kasus rd [karlina].doc

7/25/2019 Kasus RD [Karlina].doc

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PRESENTASI KASUS

RETINOPATI DIABETIK

PEMBIMBING:

DR. DONNY ALDIAN , SP.M

DISUSUN OLEH:

KARLINA DAHLIANINGRUM

1410221051

DEPARTEMEN ILMU PENYAKIT MATA

RSPAD GATOT SOEBROTO

JAKARTA

0


2/25

BAB I

PEMBAHASAN KASUS

I. IDENTITAS PASIEN

Nama Pas!" : T". MSUm#$ : 4% &a'#"

J!"s K!(am" : La)*(a)

Da&a"+ )! P( Ma&a RSPAD &a"++a( - J#" 201-

II. ANAMNESA

A"am"!sa : A#&*A"am"!ss /a" a((*a"am"!ss /!"+a" sa#/a$a

as!" Pa/a &a"++a( - J#" 201-

K!(#'a" U&ama : Ma&a )a"a" )a#$.

K!(#'a" Tama'a" : *

RI3AYAT PERJALANAN PENYAKIT:

Pas!" /a&a"+ )! )!(#'a" ma&a )a"a" )a#$ s!a) )#$a"+ (!' sa #(a" a"+ (a(#. Ma&a

)a"a" )a#$ !$&a'a &a"a /s!$&a /!"+a" ma&a m!$a', !$a$, +a&a(, "!$. Ka#$ a"+

/$asa)a" as!" s!!$& a/a a6a" a&a# asa a"+ m!"+'a(a"+ a) /a$ a$a) a#' /a" /!)a&.

J)a m!('a& '#$#7 /a$ a$a) a#', as!" m!$asa m!('a& '#$#7 &!$s!#& s!!$& !8a' /a" )!&)a

//!)a&)a" '#$#7"a sama &/a) !$#a'. Pas!" m!m() $6aa& m!"++#"a)a" )a8ama&a,

"am#" )!(#'a" " &/a) !$)#$a"+ /!"+a" m!"++#"a)a" )a8ama&a (ama"a.

K!(#'a" as!" &/a) /s!$&a /!"+a" s(a# )!&)a m!('a& 8a'aa, /a" &/a) !$"a'

m!"+a(am &$a#ma a/a ma&a )a"a""a

K!(#'a" as!" &/a) /s!$&a /!"+a" "!$ )!a(a '(a"+ &m#(, &/a) m!$asa

!"+('a&a""a m!"!m& s!!$& m!('a& &!$"+.

Pas!" &/a) m!"+!(#')a" s#(& m!('a& / &!ma& +!(a /a" m!"+a(am )!(#'a" m!('a&

6a$"a.

RI3AYAT PENYAKIT DAHULU

1


3/25

Pas!" m!m() $6aa& &$a#ma a/a ma&a )$"a saa& "/a'a" $#ma' s!)&a$ 10 &a'#"

a"+ (a(#, s!'"++a ma&a )$"a /+a"& /!"+a" ma&a a(s# Pas!" m!"+a)# &/a) !$"a' m!"+a(am +!a(a ma&a #$am s!!$& " s!!(#m"a.

M!m() $6aa& /a!&!s m!((s s!(ama 15 &a'#" /!"+a" !"++#"aa" "s#("

"9$a/ 214 U

RI3AYAT PENYAKIT KELUARGA

Aa' as!" m!""++a( )a$!"a s&$)!

RI3AYAT SOSIAL EKONOMI

L"+)#"+a" : Pas!" &"++a( !$sama )!(#a$+a

Ssa( !)"m : ;#)#

RI3AYAT KEBIASAAN < POLA HIDUP

Pas!" m!m() )!asa" m!$)), &/a) m!"+)"s#ms m"#ma" a(8'(, &/a)

m!"+)"s#ms a& = a&a" &!$(a$a"+.

Pas!" &/a) m!m() $6aa& a(!$+ &!$'a/a ma)a"a" ma##" a&.

III. PEMERIKSAAN FISIK

STATUS GENERALIS

K!sa/a$a" : ;msm!"&s

Ta"/a = &a"/a 9&a(

Na/ : %0 < m!"&

S#'# : >-.?

@$!)#!"s Na7as : 20 < m!"&

T!)a"a" Da$a' : 1>0


4/25

STATUS OFTALMOLOGI

1.Visus

KETERANGAN OD OS

Taam !"+('a&a" S 1.5 T/a) /(a)#)a"

K$!)s 0.% T/a) /(a)#)a"

A//s A// 1.?5 *

Ds&a"sa P#( -2


5/25

L!&a) Sm!&$s Sm!&$s

(. Pa"&e'a su&e'i!' in)e'i!'

KETERANGAN OD OS

E/!ma T/a) a/a T/a) a/a

N!$ &!)a" T/a) a/a T/a) a/a

E)&$" T/a) a/a T/a) a/a

E"&$" T/a) a/a T/a) a/a

B(!7a$sasm! T/a) a/a T/a) a/a

T$)ass T/a) a/a T/a) a/a

S)a&$)s T/a) a/a T/a) a/a@ss#$a a(!$a % mm % mm

P&ss T/a) a/a T/a) a/a

H$/!(#m T/a) a/a T/a) a/a

Ka(aC" T/a) a/a T/a) a/a

Ps!#/&ss T/a) a/a T/a) a/a

*. K!n+un,$i-a $a'sa"is su&e'i!' In)e'i!'

