition can help prevent vision loss, which can be severe. The clinical findings in
DUSN can be divided into acute and endstage manifestations. In the acute phase, patients frequently have
decreased visual acuity, vitritis, papillitis, and clusters of gray- white or yellow- white outer ret i nal and
choroidal lesions. The clustering of the lesions is impor tant because it often helps localize the causative
nematode. The degree of vision loss is often greater than might be expected from the clinical examination.
Left untreated, late sequelae ultimately develop, which include optic atrophy, ret i nal arterial narrowing,
and diffuse RPE disruption with severe vision loss. AAO Chapter 11 hal 246
28. Di bawah ini merupakan komplikasi dari tindakan fotokoagulasi : (dr. Putri)
a. Corneal opacities
b. Optic neuropathy
c. Foveal burn
d. Semua benar
Jawaban : D
Pembahasan :
Complications that may be associated with photocoagulation include inadvertent corneal burns, which
can lead to opacities. Treatment of the iris may cause iritis and create zones of atrophy. Pupillary
abnormalities may arise from thermal damage to the long ciliary nerves in the suprachoroidal space or
the iris sphincter muscle. Absorption by lens pigments may create lenticular burns and resultant
opacities. Optic neuropathy may occur from treatment directly to or adjacent to the optic nerve head, and
nerve fiber damage may follow intense absorption in zones of intraretinal hemorrhage, increased
pigmentation, or retinal thinning. Chorioretinal complications include foveal burns, Bruch membrane
ruptures, creation of retinal or choroidal lesions, and exudative choroidal or retinal detachment.
29. Within the fovea there is a region devoid of retinal vessels known as: (dr. Putri)
a. Macula
b. foveal avascular zone (FAZ)
c. Henle fibre layer
d. Inner nuclear layer
Jawaban : B
Pembahasan :
Within the fovea is a region devoid of retinal vessels known as the foveal avascular zone (FAZ). The
geometric center of the FAZ is often taken to be the center of the macula and thus the point of fixation;
it is an important landmark in fluorescein angiography.
30. Keuntungan pemakaian opthalmoskope indirek untuk pemeriksaan retina adalah: (dr. Putri)
a. Bayangan terbalik
b. Stereopsis
c. Pembesaran lebih kecil dibanding direk opthalmoskope
d. Lapangan penglihatan lebih kecil
e. Sulit menilai retina perifer
Jawaban : B
Pembahasan :
Binocular indirect ophthalmoscopes allow for stereopsis, have a field of view that depends on the
dioptric power of the con- densing lens (higher powers deliver wider angles of view, but at a lesser
magnification), and, with ocular steering, can visualize the entire fundus as compared with direct
ophthalmoscopes. If the patient’s pupil can be dilated widely, the ora serrata may be seen without any
additional instrumentation. If the pupil cannot be widely dilated or the clinician needs to see peripheral
retinal details in profile, scleral depression must be performed.
31. Extraretinal fibrovascular proliferation, which defines PDR, progresses through 3 stages except:
a. Fine new vessels with minimal fibrous tissue cross and extend beyond the ILM, often using the
posterior hyaloid as a scaffold.
b. Fine new vessel with severe fibrous tissue cross and extend beyond the ILM
c. The new vessels increase in size and extent, developing an increased fibrous component.
d. The new vessels regress, leaving residual fibrovascular tissue that may be tethered within the
posterior hyaloid.
Jawaban : B
Pembahasan:
Dalam perkembangannya, retinopati akan menyebabkan kerusakan kapiler dan peningkatan nonperfusi.
Perburukan iskemik retina menyebabkan pelepasan faktor vasoproliferatif dan mencetuskan
perkembangan neovaskularisasi retina. VEGF merupakan faktor angigenetik yang dijumpai pada
vitreous dengan pasien PDR. Faktor ini dapan menstimulasi proses neovaskularisasi retina, optic nerve
head, dan segmen anterior. Proliferasi fibrovaskular ekstraretina pada PDR, berkembang dengan 3
tahapan, yakni:
1. Fine new vessels with minimal fibrous tissue cross and extend beyond the ILM, often using the
posterior hyaloid as a scaffold.
2. The new vessels increase in size and extent, developing an increased fibrous component.
3. The new vessels regress, leaving residual fibrovascular tissue that may be tethered within the
posterior hyaloid.
(AAO 2020-2021 Section 12. Chapter 5. Hal 102)
32. Which of the following is not PDR with high risk characteristics:
a. Any NVD with massive retinal hemorrhage
b. Any NVD with vitreous or preretinal hemorrhage
c. Extent of NVD greater than or equal to one- fourth disc area, with or without vitreous or preretinal
hemorrhage (≥ ETDRS standard photograph 10A)
d. Extent of NVE greater than or equal to one- half disc area, with vitreous or preretinal hemorrhage
Jawaban : A
Pembahasan:
Tatalaksana pada pasien PDR dapat dilakukan pada semua stadium, biasanya yang menjadi
pertimbangan bila mata sebelahnya mengarah kesuatu risiko tinggi, yaitu:
1. any NVD with vitreous or preretinal hemorrhage
2. extent of NVD greater than or equal to one-fourth disc area, with or without vitreous or preretinal
hemorrhage (≥ ETDRS standard photo graph 10A)
3. extent of NVE greater than or equal to one-half disc area, with vitreous or preretinal hemorrhage
33. The most important risk factor for the development of CRVO is:
a. Systemic arterial hypertension
b. Open- angle glaucoma
c. Diabetes mellitus
d. Age
Jawaban : D
Pembahasan:
Faktor risiko paling penting dalam perkembangan CRVO adalah usia, dimana 90% pasien memiliki
usia lebih dari 50 tahun saat terjadinya onset. CRVO ringan biasanya terjadi pada usia muda.
Menurut The Eye Disease Case-Control Study dan studi-studi lainnya menyebutkan bahwa faktor risiko
CRVO dapat meliputi yaitu:
1. systemic arterial hypertension
2. open- angle glaucoma
3. diabetes mellitus
4. hyperlipidemia
5. hypercoagulability
34. In patients with intermediate or advanced AMD, to what degree did the nutritional
supplementation used in the AREDS (Age- Related Eye Disease Study) reduce the risk for
progression to more- advanced stages of AMD?
a. 45%
b. 25%
c. 35%
d. 55%
Jawaban : b. 25%
Pembahasan : AAO BCSC 2020-2021Section 21. Retina dan Vitreous Hal. 69
Micronutrients
AREDS (Age- Related Eye Disease Study) first established the benefit of vitamin and zinc
supplementation in reducing the risk of vision loss in nonexudative AMD. In the study, after
supplementation with the antioxidant vitamins C (500 mg) and E (400 IU), beta carotene (15 mg), and
the micronutrient zinc (80 mg zinc oxide and 2 mg cupric oxide to prevent zinc- induced anemia),
patients with intermediate or advanced AMD showed a 25% risk reduction for progression to more-
advanced stages of AMD and a 19% risk reduction in rates of moderate vision loss (≥3 lines of visual
acuity) at 5 years. The study defined intermediate (stage 3) AMD as the presence of at least 1 large druse
(≥125 μm), extensive intermediate drusen (63–124 μm dia meter), or nonsubfoveal GA; advanced (stage
4) AMD was defined as vision loss due to neovascular AMD or subfoveal GA in only 1 eye. At 10
years, 44% of placebo recipients compared with 34% of the supplement recipients had advanced AMD
(a 23% risk reduction). Among participants with no AMD or with only early- stage AMD (a few small
drusen), there was no mea sur able benefit. There was no increased mortality among patients taking the
formula recommended by AREDS.
35. Berdasarkan AREDS (Age- Related Eye Disease Study), bila ditemukan drusen dengan diameter
≥ 125-μm dan terdapat neovaskular AMD, berapa persen resiko 10-tahun berkembang menjadi
advanced AMD
a. 22%
b. 25%
c. 50%
d. 67%
Jawaban : c. 50%
AREDS developed a simplified 4- point grading scale for classifying the severity of AMD and
predicting the disease course based on the following findings:
• presence of 1 or more large (≥ 125- μm dia meter) drusen (1 point)
• presence of any pigment abnormalities (1 point)
• for patients with no large drusen, presence of bilateral intermediate (63–124 μm) drusen (1 point)
• presence of neovascular AMD (2 points)
Risk factors were totaled across both eyes to reach a number between 0 and 4 that was used to estimate
patients’ 5- and 10- year risk of developing advanced AMD in 1 eye.
 drusen dengan diameter ≥ 125-μm (1 point) dan
 terdapat neovaskular AMD (2 point)
➔ Risiko 5 tahun : 25%

