DAFTAR ISI
JUDUL..................................... JUDUL............................................................ .............................................. .............................................. .............................................. ................................... ............ DAFTAR DAFTAR ISI........................................... ISI.................................................................. .............................................. .............................................. ........................................... .................... BAB I PENDAHULUAN A.LAT A.LATAR BELAKANG............................... BELAKANG...................................................... .............................................. ............................................................ ..................................... BAB II TINJAUAN PUSTAKA A.ANAT A.ANATOMI DAN FISIOLOGI................. FISIOLOGI........................................ .............................................. ............................................................. ...................................... B.DEFINISI GLAUKOMA.................................... GLAUKOMA........................................................... .............................................. .................................................. ........................... C.KLASIFIKASI GLAUKOMA................................... GLAUKOMA.......................................................... .............................................. ........................................... .................... D.ETIOLOGI.................................. D.ETIOLOGI......................................................... .............................................. .............................................. ................................................. .......................... E.PA E.PATOFISIOLOGI................................... OFISIOLOGI.......................................................... ............................................... ............................................... ..................................... .............. F.GLAUKOMA STEROID-INDUCE ............................................................................................ ............................................................................................ G.MANIFESTASI G.MANIFESTASI KLINIS....................................... KLINIS.............................................................. ................................................................... ............................................ . H.DIAGNOSIS.................................. H.DIAGNOSIS........... .............................................. .............................................. .............................................. .............................................. ....................... I.PENAT I.PENATALAKSANAAN................ ALAKSANAAN....................................... .............................................. .............................................. ..................................... ........................ .......... J.KOMPLIKASI.................................. J.KOMPLIKASI........... .............................................. .............................................. ................................................................... ............................................ K.PROGNOSIS.............................. K.PROGNOSIS...................................................... ............................................... ....................................................................... ................................................ L.KORTIKOSTEROID................ L.KORTIKOSTEROID....................................... .............................................. .............................................. ..................................... ............................ .............. DAFTAR DAFTAR PUSTAKA.... PUSTAKA........................... .............................................. .............................................. .............................................. ............................................ .....................
1
BAB I PENDAHULUAN
A.
Latar Belakang Glaukoma Glaukoma dis!u" s!a#ai s!a#ai $P%&u'i $P%&u'i P%#li(a"a% P%#li(a"a%)) s!a! *ada s!a#ia% s!a#ia%
!sa' kasus #laukoma+ #,ala s'i%# "idak di'asaka% ol( *%d'i"a. Pada "a(a* a-al+ a-al+ k'usak k'usaka% a% "',ad "',adii *ada *ada "*i "*i la*a%# la*a%#a% a% *a%da% *a%da%# # s(i%# s(i%##a #a *%d' *%d'i"a i"a "idak "idak m%ada'i%a+ *%d'i"a aka% m'asa "'#a%##u% ,ika k'usaka% suda( m%#%ai la*a%#a% *a%da%# s%"'al da% *ada saa" i"u *%aki" suda( "'la%,u' *a'a(. P'oss k'usaka% sa'a/ o*"ik !',ala% s&a'a *'la(a% sam*ai ak(i'%a "',adi k!u"aa% "o"al. Ak(i'%a Ak(i'%a *%d'i"a m%,adi !%a'0!%a' !u"a. Glaukoma Glaukoma m'u*aka% m'u*aka% *%!a! *%!a! k!u"aa% k!u"aa% *'i%#ka" *'i%#ka" kdua di I%do%sia I%do%sia s"la( ka"a'ak. K!u"aa% a%# "',adi *ada #laukoma !'si/a" m%"a*+ "idak s*'"i ka"a'ak a%# !isa di*uli(ka% d%#a% *m!da(a%. Maka (al a%# *%"i%# *ada "'a*i #laukoma adala( d"ksi di%i s(i%##a "idak "',adi k'usaka% sa'a/ o*"ik a%# smaki% *a'a(. T'a*i #laukoma iala( d%#a% m%u'u%ka% TIO k "i%#ka" $ama%). Ama% disi%i !'a'"i m%&a*ai TIO a%# "idak la#i m'usak sa'a/ o*"ik. o*"ik. P%u'u P%u'u%a% %a% TIO da*a" da*a" dilaku dilakuka% ka% a%"a'a a%"a'a lai% lai% d%#a% d%#a% &a'a &a'a m%u'u m%u'u%ka %ka% % *'oduksi a"au m%am!a( *m!ua%#a% &ai'a% akuos+ a"au kdua%a. Pada "ka%a% a%# ama% "'s!u" di(a'a*ka% "idak "',adi k'usaka% sa'a/ o*"ik l!i( la%,u" s(i%##a k!u"aa% da*a" di&#a(.1 Di*'ki'aka% (am*i' 23 ,u"a o'a%# m%d'i"a #laukoma sudu" "'!uka di slu'u( slu'u( du%i du%iaa *ada *ada 4515. 4515.