KETERANGAN OD OS

H!$!ms T/a) a/a T/a) a/a

@()!( T/a) a/a T/a) a/a

Pa( T/a) a/a T/a) a/a

S)a&$)s T/a) a/a T/a) a/a

A"!ma T/a) a/a T/a) a/a

K!mss T/a) a/a T/a) a/a

/. K!n+un,$i-a u"i

KETERANGAN OD OS

I"!)s )"#"+&9a T/a) a/a T/a) /(a)#)a"

4


6/25

I"!)s S(a$ T/a) a/a T/a) /(a)#)a"

P!$/a$a'a"

s#)"#"+&9a

T/a) a/a T/a) /(a)#)a"

P&!$+#m T/a) a/a T/a) /(a)#)a"

P"+#!)#(a T/a) a/a T/a) /(a)#)a"

N!9#s P+m!"&s#s T/a) a/a T/a) /(a)#)a"

Ks&a /!$m/ T/a) a/a T/a) /(a)#)a"

0. Sis$i# "ak'i#a"is

KETERANGAN OD OS

P#"8m La8$ma( T!$#)a T!$#)a

T!s a"!( T/a) /(a)#)a" T/a) /(a)#)a"

. Sk"e'a

KETERANGAN OD OS

3a$"a P#&' T/a) /(a)#)a"

I)&!$) T/a) a/a T/a) /(a)#)a

. K!'nea

KETERANGAN OD OS

K!!$"'a" J!$"' T/a) /(a)#)a"

P!$m#)aa" L8" T/a) /(a)#)a"

U)#$a" 10 mm T/a) /(a)#)a"

S!"s(&as Ba) T/a) /(a)#)a"I"7(&$a& /a" D!"/$& T/a) aa T/a) /(a)#)a"

U()#s T/a) a/a T/a) /(a)#)a"

P!$7$as T/a) a/a T/a) /(a)#)a"

A$)#s s!"(s T/a) a/a T/a) /(a)#)a"

E/!ma T/a) a/a T/a) /(a)#)a"

5


7/25

T!s P(a8/ K"s!"&$s T/a) /(a)#)a"

13. Bi"ik #a$a de&an

KETERANGAN OD OS

K!/a(ama" Da(am T/a) /(a)#)a"

K!!$"'a" J!$"' T/a) /(a)#)a"

H7!ma T/a) a/a T/a) /(a)#)a"

H" T/a) a/a T/a) /(a)#)a"

E7!) T"/a(( @(a$! * T/a) /(a)#)a"

11. I'is

KETERANGAN OD OS

3a$"a ;)(a& T/a) /(a)#)a"

K$&a! J!(as T/a) /(a)#)a"

B!") B#(a& T/a) /(a)#)a"

S"!)a T/a) a/a T/a) /(a)#)a"

K(ma T/a) a/a T/a) /(a)#)a"

12. Lensa

KETERANGAN OD OS

6


8/25

K!!$"'a" K!$#' T/a) /(a)#)a"

L!&a) D !(a)a"+ $s T/a) /(a)#)a"

S'a/6 T!s& Ps&7 T/a) /(a)#)a"

1%. Badan ka4a

KETERANGAN OD OS

K!!$"'a" J!$"' S#(& /"(a

1(. Fundus !ku"i

KETERANGAN OD OS

R!7(!)s 7#"/#s Ps&7 T/a) /(a)#)a"

a. Pa&i"B!") B#(a& s!"&$a( T/a) /(a)#)a"

Ba&as T!+as T/a) /(a)#)a"

3a$"a K!m!$a'a" T/a) /(a)#)a"

;D Ra& 0.> T/a) /(a)#)a"

A$&!$ !"a 2:> T/a) /(a)#)a"

. Maku"a Lu$ea

R!7(!)s T/a) a/a T/a) /(a)#)a"

E/!ma A/a T/a) /(a)#)a"

4. Re$ina

P!$/a$a'a" T/a) a/a T/a) /(a)#)a"

E)s#/a& T/a) a/a T/a) /(a)#)a"

E/!ma T/a) a/a T/a) /(a)#)a"

S)a&$)s T/a) T/a) /(a)#)a"

M)$a"!#$sma A/a T/a) /(a)#)a"

1*. Pa"&asi

7


9/25

KETERANGAN OD OS

N!$ T!)a" T/a) a/a T/a) A/a

Massa T#m$ T/a) a/a T/a) a/a

T!"s O)#( N$ma( < a(as T/a) /(a)#)a"

T"m!&$ S8'&C T/a) D(a)#)a" T/a) D(a)#)a"

1/. 5a#&us -isi

KETERANGAN OD OS

T!s K"7$"&as Sama /!"+a" !m!$)sa T/a) /(a)#)a"

IV. RESUME

Pas!" s!$a"+ (a)*(a), !$#sa 4% &a'#" /a&a"+ /!"+a" )!(#'a" ma&a )a"a" )a#$

s!a) 1 #(a" sm$s. K!(#'a" as!" &!$a/ s!8a$a !$(a'a" &a"a /s!$&a /!"+a" ma&a

m!$a'. Ka#$ a"+ /$asa)a" s!!$& m!('a& a6a" a&a# )a#&, /a" )!&)a 7)#s )! '#$#7

/a$ a$a) a#', '#$#7 a"+ /('a& s!!$& !8a'. K!(#'a" as!" &/a) !$)#$a"+ /!"+a"

)a8ama&a. Pas!" m!m() $6aa& /a!&!s m!((s s!(ama 15 &a'#" /!"+a" !"++#"aa""9$a/ 214 U.

Pa/a !m!$)saa" 7s) //aa&)a", as!" m!"+a(am +a"++#a" 9s#s '!$m!&$

1.5 /a" $!s 1.?5. Pas!" m!ma)a )a8ama&a (ama /!"+a" #)#$#a" 1.5. Pa/a

!m!$)saa" (!"sa //aa&)a" s'a/6 &!s& a/a ma&a )a"a". Pa/a !m!$)saa"

7#"/#s) //aa&)a" ma)#(a !/!ma.

