Dr Yunani Setyandriana, Sp M

Medical Faculty
UMY
Cataract
Diabetic Retinopathy
Neovascular Glaucoma
Cataract
Diabetes
Kadar gula kadar gula dlm lensa
sorbitol (menarik air dalam lensa)
keruh.
THERAPY
ECCE
SICS
Facoemulsifikasi
WHAT IS DIABETIC RETINOPATHY?

It is a consequence of diabetes
High blood sugar level
Thickening of blood vessels in the retina

Leakage causes macular edema

Blockage of vessels causes proliferation of new

blood vessels
 The risk factors ???

Duration of diabetes mellitus

DM>10 th 50%
DM>30 th 95%

Increase and fluctuations of blood sugar levels

FBS -> 110-120 mg/dl

PPBS (2 hrs) -> 150-160mg/dl
Hb A1c > 4-8 mg
 Associated diseases like hypertension, cardiac
and renal diseases and neuropathy
Associated conditions like hyperlipidaemia and
pregnancy
 Diabetic retinopathy in Indonesia
8.2 million diabetics in urban areas and 5.5 million in
rural areas in 2003

The WHO projected the number of Indonesian

diabetics to increase to 20.9 million by 2025, making
Indonesia one of the top-five countries with the highest
estimated cases of diabetes.
Sebagian besar kebutaan dapat dicegah
dengan fotokoagulasi laser yang
dilaksanakan tepat waktu
Kenyataan sebagian besar penderita
datang terlambat
Stadium lanjut Vitrektomi
Pathogenesis
Hyperglycemic Mikroangiopati

Imbalance of Biochemical mechanism

Capillary Occlusion
Mikrovaskuler damage dysfunction
- Breakdown blood retinal barrier
- Pericyte loss Leakage
- Thinner of basement membrane -Hemorrhage
- Endothelial cell damage & proliferative -Edema
-Exudates
 Peningkatan aktivitas enzim aldosa reduktase
Glikolisasi non-enzimatik
Pembentukan senyawa dikarbonil
Stress oksidatif
Pathogenesis (cont)
High Blood Sugar Levels affect retinal Capillaries
RETINOPATI DM:
Perubahan retina
karena :
1. Kebocoran
pembuluh darah
halus
Akibatnya:
Edema retina
Hard Exudate
Perdarahan retina
2. Sumbatan pembuluh
darah halus di retina
(oklusi mikrovaskuler)
Arteria-venous Shunt.
Terbentuk pembuluh
darah neovaskuler:
-Perdarahan vitreus
-Jaringan fibrous
-Ablasi retina
3.Pembentukan
pembuluh darah
baru yang rapuh
Klasifikasi klinis
Non-Proriferative Diabetic Retinopathy
mild
moderate
Severe
Proliferative Diabetic Retinopathy
NORMAL EYE
NPDR
 PDR

NVD NVE
Penanganan Retinopati DM
Kontrol kadar gula darah
Deteksi dini :
DM tipe 1: periksa retina 5 th setelah onset
DM tipe 2: periksa retina setahun sekali mulai diagnosa
DM ditegakkan
 Prinsip : Pencegahan penurunan penglihatan
dengan fotokoagulasi laser
Syarat:
Tepat waktu

Adekuat

Vitrektomi
Fotokoagulasi laser
Prinsip :
Energi cahaya diubah menjadi panas koagulasi
protein
Vitrectomy
Surgery indicated for:
Vitreal hemorrhage
Regmatogenous and tractional retinal
detachment
Laser photocoagulation does not eliminate
neovascularization
Retinal edema does not improve by Laser.
Combine surgery

Advantages
One surgical episode, anaesthesia, and
postoperative recovery
Improved visualization of vitreoretinal
pathology
Superior anatomic and visual results of in the
bag intraocular lens (IOL) in parsplana
lensectomy are better.
VITREKTOMI