Pada Pada
"a(u% "a(u% 4545 4545 ,umla ,umla( ( i%i di* di*'ki 'ki'ak 'aka% a% aka% aka%
m%i%# m%i%#ka" ka" m%,adi m%,adi 36+3 36+3 ,u"a ,u"a o'a%#. o'a%#. Ham*i' Ham*i' s*a'u( s*a'u(% %aa 7289: 7289: da'i da'i slu'u( slu'u( *o*ulasi "'s!u" adala( 'as Asia+ sda%#ka% 429 m'u*aka% 'as E'o*a. R'a"a *';al%si di*'ki'aka% 1+<=9 da'i *%duduk du%ia. M%u'u" Risksdas 74558: *';al%si %asio%al #laukoma adala( 5+39 da% *';al%si di I%do%sia adala( 2+= 9.
BAB II
2
TINJAUAN PUSTAKA 2.1.
Anatomi dan Fisiologi
.!.!. A%a"omi Humo' Akuos
Bola Bola ma"a ma"a o'a% o'a%# # d-a d-asa sa (am* (am*i' i' m%d m%dk ka"i a"i !ula !ula"+ "+ d%# d%#a% a% diam diam" "' ' a%"'o a%"'o*os *os"'i "'io' o' ski"a ski"a'' 42+3 42+3 mm. mm. Bola Bola ma"a ma"a "'di' "'di'ii da'i da'i ko%,u% ko%,u%#"i #"i;a+ ;a+ ka*sul ka*sulaa "%o% "%o%++ skl'a skl'a da% *iskl *iskl'a+ 'a+ ko'%a ko'%a++ u;a+ u;a+ l%sa+ l%sa+ (umo' (umo' akuou akuous+ s+ '"i%a+ '"i%a+ da% ;i"'us.4
Gam!a' 1. A%a"omi Ma"a Sudu" Fil"'asi Sudu" /il"'asi m'u*aka% !a#ia% a%# *%"i%# dalam *%#a"u'a% &ai'a% !ilik ma"a. Sudu" i%i "'da*a" di dalam lim!us ko'%a. Lim!us adala( !a#ia% a%# di!a"a di!a"asi si ol( ol( #a'is #a'is a%# a%# m%#(u m%#(u!u% !u%#ka #ka% % ak(i' ak(i' da'i da'i mm!'a% mm!'a% Ds&m Ds&m" " da% mm!'a% Bo-ma%. Ak(i' Ak(i' da'i mm!'a% Ds&m" dis!u" #a'is S&(-al!.4
3
Gam!a' 4. A%a"omi I'is da% Pu*il Lim!us "'di'i da'i 4 la*isa% ai"u *i"l da% s"'oma. E*i"l%a 4 kali k"!ala% *i"l ko'%a. Di dalam s"'oma%a "'da*a" s'a"0s'a" sa'a/ da% &a!a%# ak(i' da'i a'"'i silia'is a%"'io'.1 Ba#ia% "'*%"i%# da'i sudu" /il"'asi adala( "'a!kula'+ a%# "'di'i da'i > 4+? 1: T'a!kula ko'%oskl'al S'a!u"%a !'asal da'i la*isa% s"'oma ko'%a da% m%u,u k !laka%# m%#lili%#i ka%alis S&(lmm u%"uk !'i%s'si *ada skl'a. 4: T'a!kula u;al S'a!u"%a !'asal da'i la*isa% dalam s"'oma ko'%a+ m%u,u k s&l'a s*u' 7i%s'si da'i m.silia'is: da% s!a#ia% k m.silia'is m'idio%al. ?: S'a!u" a%# !'asal da'i ak(i' mm!'a% Ds&m" 7#a'is S&(-al!: S'a!u" i%i m%u,u k ,a'i%#a% *%#ika" m.silia'is 'adialis da% si'kula'is. 2: Li#am%"um *k"i%a"um 'udim%"' Li#am%"um i%i !'asal da'i da"a'a% d*a% i'is m%u,u k d*a% "'a!kula.
T'a!kula "'di'i da'i ,a'i%#a% kola#%+ (omo#%+ las"is da% slu'u(%a dili*u"i ol( %do"l. Kslu'u(a%%a m'u*aka% s*o%s a%# "m!us *a%da%#+ s(i%##a !ila ada da'a( di dalam ka%alis S&(lmm+ da*a" "'li(a" da'i lua'.
