Jurnal Reading

Disusun oleh :
Octadikho Mega Nugraha

30101407282
Acute emotional stress as

Pembimbing :
Dr. Puryanto, Sp.M
a trigger for intraocular
pressure elevation in
Glaucoma
Fakultas Kedokteran
Universitas Islam Sultan Agung Semarang
2019
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Journal
Identity 01 TITLE
Acute emotional stress as a trigger for intraocular
pressure elevation in Glaucoma
02 AUTHORS
Kevin Gillmann, Kirsten Hoskens and Kaweh Mansouri
03 PUBLISHER
BMC Ophthalmology
04 TAHUN TERBIT
2019.
Abstrak
Insert the Sub Title of Your Presentation
Latar Belakang: Aktivasi sistem saraf simpatik yang diinduksi oleh stres
menyebabkan serangkaian reaksi metabolik. Stres emosional adalah bentuk stres
yang lebih spesifik di mana stresor merupakan respons psikologis terhadap situasi
yang secara subyektif dianggap traumatis. Hormon stres dapat memiliki berbagai
efek pada tubuh, namun, masih belum jelas apakah dan bagaimana hal itu dapat
mempengaruhi fisiologi mata.
Presentasi kasus: Seorang wanita berusia 78 tahun, tipe A kepribadian, dengan
riwayat pseudo-eksfoliatif glaukoma disajikan dengan peningkatan asimetris akut
dalam tekanan intraokular (TIO) segera setelah gangguan keluarga. TIO-nya
sebelumnya tetap stabil setelah sklerektomi mendalam di mata kanan dan shunt EX-
PRESS di mata kiri. Pemeriksaannya sepenuhnya normal jika tidak, dengan filtrasi
paten dan bleb difus yang dikonfirmasi dengan pencitraan OCT segmen anterior.
Hampir normalisasi TIO-nya diamati dalam 24 jam, bersamaan dengan penurunan
tingkat stresnya. Tidak ada penyebab lain untuk episode hipertensi akut sementara
yang ditemukan.
Kesimpulan: stres emosional akut dapat sangat mempengaruhi TIO pada pasien
yang menderita glaukoma. Tipe kepribadian, dan konteks emosional dan sosial
adalah lebih banyak faktor untuk dipertimbangkan dalam studi glaukoma.
Pengamatan didasarkan pada laporan kasus tunggal dan perlu diverifikasi pada skala
yang lebih besar.
Latar Belakang
Latar Belakang
↑ IOP GLAUKOMA ↓IOP : prognosis visus
↑ tekanan darah
STRESS
↑cortisol
EMOSIONAL
gg.
hoemeostasis
Laporan Kasus
Your Text Here
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Laporan Wanita 78 tahun. Etnis hispanik dengan pseudo-exfoliative glaucoma (PEXG) dan
exudate age-related macular degenartion (AMD) pada checkup rutin di klinik
Kasus mata dengan peningkatan IOP akut pada mata kiri.
• Riwayat operasi Ex-PRESS glaucoma akut dan katarak pada mata kiri adalah
12 tahun lalu.
• Riwayat operasi combined deep scleretomy dan katarak pada mata kanan 11
tahun lalu. YAG laser 2 terapi 2 tahun paska operasi.
• IOP mata kanan stabil (14-19 mmHg) dan mata kiri 16-21 mmHg.
• Mata kiri mendapatkan teraoi latanoprost dan timolol 0.1%
• AMD pada pasien stabil setela mendapatkan terapi ranibizumab 3 seies
injeksi intravitreal pada mata kiri 4 bulan sebelumnya.
Your Text Here
Laporan • Pasien datang tanpa keluhan, tanpa nyeri maupun ketidaknyamanan pada
mata. BCVA mata kanan 10/10 dan mata kiri 7/10
Kasus • IOP : 18 mmHg(kanan) dan 48 mmHg (kiri) pengukuran dengan Golmann

tonometry. Dengan pachymetry 552 μm (kanan)dan 555 μm (kiri)
• Pada pemeriksaan fisik dengan slitlamp didapatkan : IOL pada posisinya,
filtration bleb difus agak besar dengan 2 jahitan insitu di sclera mata kiri.
• Gonioskopi didapatkan : sudut terbuka pada kedua mata dengan trabekulo-
descemetic membrane pada mata kanan dan Ex-PRESS shunt in situ pada
mata kiri. Posisi dan patensi dipastikan dengan OCT, didapatkan berfungsi
dantampak difus pada kedua filtation blebs.
Your Text Here
Laporan • Pemeriksaan fundus, lapang pandang dan OCT didapatkan stabil dengan
ekstensif drusens pada kedua mata. Tidak ada rekuren macula edel,
Kasus vaskulatur retina normal, cup/disc ratio 0.6(kanan) dan 0.7 (kiri) dengan
diameter papil 1.4mm,
• Pada anamnesis didapatkan kepatuhan terhadap terapi yang dijalani dan
tidak ada trauma. Akan tetapi pasien mengalami severe emotional stress
karena masalah keluarga. Pasien memiliki kepribadian tipe A
• Pasien diberikan terapi kombinasi timolol topical dan dorzolamide dan
brimonidine 2kali perhari pada mata kiri dan acetazolamide 500mg/hari p.o
untuk menormalkan IOP dan mempertahankan serabut saraf
Your Text Here
Laporan • Hari selanjutnya, IOP pasien didapatkan normal ; 10 mmHg(kanan)