Risiko 10 tahun : 50% (c)
36. What are the 2 known major susceptibility genes for age- related macular degeneration (AMD)?
a. CFI and ARMS2
b. ARMS2 and CFH
c. APOE and ARMS2
d. CFI and CFH
Jawaban : b. ARMS2 and CFH

The 2 major susceptibility genes for AMD are CFH (1q31), which codes for complement factor H, and
ARMS2 (10q26), for which the gene product and function are poorly understood. ARMS2/HTRA1 and
MMP20 are associated with choroidal neovascularization (CNV) lesion size. The CFH Y402H mutation
confers a 4.6- fold increased risk for AMD when heterozygous and a 7.4- fold increased risk when
homozygous. The ARMS2 A69S mutation confers a 2.7- fold increased risk for AMD when
heterozygous and an 8.2- fold increased risk when homozygous. When both genes are homozygous for
the aforementioned mutations in an individual, the risk for AMD is increased to 50- fold.
37. To help clinicians identify those patients at greatest risk of progression to PDR and high risk PDR,
the ETDRS investigators developed the 4:2:1 rule which consists of these following rules except…
a. severe intraretinal hemorrhages and microaneurysms in 4 quadrants
b. definite venous beading in 2 or more quadrants
c. moderate IRMA in 1 or more quadrants
d. cotton wool spots in 4 quadrants
Pembahasan:
To help clinicians identify those patients at greatest risk of progression to PDR and high-risk PDR, the
ETDRS investigators developed the 4:2:1 rule, which is largely based on results from the ETDRS
Report Number 9 (Clinical Trial 5-3). A case of severe NPDR was defined as having any 1 of the
following features:
• severe intraretinal hemorrhages and microaneurysms in 4 quadrants
• definite venous beading in 2 or more quadrants
• moderate IRMA in 1 or more quadrants
AAO Section 12 Retina and Vitreous 2019-2020 Hal 128
38. Pooling refers to the accumulation of fluorescein in a fluid filled space in the retina or choroid. One
of the conditions or structures that can cause pooling is…
a. Drusen
b. RPE detachment in central serous chorioretinopathy
c. fibrotic tissue
d. Optic nerve tissue
Pembahasan
Pooling refers to the accumulation of fluorescein in a fluid-filled space in the retina or choroid. As
fluorescein leaks into the space, the margins of the space trap the fluorescein and appear distinct, for
example, as seen in an RPE detachment in central serous chorioretinopathy
39. In a premature infant born at 28 weeks’ gestation, what is the appropriate time for the initial
screening examination for retinopathy of prematurity (ROP)?
a. at birth
b. 1–3 weeks after birth
c. 4–6 weeks after birth
d. no examination indicated
Pembahasan:
All infants with a birth weight of less than 1500 g or a gestational age of 30 weeks or less should be
screened. In addition, infants with a birth weight between 1500 g and 2000 g or a gestational age greater
than 30 weeks, with an unstable clinical course, and who are believed to be at high risk by their
attending pediatricians or neonatologists should be screened. The first examination should generally
be performed between 4 and 6 weeks of postnatal age or, alternatively, between 31 and 33 weeks’
postconceptional or postmenstrual age, whichever is later.
40. Manifestasi klinis sindrom VKH dapat dibagi atas 3 fase. Pada fase kronis/konvalesen biasanya
ditandai dengan beberapa tanda dan gejala seperti:
(dr. Felanda)
a. Sugi-ura sign
b. Sunset glow sign
c. Meningismus
d. A dan B benar
e. Semua benar
Jawaban : D
AAO 2020-2021 Section 12 Chapter 11 hal 233
The clinical course of VKH disease can be divided into 3 phases:
1. prodromal phase: characterized by a flulike illness with symptoms that can include headache,
meningismus, tinnitus, and dysacusis
2. acute uveitic phase: closely follows the prodromal phase; characterized by pain, photophobia, and
vision loss accompanied by the onset of bilateral panuveitis with serous retinal detachments
3. chronic (convalescent) phase: the uveitis subsides, but depigmentation of the skin and uvea can occur;
ocular depigmentation may develop at the limbus (“Sugi- ura” sign), the trabecular meshwork (“Ohno”
sign), or within the choroid (“sunset glow” sign)
41. Pada trauma tumpul, objek tidak berpenetrasi ke dalam mata tetapi dapat menyebabkan ruptur
dinding bola mata. Beberapa sequele trauma tumpul yang mengenai segmen anterior adalah (dr.
Felanda)
a. Commotio retina
b. Angle recession
c. Macular hole
d. Semua benar
e. Semua salah
Jawaban : B
In blunt trauma, the object does not penetrate the eye but may cause rupture of the eye- wall. Serious
sequelae from blunt trauma affecting the anterior segment include
• angle recession (see also BCSC Section 10, Glaucoma)
• iridodialysis (see also BCSC Section 8, External Disease and Cornea)
• iritis (see also BCSC Section 9, Uveitis and Ocular Inflammation)
• hemorrhage into the anterior chamber (hyphema)
• subluxated or dislocated lens (see also BCSC Section 11, Lens and Cataract)
42. Dislokasi diskus nervus optikus ke posterior yang kuat dari kanal sklera dapat terjadi di akibat
beberapa keadaan, antara lain: (dr. Felanda)
a. Rotasi ekstrim dan perpindahan bola mata ke depan
b. Cedera tembus orbita, menyebabkan tarikan ke belakang pada nervus optikus
c. Peningkatan TIO yang tiba-tiba, menyebabkan ruptur lamina kribrosa
d. Semua benar
e. Semua salah
Jawaban : D
A forceful backward dislocation of the optic nerve from the scleral canal can occur under several
circumstances, including
• extreme rotation and forward displacement of the globe
• penetrating orbital injury, causing a backward pull on the optic nerve
• sudden increase in IOP, causing rupture of the lamina cribrosa
43. Perdarahan suprakoroid dapat terjadi selama atau setelah operasi intraokuler. Yang tidak termasuk
dalam faktor resiko untuk terjadinya perdarahan suprakoroid adalah
A. Usia tua
B. Afakia
C. Hipotensi
D. Miopia
E. Glaukoma
Jawaban : C
Pembahasan : AAO Section 12 halaman 394
Faktor resiko untuk perdarahan suprakoroid adalah :
1. Usia lanjut
2. Afakia
3. Arterioslerosis penyakit jantung
4. Glaukoma
5. Hipertensi
6. Takikardia intraoperative
7. Miopia
8. Hemangioma koroid yang terkait Sturge – Weber
44. A bull’s eye maculopathy can be present in what disease?