4
Ka%alis S&(lmm m'u*aka% ka*il' a%# dimodi/ikasi+ a%# m%#lili%#i ko'%a. Di%di%#%a "'di'i da'i sa"u la*isa% sl+ diam"'%a 5+3 mm. Pada di%di%# s!la( dalam+ "'da*a" lu!a%#0lu!a%# s(i%##a "'da*a" (u!u%#a% la%#su%# a%"a'a "'a!kula da% ka%alis S&(lmm. Da'i ka%alis S&(lmm klua' salu'a% kolk"o'+ 450?5 !ua(+ a%# m%u,u k *lksus ;%a di dalam ,a'i%#a% skl'a da% *iskl'a da% ;%a silia'is a%"'io' di !ada% silia'. 4 Sudu" kam'a okuli a%"'io' mmiliki *'a% *%"i%# dalam d'ai%as akuous (umo'. Sudu" i%i di!%"uk ol( *a%#kal i'is+ !a#ia% d*a% !ada% silia'is+ "a,i skl'al+ ,ali%a% "'a!kula' da% #a'is S&(-al! 7!a#ia% u,u%# mm!'a% ds&m%" ko'%a a%# *'omi%%:. L!a' sudu" i%i !'!da *ada s"ia* o'a%#+ da% mmiliki *'a%a% a%# !sa' dalam m%%"uka% *a"omka%ism "i* #laukoma a%# !'!da0!da. S"'uk"u' sudu" i%i da*a" dili(a" d%#a% *m'iksaa% #o%iosko*i. Hasil%a di!ua" dalam !%"uk #'adi%#+ da% sis"m a%# *ali%# s'i%# di#u%aka% adala( sis"% #'adi%# S(a//'.? G'ad
L!a' sudu"
Ko%/i#u'asi
Ksm*a"a% S"'uk"u' u%"uk
*ada
Go%iosko*i
m%u"u* I@
?3023
T'!uka l!a'
Ni(il
SL+ TM+ SS+ CBB
III
450?3
T'!uka
Ni(il
SL+ TM+ SS
II
45
Sm*i"
Mu%#ki%
SL+ TM
7mod'a": I
15
Sa%#a" sm*i"
Ti%##i
Ha%a SL
5
5
T'"u"u*
T'"u"u*
"idak
"am*ak
s"'uk"u'
Ta!l 1. Sis"m G'adi%# S(a//' 2 K"'a%#a% >
5
SL > S&(-al!s li%+ TM > "'a!&ula' ms(-o'k+ SS > s&l'al s*u'+ CBB > &ilia' !od !a%d. .!.. Fisiologi "#mor ak#e#s $ Aqueous Humour %
Aqueous humor adala( sua"u &ai'a% ,'%i( a%# m%#isi kam'a a%"'io' da% *os"'io' ma"a+ di*'oduksi di ko'*us silia'is. @olum%a ski"a' 435 uL+ d%#a% k&*a"a% *m!%"uka% ski"a' 1+304 uLm%i". Tka%a% osmo"ik sdiki" l!i( "i%##i da'i *lasma. Kom*osisi mi'i* *lasma+ k&uali ka%du%#a% ko%s%"'asi asko'!a"+ *i'u;a" da% lak"a" l!i( "i%##i da% *'o"i%+ u'a+ da% #lukosa l!i( '%da(. S"la( mmasuki kam'a *os"'io'+ mlalui *u*il aka% masuk k kam'a a%"'io' da% kmudia% k *'i/' m%u,u sudu" kam'a a%"'io'. 1+4 Jali%a%,ala "'a!kula' "'di'i da'i !'kas0!'kas ,a'i%#a% kola#% da% las"ik a%# di!u%#kus ol( sl0sl "'a!kula' a%# mm!%"uk sua"u sa'i%#a% d%#a% uku'a% *o'i0*o'i smaki% m%#&il s-ak"u m%dka"i ka%alis S&(lmm. Ko%"'aksi o"o" silia'is mlalui i%s'si%a k dalam ,ali%a% "'a!kula mm*'!sa' uku'a% *o'i0*o'i di ,ali%a% "'s!u" s(i%##a k&*a"a% d'ai%as (umo' akuous ,u#a m%i%#ka". Ali'a% aqueous humor k dalam ka%alis S&(lmm !'#a%"u%# *ada *m!%"uka% salu'a%0salu'a% "'a%slul' siklik di la*isa% %do"l. Salu'a% /'% da'i ka%alis S&(lmm 7ski"a' ?5 salu'a% *%#um*ul da% 14 ;%a akuous: m%alu'ka% &ai'a% k dalam sis"m ;%a. S,umla( k&il Aqueous humor klua' da'i ma"a a%"a'a !'kas o"o" silia'is da% l-a" sla0sla s&l'a 7ali'a% u;oskl'a:. Rsis"%si u"ama "'(ada* ali'a% Aqueous humor da'i kam'a a%"'io' adala( la*isa% %do"l salu'a% S&(lmm da% !a#ia%0!a#ia% ,ali%a% "'a!kula' di dka"%a+ !uka% da'i sis"m *%#um*ul ;%a. T"a*i "ka%a% di ,a'i%#a% ;%a *iskl'a m%%"uka% !sa' mi%imum "ka%a% i%"'aokul' a%# di&a*ai ol( "'a*i mdis.4 Sis"m ali'a% d'ai%as aqueous humor + "'di'i da'i ,ali%a% "'a!kula'+ ka%al S&(lmm+ ,m!a"a% *%#um*ul+ ;%a0;%a auous da% ;%a *iskl'al. Ada*u% ,ali%a% "'a!kula' "'di'i da'i "i#a !a#ia% ak%i ,ali%a% u;al+ ko'%oskl'al+ da% ,uks"akala%ikula'. Jali%a% u;al m'u*aka% ,ali%a% *ali%# dalam da% mluas da'i *a%#kal i'is da% !ada% silia'is sam*ai #a'is S&(-al!. Jali%a% ko'%oskl'al
