Lapsus Diabetic Retinopathy

8/18/2019 Lapsus Diabetic Retinopathy

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KEPANITERAAN KLINIK MADYA (KKM)BAGIAN/SMF ILMU KESEHATAN MATA

RUMAH SAKIT UMUM PUSAT (RSUP) SANGLAH

DENPASAR2015

By:Ni Luh Gede Yoni Komalasari (1102005100)

Putu Mita Wulandari (1102005130)


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Bac!roundLiterature "e#ie$

%ase "e&ort'iscussionummar


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'ia*etes melitus ('M) is ais!as! "i#$ #$! si%&s 'i&*!asi&% +,'' %,-'s!.

I&'&!sia is '& #$! #$ ,a!a'*i&% #' #$! #'#a, DM

a#i!s. I# is !s#ia#! "i,,i&*!as! #' 213 i,,i'& '& 20301

DM ',ia#i'&s

retino&ath T$! Dia+!#!s 4a*! Asia 200

S#-y *!'*#! 26 ia+!#ia#i! $a *!#i&'a#$y a& 76a'&% #$! "!*! *',i!*a#i8!ia+!#i *!#i&'a#$y

'ia*etic retino&ath $as

'#!ia, #' a-s! +,i&&!ss

• 9i, S R'%,i G G*!!& A Si*!! R Ki&% H. Global prevalence of diabetes: estimates for the year 2000 and projectionsfor 2030. Dia+!#!s 4a*!. 2002;:10;


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D-*a#i'& ' DMDMT1 a#i!s #!& #' s$'" si%&s ' *!#i&'a#$y a#!* 10


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Non &roli+erati#e dia*eticretino&ath (NP'")

P*'%*!ssi8! i*'a&%i'a#$y "i#$ 8as-,a*aa%! a& ',-si'&s. -s-a,,yasy#'a#i '* "i#$ i&ia,sy#'s

Proli+erati#e dia*etic retino&ath

(P'")*!#i&a, is$!i '* a,! a& '*i&% #$!

&!" a+&'*a, 8as-,a*iCa#i'&. T$'s!8as-,a*iCa#i'& s'!#i!s *-#-*! a&a-s! $!'**$a%! i& 8i#*!'-s +'y

Classification

• N'+,! = 4$a-$a*y >. Diabetic retinopathy . 4MA=. 2010 12(15):177.• B$a8sa* AR K$a*'*i R. Diabetic $etinopathy . A*i, 2015. A8ai,a+,! a#

$##://!!ii&!.!sa!.'/a*#i,!/1225122 A!ss! i& =-,y 30#$ 2015


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Pathogenesis

B$a8sa* AR K$a*'*i R. Diabetic $etinopathy . A*i, 2015. A8ai,a+,! a# $##://!!ii&!.!sa!.'/a*#i,!/1225122 A!ss! i& =-,y30#$ 2015K!*& TS H-a&% S. %ascular dama"e in diabetic retinopathy . I&: L!8i& LA A,+!*# DM !i#'*. -,a* is!as!: !$a&iss a&

<


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Mi*'a&!-*is *-#-*!

$!'**$a%!

Li'*'#!i& ,!a?a%! harde,udates (*'-& '* "$i#!y!,,'"is$ ','*)

A*#!*i',a ai,,a*y ',-si'&

$y'@ia sa,, is$!i a*!a

',,a#!*a,iCa#i'& Hy'@ia so+t e,udates (cotton

$ool &atch) 8!i& is#!i'& i&-!

&!'8as-,a*iCa#i'& *',i!*a#i'&

• 4$-i TYP T$i+'s LN B*a,!y A B-*&s SA. &he mechanism of vision loss associated #ith a cotton #ool spot . >isi'& R!s. 200:227<3.

• 9!s#!*!, 4B Mi,,!* =9. 'eovasculari(ation in diabetic retinopathy . I&: L!8i& LA A,+!*# DM !i#'*. -,a* is!as!: !$a&iss a&

Pathogenesis


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-sm&tomatic i& !a*,y $as! La#! $as! "i#$ sy#'s ' 'a#!*s

+,-**! 8isi'& is#'*#i'& a& ,'s# '8is-a, a-i#y *'%*!ssi8!,y. Si%&s ' ia+!#i *!#i&'a#$y:o Mi*'a&!-*iso D'# a& +,'# $!'**$a%!o R!#i&a, !!a a& $a* !@-a#!so