V. DIAGNOSA BANDING

a. R!&"a& /a!&)#m OD

. Ka&a$a) Ima$ OD

8. D!+!"!$as ma)#(a

VI. DIAGNOSA KER6A

R!&"a& Da!&)#m OD

Ka&a$a) ma$ OD

8


10/25

VII. PEMERIKSAAAN AN6URAN

P!m!$)saa" /a$a' (!"+)a &!$mas#) +#(a /a$a' s!6a), +#(a /a$a' 2 am s& $a"/a(

@#"/#s 7(#$!s8!" a"++$a'

O8#(a$ 8'!$!"8! &m+$a'

VIII. PENATALAKSANAAN

7 R##)a" )! /)&!$ s!sa(s ma&a

7 E/#)as #") m!"+"&$( +#(a /a$a' /a" 8!) +#(a /a$a' $#&"

7 M!(a)#)a" 7((6 # s!&a 2 sama 4 #(a" s!)a( m!(a)#)a" !m!$)saa"

!"#"a"+ !$#a @@A a&a# O;T

7 K"s#( )! /)&!$ s!sa(s ma&a #") m!(a)#)a" 78a( /a" a&a# +$/ (as!$

I8. PROGNOSIS

# A/ &am : /#a

# A/ 7#"+s"am : D#a

# A/ sa"a8&"am : D#a

PEMBAHASAN KASUS

Pas!" s!$a"+ (a)*(a), !$#sa 4% &a'#" /a&a"+ /!"+a" )!(#'a" ma&a )a"a" )a#$ s!a) 1

#(a" sm$s. K!(#'a" as!" &!$a/ s!8a$a !$(a'a" &a"a /s!$&a /!"+a" ma&a m!$a'. Ka#$

a"+ /$asa)a" s!!$& m!('a& a6a" a&a# )a#&, /a" )!&)a 7)#s )! '#$#7 /a$ a$a) a#', '#$#7

a"+ /('a& s!!$& !8a'. K!(#'a" as!" &/a) !$)#$a"+ /!"+a" )a8ama&a. Pas!" m!m()

$6aa& /a!&!s m!((s s!(ama 15 &a'#" /!"+a" !"++#"aa" "9$a/ 214 U.

Pa/a !m!$)saa" 7s) //aa&)a", as!" m!"+a(am +a"++#a" 9s#s '!$m!&$ 1.5

/a" $!s 1.?5. Pas!" m!ma)a )a8ama&a (ama /!"+a" #)#$#a" 1.5. Pa/a !m!$)saa"

(!"sa //aa&)a" s'a/6 &!s& a/a ma&a )a"a". Pa/a !m!$)saa" 7#"/#s) //aa&)a"

ma)#(a !/!ma

Da+"ss $!&"a& /a!&)#m /am( /a$ a"am"!sa a"+ &!(a' /(a)#)a" (!' as!",,

/ ma"a /a$ a"am"!sa //aa&)a" a'6a as!" m!"+a(am )!(#'a" a"+ mas#) )! /a(am

+("+a" ma&a &!"a"+ 9s#s $#" !$(a'a". Da$ s" /aa& /!(!m"as )!m#"+)"a" as!"

9


11/25

#)a" /)a$!"a)a" )!(a"a" 9s#s. Ha( " /s!a)a" )!(#'a" as!" &/a) !$)#$a"+ /!"+a"

!"++#"aa" )a8ama&a /a" )!&)a '#$#7 //!)a&)a", as!" &/a) m!"/aa& !$#a'a" a"+

!$a$&. Da$ a"am"!sa #+a &/a) //aa&)a" )!(#'a" a"+ m!"/#)#"+ )! a$a' +(a#)ma )$")

a& "!$ )!a(a /a" ""!( 9s" a&a# (aa"+ a"/a"+ as!" #+a &/a) m!"!m&. Da$

a"am"!sa /a" $6aa& !"a)& /a'#(# as!" //aa&)a" a'6a +!a(a as!" m!"+a$a' )!

$!&"a& /a!&)#m /s!a)a" )!$!"a )!(#'a" ma&a #$am !$(a'a" &a"a /s!$&a ma&a

m!$a', &/a) !$)#$a"+ /!"+a" !ma)aa" )a8ama&a, /a" a/a"a $6aa& sa)& /a!&!s m!((s

s!(ama 15 &a'#" /!"+a" !ma)aa" "9$a/ 214 U. Da$ !m!$)saa" 7#"/#s) #+a

//aa&)a" a/a"a ma)#(a !/!ma a"+ s!ma)" m!"!+a))a" /a+"ss )! $!&"a& /a!&)#m.

T!$a a"+ /!$)a" a/a(a' /!"+a" !/#)as !"+"&$(a" +#(a /a$a' /a" $##) )!

s!sa(s ma&a #") m!(a)#)a" &!$a (!' (a"#&.

BAB II

TIN6AUAN PUSTAKA

PENDAHULUAN

R!&"a& m!$#a)a" )!(a"a" a/a $!&"a a"+ &/a) /s!a)a" $a/a"+. ;&&" 6(

a&8'!s m!$#a)a" +ama$a" !)s#/a& a/a $!&"a a)a& !"#ma&a" a$&!$ $!a( s!'"++a

10


12/25

&!$a/ /a!$a' "" !$7#s / /a(am $!&"a. R!&"a& &!$/aa& a/a '!$&!"s, $!&"a& /a!&!s,

!"a)& )(a+!", a"!ma, !"a)& '/+)" /a" $!8a"#"a" m")s/a 1.

R!&"a& /a!&!s a/a(a' )!(a"a" $!&"a a"+ /&!m#)a" a/a !"/!$&a /a!&!s

m!((s. R!&"a& a)a& /a!&!s m!(s /(ama !$#a a"!#$sma, m!(!a$"a 9!"a,

!$/a$a'a", /a" !)s#/a& (!ma).

P!"/!$&a /a!&!s m!((s /!"+a" &! I "s#(" /!!"/!"& /a!&!s /a" &! II ""

"s#(" /!!"/!"& /a!&!s m!m#"a $s) #") m!"/aa&)a" $!&"a& /a!&). Ma)"

(ama m!"/!$&a /a!&!s ma)"!$&ama' $s) #") m!"/aa&)a" $!&"a&. Da!&!s a"+

//!$&a (!' 20 &a'#" a/a &! I 'am$ s!(#$#'"a /a" F-0 T! II m!"/!$&a $!&"a&.

R!&"a& /a!&!s m!$#a)a" !"#(& !"a)& /a!&!s a"+ a("+ !"&"+. Ha "

/s!a)a" )a$!"a "s/!""a a"+ 8#)# &"++ a m!"8aa 40*50 !"/!$&a /a!&!s /a"

$+"ss"a a"+ )#$a"+ a) &!$#&ama a+ !"+('a&a".