A. Tay- Sachs disease
B. Cystinosis
C. Fabry disease
D. Batten disease
Jawaban : B
Pembahasan : AAO Section 12 halaman 283
Bull’s eye maculopathy dapat dijumpai pada degenerasi retina dengan
keterlibatan sistemik, salah satunya adalah Batten disease. Batten disease atau yang dapat juga
disebutkan sebagai Neuronal Ceroid lipofuscinoses (NCL) adalah suatu penyakit langka yang
disebabkan oleh mutasi autosom resesif yang biasanya terjadi pada anak usia 5 - 10 tahun.
45. What type of retinal detachment is most likely to be asymptomatic?
A. Rhegmatogenous
B. Tractional
C. Exudative
D. Retinoschisis - associated
Jawaban : B
Pembahasan : AAO Section 12 - Study Question nomor 39 halaman 418, pembahasan
halaman 429
Sebagian besar ablasio retina jenis tractional berasal jauh dari fovea dan umumnya asimptomatik
kecuali apabila robekan tersebut merupakan kombinasi ablasio retina jenis rhegmatogenous dan
tractional. Dalam kasus serupa, retinaschisis juga umumnya asimptomatik, namun apabila terjadi
robekan pada lapisan bagian luar dan menyebabkan ablasio jenis rhegmatogenous, maka ablasio tersebut
menjadi simptomatik. Ablasio retina jenis eksudatif (khususnya robekan makula yang terkait dengan
CNV) dan ablasio retina jenis rhegmatogenous umunya simptomatik.
46. A 60- year- old woman with unexplained peripheral neuropathy but no additional ophthalmicor
medical history reports bilateral visually significant floaters. What is the most likely diagnosis?
a. asteroid hyalosis
b. cholesterolosis
c. amyloidosis
d. chronic vitreous hemorrhage
Jawaban C
Sumber AAO, Study Quetion Hal-429
Kekeruhan vitreous dapat menjadi salah satu tanda awal amiloidosis familial. Materi amiloid juga dapat
disimpan di tempat lain dalam struktur okular, dan keluhan nonokular awal mungkin termasuk neuropati
perifer. Pewarnaan merah Kongo dari sampel vitreous dapat mengkonfirmasi diagnosa. Hyalosis
asteroid biasanya unilateral dan jarang signifikan secara visual.
Kolesterolosis, atau synchysis scintillans, terjadi pada mata dengan riwayat perdarahan intravitreal yang
biasanya berhubungan dengan trauma okular yang tidak disengaja atau pembedahan sebelumnya.
Meskipun patologi oftalmik sebelumnya yang mengarah ke perdarahan vitreous dehemoglobinized harus
selalu
dipertimbangkan, kemungkinannya kecil dalam skenario ini.
47. Which of the following diagnostic studies is indicated in the evaluation of age-related macular
degeneration (AMD) to detect the presence of choroidal neovascularization (CNV)?
a. fluorescein angiography
b. magnetic resonance imaging
c. corneal topography
d. computerized axial tomography
Jawaban: A
Sumber AAO, Chapter 4 Hal-72
Angiografi fluorescein dari CNV Pola FA CNV dapat diklasifikasikan sebagai klasik, okultisme, atau
beberapa kombinasi keduanya. CNV klasik mengacu pada lesi hiperfluoresen yang terang, berenda, dan
berbatas tegas yang muncul pada fase awal dan secara progresif bocor pada fase akhir. Occult CNV
mengacu pada hiperfluoresensi yang lebih menyebar yang mengambil 1 dari 2 bentuk:
(1) PED, baik PED fibrovaskular atau PED serosa vaskularisasi, atau (2) kebocoran lambat dari sumber
yang belum ditentukan.
PED fibrovaskular adalah elevasi RPE yang tidak teratur dengan kebocoran FA yang progresif dan
berbintik-bintik. Sebagai alternatif, PED dapat mengumpulkan pewarna dengan cepat dalam gelas dasar
yang homogen pola yang konsisten dengan PED serosa tetapi memiliki takik, atau hot spot, karena
pembuluh darah komponen, maka istilah PED serosa vaskularisasi.
Kebocoran terlambat dari sumber yang tidak ditentukan menggambarkan fluoresensi pada tingkat RPE
yang tidak didefinisikan dengan baik pada fase awal FA, tetapi lebih dihargai pada fase akhir
48. Which of the following factors is an important risk factor for ocular toxoplasmosis?
a. consumption of undercooked meat
b. exposure to ticks
c. exposure to mosquitoes
d. living in the Ohio River Valley
Jawaban: A
Sumber AAO, Chapter11 Hal-243
Retinokoroiditis toksoplasma adalah penyebab paling umum dari infeksi segmen posterior di seluruh
dunia. Organisme penyebab, Toxoplasma gondii, adalah protozoa parasit intraseluler obligat. Karena
seropositif untuk T gondii sangat umum, seropositif saja tidak mengkonfirmasi bahwa uveitis
berhubungan dengan toksoplasmosis. Penyakit kongenital terjadi melalui akuisisi organisme oleh wanita
hamil terkena kista jaringan atau oosit di daging mentah atau zat yang terkontaminasi kotoran kucing
toksoplasmosis adalah bekas luka korioret, biasanya di makula dan sering bilateral. Kebanyakan kasus
toksoplasmosis saat ini diasumsikan diperoleh setelah lahir, meskipun membuktikan hal ini asumsi bisa
sulit. Hasil tes serologi positif untuk imunoglobulin M (IgM) antibodi anti-T gondii mendukung
diagnosis penyakit yang didapat.
49. What are the characteristics of a stage 3 macular hole?