4'##'& "'', s'#so >!&'-s ,''s a& 8!&'-s +,!!i&%o R!#i&a, &!'8as-,a*iCa#i'&o Ma-,a* !!a

Clinical Manifestations

•B$a8sa* AR K$a*'*i R. Diabetic $etinopathy . A*i, 2015. A8ai,a+,! a# $##://!!ii&!.!sa!.'/a*#i,!/1225122 A!ss! i& =-,y 30 #$

2015•E8a PR ='$& P9. >a-%$a& As+-*y: #a,','%i U-. Eisi ?! 1;. =a?a*#a: EG4 200•Ga&$i MF. Dia+!#i *!#i&'a#$y %-i!,i&!s. L'&'&: 2012 T$! R'ya, 4',,!%! ' $#$a,','%is#s.


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o N'& *',i!*a#i8! ia+!#i *!#i&'a#$y Mild : A# ,!as# 1 i*'a&!-*is

Moderate : H!'**$a%!i*'a&!-*is a& $a* !@-a#!s e#ere : $!'**$a%!

is*'a&!-*is i& -a*as8!&'-s +!ai&% a# ,!as# '& 2-a*as

o P*',i!*a#i8! ia+!#i *!#i&'a#$yN!'8as-,a*iCa#i'& -s-a,,y '-* &!a*

'#i is

Clinical Manifestations

•B$a8sa* AR K$a*'*i R. Diabetic $etinopathy . A*i, 2015. A8ai,a+,! a# $##://!!ii&!.!sa!.'/a*#i,!/1225122 A!ss! i& =-,y 30 #$

2015•E8a PR ='$& P9. >a-%$a& As+-*y: #a,','%i U-. Eisi ?! 1;. =a?a*#a: EG4 200•Ga&$i MF. Dia+!#i *!#i&'a#$y %-i!,i&!s. L'&'&: 2012 T$! R'ya, 4',,!%! ' $#$a,','%is#s.


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o P*',i!*a#i8! ia+!#i *!#i&'a#$y Mi, (&'& $i%$ *is?) : N>D ,!ss

#$a& is a*!a '* N>E "i#$'-#*!*!#i&a, '* 8i#*!'-s $!'**$a%! S!8!*! ($i%$ *is?) i #$!*! a*! 3 '*

' #$!s! *is? a#'*s: N>E N>D N!" 8as-,a*iCa#i'& '*! #$a&

is-s a*!a >i#*!'-sa-%$a& As+-*y: #a,','%i U-. Eisi ?! 1;. =a?a*#a: EG4 200•Ga&$i MF. Dia+!#i *!#i&'a#$y %-i!,i&!s. L'&'&: 2012 T$! R'ya, 4',,!%! ' $#$a,','%is#s.


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Diagnosis

• B$a8sa* AR K$a*'*i R. Diabetic $etinopathy . A*i, 2015. A8ai,a+,! a# $##://!!ii&!.!sa!.'/a*#i,!/1225122 A!ss! i& =-,y30#$ 2015

•

Bas! '& histor tain! a&&hsical e,amination.

>is-a, a-i#y s,i# ,ai*a'-,a* *!ss-*! a&-&-s !@ai&a#i'&

Supporting Examination

Fas#i&% %,-'s! a&H+A1

F,-'*!s!i& a&%i'%*a$y #ia, 4'$!*!&!

T''%*a$y


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Management and Prognosis

M,!' SD F!!* RS ,s!& T9.. Dia+!#i *!#i&'a#$y *!!**! *a#i! a##!*& %-i!,i&!s. Sa& F*a&sis': 2012A!*ia& Aa!y ' $#$a,','%y.

N'*a, '* i&ia, NPDR *'-#i&! *!

!8a,-a#i'& "i#$i& 7as-,a* !&'#$!,ia,%*'"#$ a#'* (>EGF)

S!8!*! NPDR a& &'& $i%$ *is? PDR a&*!#i&a,

$'#''a%-,a#i'& a& *'-#i&! ',,'" - Hi%$ *is? PDR a&*!#i&a, $'#''a%-,a#i'&. 4'+i&a#i'&' a&*!#i&a, $'#''a%-,a#i'& a& aiEGF #$!*ay.>i#*!#'y '* &!'8as-,a*iCa#i'& '& i*is ai,!&!'8as-,a* *!%*!ssi'& &!" 8i#*!'-s $!'**$a%!&!'8as-,a*iCa#i'& '& &!" a*!a


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Patient Identity

Name SMT

-!e 5 Y

Gender F!a,!