D Am!$)a s!$)a& &!$/aa& )!#&aa" 5000 $a"+ !$&a'#" a)a& $!&"a& /a!&!s,

s!/a"+)a" / I"++$s $!&"a& /a!&!s m!$#a)a" !"!a )!#&aa" "m$ 4 /a$ s!(#$#'

!"!a )!#&aa".

Gama$a" $!&"a& /s!a)a" !$#a'a" m)$9as)#(a$ $!&"a. H!$+()!ma

m!"+a)a&)a" )!ma&a" !$s& "&$a m#$a( /a" !"!a(a" m!m$a"! asa(s m!"+a)a&)a"

/"/"+ !m#(#' /a$a' (!ma'.

P!"m#"a" +(#)sa /a" 7$#)&sa m!$#sa) !m#(#' /a$a' 'a(#s.

ANATOMI RETINA

R!&"a a&a# s!(a#& a(a, m!$#a)a" a+a" ma&a a"+ m!"+a"/#"+ $!s!&$ a"+

m!"!$ma $a"+sa"+a" 8a'aa 1.

R!&"a !$a&as &!+as /!"+a" )$/ /!"+a" s!( +m!" !&!( $!&"a, /a" &!$/$ a&as (asa":

1. Lasa" 7&$!s!&$, m!$#a)a" (as &!$(#a$ $!&"a &!$/$ a&as s!(( a&a"+ a"+

m!mm#"a !") $am"+, /a" s!( )!$#8#&.

11


13/25

2. M!m$a" (m&a" !)s&!$"a a"+ m!$#a)a" m!m$a" maa.

>. Las "#)(!#s (#a$, m!$#a)a" s#s#"a" (as "#)(!#s )!$#8#& /a" a&a"+. K!&+a (as /

a&as a9as)#(a$ /a" m!"/aa& m!&a(sm! /a$ )a(!$ )$/.

4. Las (!)s7$m (#a$, m!$#a)a" (as as!(#(a$ /a" m!$#a)a" &!ma& s"ass s!(

7&$!s!&$ /!"+a" s!( (a$ /a" s!( '$C"&a(.

5. Las "#)(!#s /a(am, m!$#a)a" #' s!( (a$, s!( '$C"&a(, /a" s!( m#((!$ (as "

m!"/aa& m!&a(sm! /a$ a$&!$ $!&"a s!"&$a(.

-. Las (!)s7$m /a(am, m!$#a)a" (as as!(#(a$ m!$#a)a" &!ma& s"as s!( (a$,

s!( ama)$" /!"+a" s!( +a"+(".

?. Las s!( +a"+(" a"+ m!$#a)a" (as a/a" s!( /a$a/a "!#$" )!/#a

%. Las s!$a#& sa$a7, m!$#a)a" (as a)s" s!( +a"+(" m!"## )! a$a' sa$a7 &). D

/a(am (asa"*(asa" " &!$(!&a) s!a+a"!sa$ !m#(#' /a$a' $!&"a.

. M!m$a" (m&a" "&!$"a, m!$#a)a" m!m$a" 'a(" a"&a$a $!&"a /a" a/a" )a8a.

3a$"a $!&"a asa"a "++a, )a/a"+ #8a& a/a a"!ma /a" s)!ma, m!$a' a/a

'!$!ma.

P!m#(#' /a$a' / /a(am $!&"a m!$#a)a" 8aa"+ a$&!$ 7&a(m)a, a$&!$ $!&"a s!"&$a( mas#)

$!&"a m!(a(# a( sa$a7 &) a"+ a)a" m!m!$)a" "#&$s a/a $!&"a /a(am. Lasa" (#a$

$!&"a a&a# s!( )!$#8#& /a" a&a"+ m!"/aa& "#&$s /a$ )$/.

U") m!('a& 7#"+s $!&"a ma)a /(a)#)a" !m!$)saa" s#!)&7 $!&"a s!!$&: &aam

!"+('a&a", !"+('a&a" 6a$"a, /a" (aa"+ a"/a"+. P!m!$)saa" !)&7 a/a(a'

!(!)&$$!&"+$a7 ERG, !(!)&$)#(+$a7 EOG, /a" 9s#a( !9)!/ $!s"s ER.

FISIOLOGI RETINA 92:

K!$#8#&:+#"a"a #") '&&8 9s", a m!('a& 6a$"a, 8a'aa /!"+a" "&!"s&as &"++

/a" !"+('a&a" s!"&$a( )!&aama" !"+('a&a"

12


14/25

Ba&a"+: +#"a"a #") s8&&8 9s", a #") m!('a& 8a'aa /!"+a" "&!"s&as $!"/a',

&/a) /aa& m!('a& 6a$"a, #") !"+('a&a" !$7!$ /a" $!"&as $#a"+a".

D /a(am s!( )!$#8#& &!$/aa& > ma8am +m!", a"+ mas"+*mas"+ !)a &!$'a/a s"a$ m!$a',

'a#, $#. P+m!" a"+ !)a &!$'a/a s"a$ m!$a', s!)&$#m as$s"a (#as, /!"+a"

ma)sm#m as$s 5?5 mA. P+m!" a"+ !)a &!$'a/a s"a$ 'a# m!m#"a 7$!)6!"s

as$s ma)sma( 540 mA, s!/a"+ +m!" a"+ !)a, &!$'a/a s"a$ $#, 7$!)6!"s as$s

ma)sma("a 4>0 mA.Da!$a' s!)&$#m " sa("+ m!(!"+)a.

GE6ALA

P!$#a'a" /" a&a# aa a"+ /s!#& ""$(7!$a&9! /a!&8 $!&"a&' NPDR, &/a)

m!m!$)a" )!(#'a" +a"++#a" !"+('a&a". P!$#a'a" /" a"+ $!9!$s(! /a" &/a)

m!"+a)a&)a" +a"++#a" !"+('a&a" s!"&$a( /"ama)a" $!&"a& sm(!)s a&a# a8)+$#"/

$!&"a&'. B(a !m#(#' /a$a' $#sa) /a" 8& /a" mas#)"a (/ )! ma)#(a, ma)#(a a)a"

!/!m /a" !"+('a&a" m!"#$#".