a. a fully developed hole (≥400 μm in diameter), typically surrounded by a rim of thickened and
detached retina
b. a fully developed hole with a complete posterior vitreous detachmentc. an early full - thickness
macular hole that is less than 400 μm in diameter
d. impending macular hole
A stage 3 macular hole is a fully developed hole (≥400 µm in dia meter), typically surrounded by a rim
of thickened and detached ret ina. Visual acuity ranges widely. The posterior hyaloid remains attached
to the optic nerve head but is detached from the fovea. An operculum suspended by the posterior hyaloid
may be seen overlying the hole. On OCT, this stage represents a large macular hole with no VMT. AAO
Chapter 17 hal 399
50. Characteristics of RPE abnormalities seen in patients with nonneovascular AMD include:
a. focal hyperpigmentation
b. focal atrophy
c. geographic atrophy
d. All of the above
Characteristic RPE abnormalities seen in patients with nonneovascular AMD include focal
hyperpigmentation, focal atrophy, and geographic atrophy. Focal RPE hyperpigmentation appears as
increased pigmentation at the level of the outer ret ina. These areas typically produce blockage of
fluorescence on FA, and appear as hyperreflective outer ret i nal foci on SD- OCT. The incidence of
focal hyperpigmentations increases with age; their presence is associated with a greater risk of
progression to the more advanced forms of AMD. AAO Chapter 4 hal 66
51. According to ARED study, the following food supplementations are proved beneficial to reducing
the risk of vision loss in non-exudative AMD:
a. Vitamin C 500 mg
b. Vitamin E 400 IU
c. Beta carotene 15 mg
d. Zinc oxide 80 mg + 2 mg Cupric oxide
e. All of the above
AREDS (Age- Related Eye Disease Study) first established the benefit of vitamin and zinc
supplementation in reducing the risk of vision loss in nonexudative AMD. In the study, after
supplementation with the antioxidant vitamins C (500 mg) and E (400 IU), beta carotene (15 mg), and
the micronutrient zinc (80 mg zinc oxide and 2 mg cupric oxide to prevent zinc- induced anemia),
patients with intermediate or advanced AMD showed a 25% risk reduction for progression to more-
advanced stages of AMD and a 19% risk reduction in rates of moderate vision loss (≥3 lines of visual
acuity) at 5 years. The study defined intermediate (stage 3) AMD as the presence of at least 1 large druse
(≥125 μm), extensive intermediate drusen (63–124 μm dia meter), or nonsubfoveal GA; advanced (stage
4) AMD was defined as vision loss due to neovascular AMD or subfoveal GA in only 1 eye. At
10 years, 44% of placebo recipients compared with 34% of the supplement recipients had advanced
AMD (a 23% risk reduction). Among participants with no AMD or with only early- stage AMD (a few
small drusen), there was no mea sur able benefit. There was no increased mortality among patients
taking the formula recommended by AREDS. AAO Chapter 4 hal 69
52. In patients with Type 1 Diabetes, when is the recommended time for the first eye examination?
a. 5 years after diagnosis
b. Upon diagnosis
c. 3 months after diagnosis
d. 2 years after diagnosis
e. 1 year after diagnosis
Penjelasan:
53. Pada Age related macular degeneration biasanya di tandai dengan adanya drusen, drusen pada
AMD terletak pada bagian?
a. Sepanjang lapisan basal RPE
b. Choroid
c. Subretina
d. Epiretina
e. Intraretina
Penjelasan:
Clinically, drusen are small, round, yellow lesions located along the basal surface of the RPE, mostly in
the postequatorial retina. Histologically, this material corresponds to the abnormal thickening of the
inner aspect of Bruch membrane. Ultrastructurally, basal laminar deposits (granular, lipid- rich material
and widely spaced collagen fibers between the plasma membrane and basement membrane of the RPE
cell) and basal linear deposits (phospholipid vesicles and electron- dense granules within the inner
collagenous zone of Bruch membrane) are present
54. Kondisi-kondisi berikut terkait dengan choroidal neovascularization, kecuali?
a. Rupture koroid
b. ARMD
c. Myopic degeneration
d. Simpatetic oftalmia
e. Traumatic optic neuropathy
Penjelasan:
55. First line therapy pada diabetic macular edema terutama jika keterlibatan visual adalah?
a. Corticosteroid
b. Laser treatment
c. Pars plana vitrectomy
d. Anti VEGF
e. Asetazolamide
Jawab :
Treatment is typically indicated when the macular edema is center-involved and affects visual acuity.
anti-VEGF drugs are now the first-line therapy for most eyes with center involved DME, especially
those with vision impairment caused by the DME. Corticosteroids are also useful as alternative agents
for eyes that are not candidates for anti-VEGF therapy or that were incompletely responsive to previous
anti-VEGF treatment. (AAO page 111)
56. Pasien usia 40 tahun datang dengan keluhan penglihatan mata kanan kabur. VOD 20/200 VOS
20/20. Segmen anterior dalam batas normal. Pada pemeriksaan OCT didapatkan hole sebesar 440
micron pada OD tanpa vitreomacular traction. Apakah diagnosis pada pasien ini?
a. Macular Hole stadium 1A
b. Macular Hole stadium 1B
c. Macular Hole stadium 2
d. Macular Hole stadium 3
e. Macular Hole stadium 4
The following description of the stages of macular hole formation is useful in making
management decisions (Fig 17-7):
• A stage 0, or premacular, hole occurs when a PVD with persistent foveal attachment develops.
Subtle loss of the foveal depression can be observed, and visual acuity is usually unaffected. Most stage
0 holes do not progress to advanced stages. This stage represents a VMA.
• A stage 1 macular hole (impending macular hole) typically causes visual symptoms of
metamorphopsia and central vision decline, usually to a visual acuity range of 20/25 to 20/60. The
