RETINAL DISEASE 1

HABIBAH S. MUHIDDIN

ANDI MUHAMMAD ICHSAN

S U R YA N I TA TA J U D D I N

OPH TH ALM O LOG Y D EPAR T ME NT –

H AS ANU DD IN UNIV E RS IT Y
VASKULARISASI RETINA
NORMAL FUNDUS
 ACUTE
RETINAL
DISEASE

RETINAL RETINAL
DETACHMEN VASCULAR
T OCCLUSION

RETINAL RETINAL
VEIN ARTERY
OCCLUSION OCCLUSION
RETINAL
DETACHMENT
 RETINAL
DETACHMENT
• Separation of the neurosensory
part of the retina from the retinal
RHEGMATOGEN
pigment epithelium (RPE)

• There is an accumulation of fluid NON

RHEGMATOGEN
in the space between the neural
retina and the RPE known as EXUDATIVE
subretinal fluid

TRACTIONAL
 RHEGMATOGENOUS RETINAL
DETACHMENT

• Serious and sight-threatening vision

• This is the most common form of retinal detachment,
caused by the recruitment of fluid from the vitreous
cavity to the subretinal space via a full-thickness
discontinuity (a retinal“break”) in the sensory retina

• Unless the retina is reattached soon, permanent

visual loss may result.
Vitreus traction

prediposes to
retinal breaks
ETIOLOGY

• Retinal degeneration of peripheral retina (lattice degeneration

in high myopia >>>

• Vitreous change ( posterior vitreous detachment/PVD 

Vitreous traction)

• Trauma
PATOPHYSIOLOGY
Liquefaction Fluid through
Hole in posterior
defect into
of the hyaloid
retrohyaloid
vitreous gel membrane
space

Detachment of Vitreous gel

posterior collapses
Acute PVD vitreous from synchitic fluid in
ILM space

Fluid through Retinal

subretinal space
via hole/tear detachment
 TRACTIONAL RETIINAL DETACHMENT
• This form of retinal detachment develops as a result of
tractional forces within the vitreous gel pulling on the retina,
causing the retina to be tented up from the RPE.
• No retinal breaks.

ETIOLOGY
• Advanced diabetic retinopathy most common
 EXUDATIVE RETINAL DETACHMENT

• The fluid gains access to the subretinal

space through an abnormal choroidal
circulation

ETIOLOGY
• A choroidal malignant melanoma
• Secondary to inflammation of the RPE or
deeper layers of the eye (e.g., scleritis).
SYMPTOMS SIGN

• FLOATERS • DECREASE IOP

• PHOTOPSIA
• TOBACCO DUST
• SUDDEN BLURRY VISION
• RAPD / MARCUS GUNN PUPIL
• VISUAL FIELD DEFECT
• RETINAL DETACHMENT
• The quadrant of the visual field in
which the field defect first appears • RETINAL BREAKS
is useful in predicting the location
of the primary retinal break,
which will be in the opposite
quadrant
ADDITIONAL EXAMINATION
FUNDUSCOPY/OPHTHALM
USG B SCAN OSCOPY
 Rhegmatogenous retinal detachment

A. Horseshoe tears
U-shaped tears
Tractional ret. Detachment in PDR
MANAGEMENT
• Find all retinal breaks
• Create a chorioretinal irritation around each break
RRD • Close retinal breaks

• Non operative
• Causative
ERD
• Fibrous tissues pulling retinal layer are cut away till retinal
re-attach.
TRD • VITRECTOMY
RETINAL DETACHMENT
SURGERY
SCLERAL
BUCKLING
PNEUMATIC
RETINOPEXY
VITREKTOMI PARS PLANA
 PROGNOSIS

• IMMEDIATE THERAPY  GOOD RESULT

• SOMETIMES ANATOMICALLY RECOVERY

INCONSISTENT WITH VISUAL RECOVERY
RETINAL ARTERY OCCLUSION
• Central Retina Arterie Occlusion/CRAO
• Branch Retina Arterie Occluision/BRAO
• Caused by arteriosclerotic changes,
emboli, (from heart or carotids) or
inflammation (temporal arteritis)
 FEATURES
• Sudden painless unilateral visual loss, complete (central artery) or
partial (branch artery)
• May be transient (a form of TIA – amaurosis fugax) with return of normal
vision.
• Patient usually have a history of hypertension or heart disease
• Relative afferent pupillary defect is present in central retinal artery occlusion
• In CRAO, the fovea shows a cherry-red spot against the white infarcted
retina.
NORMAL RETINA CRAO

Pale and cherry-red spot

BRAO
TREATMENT

True emergency! Quick referral.

R/ DECREASE IOP
• Ocular massage  to release trombus
• Acetazolamide
• Paracentesis (done by ophthalmologist)
RETINAL VEIN OCCLUSION
• Retinal vein occlusion is relatively common
with infarction (not ischaemia) caused by
impaired venous blood flow.
• Seen mainly in elderly, DM & HT.
• It is second only to diabetes mellitus as a
vascular cause of impaired vision
 CLINICAL MANIFESTATION
• Sudden onset painless blurred vision
• Less commonly painful red eye due to neovascular glaucoma as a result
of recent CRVO.
• Visual acuity dependent on the severity of the occlusion, May be
normal in branch retinal vein occlusion, if the fovea is not involved.
• Relative afferent pupillary defect if severe CRVO
• Ophthalmoscopy reveals extensive intraretinal and preretinal
haemorrhage with distended retinal veins.
BRVO
CRVO
TREATMENT
• Regulation risk factors
• Refer within 24 hours
• Follow-up in eye clinic to monitor for
neovascular glaucoma
• Laser panretinal photocoagulation
• Anti VEGF intravitreal
THANK YOU