Dr Yunani Setyandriana, Sp M

Medical Faculty
UMY
Cataract
Diabetic Retinopathy
Neovascular Glaucoma
Cataract
Diabetes
Kadar gula kadar gula dlm
lensa sorbitol (menarik air
dalam lensa) keruh.
THERAPY
ECCE
SICS
Facoemulsifikasi
WHAT IS DIABETIC
RETINOPATHY?
It is a consequence of diabetes
High blood sugar level
Thickening of blood vessels in the retina

Leakage causes macular edema

Blockage of vessels causes proliferation of

new blood vessels
 The risk factors ???

Duration of diabetes mellitus

DM>10 th 50%
DM>30 th 95%

Increase and fluctuations of blood sugar

levels
FBS -> 110-120 mg/dl
PPBS (2 hrs) -> 150-160mg/dl
Hb A1c > 4-8 mg
Associated diseases like hypertension,
cardiac and renal diseases and
neuropathy
Associated conditions like
hyperlipidaemia and pregnancy
Diabetic retinopathy in
Indonesia
8.2 million diabetics in urban areas and 5.5
million in rural areas in 2003

The WHO projected the number of Indonesian

diabetics to increase to 20.9 million by 2025,
making Indonesia one of the top-five countries
with the highest estimated cases of diabetes.
Sebagian besar kebutaan dapat
dicegah dengan fotokoagulasi laser
yang dilaksanakan tepat waktu
Kenyataan sebagian besar
penderita datang terlambat
Stadium lanjut Vitrektomi
Pathogenesis
Hyperglycemic Mikroangiopati

Imbalance of Biochemical mechanism

Capillary Occlusion
Mikrovaskuler damage dysfunction
- Breakdown blood retinal barrier
- Pericyte loss Leakage
- Thinner of basement membrane -Hemorrhage
- Endothelial cell damage & proliferative -Edema
-Exudates
Peningkatan aktivitas enzim aldosa reduktase
Glikolisasi non-enzimatik
Pembentukan senyawa dikarbonil
Stress oksidatif
Pathogenesis (cont)
High Blood Sugar Levels affect
retinal Capillaries
RETINOPATI DM:
Perubahan retina
karena :
1. Kebocoran
pembuluh darah
halus
Akibatnya:
Edema retina
Hard Exudate
Perdarahan retina
2. Sumbatan
pembuluh darah
halus di retina
(oklusi
mikrovaskuler)
Arteria-venous
Shunt.
Terbentuk pembuluh
darah neovaskuler:
-Perdarahan
vitreus
-Jaringan fibrous
-Ablasi retina
3.Pembentukan
pembuluh
darah baru
yang rapuh
Klasifikasi klinis
Non-Proriferative Diabetic Retinopathy
mild
moderate
Severe
Proliferative Diabetic Retinopathy
NORMAL EYE
NPDR
 PDR

NVD NVE
Penanganan Retinopati
DM
Kontrol kadar gula darah
Deteksi dini :
DM tipe 1: periksa retina 5 th setelah onset
DM tipe 2: periksa retina setahun sekali mulai
diagnosa DM ditegakkan
Prinsip : Pencegahan penurunan
penglihatan dengan fotokoagulasi laser
Syarat:
Tepat waktu
Adekuat

Vitrektomi
Fotokoagulasi laser
Prinsip :
Energi cahaya diubah menjadi panas
koagulasi protein
Vitrectomy
Surgery indicated for:
Vitreal hemorrhage
Regmatogenous and tractional retinal
detachment
Laser photocoagulation does not
eliminate neovascularization
Retinal edema does not improve by
Laser.
Combine surgery

Advantages
One surgical episode, anaesthesia, and
postoperative recovery
Improved visualization of vitreoretinal
pathology
Superior anatomic and visual results of
in the bag intraocular lens (IOL) in
parsplana lensectomy are better.
VITREKTOMI