characteristic findings are either a small yellow spot (stage 1A) or a yellow circle (stage 1B) in the
fovea. OCT examination reveals that a stage 1A hole is a foveal “pseudocyst,” or horizontal splitting
(schisis), associated with vitreous traction to the foveal center. A stage 1B hole indicates a break in the
outer fovea, the margins of which constitute the yellow ring noted clinically. Spontaneous reso- lution of
a stage 1 hole occurs in approximately 50% of cases without ERM. This stage represents VMT
syndrome.
• A stage 2 macular hole represents an early full-thickness macular hole that is less than 400 μm
in diameter. It results from the progression of a foveal schisis (pseudocyst) to a full-thickness
dehiscence, as a tractional break develops in the “roof ” (inner layer) of the pseudocyst. Progression to
stage 2 is accompanied by a further decline in visual acuity. OCT demonstrates the full-thickness defect
and the con- tinuing attachment of the posterior hyaloid to the foveal center. This stage represents
VMT syndrome with a small- to medium-sized macular hole.
• A stage 3 macular hole is a fully developed hole (≥400 μm in diameter), typically
surrounded by a rim of thickened and detached retina. Visual acuity ranges widely. The posterior
hyaloid remains attached to the optic nerve head but is detached from the fovea. An operculum
suspended by the posterior hyaloid may be seen overlying the hole. On OCT, this stage represents a
large macular hole with no VMT (Activity 17-3, Fig 17-8).
• A stage 4 macular hole is a fully developed hole with a complete posterior vitreous
detachment, as evidenced by the presence of a Weiss ring. On OCT, this stage represents a large
macular hole with no VMT.
57. A 28- year- old otherwise healthy man presents with recent onset of unilateral slightly blurred
vision. On evaluation, the right eye has a visual acuity of 20/25, there is serous subret i nal fluid in the
macula, and the choroid is thickened. The patient is minimally symptomatic. What is the most
appropriate initial management?
a. observation
b. topical steroids
c. photodynamic therapy
d. argon laser treatment
Central serous chorioretinopathy (CSC) causes an idiopathic serous detachment of the retina related to
leakage at the level of the retinal pigment epithelium (RPE), secondary to hyperpermeability of the
choriocapillaris, as seen on indocyanine green angiography.
Verteporfin photodynamic therapy (PDT) reduces or eliminates subretinal fluid and is associated with
few complications, the most common of which is atrophy, which occurs in about 4% of treated eyes.
Recurrence after successful PDT is rare. Laser photocoagulation has no effect on choroidal thickness,
while PDT decreases choroidal thickness and reduces choroidal vascular hyperpermeability.
58. What symptom following intravitreous injection would be unexpected and warrant immediate
evaluation?
a. progressive floaters with progressive blurring of vision
b. sharp pain following the injection
c. foreign body sensation
d. small floaters that are noticed immediately following injection
Jawaban A
Sumber AAO, Study Quetion Hal-419
a. Vitritis, or inflammation of the vitreous, is the first presenting feature of injection- related
endophthalmitis. It is perceived by patients as progressive floaters and blurring of vision, often
culminating in essentially no formed vision (eg, light perception only). Immediate evaluation is
necessary to determine whether endophthalmitis is pres ent. Sharp pain following the injection or
foreign body sensation are likely caused by surface irritation or damage form the povidone iodine
solution, the manipulation of the conjunctiva, or from the needle stick. Occasionally, patients may suffer
severe pain that that starts some time following the injection, which may be caused by corneal abrasions.
Small floaters that are noticed immediately following injection are usually caused by small air bubbles,
and less commonly by silicone oil bubbles from the syringe lubricant, in the injected liquid, a common
occurrence. Air bubbles usually dis appear after a few hours, while the silicone oil bubbles persist, but
usually float out of view.
Vitritis, atau peradangan vitreous, adalah gambaran pertama dari endophthalmitis terkait injeksi. Hal ini
dirasakan oleh pasien sebagai floaters progresif dan penglihatan kabur, sering berpuncak pada dasarnya
tidak ada penglihatan yang terbentuk (misalnya, hanya persepsi cahaya). Evaluasi segera diperlukan
untuk menentukan apakah ada endoftalmitis. Nyeri tajam setelah injeksi atau sensasi benda asing
kemungkinan disebabkan oleh iritasi permukaan atau kerusakan dari larutan povidone iodine,
manipulasi konjungtiva, atau dari tusukan jarum. Kadang-kadang, pasien mungkin menderita sakit parah
yang dimulai beberapa saat setelah injeksi, yang mungkin disebabkan oleh lecet kornea. Floaters kecil
yang terlihat segera setelah injeksi biasanya disebabkan oleh gelembung udara kecil, dan lebih jarang
oleh gelembung minyak silikon dari pelumas jarum suntik, dalam cairan yang disuntikkan, merupakan
kejadian umum. Gelembung udara biasanya hilang setelah beberapa jam, sementara gelembung minyak
silikon tetap ada, tetapi biasanya melayang keluar dari pandangan
59. A 60 year-old woman come to the clinic complaining sudden blurred vision of the right eye since
2 days ago. No pain and redness in the affected eye. Visual acuity of RE is 1/60 and RAPD (+) in the
RE. Patient has history of diabetes and hypertension since 5 years ago. In the funduscopic
examination, appear like the picture below. The most likely diagnosis of the patient is:
(Questions for 59-61)
a. CRVO
b. BRVO
c. CRAO
d. PDR
e. Severe NPDR
Jawaban A
Sumber AAO Chapter 6, Hal-132
60. In the case above, Panretinal photocoagulation is indicated if we found:

a. Iris neovascularitation in 1 clock hour
b. Iris neovascularitation in 2 clock hour
c. Iris neovascularitation in 3 clock hour
d. Iris neovascularitation in 4 clock hour
e. None of the above is true
Jawaban B
Sumber AAO, Chapter 6 Hal-135
FOTOKOAGULASI PANRETINAL CVOS menemukan bahwa fotokoagulasi panretina profilaksis
(PRP) tidak menghasilkan penurunan yang signifikan secara statistik dalam kejadian neovaskularisasi
iris. Faktanya, 20% peserta yang menerima PRP profilaksis masih berkembang neovaskularisasi iris.
Oleh karena itu, pasien dengan risiko tinggi neovaskularisasi iris harus dipantau secara ketat. Meskipun
peneliti CVOS merekomendasikan menunggu sampai pemeriksaan gonioskopi yang tidak berdilatasi
mengungkapkan setidaknya 2 jam-jam iris neovaskularisasi sebelum melakukan PRP, dalam praktek
klinis PRP sering dilakukan di tanda pertama neovaskularisasi iris, terutama ketika tindak lanjut yang
dekat tidak memungkinkan
atau tampaknya tidak mungkin. Angiografi bidang lebar memberikan visualisasi periferal yang lebih
luas nonperfusi di CRVO; namun, tidak ada bukti yang mendukung perubahan kriteria pengobatan
berdasarkan informasi ini.
61. Risk factors that can be associated to the condition in the case above is:
a. systemic arterial hypertension
b. open- angle glaucoma
c. diabetes mellitus
d. hyperlipidemia
e. all of the above is true
Pembahasan
Risk factors and causes of CRVO
The most impor tant risk factor for the development of CRVO is age; 90% of patients are
older than 50 years at the time of onset. Mild CRVOs generally occur at a younger age.
The Eye Disease Case- Control Study and other studies found the following additional risk
factors associated with CRVO:
• systemic arterial hypertension
• open- angle glaucoma
• diabetes mellitus
• hyperlipidemia
• hypercoagulability
It is common for patients presenting with CRVO to have elevated intraocular pressure (IOP) or frank
open- angle glaucoma, either only in the affected eye or in both eyes; if CRVO is pres ent in 1 eye, it is
impor tant to assess the fellow eye for glaucoma. CRVO can also lead to a transient shallowing of the
anterior chamber that, in some instances, leads to angle- closure glaucoma
62. Vitreous attaches to the internal limiting membrane (ILM) of the ret i nal surface via what2 primary
adhesion molecules?
a. fibronectin and laminin
b. fibronectin and integrin
c. fibronectin and connectin
d. laminin and connectin
Pembahasan
The vitreous attaches to the internal limiting membrane (ILM) of the retinal surface primarily via
fibronectin and laminin. The integrin molecule has been shown to induce posterior vitreous detachment,
not facilitate attachment. The connectin molecule does not appear to play a significant role in
vitreoretinal adhesion.
63. What percentage of cones overall reside outside the foveal region?
a. 30%
b. 50%
c. 70%
d. 90%
Pembahasan
The density and distribution of photoreceptors vary with topographic location. In the fovea, cones are
predominantly red- and green- sensitive, with a density exceeding 140,000 cones/mm2. The foveola has
no rods. The fovea contains only photoreceptors, rods and cones, and pro cesses of Müller cells. The
number of cone photoreceptors decreases rapidly away from the fovea, even though 90% of cones
overall reside outside the foveae region. The density of rods also decreases toward the periphery.
64. What noninvasive diagnostic test is most specific for detecting retinal pigment epithelial (RPE)
cell death ? (dr. Yudhi)
a. fundus autofluorescence (FAF)
b. fluorescein angiography
c. fundus photography
d. optical coherence tomography angiography (OCTA)
Jawaban : A
Pembahasan : AAO SECTION 12 BAB 20 HALAMAN 423
65. The RPE contributes to retinal function by … (dr. Yudhi)

