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Graves Ophthalmopathy

All about graves ophthalmopathy, manifestation of disthyroid in the eyes

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Graves Ophthalmopathy

  1. 1. GRAVE’S OPHTHALMOPATHY DIAGNOSIS DAN PENATALAKSANAANNYA Disusun oleh : Dr. Satya Hutama Pragnanda Pembimbing : Dr. A. Kentar Arimadyo, Sp.M September 19, 2013
  2. 2. PENDAHULUAN penyakit Graves hipertiroidisme autoimun edema pretibial kemosis proptosis clubbing fingers oftalmopati September 19, 2013
  3. 3. DEFEK RESPON IMUN BERBEDA pada oftalmopati  otot ekstra orbital & kelenjar lakrimal pada penyakit Graves  sel-sel folikel tiroid September 19, 2013
  4. 4. Studi Epidemiologi Pada Kulit Putih Amerika Tahun 1996 Insidensi per 100.000 populasi per tahun wanita pria 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
  5. 5. PEMBAHASAN GRAVES 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
  6. 6. ANATOMI & FISIOLOGI KELENJAR TIROID Glandula Thyroid September 19, 2013
  7. 7. REGULASI HORMON TIROID September 19, 2013
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  11. 11. PATOGENESIS September 19, 2013
  12. 12. MANIFESTASI KLINIS September 19, 2013
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  14. 14. 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
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  16. 16. PEMERIKSAAN FISIK Exophthalmometer Hertel September 19, 2013
  17. 17. PEMERIKSAAN PENUNJANG Laboratorium CT Scan MRI USG Orbita September 19, 2013
  18. 18. LABORATORIUM September 19, 2013
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. KLASIFIKASI DIAGNOSIS Riwayat pengobatan disfungsi Tiroid Tanda Orbita Tipikal Bukti radiografis The Mourits Classification System to Access Disease Activity in Graves Ophthalmopathy NOSPECS American Thyroid Association (ATA) PAIN REDNESS SWELLING IMPAIRED FUNCTION Diagnosis Graves Ophthalmopathy ditegakkan apabila memenuhi 2 dari 3 tanda September 19, 2013
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  24. 24. • Detailed classification of eye changes of Graves Disease (Modified 1977) • 0 No physical signs or symptoms I Only Signs II Soft-tissue involvement with symptoms and signs o Absent a Minimal b Moderate c Marked III Proptosis ≥ 3 mm in excess of upper normal limit, with/without symptoms o Absent a 3-4 mm increase over upper normal b 5-7 mm increase c 8 or more mm increase IV Extraocular muscle involvement,usually with diplopia,other symptoms/sign o Absent a Limitation of motion, at extreme gaze b Evident restriction of motion c Fixation of globe or globes V Corneal involvement (primarity due to lagophthlmos) o Absent a Stippling or cornea b Ulceration c Clouding, necrosis, perforation VI Sight lost caused by optic nerve involvement o Absent a Disc pallor or choking, or visual field defect acuity 20/20 to 20/60 b Same, acuity 20/70 to 20/200 c Blindness (failure to perceive light), acuity less than 20/200 September 19, 2013
  25. 25. ALGORITMA TED September 19, 2013
  26. 26. DIAGNOSIS BANDING Graves Ophthalmo pathy Pseudo tumor Orbita Myositis Orbital September 19, 2013
  27. 27. TATALAKSANA September 19, 2013
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  29. 29. KESIMPULAN Manifestasi Klinis Pemeriksaan Fisik Pemeriksaan Penunjang Penatalaksanaan Grave’s Ophthalmo pathy Anatomi Fisiologi Patogenesis September 19, 2013
  30. 30. TERIMAKASIH MOHON BIMBINGAN DAN SARAN September 19, 2013

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