6
mm!%"uk !a#ia% "%#a( a%# l!a' da% mluas da'i "a,i skl'al sam*ai di%di%# la"'al sulkus skl'al. Jali%a% ,uks"aka%alikula' mm!%"uk !a#ia% lua'+ da% "'di'i da'i la*isa% ,a'i%#a% ko%k"i/. Ba#ia% i%i m'u*aka% !a#ia% sm*i" "'a!kula' a%# m%#(u!u%#ka% ,ali%a% ko'%oskl'al d%#a% ka%al S&(lmm. S!%a'%a la*isa% %do"l lua' ,ali%a% ,uks"aka%alikula' !'isi di%di%# dalam ka%al S&(lmm a%# !'/u%#si m%#ali'ka% auous k lua'. ? Ka%al S&(lmm m'u*aka% sua"u salu'a% a%# dila*isi %do"l+ "am*ak mli%#ka' *ada sulkus skl'al. Sl0sl %do"l *ada di%di%# dalam i'#ul'+ !'!%"uk s*i%dl+ da% "'di'i da'i ;akuol0;akuol !sa'. Pada di%di%# !a#ia% lua' "'da*a" sl0sl o"o" da"a' da"a' da% mm*u%ai *m!ukaa% salu'a% *%#um*ul. ? Salu'a%
*%#um*ul
dis!u"
,u#a
*m!ulu(
auous
i%"'askl'al+
,umla(%a ski"a' 430?3+ m%i%##alka% ka%al S&(lmm *ada sudu" o!lik da% !'ak(i' di ;%a0;%a *iskl'al. @%a i%i di!a#i m%,adi dua sis"m. Sis"m la%#su%#+ ak%i dima%a *m!ulu( !sa' mlalui ,alu' *%dk i%"'askl'al da% la%#su%# k ;%a *iskl'al. Sda%#ka% salu'a% *%#um*ul a%# k&il+ s!lum k ;%a *iskl'al+ "'l!i( da(ulu mm!%"uk *lksus i%"'askl'al. 2
Gam!a' ?. Sudu" I'idoko'%a
Sis"m d'ai%as aqueous humor "'di'i da'i dua ,alu'+ ak%i ,alu' "'a!kula' 7ko%;%sio%al: da% ,alu' u;oskl'al. Jalu' d'ai%as "'!a%ak adala( "'a!kula' ak%i ski"a' <59 sda%#ka% mlalui ,alu' u;oskl'al (a%a ski"a' 159.
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Pada ,alu' "'a!kula'+ ali'a% auous aka% mlalui kam'a *os"'io'+ kam'a a%"'io'+ m%u,u ka%al S&(lmm da% !'ak(i' *ada ;%a *iskl'al. Sda%#ka% ,alu' u;oskl'al+ auous aka% masuk k 'ua%# su*'ako'oidal da% diali'ka% k ;%a0;%a *ada !ada% silia'is+ ko'oid da% s&l'a. ?
Gam!a' 2. Skma si'kulasi (umo' akuos
2.2.
De&inisi 'la#koma Glaukoma adala( %u'o*a"i o*"ik a%# dis!a!ka% ol( "ka%a%
i%"'aokula' 7TIO: a%# 7'la"i/: "i%##i+ a%# di"a%dai ol( klai%a% la*a%#a% *a%da%# a%# k(as da% a"'o/i *a*il sa'a/ o*"ik. Pada kadaa% i%i TIO "idak (a'us slalu 7a!solu": "i%##i+ ""a*i TIO 'la"i/ "i%##i u%"uk i%di;idu "'s!u". Misal u%"uk *o*ulasi %o'mal TIO s!sa' 16 mmH# masi( %o'mal+ ""a*i *ada i%di;idu "'"%"u "ka%a% s!sa' i"u suda( da*a" m%!a!ka% #laukoma a%# dis!u" #laukoma %o'mo"%si a"au #laukoma "ka%a% '%da(. 1 2.3. Klasi&ikasi 'la#koma B'dasa'ka% "iolo#i+ #laukoma di!a#i m%,adi > 1. Glaukoma *'im'
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Adala( #laukoma a%# "idak dik"a(ui *as"i *%!a!%a a"au idio*a"ik. T'!a#i m%,adi > a: Glaukoma *'im' sudu" "'!uka Glaukoma *'im' sudu" "'!uka !iasa%a !'si/a" k'o%ik+ da% "ka%a% i%"'a okula'%a !isa sa,a %o'mal !: Glaukoma *'im' sudu" "'"u"u* Glaukoma *'im' sudu" "'"u"u* da*a" !'si/a" aku"+ su!aku"+ k'o%ik+ i'is *la"u. 4. Glaukoma sku%d' Glaukoma sku%d' adala( sua"u kadaa% a%# di"a%dai d%#a% *%i%#ka"a% TIO 7Tka%a% I%"'a Okula': "a%*a ada%a dis/u%#si "'a!kula' ms(-o'k. Mka%ism *%i%#ka"a% TIO m'u*aka% *%!a! u"ama #laukoma sku%d'. B!'a*a ,%is #alukoma sku%d' adala( > a) Glauoma ka'%a l%sa 7lens induced glaucoma) b) Glaukoma *ada u;i"is 7uveiic glaucoma) c) Glaukoma *as&a "'auma 7raumaic glaucoma) d) Glaukoma ka'%a s"'oid 7coricoseroid induced glaucoma) ?. Glaukoma ko%#%i"al 2. Glaukoma a!solu" 3. Glaukoma s"adium "'ak(i' dima%a suda( "',adi k!u"aa% "o"al. 2.4.