R!&"a& m!$#a)a" +!a(a /a!&!s m!(s #&ama a/a ma&a, / ma"a /&!m#)a" a/a

$!&"a:

1. M)$a"!#$sma, m!$#a)a" !""(a" /"/"+ )a(!$, &!$#&ama /a!$a' 9!"a /!"+a"

!") !$#a "&) m!$a' )!8( a"+ &!$(!&a) /!)a& !m#(#' /a$a' &!$#&ama (#s

s&!$$. Ka/a"+*)a/a"+ !m#(#' /a$a' " /!m)a" )!8("a s!'"++a &/a) &$('a&

s!/a"+ /!"+a" a"a" a"++$a7 7(#$!s!" (!' m#/a' /!$"#))a" a/a"a

m#)$a"!#$sma&a ". M)$a"!#$sma&a m!$#a)a" )!(a"a"a" /a!&!s m!(s /"

a/a ma&a.

2. P!$/a$a'a" /aa& #(a /a(am !") &&), +a$s, /a" !$8a) a"+ asa"a &!$(!&a) /!)a&

m)$a"!#$sma&a / (#s s&!$$. B!") !$/a$a'a" " m!$#a)a" $+"ss !"a)&

)/ ma"a !$/a$a'a" a"+ (#as m!m!$)a" $+"ss (!' #$#' /a"/"+)a" a"+

)!8(. P!$/a$a'a" a"+ &!$a/ a)a& +a"++#a" !$m!a(&as a/a m)$a"!#$sma, a&a#

)a$!"a !8a'"a )a(!$.

>. D(a&as !m#(#' /a$a' a() /!"+a" (#m!""a $!+#(a$ /a" !$)!()*)!(), !") "

s!a)a"*a)a" /aa& m!m!$)a" !$/a$a' &a 'a( " &/a)(a' /!m)a". Ha( " &!$a/

13


15/25

a)a& )!a"a" s$)#(as /a" )a/a"+*)a/a"+ /s!$&a )!(a"a" !"/&!( /a" !)s#/as

(asma.

4. Ha$/ !#/a&! m!$#a)a" "7(&$as (/ )! /a(am $!&"a. Gamaa""a )'#s#s a

$!+#(!$, )!)#""+*)#""+a". Pa/a !$m#(aa" !)s#/a& #"+&a&a m!m!sa$ /a"

!$+a#"+. E)s#/a& " /aa& m#"8#( /a" '(a"+ /a(am !!$aa m"++#. Pa/a m#(a"a

&ama) a/a +ama$a" a"++$a7 7(#$!s!" s!a+a )!8$a" / (#a$ !m#(#' /a$a'.

K!(a"a" " &!$#&ama &!$/$ a&as a'a"*a'a" (/ /a" &!$#&ama a"a) /&!m#)a" a/a

)!a/aa" '!$($&!"!ma.

5. S7& !#/a&! a"+ s!$"+ /s!#& 8&& 6( a&8'!s m!$#a)a" s)!ma $!&"a. Pa/a

!m!$)saa" 7&a(ms) a)a" &!$('a& !$8a) !$6a$"a )#""+ !$s7a& /7#s /a"

!$6a$"a #&'. Basa"a &!$(!&a) / a+a" &! /a!$a' ""$+as /a" /'##"+)a"

/!"+a" s)!ma $!&"a.

-. P!m#(#' /a$a' a$# a/a $!&"a asa"a &!$(!&a) /!$m#)aa" a$"+a".

N!9as)#(a$saas &!$a/ a)a& $(7!$as s!( !"/&!( !m#(#' /a$a'. Tama) s!a+a

!m#(#' a"+ !$)!()*)!(), /a(am )!(m)*)!(m), /a" !")"a $!+#(a$. Ha(

" m!$#a)a" a6a( !"a)& a"+ !$a& a/a $!&"a& /a!&!s. M#(a*m#(a &!$(!&a) /

/a(am a$"+a" $!&"a, )!m#/a" !$)!ma"+ )! /a!$a' $!$!&"a(, )! a/a" )a8a.

P!8a'"a "!9as)#(a$saas a/a /a!$a'*/a!$a' " /aa& m!"m#()a" !$/a$a'a"

$!&"a, !$/a$a'a" s#'a(/ $!$!&"a(, ma##" !$/a$a'a" a/a" )a8a. P$(7!$as

$!$!&"a( /a$ s#a "!9as)#(a$sas asa"a /)#& $(7!as a$"+a" +a"+(a /a"

!$/a$a'a".

?. E/!ma $!&"a /!"+a" &a"/a '(a"+"a +ama$a" $!&"a &!$#&ama /a!$a' ma)#(a s!'"++a

sa"+a& m!"++a"++# &aam !"+('a&a" as!".

%. H!$(/!ma s#a )!

Da!&) $!&"a& !$a(a"a" /a(am 4 &"+)a&:

a. R!&"a& ""$(7!$a&7 $"+a" m)$a"!#$sma

. R!&"a& ""$(7!$a&7 s!/a"+ !"#ma&a" a/a !!$aa !m#(#' /a$a' $!&"a

14


16/25

8. R!&"a& ""$(7!$a&7 !$a& (!' a"a) !m#(#' /a$a' &!$s#ma& /a" m!$a"+sa"+

!m#(#' /a$a' a$#

/. R!&"a& $(7!$a&7 s&a/#m (a"#&

R!&"a& /a!&!s asa"a /&!m#)a" (a&!$a(, sm!&$s /a" $+$!s7, /!"+a" > !"):

1. Ba8)+$#"/: m)$a"!#$sma&a, !$/a$a'a" !$8a) /a" &&), s!$&a !/!ma s$s"a&a

2. Ma)#(a&: !/!ma $!&"a /a" +a"++#a" 7#"+s ma)#(a

>. P$(7!$as: 9as)#(a$sas $!&"a /a" a/a" )a8a

K!a/aa"*)!a/aa" a"+ /aa& m!m!$!$a& $!&"a& $!&"a& /a!&!s:

1. Pa/a /a!&!s #9!"(s a"+ "s#(" /!!"/!"& /a" )!'am(a" /aa& m!$a"+sa"+

&m#("a !$/a$a'a" /a" $(7!$as

2. A$&!$s(!$ss /a" $s!s m!"#a !m#(#'*!m#(#' /$a' m!m!$#$#) $+"ss

>. H!$($&!"!ma //#+a m!m!$8!a& !$a(a"a" /a" $+$!s7&as )!(a"a" /!"+a"