a. Absorbs light
b. Phagocytoses rod and cone outer segment
c. Forms the outer blood-ocular barrier
d. Heals and forms scar tissue
e. All above
Jawaban : E
66. The most common modifiable risk factors for AMD are … (dr. Yudhi)
a. Cigarette smoking
b. Hypercolesterolemia
c. Sex
d. Hyperopia
Jawaban : A
67. A patient develops branch retinal vein occlusion (BRVO) at a site other than an arteriovenous
crossing. What under lying etiology should be considered ? (dr. Yudhi)
a. hypertension
b. embolus
c. vasculitis
d. glaucoma
Jawaban : C
68.Which of the following findings constitutes a pertinent clinical feature of neovascular AMD ? (dr.
Rini)
a. subretinal fluid
c. drusen
Jawaban : D
69. Which of the following disorders would be least likely to be considered in the differential
diagnosis of chloroquine phosphate and hydroxychloroquine toxicity? (dr. Rini)
a. AMD with geographic atrophy
b. Stargardt disease
c. Tay-Sachs disease
d. cone dystrophy
Jawaban : C
Pembahasan : AAO SECTION 12 BAB 4 HALAMAN 68 dan BAB 15 HALAMAN 295
70. If pars plana vitrectomy is performed on a patient whose fundus has a macular
epiretinalmembrane, what is the most likely postsurgical complication to occur? (dr. Rini)
a. nuclear sclerosis
b. retinal tear/detachment
c. endophthalmitis
d. macular pucker
Jawaban : A
71. AREDS developed a simplified 4-point grading scale for classifying the severity of AMD
andpredicting the disease course based on the following findings, except… (dr. Rini)
a. presence of 1 or more large (≥ 125-μm diameter) drusen ()
b. presence of any pigment abnormalities ()
c. for patients with no large drusen, presence of bilateral intermediate (63–124 μm) drusen (1
point)
d. presence of neovascular AMD (2 points)
e. presence of nonneovascular AMD (1point)
Jawaban : E
72. The recommended eye examination schedule based on diabetic retinopathy severity for severe
NPDR with non center involved DME is suggested follow up interval …(dr. Insan)
a. 2-4 month
b. 1 month
c. 3-6 month
d. 4-6 month
e. 12 month
Jawaban : A
73. A severe NPDR was define as having any of the following feature:
a. severe intraretinal hemorrhages and microaneurysms in 4 quadrants ,definite venous
beading in 2 or more quadrants ,moderate IRMA in 1 or more quadrants
b. severe intraretinal hemorrhages and microaneurysms in 2 quadrants ,definite venous beading in 2
or more quadrants ,moderate IRMA in 2 or more quadrants
c. severe intraretinal hemorrhages and microaneurysms in 1 quadrants, definite venous beading in 1
or more quadrants, moderate IRMA in 1 or more quadrants
d. severe intraretinal hemorrhages and microaneurysms in 4 quadrants, definite venous beading in 4
quadrants, moderate IRMA in 4 quadrants
e. severe intraretinal hemorrhages and microaneurysms in 1 quadrants, definite venous beading in 2
quadrants, moderate IRMA in 4 quadrants
Jawaban : A
74. What is a defining feature of a stage 2 macular hole ? (dr. Insan)