dan 16 mmHg(kiri).
Kasus • Pengobatan sistemik diturunkan dosisnya dan dihentikan dan IOP

kembali mendekekati level baseline dengan ukuran 12 dan 16
mmHg(kanan) dan 18-23 mmHg (kiri)
• Pasien juga mengalami penurunan kadar stress walaupun
mengalami anxietas karena masalah keluarga
• 2 bulan kemudian, IOP pada kedua mata masih stabil dengan
pengobatan timolol topical dan dorzolamide pada mata kiri
Your Text Here
• 2 bulan kemudian, IOP pada kedua mata masih stabil dengan

pengobatan timolol topical dan dorzolamide pada mata kiri
Laporan • Untuk mengeksklusi antar ukuran dan variasi diurnal, dilakukan

monitoring variasi IOP selama 24 jam dengan sensor Triggerfish
Kasus contact lens yang menunjukan stabilitas relative dari tekanan

sepanjang hari dan malam dengan perubahan minimal diikuri
dengan pemberian terapi topical.
• Posterior needling dikombinasikan denga suture lysis dilakukan
untuk meningkatkan kontrol IOP paada mata kiri, meskipun terjadi
perbaikan awal yang ringan dengan IOP stabil 22 mmHG setelah 2
bulan
• Prosedur Xen-augmented baerveldt dilakukan dan didapatkan IOP
tanpa pemberian obat adalah 16 mmHg pada 1 bulan
Diskusi
&
Kesimpulan
Tidak ditemukan kelainan
Stress Emosional IOP pada pasien PEXG anatomi dan fisiologi
pengaliran karena sudah
memiliki filtration bleb
Dekompensasi presisten
Tidak stabil Agresif
Mekanisme kompleks
sklerektomi dalam
non penetrasi
implantasi shunt Ex-
dilanjutkan dengan
PRESS
laser goniopunic-
ture Nd:YAG 
menghubungkan
COA dan spatium CDR 0.7
subkonjungtiva
Pada kasus ini terdapat respon asimeteri  perbedaan IOP yang sangat jauh pada
mata kiri dibandingkan mata kanan.
Stress Emosional
Pengaliran Produksi aqueous humor
Penggunaan anti VEGF

IOP Keparahan penyakit
• Berhubungan
Anti VEGF  Méndez-Ulrich et al dan Ismail et al dengan kerusakan
menurunkan kadar PGI2 “tingkat anksietas mempengaruhi akson pd n. II
 potensiasi kortisol  tingginya IOP dipengaruhi o/kadar • Jumlah material
meningkatkan IOP melantonin” pseudo-exfoliative
(PEX) pada canal
Schlemm
Pengaruh Anksietas terhadap IOP
• Adanya sidroma white coat pada bebarapa tipe personalitas

• Stress emosisonal  perasaan subjektif.
• Usia dan tipe personalitas dapat mempengaruhi IOP (tipe
personalitas A memiliki variabilitas tinggi)
• Pasien dengan glaukoma yang disertai pEXG memiliki variasi
IOP yang besar
• Melantonin tidak secara spesifik menyebabkan glaukoma
• KESIMPULAN
1. Stres emosional akut dapat menyebabkan

peningkatan respon okular terhadap peningkata
IOP
2. Dapat diipengaruhi oleh beberapa faktor:
diagnosis galukoma, tipe glaukoma, tipe
pembedahan, tipe personalitas pasien dan beda
persepsi emosi antar pasien
3. Observasi ini adalah hiipotesa yang didasarkan
pada satu kasus penelitian dengan skala yang
lebih besar dibutuhkan
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Latar Wanita 78 tahun. Etnis hispanik dengan pseudo-exfoliative glaucoma (PEXG) dan
exudate age-related macular degenartion (AMD) pada checkup rutin di klinik
Belakang mata dengan peningkatan IOP akut pada mata kiri.
• Riwayat operasi Ex-PRESS glaucoma akut dan katarak pada mata kiri adalah
12 tahun lalu.
• Riwayat operasi combined deep scleretomy dan katarak pada mata kanan 11
tahun lalu. YAG laser 2 terapi 2 tahun paska operasi.
• IOP mata kanan stabil (14-19 mmHg) dan mata kiri 16-21 mmHg.
• Mata kiri mendapatkan teraoi latanoprost dan timolol 0.1%
• AMD pada pasien stabil setela mendapatkan terapi ranibizumab 3 seies
injeksi intravitreal pada mata kiri 4 bulan sebelumnya.
Two Your Text Here Your Text Here
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Reputation. Reputation.
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Thank You
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Octadikho Mega Nugraha

Acute emotional stress as

↑ IOP GLAUKOMA ↓IOP : prognosis visus

Kasus mata dengan peningkatan IOP akut pada mata kiri.

Kasus • IOP : 18 mmHg(kanan) dan 48 mmHg (kiri) pengukuran dengan Golmann

Laporan • Hari selanjutnya, IOP pasien didapatkan normal ; 10 mmHg(kanan)

Kasus • Pengobatan sistemik diturunkan dosisnya dan dihentikan dan IOP

• 2 bulan kemudian, IOP pada kedua mata masih stabil dengan

Laporan • Untuk mengeksklusi antar ukuran dan variasi diurnal, dilakukan

Kasus contact lens yang menunjukan stabilitas relative dari tekanan

Tidak stabil Agresif

Pengaliran Produksi aqueous humor

Penggunaan anti VEGF

• Adanya sidroma white coat pada bebarapa tipe personalitas

1. Stres emosional akut dapat menyebabkan

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