ANATOMI DAN FISIOLOGI

KORNEA
Kornea adalah bagian mata yang paling depan, transparan.
Kornea tidak ada pembuluh darah dan jaringan yang
stuktumya seragam. Kornea ini disisipkan ke dalam sklera
pada limbus, lekukan melingkar pada sambungan ini disebut
sulcus scleralis. Kornea dewasa mempunyai rata-rata tebal
550 um di pusatnya(terdapat variasi menurut ras).
Diameter horizontalnya sekitar 11,75 mm dan vertikalnya 10,6
mm. Dari anterior ke posterior, kornea mempunyai enam lapis
yang berbeda-beda.
ANATOMI DAN FISIOLOGI
KORNEA
ANATOMI DAN FISIOLOGI
KORNEA
Secara histologi kornea terdiri dari 6 lapis yaitu :
Epitel, tebalnya 50 um, terdiri atas 5 lapis sel epitel tidak bertanduk yang
saling tumpang tindih, satu lapis sel basal, sel poligonal,dan sel gepeng.
Pada sel basal sering terlihat mitosis sel, dan sel muda ini terdorong ke depan
menjadi lapis sel sayap dan semakin maju ke depan menjadi sel gepeng, sel basal
berikatan serta dengan sel basal di sampingnya dan sel poligonal di depannya
memaluli desmosom dan macula olduden, ikatan ini menghambat pengaliran air,
elektrolit dan glukosa yang merupakan barrier.
Sel basal menghasilkan membran basal yang melekat erat kepadanya. Bila terjadi
gangguan akan mengakibatkan erosi rekuren. Epitel berasal dari ectoderm
permukaan.
ANATOMI DAN FISIOLOGI
KORNEA
Lapisan Bowman, terletak di bawah membran basal epiel kornea yang
merupakan kolagen yang tersusun tidak teratur seperti stroma dan berasal dari
bagian depan stroma. Lapis ini tidak memiliki daya regenerasi.
Stroma, terdiri atas lamel yang merupakan susunan kolagen yang sejajar satu
dengan lainnya, pada permukaan terlihat anyaman yang teratur sedang di
bagian perifer serat kolagen ini bercabang; terbentuknya kembali serat
kolagen memakan waktu yang lama yang kadang-kadang sampai 15 bulan.
Keratosit merupakan sel stuma kornea yang merupakan fibroblast terletak di
antara serat kolagen stroma.diduga keratosit membentuk bahan dasar dan
serat kolagen dalam perkembangan embrio atau sesudah trauma.
ANATOMI DAN FISIOLOGI
KORNEA
Dua’s Layer
Sebuah lapisan di kornea manusia. Tebalnya hanya 15 mikron dan terletak
antara stroma kornea dan membran Descemet. Meski tipis, lapisan ini sangat
kuat dan kedap udara. Lapisan ini mampu bertahan di bawah tekanan sebesar
dua bar
Membran Descement
Merupakan membran aseluler dan merupakan Batas belakang stroma kornea,
dihasilkan sel endotel dan merupakan membrane basalanya
Bersifat sangat elastic dan berkembang terns seumur hidup, mempunyai tebal
401.tm.
ANATOMI DAN FISIOLOGI
KORNEA
Endothelium, berasal clan mesotelium, berlapis 1, bertuk heksagonal, besar 20 - 40
m. Endotel- melekat pada membrane descement melalui hemidesmosom dan
sonula akiuden.
LAPISAN KORNEA
KORNEA

Tebal: 550 µm disentral, Ø horizontal 11,75 mm dan vertikal 10,6 mm

Lapisan epitel  5-6 lapis sel
Lapisan bowman  lapisan jernih aseluler
Lapisan stroma  menyusun 90 % ketebalan kornea, tdd serat-serat
kolagen dengan lebar 10-250µm dan tinggi 1-2 µm
Lapisan descemet  lamina basalis endotel kornea, homogen, tebal 10-12
µm
Lapisan endotel 1 lapis sel yg berperan mempertahankan deturgesensi
stroma
KORNEA

