RETINOPATHY

HABIBAH S. MUHIDDIN
BAGIAN I.P. MATA FK UNHAS
Fundus normal
Papil normal
 DIABETIC RETINOPATHY

Frequent cause of blindness in USA,

aged 20 to 64 years
Indonesia blindness due to D.R.
increase
PATHOGENESIS

The exact cause is still unclear

It is believed :
Hiperglycemia over an extended period results in
a number biochemical and physiologic changes ---
endothelial damage.
Retinal vascular changes : loss of pericyte
basement membrane thickening---compromises
capillary lumen--- decompensation of endothelial
barrier function
 Hematologic and biochemical
abnormalities
Increased platelet adhesiveness
Increaser erythrocyte aggregation
Abnormal serum lipids
Defective fibrinolysis
Abnormal levels of growth hormone : ex
vascular endothelial growth factor (VEGF)
Abnormalities in serum and whole blood
viscosity
ADVANCED DIABETIC RETINOPATHY

Risk factor for :

Cardiovascular disease
Heart attack

Stroke

Diabetic nephropathy

Amputatia

Death
CLASSIFICATION
Non proliferative diabetic retinopathy (NPDR) =
back ground diabetic retinopathy :
Mild
Moderate
Severe
Very severe
Proliferative Diabetic Retinopathy :
Early
High risk
Advanced
Macular edema
NPDR : Retinal microvasculer changes
limited to the retina
Micro aneurysme
Dot & blot hemorrhage
Retinal edema
Hard exudates
Dilatation & bleading of the vein
Intraretinal micro vascular abnormalites (IRMA)
Nerve fiber layer infarct (cotton wool spot)
Areas of capillary non perfussion
RH :
RD tahap awal
RD : mikroaneurisma + hard exudate
Gamb. fluoresin
RD 1: cotton wool + Flame shaped
RD 2
RD 2 (fluoresin)
Affect visual function through
Capillary disease ischemic
Vascular permeability edema
Diabetic macular edema
The most common :
Cause of VA
Cause focal

Cause diffuse
Proliferative diabetic retinopathy (PDR)
Extra retinal fibrovascular proliferation
extends beyond the ILM
RD proliferatif
 NPDR

Ischemic retina

Release of vaso poliferative factors

Neovascularization of the retina

optic neuro head, ant.signal
RD proliferatif
 COMPLICATION

Reduced of visual acuity

Vitreous hemorrhage
Traction retinal detachment
Neurovascular glaucoma
RD prolif.+ ablasio
 TREATMENT

Regulation of blood glucose level

Laser photocoagulation
Vitrectomy
RD prolif + tx laser
 HYPERTENSIVE RETINOPATHY

Effect of systemic arterial hypertension

to chronic retinal vascularization
Hypertensive retinopathy
Hypertensive choroidopathy

Hypertensive optineuropathy
HYPERTENSIVE RETINOPATHY (HR)

Hypertensive vascular changes &

arterio sclerata vascular disease
express in HR.
Classification of HR, the modified
scheir.
Grade 0 : No change (a/v 2 : 3)
Grade 1 : barely table arterial narrowing
a:v=1:2
CLASSIFICATION OF HR
Grade 2 : obvious arterial narrowing
with focal irregularities.
Copper wire arteries
Silver wire arteries

Banking sign

Salus sign
RH : crossing/Gunn sign
RH : Gunn phenomen
RH: gunn, copper wire, Salus
RH dg Gunn phenomen
 Classification. cont

Grade 3 : grade 2 + retinal

hemorrhages and/or exudate

Grade 4 : grade 3 + disc swelling

Associated condition

Branch retinal artery occlusion (BRAO)

Branch retinal vein occlusion (BRVO)
Central retinal vein occlusion (CRVO)
Retinal arterial macroaneurysms
Preretinal and vitreous hemorrhage
Epiretinal membrane
HYPERTENSIVE CHOROIDOPATHY

Typically occur in young patients : with

acute hypertension ex :
Preeclampsia, eclampsia
Pheochromacytoma

Acute renal failure

RH pd HT renal
RH ok HT renal + edem papil
Funduscopic findings

Choriocapillaries nonperfusion
Hemorrhages
Retinal edema
Infark nerve fiber layer
RPE detachment
Retinal detachement
RH ok HT renal + edem papil
Hypertensive Optic Neuropathy

Flame-shaped hemorrhages around the

disc
Blurring of the disc margin
Congestion of the retinal vein
Secondary macular exudates
Retinopati angiospastik : cotton wool +
flame shaped + dot hemorrhage
Other types of retinopathy

Leukemia retinopathy
Thrombocytopenia retinopathy
Anemia retinopathy
Trombositopenia
Hemofilia
Leukemia akut