.ccu&ation <

"ace I&'&!sia&

"eli!ion M-s,i

Marital tatus a**i!

%hie+ %om&laintB,-**! 8isi'&


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Present Illness History

Pa#i! a! #' #$! Ey! 4,i&i Sa&%,a$ '& =-,y 30#$ 2015. T$!a#i! a! !s'*#! +y $!* $-s+a& "i#$ sy#'s '*lurred #ision "$i$ is %!##i&% "'*s! si&! 2 '$s a%'.Pa#i!s $as $is#'*y ' +,-**! 8isi'& si&! 2 y!a*s +-# s$!a& s#i,, a&a%! i# +y -si&% %,ass!s. B-# i& s!8!*a, '$s#$is sy#'s a& &'# +! +!##!* +y -si&% %,ass!s a&y'*!.S$! i &'# ai# '#$!* ',ais s-$ as ai& i& +'#$!y!+a,, a& *!&!ss


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Past Illness History

1. Pa#i! $as $is#'*y ' ia+!#!s !,,i#-s si&! 5 y!a*sa%'. H!* !ia#i'& is i&s-,i& i&!#i'& si&! 2 y!a*s

a%'2. S$! $as $is#'*y ' $'si#a,iCa#i'& 2 y!a*s a%' -! #'

8!*y $i%$ +,'' %,-'s! a#!* #$a# $!* !ia#i'&"as s$i#! #' i&s-,i& i&!#i'&

3. T$!*! is &' $is#'*y ' $y!*#!&si'& ?i&!y is!as!

a& ,i8!* is!as!


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Family Illness History

N' ai,y !+!*s "$' s-!* *' sii,a* ',ais.N' $is#'*y ' DM i& $!* ai,y

Social History

Pa#i!s is a $'-s!"i! "i#$ i, ai,y a#i8i#y a&

s!,' #' ' !@!*is! T$!*! is &' $is#'*y ' a,,!*%y


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Physical Examination

General %ondition G''%onsciousness 4M

/ital i!n BP: 120/0P-,s!: @/i&-#!RR: 1@/!&i# T!!*a#-*!: 375' 4

General,amination


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&ecic,amination "i!ht e Le+t e

/isus 40 PG N6 40 P N6u&ra cilia

Madarosis

car

No

No

No

No

u&erior &al&eral

dema

i&eremintero&ion

tero&ion

Nodule

No

NoNo

No

No

No

NoNo

No

No


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6n+erior %on7uncti#al

Pal&e*rai&eremi

8oliel

car

Nodule

NoNo

No

No

NoNo

No

No

Bul*i %on7uncti#a

%hemosisi&eremi

-%on7uncti#a

-ilier

u*con7uncti#al Bleedin!

Pter!ium

Pin!ueculae

No

No

No

Yes

No

No

No

No

No

Yes

No

No

&ecic,amination


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&ecic,aminationSclera

ColorPigmentation

WhiteNo

WhiteNo

im!us

Senile arc No

No

Cornea

"dem

Infiltrate#lcer

Cicatrix

$erati% presipitat

No

NoNo

No

No

No

NoNo

No

No


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&ecic,amination-nterior ocular

%ham*erPurit

'e&th

,!a*N'*a,

,!a*N'*a,

6ris

%olor

Kolo*oma

-nterior snechiaPosterior snechia

B*'"&

N'

N'N'

B*'"&

N'

N'N'

Pu&il

ha&e

"e!ularrit

'irect li!ht re9e,

%onsensual li!htre9e,

R'-&

R!%-,!*

Y!s

Y!s

R'-&

R!%-,!*

Y!s

Y!s


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&ecic,aminationLens

Purit'islocation4su*lu,atio

n

6ris shado$ test

%loud minimalNo

:

%loud minimalNo

:

e mo#ement

%on+rontation test Normal normal6ntraocular &ressure 1;


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&esume

A 5


24/31

&esume


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Differential Diagnosis

• RLE N'& *',i!*a#i8! ia+!#i *!#i&'a#$y 4SME• RLE ia#-*! s!&i,! a#a*a#• RLE *',i!*a#i8! ia+!#i *!#i&'a#$y

Diagnosis

• RLE '!*a#! N'& *',i!*a#i8! ia+!#i *!#i&'a#$y

4SME• RLE ia#-*! s!&i,! a#a*a#

Examination Proposed

- S,i# ,a ,a+ (+,'' %,-'s! +,'' $',!s#!*',)- P$'#' -&-s

--,a* '$!*!&! #''%*a$y (4T)