8a$a m!m!"+a$#' a$&!$s)(!$ss /a" )!(a"a" '!m(+)

4. H!$&!"s a$&!$. M!m!$#$#) $+"ss &!$#&ama a/a !"/!$&a #sa a

5. H+()!ma a&a# &$a#ma /aa& m!"m#()a" !$/a$a'a" $!&"a a"+ m!"/a/a).

STADIUM RETINOPATI

P!ma+a" s&a/#m m!"#$#& Da"!( a#+'a">

a. S&a/#m Im)$a"!#$sma&a, a"+ m!$#a)a" &a"/a )'as, &ama) s!a+a !$/a$a'a"

#(a& )!8( / /a!$a' a( /a" ma)#(a

!"a s!/)& m!(!a$

Hs&(+s, //aa&)a" m)$a"!#$sma&a / )a(!$ a+a" 9!"a / /a!$a' "#)(!a$

(#a$

15


17/25

. S&a/#m II

!"a m!(!a$

E)s#/a& )!8(*)!8(, &ama) )!$as s!!$& ((", &!$s!a$ a&a# &!$)#m#( s!!$&

#"+a 8$8"a$ a"+ 's&(+s &!$(!&a) / /a!$a' (asa" (!7$m (#a$.

8. S&a/#m III s&a/#m II 8&&" 6( a&8'!s, s!a+a a)a& s)'!ma a/a a$&!$(a

&!$m"a(. D/#+a a'6a 8&&" 6( a&8'!s &!$/aa&, (a /s!$&a $!&"a& '!$&!"s

a&a# a$&!$s)(!$s!.

/. S&a/#m I 9!"a*9!"a m!(!a$, sa"ss, &ama) s!a+a sss, /s!$&a s'!a&"+

!m#(#' /a$a'. P!$/a$a'a" "a&a !sa$ /a" )!8(, &!$/aa& a/a s!m#a (asa" $!&"a,

/aa& #+a $!$!&"a.

!. S&a/#m !$/a$a'a" !sa$ / $!&"a /a" $!$!&"a /a" #+a / /a(am a/a" )a8a.

Ya"+ )!m#/a" /s#s#( /!"+a" &!$a/"a $!&"&s $(7!$a"s, a)a& &m#("a a$"+a"

7$&) a"+ /s!$&a /!"+a" "!9asa$sas. R!&"&s $(7!$a"s " m!(!)a& a/a $!&"a,

a"+ (a m!"+)!$#& /aa& m!"m#()a" a(as $!&"a, /a" /aa& m!"+aa&)a" &!$a/"a

)!#&aa" &&a(.

KLASIFIKASI

K(as7)as $!&"a& /a!&!s m!"#$#& a+a" Ma&a @a)#(&as K!/)&!$a" U"9!$s&as

I"/"!sa


18/25

J)a +ama$a" 7#"/#s ma&a )$ &/a) sama !$a&"a /!"+a" ma&a )a"a" ma)a /+("+)a" a/a

/!$aa& a"+ (!' !$a&.

Tae" 1. K(as7)as R!&"a& Da!&) B!$/asa$)a" Early Treatment Diabetic Retinopathy

Study(4)

Ka$e,!'i;Desk'i&si

Re$in!&a$i Diae$ik N!n&'!"i)e'a$i)

R"+a": 'a"a a/a m)$a"!#$sma

S!/a"+: a/a"a &!m#a" a&(+s (a" s!(a" m)$a"!#$sma "am#" (!' $"+a"

/a"/"+)a". I"&$a$!&"a( m8$9as8#(a$ a"$ma(&!s IRMA s!/a"+ a/a 1 a&a# (!' )#a/$a"

Sa"+a& !$a&: /&!m#)a" 2 )$&!$a !$a&

Re$in!&a$i Diae$ik P'!"i)e'a$i)

1. A/a"a "!9as)#(a$sas

2. A/a"a !$/a$a'a" 9&$!#s a&a# !$/a$a'a" $a$!&"a

PATOGENESA 92:

R!&"a& /a!&!s m!$#a)a" m)$a"+a&, s!a+a a)a& /a$ +a"++#a" m!&a(), a

/!7s!"s "s#(" /a" '!$+()!m. P!""+)a&a" +#(a /a$a' sama )!&"++a" &!$&!",

m!"+a)a&)a" )!$a8#"a" s!(*s!( #', &!$#&ama /a$a' /a" /"/"+ !m#(#' /a$a', a"+

/s!#& +()&)ss&as. P!$s&6a " m!$#a)a" !"++a#"+a" $!9!$s!( /a$ m(!)#( +(#)s!

/!"+a" $&!" a/a", a"+ /s!#& +()s(as! /a$ $&!".

17


19/25

Da(am )!a/aa" "$ma( +()s(as! " 'a"a s!)&a$ 4*, s!/a"+ a/a !"/!$&a /a!&!s

m!"8aa 20. G()s(as! " /aa& m!"+!"a s /a" /"/"+ !m#(#' /a$a', a"+ s!8a$a

)!s!(#$#'a" /aa& m!"!a)a" m!""+)a&"a 9s)s&as /a$a', +a"++#a" a($a" /a$a', a"+

/m#(a a/a a($a" / /a!$a' s$)#(as )!8(, )!m#/a" /s#s#( /!"+a" +a"++#a" a/a /a!$a'

s$)#(as !sa$ /a" m!!a)a" ')s a$"+a" a"+ /#$#s"a. K!(a"a"*)!(a"a" "

//aa&)a" #+a / /a(am !m#(#'*!m#((#' /a$a' $!&"a a"+ /aa& /ama& /!"+a"

m!(a)#)a":

1. @#"/#s 7(#$!s8!" a"++$a'