Sumber nutrisi pembuluh darah limbus, HA, dan air mata

Saraf-saraf sensorik kornea didapat dari cabang 1 N. kranialis V (trigeminus)
Transparansi kornea o/k strukturnya yang homogen, avaskularisasi dan
deturgensinya
 CORNEA
16

50 µm Epithelium
12 µm Bowman’s membrane

90 % total corneal thickness

Stroma

10-12 µm Descemet’s membrane

4-6 µm Endothelium
PENYEMBUHAN EPITEL KORNEA
Dalam 1 jam Luka pada sel epitel parabasilar mulai bergeser
dan bermigrasi melewati area yg polos hingga menempel
ke sel yg bermigrasi.
Secara simultan, sel basal sekitar mulai bermitosis untuk
menyuplai sel tambahan untuk menutup defek.
Mskipun erosi kornea luas biasanya dilapisi dengan sel
epitel yg bermigrasi dalam 24-48 jam hingga luka sembuh
sempurna, termasuk restorasi epitel full thickness(4-6
lapis). Reformasi dari anchoring fibrin dalam 4-6 minggu
Untuk reepitelisasi, kornea itu membutuhkan stem cell stem cell ini adanya di limbus. Stem
cell bermigrasi kearah sel sambil berdeferensiasi. berdefernsiasi mulai dari sel basal
kornea, kemudian bergerak ke permukaan menjadi bentuk sel wing sampai ke permukaan
berubah bentuk menjadi squamous, di limbus itu ada lingkungan yang disebut Niche stem
cell, ini istilah yang digunakan oleh para ahli untuk menggambarkan lingkungan stem cell,
lingkungan inilah yang menjaga stem cell tetap diam atau tidur, dan memerintahkan stem
cell untuk bermigrasi dan berdeferensiasi jika ada gangguan di epital
CORNEAL HEALING
HEALING BY INTENTION

From: Naseri A. Basic Principles of Ophthalmic Surgery 3rd Ed. American Academy of Ophthalmology 2015: p. 308-317.
HEALING BY INTENTION

From: Naseri A. Basic Principles of Ophthalmic Surgery 3rd Ed. American Academy of Ophthalmology 2015: p. 308-317.
HEALING BY INTENTION

From: Naseri A. Basic Principles of Ophthalmic Surgery 3rd Ed. American Academy of Ophthalmology 2015: p. 308-317.
THE PROCESS OF HEALING

From: Naseri A. Basic Principles of Ophthalmic Surgery 3rd Ed. American Academy of Ophthalmology 2015: p. 308-317.
TIME NEEDED FOR WOUND HEALING

From: Naseri A. Basic Principles of Ophthalmic Surgery 3rd Ed. American Academy of Ophthalmology 2015: p. 308-317.
CORNEAL WOUND HEALING

From: Naseri A. Basic Principles of Ophthalmic Surgery 4th Ed. American Academy of Ophthalmology 2019: p. 236-7
CORNEAL WOUND HEALING

From: Naseri A. Basic Principles of Ophthalmic Surgery 4th Ed. American Academy of Ophthalmology 2019: p. 236-7
BEDA INJEKSI KONJUNGTIVA
DAN SILIAR
Injeksi konjungtiva berasal dari A.konjungtiva posterior dan berlokasi dari
perifer ke sentral (dari forniks ke arah limbus )

Injeksi siliar berasal dari A. siliaris anterior dan berlokasi dari limbus ke arah
perifer, menandakan infeksi

Konjungtiva hiperemis menandakan adanya trauma

 PATOGENESIS
INJEKSI/KONGESTI
Injeksi/Kongesti adalah terbendungnya pembuluh darah, sehingga terjadi
akumulasi eritrosit dalam darah yang diakibatkan adanya gangguan sirkulasi
pada pembuluh darah