Etiologi Glaukoma "',adi a*a!ila "'da*a" k"idaksim!a%#a% a%"a'a *m!%"uka%
da% *%#ali'a% (umo' akuous. Pada s!a#ia% !sa' kasus+ "idak "'da*a" *%aki" ma"a lai% 7#laukoma *'im':. Sda%#ka% *ada kasus lai%%a+ *%i%#ka"a% "ka%a% i%"'aokula'+ "',adi s!a#ai ma%i/s"asi *%aki" ma"a lai% 7#laukoma sku%d':. ?+3 2.5. Pato&isiologi Glaukoma m'u*aka% s0klom*ok *%aki" k'usaka% sa'a/ o*"ik 7%u'o*a"i o*"ik: a%# !iasa%a dis!a!ka% ol( /k *%i%#ka"a% "ka%a% okula' *ada *a*il sa'a/ o*"ik. Iskmia *ada *a*il sa'a/ o*"ik ,u#a *%"i%#. Hila%#%a akso% m%!a!ka%
d/k
la*a%#a% *a%da%#
da%
(ila%#%a
k"a,ama%
*%#li(a"a% ,ika la*a%#a% *a%da%# s%"'al "'k%a.1+4+15 Ada dua "o'i u"ama m%#%ai mka%ism k'usaka% s'a!u" sa'a/ ol( *%i%#ka"a% "ka%a% i%"'aokula' ai"u "o'i mka%ik da% "o'i ;askula'> •
8+<
P%i%#ka"a% "ka%a% i%"'aokula' m%!a!ka% k'usaka% mka%ik *ada akso%
sa'a/ o*"ik da% *%i*isa% la*isa% s'a" sa'a/ da% i%"i !a#ia% dalam '"i%a+ i'is da%
9
ko'*us silia' ,u#a m%,adi a"'o/i+ da% *'ossus silia'is mm*'li(a"ka% d#%'asi (iali% s(i%##a "',adi *%u'u%a% *%#li(a"a%. P%i%#ka"a% "ka%a% i%"'aokula' m%!a!ka% iskmia akso% sa'a/ aki!a" • !'ku'a%#%a ali'a% da'a( *ada *a*il sa'a/ o*"ik. Diskus o*"ikus m%,adi a"'o/i dis'"ai *m!sa'a% &ku%#a% o*"ikus. Gam!a'a% *a"olo#ik u"ama *ada #laukoma sudu" "'!uka *'im' adala( *'oss d#%'a"i/ di ,a'i%#a% "'a!kula' !'u*a *%!ala% lamlla "'a!kula a%# m%#u'a%#i uku'a% *o'i da% !'ku'a%#%a ,umla( sl "'a!kula *m!a"as. Ju#a "'masuk *%#%da*a% !a(a% ks"'asl di dalam ,ali%a% da% di !a-a( la*isa% %do"l ka%alis S&(lmm. Hal i%i !'!da d%#a% *'oss *%uaa% %o'mal. Aki!a"%a adala( *%u'u%a% d'ai%as (umo' akuous a%# m%!a!ka% *%i%#ka"a% "ka%a% i%"'aokul'.4+8 Tka%a% i%"'aokul' a%# "i%##i s&a'a mka%ik m%ka% *a*il sa'a/ o*"ik a%# m'u*aka% "m*a" d%#a% daa "a(a% *ali%# lma( *ada !ola ma"a. Ba#ia% "*i *a*il sa'a/ o*"ik 'la"i/ l!i( kua" da'i*ada !a#ia% "%#a( s(i%##a "',adi &ku%#a% *ada *a*il sa'a/ o*"ik. 3 2.6.