2. P!m&$!&a" /!"+a" m!ma)a 7(m !$6a$"a

>. O7&a(ms) (a"+s#"+ /a" &a) (a"+s#"+

4. Bm)$s) /!"+a" (!"sa )"&a) /a$ G(/ma"

M#(a*m#(a //aa&)a" )!(a"a" a/a )a(!$ 9!"a, a"+ /"/"+"a m!"!a( /a" m!m#"a

a7"&as a"+ !sa$ &!$'a/a 7(#$!s!". K!a/aa" " m!"!&a #") 6a) a"+ (ama &a"a

m!"++a+# !"+('a&a". D!"+a" m!(!ma'"a /"/"+ )a(!$, ma)a a)a" m!""( m!m!")

m)$a"!#$sma. M#(a*m#(a )!a/aa" " &!$('a& a/a /a!$a' )a(!$ 9!"a / s!)&a$ ma)#(a,a"+

&ama) s!a+a &&)*&&) m!$a' a/a 7&a(ms). A/a"a 1*2 m)$a"!#$sma s#/a' 8#)#

m!"/a+"sa a/a"a $!&"a& /a!&)#m. Pa/a )!a/aa" (a"#& m)$a"!#$sma //aa&)a"

sama a"a) a/a )a(!$ 9!"a ma##" a$&!$. Ba) )a(!$ a"+ a"$ma( ma##"

m)$a"!#$sma m!"m#()a" )!8$a", a"+ &ama) s!a+a !/!ma, !)s#/a&, !$/a$a'a", /

s!)&a )a(!$ /a" m)$a"!$sma.

A/a"a !/!ma /aa& m!"+a"8am )!&aama" !"+('a&a" (a &!$/aa& / /a!$a' ma)#(a.

E/!ma a"+ $"+a" /aa& /as$s, &!&a a"+ '!a& /a" (ama m!"+a(am /!+!"!$as )$s&/.

B(a 'a( " &!$a/ / /a!$a' ma)#(a, )!&aama" !"+('a&a" a)a" &!$+a"++#, &a) /aa&

/)!ma()a" )! )!a/aa" s!m#(a m!s)#" /(a)#)a" 7&)a+#(as a/a !"+a&a".

P!$/a$a'a" s!(a" a)a& )!8$a" #+a /aa& /s!a)a" (!' )a$!"a !8a'"a

m)$a"!#$sma. K!8$a" ($&!"", &ama) s!a+a !)s#/a& )!$as, m!"!$#a (("

!$)!(m) m!$#a)a" ("+)a$a" / /a!$a' ma)#(a, a"+ /s!#& !") s$s"!$ !$6a$"a

18


20/25

#&' )!)#""+*)#""+a". E)s#/a& (!ma) " //aa&)a" a/a !"/!$&a a"+ !m#) /!"+a" )a/a$

(!ma) /a$a' a"+ &"++.

A)a& !$#a'a" ss /a" /"/"+ !m#(#' /a$a', /aa& m!"m#()a" !"#ma&a"

a"+ /m#(a / )a(!$, )! a$&!$(a /a" !m#(#' /a$a' !sa$, )a$!"a"a &m#( ')sa,

/s#s#( /!"+a" /a!$a' s)!m )!8( /a" &m#("a )(a&!$a(*)(a&!$a(. H)s m!m!$8!a&

&m#("a )!8$a", "!9as)#(a$sas, /a" m)$a"!#$sma a"+ a$#. A)a& ')s &m#(

!)s#/a& (#"a a"+ /s!#& 8&&" 6( a&8', a"+ m!$#a)a" !$8a) "!)$ss.

P!m#(#' /a$a' 9!"a m!(!a$ /!"+a" (#m!" /a" /am!&!$ a"+ &/a) &!$a$. J#+a / s"

&!$a/ )!8$a" /a" !"#ma&a", s!'"++a //aa&)a" !$/a$a'a" s!a"a"+ !m#(#' /a$a'

9!"a. Ga"++#a" a($a" /a$a' 9!"a #+a m!$a"+sa"+ &m#("a !m#(#' /a$a' a$# a"+ /aa&

&m#( /a$ !m#(#' /a$a' a"+ a/a / a( a&a# /a$ (!"+)#"+ !m#(#' /a$a', &!&a

s!(a"#&"a /aa& &!$a/ / ma"a saa. B!")"a /aa& !$#a +#(#"+a" a&a# !$#a $!&!

m$a(!. L!&a)"a "&$a$!&"a, m!"a(a$ m!"a/ $!$!&"a, "&$a9&$!a(. P!m#(#'*!m#(#'

/a$a' a$# " m!"#"#))a" )!8$a" a"+ &"++. N!9as)#(a$sas " )!m#/a" /)#&

/!"+a" a$"+a" $(7!$as. B(a a$"+a" 7$9as)#(a$ " m!"+)!$#& /aa& m!"m#()a"

!$/a$a'a" /a" #+a &a$)a" a/a $!&"a s!'"++a m!"!a)a" a(as $!&"a /!"+a" a&a# &a"a

$!)a". Ha( " /aa& m!"m#()a" !"#$#"a" )!a&ama" !"+('a&a" '"++a )!#&aa".

P!$/a$a'a" a"+ &m#( / /a(am a/a" )a8a /aa& m!"!a)a" +(a#)ma '!m$a+)#m, a"+

sa"+a& sa)& /a" 8!a& m!"m#()a" )!#&aa", a"+ m#"+)" 'a$#s /!"#)(!as. P!$/a$a'a"

/a(am a/a" )a8a #+a /)#& /!"+a" !m!")a" a$"+a" 7$&) a"+ /s!$&a

"!9as)#(a$sas, a"+ #+a /aa& m!"+)!$#& /a" m!"!a)a" a(as $!&" /a" )!#&aa".

D!"+a" /!m)a", (a &/a) /am( &"/a)a", $!&"a& /a!&)a 8!a& a&a# (ama& a)a"

!$a)''$ a/a )!#&aa".

N!9as)#(a$sas #+a &m#( a/a !$m#)aa" $s a"+ /s!#& $!!ss $s, a"+ /aa&

m!"m#()a" +(a#)ma a)a& &!$&"a s#/#& () ma&a (!' !m#(#' /a$a' a$# &!$s!#&/a" #+a a)a& !$/a$a'a", )a$!"a !8a'"a $!!ss $s.