Timbul jika dilatasi pembuluh arteriol dan arteri menyebabkan peningkatan

aliran darah ke dalam jaringan kapiler dengan terbukanya kapiler-kapiler
yang tidak aktif. Dilatasi pembuluh darah ini disebabkan oleh lepasan zat-zat
vasoaktif.
PATOGENESIS
INJEKSI/KONGESTI
Bendungan aktif ini timbul karena jumlah darah pada
arteriol sebagian jaringan tubuh bertambah. Disini
rangsang saraf vasodilator atau hambatan hantaran saraf
vasokonstriktor akan menyebabkan pelebaran pembuluh
darah.
Beberapa contoh bendungan yang lebih sering bersifat
akut ini antara lain organ tubuh yang sedang bergerak
aktif, kulit yang berwarna kemerahan , panas dan radang.
ZONES
OF
CORNEA

Central Zone ParacentralZone Peripheral Zone

LimbalZone
* 1-2 mm *3-4 mm

Apical Zone Transisional Zone

 Bakteri
Faktor predisposisi
Adhesin+Sekresi eksopolisakarida

Invasi

Eksotoksin

Nekrosis sel

PMN

Pelepasan enzim lisosim

(Kolagenase+Hidrolase)

Kerusakan kolagen & proteoglikan

ULKUS KORNEA
Peradangan: infiltratif supuratif
Kerusakan epitel
Penggaungan
Epitel kornea yang rusak akan mengeluarkan enzim lisozym yang
bersifat basa sehingga akan mengikat zat fluorescen (natrium
fluorescen, derivat xantin) dan dengan memakai filter kobalt biru,
terlihat warna hijau kekuningan pada epitel kornea yang rusak.
CORNEAL WOUND HEALING
Healing of the abraded epithelium occurs in several stages:
1. initially, there is a migration of peripheral cells
onto the area of denuded basement membrane
2. this is followed by proliferation of the
epithelial cells to restore epithelial thickness
3. the process ends with the formation of
hemidesmosomal attachments to the
underlying basement membrane
1.The acute inflammatory phase may last from minutes to
hours.
Blood clots quickly in adjacent vessels in response to tissue
activators. Neutrophils and fluid enter the extracellular space.
Macrophages remove debris from the damaged tissues, new
vessels form, and fibroblasts begin to produce collagen.
2.Regeneration is the replacement aflost cell s; this process
occurs only in tissues composed of labile cells (eg,
epithelium), which undergo mitosis throughout life. Repair is
the restructuring of tissues by granulation tissue that matures
into a fibrous scar.
3.Finally, contraction causes the reparative tissues to shrink
so that the scar is smaller than the surrounding uninjured
tissues.
SEIDEL TEST
The Seidel test assesses for the presence of aqueous humor leakage from the
anterior chamber.
This leakage is from a defect in the cornea or sclera from multiple causes,
including trauma, post-surgical leak, corneal perforation, and corneal
degeneration.
The test was first described in 1921 by Dr. Erich Seidel (1882-1948), a
German ophthalmologist, for which the test is named.
CORNEAL LACERATION
REPAIR
 GENERAL MANAGEMENT
PRINCIPLES OF OPEN GLOBE INJURY

From: Kuhn F, Pieramici DJ. Ocular Trauma Principles and Practice. Thieme 2002: p. 125..
GENERAL ANESTHESIA FOR
CORNEAL SURGERY

From: Brightbill FS. Corneal Surgery Theory, Technique, and Tissue 4th Ed. Mosby Elsevier 2009: p. 125
GOALS OF TREATING CORNEAL
RUPTURE/LACERATION

From: Brightbill FS. Corneal Surgery Theory, Technique, and Tissue 4th Ed. Mosby Elsevier 2009: p. 617
NONSURGICAL MANAGEMENT

From: Brightbill FS. Corneal Surgery Theory, Technique, and Tissue 4th Ed. Mosby Elsevier 2009: p. 619
GOALS OF OCULAR TRAUMA REPAIR

