Kompetensi kualifikasi tambahan FELLOWSHIP yang telah dilaksanakan

selama 3 tahun terakhir (bidang surgical retina)

Keterampilan diagnosis surgical retina

Pernyataan Disetujui oleh
pemohon reviewer
No Diagnosis *centang
*diisi oleh peer
kompetensi yang
reviewer
telah dikuasai

KELAINAN MAKULA

1 Dry Age Macular Degeneration (AMD)

2 Sindrom histoplasmosis okular

3 Angioid Streak

4 Myopia Patologis

5 Choroidal Neovascularization (CNV) Idiopatik

6 Cystoid Macular Oedema (CME)

KELAINAN PEMBULUH DARAH RETINA

Retinopati Diabetik Proliferatif/ Proliferative Diabetic

7
Retinopathy (PDR)

8 Branch Retinal Vein Occlusion (BRVO)

9 Central Retinal Vein Occlusion (CRVO)

10 Sindroma iskemik ocular

11 Branch Retinal artery Occlusion (BRAO)

12 Central Retinal Artery Occlusion (CRAO)

13 Oklusi arteri Cilioretinal

14 Oklusi Arteri Ophthalmica

15 Makroaneurisma Arterial

Paraf atasan : Paraf Pemohon :

16 Retinopati Sickle Cell

17 Vaskulitis

18 Coats Disease

19 Telangiektasis Parafoveal

20 Penyakit Von Hippel-Lindau

21 Sindrom Wyburn -Mason

22 Retinal Cavernous Hemangioma

23 Retinopati akibat Radiasi

24 Retinopati Valsalva

25 Purtscher-and Purtscherlike Retinopathy

26 Sindrom Terson

27 Retinopathy of Prematurity (ROP)

KELAINAN KOROID

28 Central Serous Choroidopathy (CSC)

29 Choroidal Perfusion Abnormalities

30 Hemangioma koroid

31 Uveal Effusion Syndrome

32 Bilateral Diffuse Uveal Melanocytic Proliferation

INFLAMASI KOROID DAN RETINA

33 White Dot Syndromes

34 Choroidal Autoimmune Conditions

35 Sympathetic Ophthalmia

36 Intraocular Lymphoma

Paraf atasan : Paraf Pemohon :

37 Retinitis Cytomeglovirus (CMV)

38 Non-CMV Necrotizing Herpetic Retinitis

39 Endophthalmitis

40 Tuberculosis okular

41 Chorioretinitis syphilis

42 Cat-scratch Disease

43 Retinochoroiditis Toxoplasma

44 Toxocariasis

45 Lyme Disease

46 Diffuse Unilateral Subacute Neuroretinitis

CONGENITAL AND STATIONARY RETINAL DISEASE

47 Colour Vision (cone system) abnormalities

48 Night Vision (rod system) abnormalities

HEREDITARY RETINAL AND CHOROIDAL DYSTROPHIES

49 Retinitis Pigmentosa

50 Leber Congenital Amaurosis

51 Cone Dystrophies

52 Stargardt Disease

53 Vitelliform Degenerations

54 Pattern Dystrophies

55 Sorsby Macular Distrophy

56 Choroidal Dystrophies

57 X-Linked Retinoschisis

Paraf atasan : Paraf Pemohon :

58 Enhanced S-cone Syndrome

DEGENERASI RETINA

59 Bardet-Biedl Syndrome

60 Usher Syndrome

61 Retinal Albinism

SYSTEMIC-DRUG-INDUCED RETINAL TOXICITY

62 Drug causing RPE + Photoreceptor abnormalities

63 Drug causing Occlusive Retinopathy

64 Drug causing Ganglion cells + Optic nerve abnormalities

65 Drug causing Macular Oedema

66 Drug causing Crystalline Retinopathy

67 Drug causing Colour vision and ERG abnormalities

ABLASI RETINA (Retinal Detachment)

68 Retinal Breaks

69 Posterior vitreous detachment (PVD)

70 Lattice Degeneration

71 Vitreoretinal Tufts

72 Meridional Folds

73 Paving stone degeneration

74 Hyperplasia Retinal Pigment Epithelium (RPE)

75 HYpertophy Retinal Pigment Epithelium (RPE)

76 Ablatio Retina

77 Optic Pit Maculopathy

Paraf atasan : Paraf Pemohon :

 DISEASES OF THE VITREOUS AND VITREORETINAL INTERFACE

78 Epiretinal membranes

79 Vitreomacular Traction Diseases

80 Idiopathic Macular Hole

81 Wagner and Stickler Syndromes

82 Familial Exudative Vitreoretinopathy

83 Asteroid Hyalosis

MANIFESTASI TRAUMA PADA SEGMEN POSTERIOR

84 Perdarahan Vitreus

85 Ruptur Koroid

86 Macular Hole pasca trauma

87 Benda asing intraokular

88 Drop Nukleus

89 Drop IOL

90 Solar Retinopathy

Paraf atasan : Paraf Pemohon :

 Keterampilan Klinis Vitreoretina
Pernyataan Disetujui oleh
pemohon reviewer
No Keterampilan Klinis *centang
*diisi oleh
kompetensi yang
peer reviewer
telah dikuasai

1 Cryotherapy pada retinal break

2 Scleral buckling
3 Vitrektomi
4 Macular Surgery
Injeksi vitreous substitute (Tamponade dan subretinal
5
injection)
Pengambilan benda asing dari segmen posterior mata
6
(IOFB)
7 Pneumatik retinopeksi dan displacement

Mengetahui, ……………….….,…….…./…………/…….……..
Atasan langsung Pemohon,

Materai 6000

Nama : …………………………………….
……………………………………..
Jabatan : ………………………………………