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7/24/2019 PRESKAS.pptx
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PR ESEN TASI KASU S
Evan Regar
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Ilustrasi Kasus
Nama : Ny. S
Usia : 42 tahun
Alamat : Palasari, Bogor, JawaBarat
Peer!aan : "i#a $eer!a
Pen#i#ian : "i#a tamat S% Status : Jan#a
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Keluhan Utam a
&ata anan $uram se!a ' hariS&RS.
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Riw ayat Penyakit Sekarang
' minggu S&RS: (ost)o( *aoemulsi+asi -/% 0#1: atara matur %. (erasi #iataan$erhasil #a(at melihat #engan !elas, mata
merah 0), mata gatal 0). Rutin tetes mata3itrol #an lo1a.
' hari S&RS: $atu #an $ersin men#a#anyeri %, mata $erat, menggan!al, agaemerahan, $anya air mata 0$ening,(an#angan a$ur 0sulit $er!alan. Nyerimeneta(, mem$erat $ila $ersin atau $atu,ti#a $ertam$ah !ia geraan $ola mata.Benturan (a#a mata 0).
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Riw ayat Penyakit Sekarang
Penggunaan #aun sirih 0)
S: ti#a #a(at melihat se!a 5
tahun. "i#a ingat a(aah (ernah$er*ungsi atau ti#a. Rutin#itetesan "E& ti#a a#a(er$aian. Saat ini ti#a #a(at
melihat 6ahaya sama seali.
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Riw ayat Penyakit Lain
7angguan A% #an AS 8urangmen#engar9 se!a e6il, sulitmemahami (em$i6araan. Bi6aralan6ar.
%& se!a 5 th y.l. onsumsi o$at atauinsulin 0).
Riwayat ;", olesterol #isangal.
Riwayat o(erasi se$elumnya#isangal.
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Riw ayat Penyakit Keluarga
-$u (asien: atara
Riwayat $uta men#a#a eluarga 0)
Riwayat atara, en6ing manis, ;",sait !antung ti#a #ietahui.
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Pem eriksaan Fisik Um um
om(os mentis
"am(a sait se#ang
"% ''<=>< mm;g Na#i '2< ali=menit
Perna(asan: 2< ali=menit
Suhu: ?>,<o@
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Status Oftalm ologi
OD OS
2=< (.h =45 isus N/P
&enurun (er (al(asi "eanan intraoular Normal (er (al(asi
Pergeraan $olamata
e#u#uan $ola mata: orto*oria
E#ema 0 Pal(e$ra "enang
-n!. on!ungtivaminimal
on!ungtiva "enang
' $uah !ahitan #iarah !am C, e#ema0), descement fold
0%iameter '2 mm
ornea /euoma C,5 mm 14,? mm
%iameter C mm
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Status Oftalm ologi (2)
OD OS
arna 6oelat, ri(ti0, sineia 0)
-ris Sulit #inilai
Bulat, #i tengah,
#iameter ? mm, R@/0, R@"/ 0
Pu(il Sulit #inilai
Pseu#o*aia /ensa Sulit #inilai
Jernih itreous Sulit #inilai
ReDes *un#us 0,
esan 6horoi#al#eta6hment
un#us Sulit #inilai
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Diagnosis
'. Pseu#o*aia % (ost)*aoemulsi+asi-/ #enganes(ulsi !ahitan ornea
2. Sus(e choroidal detachment %
?. /euoma ornea S, sus(eneratoonus S
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Perenanaan
'. Pen!ahitan ulang 0resuture
2. 7tt. o(htal lo1a ' gtt <'h %
?. 7tt. (htal @en#o 3itrol ' gtt <4h%
4. B)s6an US7 %
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Prognosis
'. Fuo a# vitam: $onam
2. Fuo a# *un6tionam:
'. %: #u$ia a# malam2. S: malam
?. Fuo a# sanatinoam:
'. %: #u$ia a# malam
2. S: malam
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!in"auan Pustaka
E@@E *aoemulsi+asi teniestrasi lensa atara, a(sul(osterior inta. ele$ihan: insisiorneosleral minimal 0? mm,emu#ahan im(lan -/, om(liasi(ost)o( minimal 0en#o*talmitis,
a$lasio retina
Khurana AK. Comprehensive ophtalmology. 4th
edition. New Delhi: New Age International (!