From: Brightbill FS. Corneal Surgery Theory, Technique, and Tissue 4th Ed. Mosby Elsevier 2009: p. 620
GENERAL CONSIDERATION

From: Brightbill FS. Corneal Surgery Theory, Technique, and Tissue 4th Ed. Mosby Elsevier 2009: p. 620
GENERAL CONSIDERATION

From: Brightbill FS. Corneal Surgery Theory, Technique, and Tissue 4th Ed. Mosby Elsevier 2009: p. 620
RUNNING VS SIMPLE SUTURE

From: Brightbill FS. Corneal Surgery Theory, Technique, and Tissue 4th Ed. Mosby Elsevier 2009: p. 621
SUTURE KNOTS

From: Brightbill FS. Corneal Surgery Theory, Technique, and Tissue 4th Ed. Mosby Elsevier 2009: p. 621
ANTERIOR CHAMBER MAINTENANCE

From: Brightbill FS. Corneal Surgery Theory, Technique, and Tissue 4th Ed. Mosby Elsevier 2009: p. 621
THE TECHNIQUE OF PRIMARY REPAIR

From: Salmon JF. Kanski’s Clinical Ophthalmology A Systematic Approach 9th Ed. Elsevier 2020: p. 908.
GENERAL RULES OF SUTURING
CORNEA

From: Kuhn F. Ocular Traumatology. Thieme 2008: p. 164.

BASIC PRINCIPLES OF SUTURE
INTRODUCTION FOR CORNEAL
WOUNDS

From: Kuhn F. Ocular Traumatology. Thieme 2008: p. 165.

BASIC PRINCIPLES OF SUTURE
INTRODUCTION FOR CORNEAL
WOUNDS

From: Kuhn F. Ocular Traumatology. Thieme 2008: p. 166.

INTERRUPTED VS RUNNING SUTURES

From: Kuhn F. Ocular Traumatology. Thieme 2008: p. 170-1.

THE ORDER OF SUTURE
INTRODUCTION IN THE CORNEA

From: Kuhn F. Ocular Traumatology. Thieme 2008: p. 172.

THE DEPTH OF CORNEAL SUTURES

From: Kuhn F. Ocular Traumatology. Thieme 2008: p. 173.

SURGICAL REPAIR OF ISOLATED
CORNEAL LACERATION

From: American Academy of Ophthalmology. Basic Techniques of Ophthalmic Surgery 3rd Ed. American Academy of
Ophthalmology 2019 : p. 587-8.
SURGICAL REPAIR OF ISOLATED
CORNEAL LACERATIONS

From: American Academy of Ophthalmology. Basic Techniques of Ophthalmic Surgery 3rd Ed. American Academy of
Ophthalmology 2019 : p. 589.
SURGICAL REPAIR OF ISOLATED
CORNEAL LACERATION

From: American Academy of Ophthalmology. Basic Techniques of Ophthalmic Surgery 3rd Ed. American Academy of
Ophthalmology 2019 : p. 587-9.
SURGICAL REPAIR OF ISOLATED CORNEAL
LACERATION

From: American Academy of Ophthalmology. Basic Techniques of Ophthalmic Surgery 3rd Ed. American Academy of
Ophthalmology 2019 : p. 587-9.
SURGICAL REPAIR OF ISOLATED CORNEAL
LACERATION

From: American Academy of Ophthalmology. Basic Techniques of Ophthalmic Surgery 3rd Ed. American Academy of
Ophthalmology 2019 : p. 587-9.
SIMPLE FULL THICKNESS CORNEAL
LACERATION REPAIR

From: Albert & Jakobiec's Principles and Practice of Ophthalmology 3rd Ed. p. 5104.
SIMPLE FULL THICKNESS CORNEAL
LACERATION REPAIR

From: Albert & Jakobiec's Principles and Practice of Ophthalmology 3rd Ed. p. 5104.
SIMPLE FULL THICKNESS CORNEAL
LACERATION REPAIR

From: Albert & Jakobiec's Principles and Practice of Ophthalmology 3rd Ed. p. 5104.
SIMPLE FULL THICKNESS CORNEAL
LACERATION REPAIR

From: Albert & Jakobiec's Principles and Practice of Ophthalmology 3rd Ed. p. 5104.
CORNEAL LACERATION

From: Ocular Trauma. p. 170-1.