'la#koma Steroid-Induced
A'mal da% B&k'
masi%#0masi%#
mla*o'ka%ka% !a(-a *o*ulasi
%o'mal da*a" di!a#i m%,adi ? klom*ok !'dasa'ka% 's*o% m'ka "'(ada* *m!'ia% *'*a'a" "o*ikal dksam"aso% da% !"am"aso%> 71: 's*o%d a%# "i%##i+ 20=9 da'i *o*ulasi+ a%# "ka%a% i%"'aokula' 7TIO: m%i%##i sam*ai di a"as ?1 mm H# a"au k%aika% l!i( da'i 13 mm H# di a"as %ilai s!lum%a 74: 's*o%d sda%#+ "'da*a" *ada
ski"a' s*'"i#a da'i *o*ulasi+ mmiliki TIO
a%"a'a 45 da% ?1 mm H#+ a"au k%aika% "ka%a% =013 mmH# da'i %ilai TIO a-al 7?: Tidak '*o%> *ada dua *'"i#a *o*ulasi a%# "'sisa+ mmiliki "ka%a% i%"'a okul' a%# m%i%#ka" ku'a%# da'i = mm H# da% TIO ku'a%# da'i 45 mmH#. Ru" a%# *ali%# umum mmi&u (i*'"%si okul' a"au #laukoma adala( "o*ikal da% i%"'aokula' a"au *m!'ia% *'iokula'. Hal i%i ,u#a da*a" "',adi s"la( m%'ima s"'oid sis"mik+ *%##u%aa% u%"uk kuli"+ i%"'a%asal+ a"au a%# mlalui i%(alasi.
10
P%##u%aa% a%# *o*ul' saa" i%i adala(
i%"'a;i"'al "'iamsi%olo%
a&"o%id 7I@TA: u%"uk !'!a#ai *%aki" ;i"'o'"i%al "la( m%!a!ka% *%i%#ka"a% i%sid% Coricoseroid-Induced (i*'"%si okula' a"au #laukoma. K'a%#ka -ak"u k"ika dimulai%a (i*'"%si okula' "'#a%"u%# *ada o!a" "'"%"u+ dosis+ /'ku%si da% 'u" *m!'ia%+ da% k'%"a%a% i%di;idu "'(ada* o!a". K,adia% seroid-induced ia"'o#%ik #laukoma a"au (i*'"%si okula' *ada "'a*i sis"mik ,au( l!i( sdiki" da'i*ada *m!'ia% s&a'a "o*ikal . Mski*u% 's*o% s&a'a aku" "la( dila*o'ka% *ada "'a*i s"'oid sis"mik i%"%si/+ 's*o% *ada TIO s'i%# "',adi s&a'a lam!a". B'%s"i% da% S&(-a'" "la( mla*o'ka% !a(-a *asi% a%# "la( mm*'ol( "'a*i s"'oid sis"mik slama l!i( da'i 2 "a(u% s&a'a si#%i/ika% mmiliki TIO l!i( "i%##i da'i*ada m'ka a%# "la( m%'ima s"'oid sis"mik ku'a%# da'i sa"u "a(u%. Mski*u% s!a#ia% !sa' s"udi mla*o'ka% !a(-a TIO %aik ?0= mi%##u s"la( a-al *%##u%aa% s"'oid "o*ikal+ !!'a*a *%i%##ia% "ka%a% da*a" di"muka% *ada k!a%aka% *asi% l!i( a-al ak%i> *ada mi%##u *'"ama a"au mi%##u kdua. 1. Fak"o' 'isiko Kmu%#ki%a% 's*o% "i%##i l!i( !sa' !'iku" i%i "',adi *ada> *asi% d%#a% #laukoma *'im' sudu" "'!uka 7POAG: a"au "'sa%#ka #laukoma+ k'a!a" klua'#a i%"i "i%#ka" *'"ama d%#a% POAG + usia "ua a"au usia ku'a%# da'i = "a(u%+ *asi% a%# mm*u%ai 'i-aa" *%aki" ,a'i%#a% ika"+ "'u"ama '(uma"oid a'"('i"is *ada *'ia+ mio*ia "i%##i+ dia!"s mlli"us "i* 1. Pasi% d%#a% /ak"o' 'isiko "'s!u" (a'us di*a%"au l!i( s'i%#
saa" m%'ima
ko'"ikos"'oid. 4. Ru" Pm!'ia%
11
S"'oid "o*ikal dalam k!a%aka% kasus+ #laukoma a"au (i*'"%si okula' ka'%a ko'"ikos"'oid dis!a!ka% ol( ""s a"au sal* ma"a.