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om(liasi (a#a o(erasi atara: -ntrao(erasi 0(er#arahan, 6i#era iris
ornea
Post)o( #ini 0hi*ema, (rola(s iris,kebocoran luka insisi, uveitis anterior,en#o*talmitis
Post)o( lan!ut: e#ema maula sistoi#,a$lasio retina
&al(osisi -/
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#ks$ulsi %ahitan
Ai$at (eningatan teananintraoular men#a#a e$o6oran#i lim$us ornea aueous humoreluar
"- #i!aga oleh: aliran venaepisklera 0#i(engaruhi @P
Batu, menge!an, muntah, $ersin#a(at meningatan "- ai$atham$atan aliran vena e(islera
'urgatroyd ) *em+ridge ,. Intraocular pressure. Contin -duc Anaesth Crit Care
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Sei&el !est (' )
%etesi e$o6oran @A e*e #ilusihumor aGueous
2luorosceindye
i3o.in
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istologi Koroi&
Khurana AK. Comprehensive ophtalmology. 4th edition. New Delhi: New Age International (! "imited# $%%&
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horoi&al Detahm ent
"i(e
• Serosa• ;emoragi
Patogenesis #anPato+siologi
• Aumulasiruangsu(raoroi#
•
Serosa:transu#asi hi(otonus =trauma = (ost)o(
• Hemoragik :
(em$. #arahoroi# 0*r:a*aia,glauoma, usialtua, (an!angasial estrem
•
alsava, $atu,menge!an,
%1
• Anamnesis:riwayat P,e$o6oran lua,(enggunaano$at (enurun "-• P: *un#uso(i
#an slit)lam(,kedalamanCOA
• Penun!ang: B)s6an US70hemoragi ##serosa
raverso C-) 5oy . Chorodial detachment. 6Internet7. 8pdated: $%0$ Nov $%.Cited: $%0/ 'ar $9. Avail+le from: emedicine.medscape.comarticle00;%/4;1
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d3o.harvard.edu
Kahoo< '=) $%%&Kissing choroid
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horoi&al Detahm ent
Umumnya (ulih s(ontan !ia -P ter!aganormal 0#alam 2 minggu
"1: &e#i: ortiosteroi# #an silo(legi to(ial
0atro(ine 'H e.# 4##I (re#nisolon asetat e.#4##
Be#ah:
-n!esi visoelastis 0e.g: ;ealon 5
%rainase su(raoroi#
Indikasi bedah: COA dangkal, resolusilambat, kontrol IOP sulit
Kahoo< '=) Noec<er 5,. >hy do chorodial form and how do you treatthem?. @laucoma today. eptem+er $%%&. Availa+le from:
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arantola 5') 2ol< ,C) hah ) *oldt C) A+ramoB 'D) 5ussel 5) et
al. intraoperative choroidal detachment during $/1gauge vitrectomy.$%00: 5etina 0% :01;
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Pem *ahasan
Riwayat o(erasi oular (enurunanta!am (englihatan men#a#a 0$atu,$ersin e6urigaan e$o6oranaueous humor ai$at $uaan lua(ost)o( Buti a#anya es(ulsi !ahitan: "- turun,
Sei#el 0, (emerisaan slit lam( omuniasi #engan esternal
emunginan in*esi @A Negati*, #i$utian: 6ell 0), Dare 0),
hi(o(ion 0)
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Penurunan ta!am (englihatan akutK A% 2=< eeruhan me#ia re*rasiK ornea !ernih,
esan e#ema 0), @A !ernih
&al(osisi lensaK ea#aan vitreousKea#aan la(isan orioretinaK (emerisaan o*talmoso(i
Kesan choroidal detachment serosa vs hemoragiK
Es(ulsi !ahitan humor aeuous eluar
"- turun
mengarah e ti(e serosa
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Pemerisaan (enun!ang: B)s6an US ##= hemoragi #an serosa
"1: Resuture 6egah e$o6oran ontrol "-
/an!utan "1 (ost)o( atara:
lo1a 0Do1a6in <mni 'h @en#o 3itrol 0%e1a <,'H Polimisin
Neomisin omni 4h
Pantau A%, "-, segmen anterior,
o*talmoso(i