SIMPLE FULL-THICKNESS CORNEAL
LACERATION REPAIR

From: Hersh P, Zagelbaum BM, Cremers SL. Ophthalmic Surgical Procedures 2nd Ed. Thieme: p. 144.
SIMPLE FULL THICKNESS CORNEAL
LACERATION REPAIR

From: Hersh P, Zagelbaum BM, Cremers SL. Ophthalmic Surgical Procedures 2nd Ed. Thieme: p. 144.
 PATCHING FOR
CORNEAL ABRASION
AAO SECTION 2 HAL 42
The cornea occupies the center of the anterior pole of the globe.
it measures about 12 mm in the horizontal meridian and about 11 mm
in the vertical.
The central cornea is about 0.5 mm thick. The peripheral cornea is about 1.0
mm thick.
AAO SECTION 2 HAL 247
The cornea is a remarkable structure, with a high
degree of transparency and excellent
self protective and reparative properties. The
cornea is made up of the following histologic
layers (Fig 8- I):
epithelium with basement membrane
Bowman's layer
stroma (or substantia propria)
Descemet's membrane
endothelium
AAO SECTION 2 HAL 247
AAO SECTION 2 HAL 248
Epithelium

The epithelium is typically about 65 µm thick and constitutes 5%- 10% of total corneal
thickness.
It is composed of 5- 6 layers, which include 1-2 layers of superficial squamous cells, 2- 3
layers of broad wing cells, and the innermost layer of the columnar basal cells.
AAO SECTION 2 HAL 43
The anterior surface of the cornea is derived from surface ectoderm
and is covered by a nonkeratinized, stratified squamous epithelium
whose basal columnar layer is attached to a basal lamina by
hemidesmosomes (Fig 2-3). The basal cell s have a width of 12 µm
and a density of approximately 6000 cell/mm2.
The occasional recurrence of corneal erosion following a traumatic
corneal abrasion may be due to improper formation of
hemidesmosomes after an epithelial abrasion.
AAO SECTION 2 HAL 44
CORNEAL
WOUND
HEALING : A
REVIEW
(SEPTEMBER
24-1999
OPTOMETRY
TODAY)
AAO SECTION 4 HAL 13-
14
AAO SECTION 8 HAL 372
PRESENTED 'AT THE AMERICAN ACADEMY OF
OPHTHALMOLOGY ANNUAL MEETING,
SAN FRANCISCO, NOVEMBER 1994
SUBJECT AND METHOD
AAO SECTION 8 HAL 88
AAO SECTION 8 HAL 352
AAO SECTION 8 HAL 372
ADVANTAGES PATCHING
reduces friction between the healing corneal epithelium and the
eyelid, thus allowing for quicker healing.
a pressure patch prevents blinking

DISADVANTAGES PATCHING
a pressure patch could be devastating if an infection is present;
thus, contact lens-related corneal abrasions are not treated with a
pressure patch."
a pressure patch covering a closed eyelid reduces corneal
oxygenation, which increases anaerobic metabolism. This leads to
a depletion of the corneal glycogen reserves and produces
decreased production of energy for vital corneal functions.
the patch increases corneal temperature, which can also slow
corneal healing and predispose the cornea to infection.
many patients do not like wearing pressure patches.
 TETANUS
PROPHYLAXIS
STATUS OF PRIMARY IMMUNIZATION
IN THE DETERMINATION OF
APPROPRIATE TETANUS
PROPHYLAXIS