Tm#("a +a"++#a" 9s#s, a/a masa s!!(#m /!") a$"+a" 7$9as)#(!$,

&!$+a""+ /a$ !sa$ /a" ()as )!(a"a". E)s#/a&, !/!ma, !$/a$a'a" a"+ &!$/aa& / /a!$a'

ma)#(a, a"+ /s!#& ma)#(a&, 8!a& m!"m#()a" +a"++#a" !"+('a&a". Pa/a #m#m"a

19


21/25

9s#s a/a s&a/#m $!$(7!$a&7 " mas' a). T!&a (a &!(a' &!$8aa !,!")a" a$"+a"

7$9as)#(!$, +a"++#a" 9s#s as& m!"#s#(.

RETINOPATI DIABETES PROLIFERATIF

B(a /a!&!s !$(a"#& a)a" &!$!") $!&"a& $(7!$a&7. B!$)#$a"+"a )s+!"

/a(am $!&"a m!"+a)a&)a" mas#)"a !m#(#' /a$a' a$# a"+ $a#' )! /a(am $!&"a /a"

a/a" )a8a / /a(am (a ma&a. B(a &/a) /a& /a$a' /a$ !m#(#' /a$a' )!(#a$, !"+('a&a"

)a#$ /a" m!$#sa) $!&"a. P$(7!$as 7$9as)#(a$ /aa& m!"+a)a&)a" &$a)s a(as $!&"a.

P!m#(#' /a$a' a$# /aa& mas#) )! /a(am s#/#& () ma&a /a" m!"+a)a&)a"

"!9as)#(a$sas +(a#)ma.

Pa/a $!&"& /a!&!s $(7!$a& 50 as!" asa"a #&a s!s#/a' 5 &a'#", $!+$!s

s"&a" /aa& #(a &!$a/.

G!a(a !$+a""+ )!a/a (#as, &!ma& )!(a"a" /a" !$a&"a )!(a"a". Um#m"a !$#a

!"#$#"a" &aam !"+('a&a" a"+ !$(a"+s#"+ !$(a'a"*(a'a".

Pa/a 7#"/#s /aa& /&!m#)a":

1. M)$a"!#$sma

2. P!$/a$a'a" $!&"a

>. E#/a&!

4. N!9as)#(a$sas $!&"a

5. Ja$"+a" $(7!$as / $!&"a a&a# a/a" )a8a

P$(7!$as /a!&) $!&"a& m!m!$)a" +ama$a" )'#s#s a/a !m!$)saa" 7&a(m(+,

a )as!(:

20


22/25

1. N!6 9!ss!( a& &'! /s8 ND m!$#a)a" "!9as)#)a$sas / a&a# /a(am sa /am!&!$

//s)#s /a$ a( "!$9#s &)#s

2. N!6 9!ss!( !(s!6'!$! NE m!$#a)a" "!9as)#(a$sas a"+ a#' /a$ /s)#s, a"+

/aa& m!"+a)a&)a" 7$ss aa(a !$&a'a" (ama

>. N!6 9!ss!( " &'! $s NI m!$#a)a" "!9as)#(a$sas a/a $s, /s!#& #+a $#!ss

$/s, /a" m!m() )!m#"+)"a" !$(a"#& m!"a/ +(a#)ma "!9as)#(a$

SKRINING DAN PEN5EGAHAN

S)$""+ /!$#"))a" a+:

1. P!"/!$&a DM &! 1: >*5 &a'#" s!&!(a' /a+"ss DM &! 1, /a" /(a"#&)a" /!"+a"

7((6 # s!&a &a'#"

2. P!"/!$&a DM &! 2: a/a saa& /a+"ss DM &! 2 /&!+a))a" /a" /(a"#&)a" /!"+a"

7((6 # s!&a &a'#"

>. S!!(#m )!'am(a" DM &! 1 /a" DM &! 2: s)$""+ /)!$a)a" s!!(#m )"s!s

/a" a/a a6a( &$m!s&!$ sa, /!"+a" 7((6 #:

a. Ta"a $!&"a& a&a# /!""+a" NPR s!/a"+ s!&a >*12 #(a"

. NPDR !$a& a&a# (!' #$#): s!&a 1*> #(a"

P!"8!+a'a" $!&"a& &!$#&ama /)!$a)a" /!"+a":

1. M!(a)#)a" )"&$( )!&a& &!$'a/a +#(a /a$a'

2. Pa/a as!" DM /!"+a" '!$&!"s, /(a)#)a" )"&$( &!)a"a" /a$a'.

TATALAKSANA

21


23/25

P!"+a&a" a/a(a' a) s!!(#m !"#(& m!m!$)a" )!$#sa)a", s!!$& !"+a&a"

(as!$, s#"&)a" )$&)s&!$/ a&a# a"&*EG@ )! /a((am ma&a /a" 9&$!)&m. P!"+a&a" a)a"

sa"+a& !$'as( #") m!"+'!"&)a" !"#$#"a" !"+('a&a". Pa/a !!$aa !"/!$&a s#")a"

&$am8"(" m!m!!$)a" !$a)a" !"+('a&a" &!$#&ama (a &!$/aa& !/!ma ma)#(a.

Las!$

Las!$ 7&)a+#(as. Las!$ )a+#(as /(a)#)a" a/a !/!ma ma)#(a.

G$/ (as!$ 7&)a+#(as

Pa"$!&"a( 7&)a+#(as, #") m!"+#$a"+)a" /a!$a' s)!ma.

I"&$a9&$!a( &$am8"("! a8!&"/!

T$am8"(" m!$#a)a" s&!$/ ("+ a8&"+ a"+ !$+#"a m!"+#$a"+)a" !/!ma ma)#(a,

!"#(& /aa& &!$a/ !"/7&a(m&s, )a&a$a) /a" a(as.

I"&$a9&$!a( A"&*EG@

B!9a8C#ma /+a#"+ !$sama (as!$ &$!8&m

&$!)&m /(a)#)a" (a &!$/aa& /a$a' /a(am a/a" )a8a

Ta!( 2. R!)m!"/as T!$a R!&"a& Da!&) B!$/asa$)a" B!$a&"a R!&"a&4

Be'a$n

kasus rd [karlina].doc

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