?. Mka%ism K',a A%ama% "'a!kula' !'*'a% (am*i' <59 *ada *'oss d'ai%as (umo' akuos da'i ma"a. Mski*u% mka%ism l;asi TIO a%# dii%duksi ko'"ikos"'oid adala( *%i%#ka"a% 'sis"%si "'(ada* ali'a% ai' mlalui 'u" i%i+ %amu% mka%ism a%# "*a" masi( da*a" !lum dik"a(ui. B'dasa'ka% *m'iksaa% (is"o*a"olo#is+ *'u!a(a% ul"'as"'uk"u' di a%ama% "'a!kula' mi'i* d%#a% #laukoma s"la( *%#o!a"a% ko'"ikos"'oid "o*ikal. B!'a*a s"udi o!s';asio%al da*a" m%im*ulka% s!a#ai !'iku"> a: A%ama% "'a!kula ma"'iks ks"'aslul' E/k s"'oid *ada a%ama% "'a!&ula'
ma"'iks
ks"'aslul'
ka'%a
"'#a%###u%a k&*a"a% si%"sis *'o"i%+ a"au d#'adasi *'o"i%+ a"au kom!i%asi da'i kdua%a. Hal i%i m%!a!ka% *%i%#ka"a% d*osisi #likosami%o#lika%+ las"i%+ /i!'o%k"i%+ lami%i%+ da% kola#% "i* I@ s!a#ai !a#ia% da'i ma"'iks ks"'aslula' sku%d' u%"uk *%i%#ka"a% *'oduksi da% *%u'u%a% k'usaka% ka'%a *%#(am!a"a% !!'a*a ma"'iks m"alo*'o"i%as *ada a%ama% "'a!&ula'. Slai% i"u+ dksam"aso%
12
dik"a(ui m%#(am!a" kmam*ua% /a#osi"osis da'i sl a%ama% "'a!kula' s(i%##a d!'is "'akumulasi dalam salu'a% d'ai%as. !: G%"ik Mo&ili% adala( #% #laukoma *'"ama 7GLC1A: a%# "la( diid%"i/ikasi ka'%a ks*'si #%"ik *ada
a%ama%
"'a!&ula' da% dii%duksi ol(
s"'oid. Mo&ili% adala( *'oduk #%+ a%# dik%al s!a#ai mo&ili% a"au *'o"i% Trabecular !esh"or#-inducible $lucocoricoid Res%onse 7TIGR:+ di dis"'i!usika% s&a'a i%"'aslul' s'"a dalam ma"'iks ks"'aslul' *ada a%ama% "'a!kula' %o'mal a"au #laukoma"us. mu"asi #% Mo&ili% !'"a%##u%# ,a-a! *ada 'ma,a a%# m%#alami #laukoma sudu" "'!uka da% ?039 da'i kasus POAG. Mu"asi #% i%i mu%&ul u%"uk m%#(asilka% dis/u%#sio%al sk'si da'i *'o"i% a%# di"',ma(ka% dalam sl a%ama% "'a!kula+ a%# mmi&u
*%u'u%a% *%#lua'a% aquos humor . T'da*a"
l!i( da'i 155 kali li*a" *%i%#ka"a% ks*'si #% mo&ili% "la( dila*o'ka% s"la( *a*a'a% dksam"aso%. Namu%+ !a'u0!a'u i%i *%li"ia% *ada sl a%ama% "'a!kula' ma%usia a%# di kul"u'ka% ak%i s"'oid ""s ma"a "idak m%u%,ukka% !a(-a o;'ks*'si #% mo&ili% dikai"ka% d%#a% *%i%#ka"a% TIO. L!i( !a%ak *%li"ia% di!u"u(ka% u%"uk m%,laska% ;a'iasi dalam #% mo&ili% da% m'ka a%# !'*'a% dalam seroidinduced #lau&oma &: Sl A%ama% T'a!kula Sl a%ama% "'a!kula' mmiliki 's*"o' #lukoko'"ikoid+ da% ak"i;asi *ada 's*"o' i%i ol( s"'oid m%##a%##u s"'uk"u' da% ks*'si *'o"i% *ada sl a%ama% "'a!&ula'. S"'oid "la( m%u%,ukka% !a#aima%a m%#u!a( mo'/olo#i sl
"'a!&ula' ms(-o'k d%#a% m%!a!ka% *%i%#ka"a%
dalam uku'a% da% ko%"% DNA. Dksam"aso% m%i%#ka"ka% kada' *'o"i% da'i o%ula o&&lud%s01 da% &o%%i% 2? di sl "'a!&ula' ms(-o'k+ a%# dia%##a* "'kai" 'a" d%#a% (am!a"a% ali'a% &ai'a% . Dksam"aso% ,u#a m%#u!a( a'si"k"u' F0ak"i% da% m%do'o%# *m!%"uka% ,a'i%#a% ak"i% a%# m%ila%#. F0ak"i% !'i%"'aksi d%#a% o%ula o&&lud%s01 u%"uk mm!a%"u mm*'kua" *'ika"a% i%"'slul' +
13
di ma%a *'ika"a% a%# kua" da% dis"'i!usi a%# k"a" mm*%#a'u(i la,u ali'a% (umo' akuos. F0ak"i% ,u#a di!ua" u%"uk m's*o% ko%"'aksi sl da% u%"uk !'*'a% dalam m%#(asilka% *mli(a'aa% "ka%a% !ola ma"a. Tla( "'!uk"i !a(-a dksam"aso% m%#i%duksi ks*'si F0ak"i% da% m%i%#ka"ka% ko%"'aksi mlalui sl "'a!&ula' ms(-o'k. Ko%"'aksi "'a!&ula' ms(-o'k m%#u'a%#i 'ua%#0'ua%# i%"'slul' da% d%#a% dmikia% m%#u'a%#i a'us klua' (umo' akuous. P'u!a(a% mik'os"'uk"u' *ada a%ama% "'a!kula da% ak"i;i"as sl da*a" mmi&u *%u'u%a% *'oli/'asi+ mi#'asi da% /a#osi"osis *ada sl a%ama% "'a!kula. Smua i%i m%!a!ka% !'ku'a%#%a kmam*ua% slul' *ada a%ama% "'a!&ula' a%# "'li(a" *ada *asi% d%#a% #laukoma seroid-induced da% akumulasi *'o#'si/ d!'is ks"'aslul' da% ak(i'%a "'da*a" *%i%#ka"a% 'sis"%si ali'a% klua' (umo' akuous.11 2.7.