a. spontaneous closure that occurs in 50% of cases
b. visible operculum
c. full- thickness defect less than 400 μm in diameter
d. posterior hyaloid that is detached from the macula and nerve
Jawaban : C
75. A bull’s-eye maculopathy can be present in what disease? (dr. Insan)
a. Tay-Sachs disease
b. cystinosis
c. Fabry disease
d. Batten disease
Jawaban : D
76. Pada periode pascaoperasi vitrektomi, manakah dari temuan berikut yang paling sering diamati ?
(dr. Gilang)
a. peningkatan tekanan intraokular
b. percepatan perkembangan katarak
c. hyphema
d. ablasio retina
Jawaban : B
77. Teknik fluorescein angiografi dilakukan dengan prosedur sebagai berikut … (dr. Gilang)
a. injeksi intramuskular 5 mL natrium fluorescein 10%
b. injeksi intravena 5 ml larutan hijau indocyanine
c. injeksi intravena 5 mL sodium fluorescein 10%
d. pemberian bersama difenhidramin oral atau intravena
Jawaban : B
Pembahasan : AAO SECTION 12 BAB 2 HALAMAN 38-39
78. Manakah dari faktor-faktor berikut yang merupakan faktor risiko penting untuk toksoplasmosis
okular? (dr. Gilang)
a. konsumsi daging setengah matang
b. paparan kutu
c. paparan nyamuk
d. tinggal di Lembah Sungai Ohio
Jawaban : A
79. Match the following descriptions of the retinal layers with their corresponding labeled spectral -
domain OCT layers on Figure. This layer is responsible for the major source of nutrition of the retinal
pigment epithelium (RPE): (dr. Gilang)
A. Z
B. W
C. V
D. Y
Jawaban : B
80. This layer represents interconnections between photoreceptors, bipolar, and horizontal cells: (dr.
Taya)
A. V
B. Y
C. W
D. Z
Jawaban : B
(AAO 2020-2021 Section 12 Chapter 1 pp 11)
V = Choriocapilaris
W = Ganglion cell layer
X = IS-OS junction (ellipsoid layer)
Y = Outer plexiform layer
Z = Nerve fiber layer
81. The cell bodies in this layer have their axons in the nerve fiber layer: (dr. Taya)
A. W
B. V
C. Y
D. X
Jawaban : A
V = Choriocapilaris
W = Ganglion cell layer
X = IS-OS junction (ellipsoid layer)
Y = Outer plexiform layer
Z = Nerve fiber layer
82. Seorang anak usia 2 bulan datang ke RSUP Dr M Djamil dengan berkurangnya respon
penglihatan. Hasil anamnesa didapatkan anak lahir prematur pada usia kehamilan 27-28 minggu, BBL
800mg, pasien tidak langsung menangis dan dirawat di NICU menggunakan CPAP selama 2 minggu.
Kontak mata dengan orang tua jarang. Di RS dilakukan pemeriksaan funduskopi dan didapatkan
gambaran sebagai berikut. Diagnosis pasien adalah : (dr. Taya)
a. retinopathy of prematurity stage 1
b. retinopathy of prematurity stage 2
c. retinopathy of prematurity stage 3
d. retinopathy of prematurity stage 4
e. Plus disease
Jawaban : Soal sulit untuk dijawab karena gambar funduskopi tidak tercantum dalam soal.
83. Seorang laki-laki berusia 21 tahun mengeluh tampak kilatan cahaya pada mata kanannya sejak 3
hari ini. Sebelumnya, mata kanan pasien telah dilakukan ekstraksi lensa karena trauma. Pada
pemeriksaan visus 20/400, TIO 5 mmHg, dan didapatkan gambaran funduskopi sebagai berikut.
Diagnosa pasien adalah: (dr. Taya)
a. Regmatogen Retinal Detachment
b. Exudative Retinal Detachment
c. Tractional Retinal Detachmen
d. Macular Hole
e. Perdarahan Vitreus
Jawaban : A
84. Seorang laki-laki usia 21 tahun, mengeluhkan pandangan kabur dan metamorfopsia pada kedua
mata. VOD 0,2 cc S-1.25 C-0.25 (60) -> 0,5 ; VOS 0,1 cc S-1.50 C-1.00(105) -> 0,3 . Riwayat operasi
LASIK 5 tahun yang lalu. VODS sebelum LASIK 2/60 S-10 -> 1,0 dan setelah LASIK : VODS S-0,25
-> 1.0Pemeriksaan funduskopi dan OCT sebagai berikut. Tatalaksana yang sebaiknya dapat dilakukan
terhadap pasien yaitu (dr. Wahyu)
a. Koreksi kacamata kembali
b. Injeksi anti VEGF
c. Verteporfin photodynamic therapy (v PDT)
d. Laser fotokoagulasi
e. CNV excision macular translocation
Jawaban : Soal sulit untuk dijawab karena gambar funduskopi dan OCT tidak tercantum dalam soal.
85. In Fluorescein angiograhy, Hyperfluorescence occurs when the fluorescence is abnormally

excessive, typically extending beyond the borders of recognized structures; this manifests in a few
major patterns, except: (dr. Wahyu)
a. Leakage
b. Staining
c. Pooling
d. Autofluorescence
e. Blocked fluorescence
Jawaban : E
Pembahasan : AAO SECTION 12 BAB 2 HAL 35
86. Pada kasus severe NPDR tanpa macular edema, berapa lama interval follow up berdasarkan Eye
examination schedule based on diabetic retinopathy severity? (dr. Wahyu)
a. 1 bulan
b. 4 bulan
c. 4-6 bulan
d. 6-12 bulan
Jawaban : B
87. Berdasarkan Early Treatment Diabetic Retinopathy Study (ETDRS), severe NPDR minimal
memiliki 1 kriteria dibawah ini, kecuali: (dr. Wahyu)
a. Severe intraretinal hemorrhages and microaneurysms in 4 quadrants.
b. Definite venous beading in 2 or more quadrants.
c. Moderate IRMA in 1 or more quadrants.
d. Any NVD with vitreous or preretinal hemorrhage
Jawaban : A
88. The most critical and constant finding in retinitis pigmentosa is (dr. Rika K)
a. dense bone-spicule pigmentation in the retinal periphery
b. an abnormality in the rhodopsin gene
c. acquired red-green color deficiency
d. significantly reduced electroretinogram (ERG)
e. small tubular visual fields
Jawaban : A
89. Which of the following is most characteristic of exudative retinal detachment? (dr. Rika K)
a. shifting fluid
b. tobacco dust
c. fixed folds
d. equatorial traction folds
e. demarcation lines
Jawaban : A
Pembahasan : AAO SECTION 12 BAB 16 HALAMAN 325-326
90. Which of the following findings constitutes a pertinent clinical feature of neovascular AMD ? (dr.
Rika K)
a. subretinal fluid
c. drusen
Jawaban : D

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2. Which of the following is most characteristic of exudative retinal detachment?

6. The classic indications for pneumatic retinopexy include:

Indikasi klasik untuk pneumatic retinopexy yaitu :

14. Exudative detachments occur in all of the following conditions:

18. What identifiable preoperative feature is a contraindication to retrobulbar anesthesia?

➔ Risiko 5 tahun : 25%

Pembahasan : AAO BCSC 2020-2021Section 21. Retina dan Vitreous Hal. 63

44. A bull’s eye maculopathy can be present in what disease?

49. What are the characteristics of a stage 3 macular hole?

60. In the case above, Panretinal photocoagulation is indicated if we found:

65. The RPE contributes to retinal function by … (dr. Yudhi)

74. What is a defining feature of a stage 2 macular hole ? (dr. Insan)

85. In Fluorescein angiograhy, Hyperfluorescence occurs when the fluorescence is abnormally

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