View
744
Download
3
Category
Preview:
DESCRIPTION
All about graves ophthalmopathy, manifestation of disthyroid in the eyes
Citation preview
GRAVE’S OPHTHALMOPATHYDIAGNOSIS DAN PENATALAKSANAANNYA
Disusun oleh :
Dr. Satya Hutama Pragnanda
Pembimbing :
Dr. A. Kentar Arimadyo, Sp.M
September 19, 2013
PENDAHULUAN
penyakit
Graveshipertiroidisme
autoimun
edema pretibial
kemosis
proptosis
clubbing fingers
oftalmopati
September 19, 2013
DEFEK RESPON IMUN BERBEDA
pada oftalmopati
otot ekstra orbital & kelenjar lakrimal
pada penyakit Graves sel-sel folikel tiroid
September 19, 2013
Studi Epidemiologi Pada Kulit Putih Amerika Tahun 1996
Insidensi per 100.000 populasi per tahun
wanitapria
3
16
TED mempengaruhi wanita 6x lebih
sering dari pria (86% vs 14%).
Umur median saat didiagnosis TED
adalah 43 tahun.
Perokok tujuh kali lebih beresiko TED.
September 19, 2013
PEMBAHASANGRAVES OPHTHALMOPATHY
• Kelenjar tiroid
• Cavum orbita
Anatomi & Fisiologi
• Inflamasi otot extraocular
• Infiltrasi sel radang
Patogenesis• Manifestasi Klinis
• Pemeriksaan Fisik
• Pemeriksaan Penunjang
• Diagnosis Banding
Diagnosis
•Medikamentosa
•Radioterapi
•Surgical decompression
Tatalaksana
September 19, 2013
ANATOMI & FISIOLOGIKELENJAR TIROID
Glandula Thyroid
September 19, 2013
REGULASI HORMON TIROID
September 19, 2013
September 19, 2013
September 19, 2013
September 19, 2013
PATOGENESIS
September 19, 2013
MANIFESTASI KLINIS
September 19, 2013
September 19, 2013
MANIFESTASI KLINIS PADA MATA• Soft Tissue Involvement
• Lid retraction
Disebabkan oleh :
Fibrotic contractur
Overaksi sekunder superior rectus complex
Overaksi M.Muller
Tanda :
Normalnya upper 2mm dari limbus, lid retraction bila ada scleral show.
Dalrymple sign
Kocher sign
Von Graefe sign
• Proptosis
• Neuropati optik
• Miopati restriktif September 19, 2013
September 19, 2013
PEMERIKSAAN FISIK
Exophthalmometer Hertel
September 19, 2013
PEMERIKSAAN PENUNJANG
Laboratorium CT Scan MRI USG Orbita
September 19, 2013
LABORATORIUM
September 19, 2013
CT SCAN
Potongan axial
menunjukkan pembesaran badan otot
extraocular tanpa keterlibatan tendo otot
Potongan coronal
menunjukkan pembesaran otot
extraocular didalam orbita
Potongan sagital
menunjukkan penambahan lemak
intraconal serta pembesaran ringan
otot extraoculer
September 19, 2013
MRI
MRI Corona menunjukkan
penjepitan (crowding) N.Opticus
akibat pembesaran Otot
Ekstraoculer
MRI Coronal menunjukkan
pembesaran M.Rectus
Inferior kanan
MRI Axial menunjukkan
pembesaran M.rectus Inferior
MRI axial menunjukkan
pembesaran massa otot
September 19, 2013
USG ORBITA
USG B-Scan menunjukkan pembesaran M.Rectus Medial
serta visualisasi insersi tendo
USG A-scan yang menunjukkan refleksi sedang
sampai tinggi dari otot ekstra ocular
September 19, 2013
KLASIFIKASI DIAGNOSIS
Riwayat pengobatan disfungsi Tiroid
Tanda Orbita Tipikal
Bukti radiografis
The Mourits Classification
System to Access
Disease Activity in
Graves Ophthalmopathy
NOSPECSAmerican Thyroid Association (ATA)
PAIN
REDNESS
SWELLING
IMPAIRED FUNCTION
Diagnosis Graves Ophthalmopathy
ditegakkan apabila memenuhi 2 dari 3 tanda
September 19, 2013
September 19, 2013
• Detailed classification of eye changes of Graves Disease (Modified 1977)
•0 No physical signs or symptomsI Only SignsII Soft-tissue involvement with symptoms and signs
o Absenta Minimalb Moderatec Marked
III Proptosis ≥ 3 mm in excess of upper normal limit, with/without symptomso Absenta 3-4 mm increase over upper normalb 5-7 mm increasec 8 or more mm increase
IV Extraocular muscle involvement,usually with diplopia,other symptoms/signo Absenta Limitation of motion, at extreme gazeb Evident restriction of motionc Fixation of globe or globes
V Corneal involvement (primarity due to lagophthlmos)o Absenta Stippling or corneab Ulcerationc Clouding, necrosis, perforation
VI Sight lost caused by optic nerve involvemento Absenta Disc pallor or choking, or visual field defect acuity 20/20 to 20/60b Same, acuity 20/70 to 20/200c Blindness (failure to perceive light), acuity less than 20/200
September 19, 2013
ALGORITMA TED
September 19, 2013
DIAGNOSIS BANDING
Graves Ophthalmo
pathy
Pseudotumor Orbita
Myositis Orbital
September 19, 2013
TATALAKSANA
September 19, 2013
September 19, 2013
KESIMPULAN
Manifestasi Klinis
Pemeriksaan Fisik
Pemeriksaan Penunjang
Penatalaksanaan
Grave’s Ophthalmo
pathy
Anatomi
Fisiologi
Patogenesis
September 19, 2013
TERIMAKASIHMOHON BIMBINGAN
DAN SARAN
September 19, 2013
Recommended