From: Albert & Jakobiec's Principles and Practice of Ophthalmology 3rd Ed. p. 5088-5089.
CLASSIFICATION OF OCULAR AND
ADNEXAL WOUNDS WITH REGARD
TO NEED FOR TETANUS
PROPHYLAXIS

From: Albert & Jakobiec's Principles and Practice of Ophthalmology 3rd Ed. p. 5088-5089.
VANCO CEFTA INTRA VITREAL
VANCOMYCIN-CEFTAZIDIME
INTRAVITREAL

From: Yan H. Mechanical Ocular Trauma. Springer 2017: p. 70.

INTRAVITREAL INJECTION

From: Yan H. Mechanical Ocular Trauma. Springer 2017: p. 85

INJEKSI
INTRAVITREAL :
Cara II (injeksi intravitreal) :
1. Ceftazidime
 masukkan 20 cc aqua (dalam kemasan vial 1gr)
Ambil 0.45 cc dg spuit 1cc, lalu jadikan dgn aqua, s/d 1cc
Yg dinjeksi hanya 0.1 cc

2. Vancomycine
Masukkan 10 cc aqua (dlm vial 500 mg)
Ambil 0.1 cc dg spuit 1cc, campur dg aqua s/d 1cc
Ambil 0,1 cc saja utk injeksi
TERMINOLOGY
Menurut Birmingham Eye Trauma Terminology (BETT), trauma mata dibagi menjadi:5
Tertutup
Kontusio: tidak ada luka pada bola mata
Laserasi lamellar: hanya mengenai setengah dari ketebalan dinding bola mata.
Terbuka
Laserasi: mengenai seluruh ketebalan dinding bola mata yang disebabkan benda tajam
Penetrasi: satu agen menyebabkan satu luka masuk
Benda asing dalam mata: sama dengan penetrasi tetapi dikelompokan sendiri karena memerlukan penanganan berbeda.
Perforasi: terdapat luka masuk dan luka keluar
Ruptur: mengenai seluruh ketebalan dinding bola mata yang disebabkan benda tumpul
BIRMINGHAM EYE TRAUMA

From: Kuhn F, Pieramici DJ. Ocular Trauma Principles and Practice. Thieme 2002: p. 5.
BIRMINGHAM EYE TRAUMA TERMINOLOGY

From: Kuhn F, Pieramici DJ. Ocular Trauma Principles and Practice. Thieme 2002: p. 4.
OPEN GLOBE INJURY CLASSIFICATION

From: Kuhn F, Pieramici DJ. Ocular Trauma Principles and Practice. Thieme 2002: p. 5.
 PERDARAHAN VITREUS
Merupakan eksttravasasi darah kedalam vitreus ,kedalam ruang potensial vitreus.
Darah bisa berada dalam anteriorhialoid,subhialoid dan vitreus gel
Dapat disebabkan: trauma dan non trauma
Penyebab:
1. Retinal break tanpa detachment(12-17%)
2. Posterior vitreus detachment()7,5-12%)
3. Regmatogen retinal detachment(7-10%)
4. Neovaskularisasi setelah BRVO atau CRVO (3,5%-10%)
Trauma tumpul maupun tembus dapat menimbulkan luka pembuluh darah secara
langsung, dan kelainan jaringan sekitar viterus menimbulkan perdarahan
vitreus,misalnya dari makroaneurisma retina,tumor,neovaskularisasi koroid yg
meluas melalui membran limitan interna ke dalam vitreus
KOMPLIKASI PERDARAHAN VITREUS
Darah dibersihkan dari vitreus rata-rata 1% per hari
Perdarahan vitreus hilang lebih cepat pd syneretic dan vitrectomized
eye dan lebih lambat pd mata yg lebih muda
Hemosiderosis bulbi
Proliferative vitreoretinopathy
Ghost cell glaukoma: sel darah merah berbentuk
sferis,kaki,kakicolored red blood cell dipenuhi dgn denaturasi
hemoglobin dan muncul perdarah vitreus lama.jika sel ini mengisi coa
akan memblok atau menyumbat trabekular meshwork
Hemolitic glaukoma:hemoglobin bebas ataui terikat magkropak atau
debris sel darah merah dpt menyumbat trabekular meswork
THE VITREOUS HEMORRHAGE DENSITY GRADING SCALE
Grade 0: No blood present in the vitreous, the entire retina is visible.
Grade 1: Some hemorrhage present, which obscures between a total of 1 to 5 clock hours of retina. Laser
photocoagulation (PRP) can be successfully performed
Grade 2: Hemorrhage obscures between a total of 5 to 10 clock hours of
central and/or peripheral retina, or a large hemorrhage is located posterior
to the equator, with varying clock hours of anterior retina visible.
Laser is feasible, but a full panretinal photocoagulation (PRP) can not be placed
Grade 3: A red reflex is present, with no retinal detail seen posterior to the equator,
precluding any photocoagulation