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Communication and Education

1. Gi8! an e,&lain #' #$! a#i! a+'-# #$! is!as! a& *is? a#'*s2. Gi8! !@,a&a#i'& a+'-# #$! +,'' %,-'s! '*', i!# a& ai,y

a#i8i#y

Prognosis

A 8i#a : -+i-s a +'&aA -&%si'&a : -+i-s a a,a

A sa&a#i'&a : -+i-s a a,a

Medication

M'&i#'*i&% +,'' %,-'s! +,'' *!ss-*! a& +,'' $',!s#!*',4'&s-,#a#i'& #' 8i#*'


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Discussion

A 5 y!a*s ', !a,! a#i! sa! #' !y! ,i&i "i#$ ',ai ' +,-**!8isi'& si&! 2 y!a*s +-# i# %!##i&% "'*s! si&! 2 '$s a%'. I& !a*,y $as! ia+!#i *!#i&'a#$y is asy#'a#i '* ,'&% !*i'. T$!& #$! a#i! "i,, ',ai 'a#!*s +,-**! 8isi'& is#'*#i'& a&i-,# i& *!ai&% s!! a*? s'#.

F*' #$! $ysia, !@ai&a#i'& i# "as '-& #$! a+&'*a,i#y ' 's#!*i'*s!%!. T$!*! a*! s'! !@-a#!s a& $!'**$a%! '& ai, a&!@-a#!s '& a-,a.

Dia+!#i *!#i&'a#$y a& +! ia%&'s! +y !*!as! ' 8is-a, a-i#y a&a+&'*a,i#y '& 's#!*i'* s!%! i&8!s#i%a#i'&

Pa#i! $as $is#'*y ' DM si&! 5 y!a*s a%' "i#$ i&s-,i& !ia#i'&. S$!$as $is#'*y ' $'si#a,iCa#i'& -! #' 8!*y $i%$ +,'' *!ss-*! 2 y!a*s a%' Dia+!#i *!#i&'a#$y is '&! ' #$! 's# ',ia#i'& ' DM. I# a& +!!8a,-a#! *' #$! -*a#i'& ' DM +,'' %,-'s! '*',


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Discussion

T$is a#i! a%! is 5 y!a*s ', a& $as $a ia+!#!s '* 5 y!a*s Pa#i! "i#$ a%! '8!* #$a& 30 "i#$ -*a#i'& ' DM 5 y!a*s $as *is? #'

!8!,' ia+!#i *!#i&'a#$y '* 06 i& a#i! "i#$ i&s-,i& a& 26 i&a#i! "i#$'-# i&s-,i&

T$is a#i! a,s' $as ia#-*! s!&i,! a#a*a# '& +'#$ !y!s 4a#a*a# a& !8!,' !a*,i!* i& ia+!#i a#i! "$i$ a& +! s$'"!as s&'" a?!

T$is a#i! "as '&s-,#! #' 8i#*'


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Summary

•I# $as +!!& *!'*#! #$! as! ' a 5 y' !a,!

a#i! "i#$ ',ai ' +,-**! 8isi'& %!##i&% "'*s!si&! 2 '$s a%'•S$! $as $is#'*y ' ia+!#!s '* 5 y!a*s "i#$ i&s-,i&#$!*ay•S$! "as ia%&'s! "i#$ DS '!*a#! NPDR 4SME

a& DS ia#-*! s!&i,! a#a*a#.•Dia+!#i *!#i&'a#$y is i*'a&%i'a#y is!as! $*'&i*'%*!ssi8! "$i$ is #$! ',ia#i'& ' DM.•I# a& +! ,assi! i' #' NPDR a& PDR.


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Summary

• T$! *is? a#'*s : +a +,'' %,-'s! '*',

a*#!*ia, $y!*#!&si'& '* $y!*,ii!ia. I& !a*,y$as! i# "i,, asy#'a#i.•I& ,a#! $as! a#i! "i,, ',ai 'a#!*s+,-**! 8isi'& is#'*#i'& i-,#y i& *!ai&% s!!

a*? s'#.•F*' #$! !@ai&a#i'& i# "i,, +! '-&i*'a&!-*is $a* !@-a#! s'# !@-a#! *!#i&a,!!a.•Ea*,y !#!#i'& '* ia+!#i *!#i&'a#$y isi'*#a !s!ia,,y i& *ia*y $!a,#$ a*! +y


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Lapsus Diabetic Retinopathy

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