2. Abstract
Purpose
To evaluate the visual outcome of patients with proliferative diabetic retinopathy and tractional
retinal detachment undergoing pars plana vitrectomy with endolaser and 10% C3F8 gas tamponade.
Method and Patient
A 55-year-old man with proliferative diabetic retinopathy and tractional retinal detachment. The
patient complained of gradully decrease in vision. The patient was diagnosed with proliferative
diabetic retinopathy and tractional retinal detachment then underwent pars plana vitrectomy with
endolaser and 10% C3F8 gas tamponade.
Result
The patient's visual outcome improved from 1/LPB at postoperative day six to 1/300 at three week
postoperative. But on retinal examination we can’t determined anything because there’s still gas.
Conclusion
Pars plana vitrectomy is treatment of choice for proliferative diabetic retinopathy and tractional
retinal detachment with variable visual outcome. Complication post operative such as rebleeding
and tractipon can occur.
3. Laporan Kasus
Anamnesis
Laki-laki, usia 55th
Keluhan :
- mata kiri buram sejak 2-3 bulan yang lalu,
keluhan dirasakan perlahan semakin lama
semakin buram, buram seperti pandangan
tertutup oleh asap hitam, floaters (+),
fotopsia (+)
- Riw. DM (+) sudah 12 tahun pengobatan
rutin di Batang, konsumsi Metformin dan
Glimepirid
- Riw. Hipertensi (+) sudah 5 tahun,
pengobatan rutin di Batang, konsumsi
Amlodipin dan Hidroclorothiazide
- Riw. Operasi Mata (+)
1. OD Vitrektomi + Endolaser + SO ai PDR TRD
20 Mei 2021
2. OD Evakuasi SO 18 Jan 2022
Pemeriksaan Fisik
VOD 0.5/60
VOS 1/300
TIO 13.3 mmHg/ 13.4 mmHg
ODS segmen anterior tenang
Funduskopi
- OD retina flat, jejak laser (+), eksudat (+), dot
blot (+), traksi (+)
- OS dot blot (+), mikroaneurism (+), NVE (+),
traksi (+), ERM (+)
4.
5. Laporan Kasus
Tatalaksana
- Durante operasi : retina total detachment (+),
perdarahan aktif menutupi papil, traksi (+)
- Mata kiri dilakukan pars plana vitrektomi
dengan endolaser, dan menggunakan gas C3F8
10% sebagai tampon
Follow Up H+1
VOD 1/60
VOS 1/LPB
TIO 17.3 mmHg/ 7.1 mmHg
Funduskopi OS : obscured, masih terisi gas C3F8
Dengan posisi biasa, kontrol 1 minggu
Follow Up H+1 minggu
VOD 1/60
VOS 1/300
TIO 16.4 mmHg/ 13.4 mmHg
Funduskopi OS : obscured, masih terisi gas
C3F8 90%
Terapi lanjut, kontrol 2 minggu
6. Diskusi
• Tractional Retinal Detachment suatu keadaan lanjut dari PDR yang
disebabkan oleh adanya tarikan yang terjadi pada perlekatan kuat antara
retina dan badan vitreous oleh pembuluh darah
• Gejala : fotopsia, floaters, penurunan visus
Pasien mengeluhkan penurunan visus pada mata kiri secara progresif,
disertai dengan fotopsia dan floaters, dengan riwayat DM selama 12 tahun
Pada pemeriksaan fisik didapatkan mata kiri traksi di area arcade superior et
inferior nasal, dan terdapat epiretinal membran di area makula
Dilakukan Vitrektomi pada mata kiri pasien, dengan Endolaser, dan Gas C3F8
sebagai tampon
9. Diabetic Retinopathy
• Diabetic Retinopathy adalah suatu komplikasi mikroangiopati dari
Diabetes Mellitus, ditandai dengan keluhan munculnya bercak atau
benang hitam pada penglihatan pasien, penglihatan buram,
penyempitan lapang pandang, hingga menghilangnya fungsi
penglihatan
13. Diabetic Retinopathy :
Diagnosis and Risk Factors
Diagnosis :
Indirect Ophthalmoscopy
Fundus photography
Slit lamp biomicroscopy
Fluorescein angiography
OCT
USG
Risk Factors :
Duration of DM
Blood Sugar control
Hypertension
Ocular factors
Pregnancy
Systemic factors
14. Diabetic Retinopathy :
Treatment
Three systemic associations :
- Blood Sugar (Diabetes Mellitus) – HbA1c
(incidence, progression) Plasma Glucose
<110mg/dL and HbA1c <7%
- Blood Pressure (Hypertension) – increased
risk of development of PDR TD <130/<85
mmHg
- Lipid – increasing severity of DR and retinal
hard exudates
- Destruction of oxygen consuming
photoreseptors and RPE may improve inner
retinal oxygenation, thus decreasing
stimulus for production of vasoproliferative
factors
- Burns are placed one burn width apart;
1600-2000 total burns are applied in 2 to 3
sittings – follow up 6-8 weeks after
completion of PRP
Medical Management
Photocoagulation
15. Additional PRP :
Indicated in cases of :
- No regression of new vessels
- Persistent new vessels
- Recurring VH
- Extensive intraretinal lessions
- Extensive skip areas
16. Diabetic Retinopathy :
Treatment
Vitrectomy surgery for complications of diabetic retinopathy
Indications for pars plana vitrectomy in patients with PDR are
• nonclearing vitreous hemorrhage
• significant recurring vitreous hemorrhage, despite use of maximal PRP
• dense premacular subhyaloid hemorrhage
• tractional retinal detachment involving or threatening the macula
• combined tractional and rhegmatogenous retinal detachment
• red blood cell– induced (erythroclastic) glaucoma and “ghost cell”
glaucoma
• anterior segment neovascularization with media opacities preventing PRP