Grade 4: Dense VH with no red reflex present

One can see the gradient along which the scale is constructed.
There are specific grades or categories in which to place the patient,
with an obviously small spectrum within each grade,
correlating to the amount of hemorrhage in each grade.
For instance, Grade 2 has between 5 and 10 clock hours of hemorrhage.
Although subdividing each grade into more specific subcategories
might make it more precise, this would complicate its ease of use.
Note that patients with a retinal tear causing VH may have that tear obscured by
hemorrhage,
and need to be treated appropriately.
CT ADVANTAGES

From: Albert & Jakobiec's Principles and Practice of Ophthalmology 3rd Ed. p. 5081
ATROPINE AND
HOMATROPINE

From: Fundamentals and Principles of Ophthalmology. Ocular Pharmacotheurapeutics. American Academy of

Ophthalmology 2020-2021 : p. 380.
ATROPINE AND
HOMATROPINE

From: Fundamentals and Principles of Ophthalmology. Ocular Pharmacotheurapeutics. American Academy of

Ophthalmology 2020-2021 : p. 381.
Source: National Center for Biotechnology Information. PubChem Database. Atropine, CID=174174,
https://pubchem.ncbi.nlm.nih.gov/compound/dl-Hyoscyamine (accessed on Des. 11, 2021)
Source: National Center for Biotechnology Information. PubChem Database. Atropine, CID=174174,
https://pubchem.ncbi.nlm.nih.gov/compound/dl-Hyoscyamine (accessed on Des. 11, 2021)
Source: National Center for Biotechnology Information. PubChem Database. Homatropine, CID=5282593,
https://pubchem.ncbi.nlm.nih.gov/compound/Homatropine (accessed on Jan. 23, 2020)
Source: National Center for Biotechnology Information. PubChem Database. Homatropine, CID=5282593,
https://pubchem.ncbi.nlm.nih.gov/compound/Homatropine (accessed on Jan. 23, 2020)
 STEROID
POTENCY

From: Fundamentals and Principles of Ophthalmology. Ocular

Pharmacotheurapeutics. American Academy of Ophthalmology 2020-
2021 : p. 402.
Indikasi suntikan ATS (Anti Tetanus Serum)

Luka cukup besar (dalam lebih dari 1 cm)

Luka berbentuk bintang
Luka berasal dari benda yang kotor dan berkarat
Luka gigitan hewan dan manusia
Luka tembak dan luka bakar
Luka terkontaminasi, yaitu: luka yang lebih dari 6 jam tidak ditangani,
atau luka kurang dari 6 jam namun terpapar banyak kontaminasi, atau
luka kurangdari 6 jam namun timbul karena kekuatan yang cukup besar
(misalnya luka tembak atau terjepit mesin)
Penderita tidak memiliki riwayat imunisasi tetanus yang jelas atau
tidak mendapat booster selama 5 tahun atau lebih