TRAUMATIC OPTIC

NEUROPATHY
RIZCKY NALDY EKA PUTRA
N 111 15 004

PEMBIMBING KLINIK
dr. NENENG HELIJANTI, Sp.M
 BAB I PENDAHULUAN

Definisi & Masalah

Traumatic Optic Neuropathy (TON) cedera akut pada sarafoptik karena trauma.

Epidemiologi
Penyebab TON tersering adalah kecelakaan kendaraan (71,4%), diikuti oleh jatuh
(17,9%) dan tindak kekerasan (10,7%).

Penatalaksanaan
Penatalaksanaan TON dilakukan dengan terapi farmakologi maupun pembedaha
n.

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 BAB II TINJAUAN PUSTAKA
Anatomi Saraf Optik

Regio Intraokular
Saraf optik Saraf kranial kedu
a
Regio Intraorbital

Regio Intrakanalikular

Regio Intrakranial

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REGIO INTRAOKULAR

Optic nerve layers (Dikutip

dari :Skuta GL, Cantor LB,
Weiss JS. Fundamentals and
Principles of ophtalmology
Singapore: American
Academy of Ophtalmology;
2012.)

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REGIO INTRAORBITA

Meningeal Sheaths (Dikutip dari :Skuta GL,

Cantor LB, Weiss JS. Fundamentals and
Principles of ophtalmology Singapore: American
Academy of Ophtalmology; 2012.)

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REGIO INTRAKANALIKULAR

Suplai pembuluh darah

saraf optik (Dikutip dari :
Khurana
AK. Comprehensive
Ophtalmology. 4th ed.
New Delhi: New Age
International; 2007.)

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REGIO INTRAKRANIAL

Kiasma Optikum (Dikutip

dari : Riordan-Eva P,
Whitcher JP. Vaughan &
Asbury's General
Ophtalmology. 17th ed.
New York: Lange; 2007.)

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JARAS PENGLIHATAN

Visual Pathway(Dikutip dari : Riordan-Eva P,

Whitcher JP. Vaughan & Asbury's General
Ophtalmology. 17th ed. New York:
Lange; 2007.)
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 DEFINISI Traumatic optic neuropathy (TON)
TRAUMATIC OPTIC NEUROPATHY
Cedera akut pada saraf optik akibat trau
ma

Hilangnya kemampuan penglihatan, defis

it lapangan pandang dan persepsi warna.

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 ETIOLOGI & EPIDEMIOLOGI

Terjatuh
3 Kasus (10,7%)

Perkelahian
5 Kasus (17,9%)
03
Kecelakaan Berkendar

20 Kasus (71,4%)
a 02 28 Sampel yang

01 di Diagnosa
Trauma Optik
Neuropati
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 Di Amerika Serikat Negara Jenis Kelamin

0,5 5% kasus trauma kepal Insidensi lebih tinggi dineg Laki-laki sebanyak 85% denga
a tertutup dan 2.5% kasus fr ara berkembang. n usia rata-rata 34 tahun.
aktur midfacial.

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 MEKANISME TRAUMA OPTIK NEUROPATI

Langsung Tidak Langsung

Iskemia Bradikinin

Peroksidasi Ion Ca Masuk Pelepasan Asam

Membran Sel Lemak Intraselular Arakidonat Neuron

Radikal Bebas Toksik Metabolik Prostaglandin

Kematian Jaringan

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 DIAGNOSIS TRAUMA OPTIK NEUROPATI

ANAMNE SA

PENURUNAN RIWAYAT
RIWAYAT TRAUMA
KESADARAN KELAINAN MATA
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 PEMERIKSAAN FISIK

Visus Pupil Warna Lapang Pandang Sensitivitas Kontras

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PEMERIKSAAN SEGMEN POSTERIOR

Papilledema pada pemeriksaan

funduskopi (Dikutip dari : Skuta GL,
Cantor LB, Weiss JS. Fundamentals
and Principles of phtalmology
Singapore: American Academy of
Ophtalmology; 2012.)
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 Tonometri
Tonometri Goldmann

Tonometri pemeriksaan objektif untuk menilai tekanan intraokular.

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 PEMERIKSAAN PENUNJANG

CT Scan Hematoma selubung saraf

optik dan kista araknoid.

MRI Melihat jaringan - jaringan lunak

menilai trauma kiasma.

Optical Coherence Tom

ography (OCT) Kerusakan akson lapisan fiber sara
f retina dan makula glaukoma d
an cedera saraf optik.

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 TATALAKSANA
Trauma Optik Neuropati

Konservati Farmakolog Pembedaha

f i n

37-71% pembedahan
0-48% Kasus tanpa 44-82% steroid dosis
dekompresi saraf
pengobatan tinggi
optik
TINDAKAN PEMBEDAHAN
Pembedahan

Tindakan orbitotomi lateral

(Dikutip dari : Skuta GL, Cantor LB,
Weiss JS. Fundamentals and
Principles of phtalmology
Singapore: American Academy of
Ophtalmology; 2012.)
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 35 Pasien TON
23 Pasien
outcome yang
buruk
PROGNOSIS
TRAUMATIC OPTIC NEUROPATHY
Perdarahan Etmoid
Posterior
Usia > 40 tahun
Penurunan Kesadaran
Tidak Ada Perbaikan
Setelah Pemberian
Kortikosteroid Dosis Tinggi
Dalam 48 Jam
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 BAB III KESIMPULAN

Traumatic optic neuropathy (TON) adalah cedera akut pada saraf optik a
1 kibat trauma.

Diagnosis ditegakkan dengan cara anamnesis dan pemeriksaan fisik ata

2 upun dengan pemeriksaan penunjang.

Penanganan trauma optik neuropati dapat dilakukan dengan terapi far

3 makologi maupun terapi pembedahan.

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Neuropathy
 DAFTAR PUSTAKA
1. Skuta GL, Cantor LB, Weiss JS. Fundamentals and Principles of Ophtalmology Singapore: American Academy of
Ophtalmology; 2012.
2. Steinsapir KD, Goldberg RA. Traumatic Optic Neuropathies. In Miller NR, Newman NJ, editors. Walsh & Hoyt's Clinical
Neuro-Ophtalmology, 6th Edition. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 431 - 446.
3. Zoumalan CI. Medscape Refference. [Online].; 2014 [cited 2017 May 11. Available from:
http://emedicine.medscape.com/article/868129-overview
4. Sundeep , Niveditha H, Nikhil N, Vinutha BV. Visual Outcome of Traumatic Optic Neuropathy in Patients Treated with
Intravenous Methylprednisolone. International Journal of Scientific Study. 2017 May; 2(3).
5. Wu N, Yin Z, Wang Y. Traumatic Optic Neuropathy Therapy: an Update of Clinical and Experimental Studies. The Journal of
International Medical Research. 2008 October; 36.
6. Srinivasan R, S. C. Traumatic Optic Neuropathy [TON] - A Review. Kerala Journal of Ophtalmology. 2008 March; XX(1).
7. Boughton B. Traumatic Optic Neuropathy: Previous Therapies Now Questioned or Shelved. Eyenet. 2009 November.
8. Miliawan S, Mahadewa TG, Putra AM. Lateral Orbitotomy for Traumatic Optic Neuropathy and Traumatic Ophtalmoplegia:
Is it Beneficial? Neurology Asia. 2009 June; 14.
9. Allon G, Seider N, Blumenthal EZ, Beiran I. Bilateral Traumatic Optic Neuropathy in an Uncoscious Patient: A Diagnostic
Challenge. The Israel Medical Journal. 2014 August; 16.
10. Lee KF, Nor NIM, Yaakub A, Hitam WHW. Traumatic Optic Neuropathy: A Review of 24 Patients. International Journal of
Ophtalmology. 2010 June;
11. Huang JJ, Chen WK, Chuang CM, Cheng YC, Ng KC. Traumatic Optic Neuropathy in Two Patients With Different
Manifestations and Outcomes. Taiwan Medical Journal. 1999 February.
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 DAFTAR PUSTAKA
12.Yanoff M, Duker JS. Yanoff & Duker Ophtalmology. 3rd ed.: An Expert Consult Title; 2008.
13.Khurana AK. Comprehensive Ophtalmology. 4th ed. New Delhi: New Age International; 2007.
14.Awan AH. Traumatic Optic Neuropathy. Pak J Ophthalmol. 2007; 23(2).
15.Riordan-Eva P, Whitcher JP. Vaughan & Asbury's General Ophtalmology. 17th ed. New York: Lange; 2007.
16.Kuo MT, Teng ICLMC. Serial Follow-Up in Traumatic Optic Neuropathy Using Scanning Laser Polarimetry and Visual Field
Testing. Chang Gung Medical Journal. 2005 August; 28(8).
17.Ahmad S, El-Sherbiny N, El-Sherbini A, Fulzele S, Liou GI. Adenosine Kinase as A Therapeutic Target in Traumatic Optic
Neuropathy. In International Genomic Medical Conference; 2013; Jeddah.
18.Lee V, Ford R, Xing W, Bunce C, Foot B. Surveilance of Traumatic Optic Neuropathy in The UK. Eyenet. 2010; 24.
19.Cunha LP, Cunha LVFC, Malta RFS, Monteiro MLR. Comparison Between Retinal Nerve Fiber Layer and Macular Thickness
Measured with OCT Detecting Progressive Axonal Loss Following Traumatic Optic Neuropathy. Arq Bras Oftalmol. 2009;
72(5).
20.Skuta GL, Cantor LB, Weiss JS. Neuro-Ophtalmology Singapore: American Academy of Ophtalmology; 2012.
21.Kanski JJ. Clinical Ophtalmology A Systematic Approach. 6th ed. Philadelphia: Elsevier Limited; 2007.
22.Tsai JC, Denniston AKO, Murray PI, Huang JJ, Aldad TS. Oxford American Handbook of Ophtalmology. 1st ed. New York:
Oxford University Press. 2011.
23.Carta A, Ferrigno L, Salvo M, Bianchi-Marzoli S, Boschi A, Carta F. Visual Prognosis After Indirect Traumatic Optic
Neuropathy. Journal of Neurosurgery Psychiatry. 2003; 74.

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