(ani&estasi Klinis
G,ala%a "idak ada a"au sa%#a" 'i%#a%+ !iasa%a klu(a%%a (a%a 'asa "idak %ama% a"au *#al di ma"a> *%#li(a"a% ""a* ,las *ada /as a-al ka'%a *%#li(a"a% s%"'al !lum "'li!a". Sla%,u"%a la*a%#a% *a%da%# mulai m%m*i". G,ala lai% adala( ksuli"a% !',ala%+ misal%a s'i%# "'sa%du%# kalau %aik0"u'u% "a%##a a"au "idak "a(u !%da disam*i%#%a ka'%a (ila%#%a la*a%# *a%da%# *'i/'. Pm'iksaa% *ada ma"a dida*a"ka% ma"a "am*ak %o'mal+ ko%,u%#"i;a "idak m'a(+ ko'%a ,'%i(+ !ilik ma"a d*a% dalam+ da% *u*il %o'mal. Fu%dusko*i m%u%,uka% a"'o/i *a*il sa'a/ o*"ik 7CD 5+=:. Smaki% luas lkuka% 7smaki% !sa' 'asio CD:+ m%a%daka% a"'o/i smaki% *a'a(. Da*a" di"muka% "a%da0"a%da *a*il #laukoma"osa a%# lai% ai"u lami%a k'i!osa %am*ak ,las+ a"'o/i '"i%a *'i*a*il+ #am!a'a% !ao%"+ %asalisasi *m!ulu( da'a( da% *%i*isa% !i%#kai sa'a/ o*"ik. Tka%a% i%"'aokula' l!i( da'i 41 mmH#. Pada
*m'iksaa%
%u'oo/"almolo#is
m%##u%aka%
*'im"'
m%u%,ukka% ada%a klai%a% la*a%# *a%da%# da% a"au sko"oma a%# k(as ai"u sko"oma di da'a( B,''um+ d/k a'kua"a+ %asal s"* da% %inhole vision *ada /as ak(i'.1 14
2.8.
Diagnosis Dia#%osis *%aki" i%i di"#akka% !'dasa'ka% (asil a%# dida*a" da'i
a%am%sis da% *m'iksaa% o/"(amolo#i. .).!. A%am%sis Masala( u"ama dalam m%d"ksi #laukoma sudu" "'!uka *'im' adala( "idak ada%a #,ala sam*ai s"adium ak(i'. Mulai "im!ul%a #,ala #laukoma *'im' sudu" "'!uka a#ak lam!a" a%# kada%#0kada%# "idak disada'i ol( *%d'i"a sam*ai ak(i'%a !'la%,u" d%#a% k!u"aa%. S-ak"u *asi% m%ada'i ada
*%#&ila%
la*a%#a%
*a%da%#+
!iasa%a
"la(
"',adi
*%&ku%#a%
#laukoma"osa a%# !'mak%a. Ma"a "idak m'a( a"au "idak "'da*a" klu(a%+ a%# m%#aki!a"ka% "'da*a" #a%##ua% susu%a% a%a"omis da% /u%#si "a%*a disada'i ol( *%d'i"a.4 Pada #laukoma sudu" "'!uka+ k'usaka% la*a%#a% *a%da%# ma"a dimulai da'i "*i la*a%#a% *a%da%# da% lam!a" lau% mluas k !a#ia% "%#a(. D%#a% dmikia% *%#li(a"a%
s%"'al
7/u%#si ma&ula:
!'"a(a% lama+
-alau*u%
*%#li(a"a% *'i/' suda( "idak ada s(i%##a *%d'i"a "'s!u" sola(0ola( mli(a" mlalui "'o*o%# 7"u%%l ;isio%:. Didu#a #laukoma *'im' sudu" "'!uka di"u'u%ka% s&a'a domi%a% a"au 'ssi/ *ada 359 *%d'i"a s(i%##a 'i-aa" klua'#a ,u#a *%"i%# dik"a(ui dalam m%##ali 'i-aa" *%aki". 4+8 .).. Pm'iksaa% P%#ama"a% a"au *m'iksaa% "'(ada* *asi% dilakuka% s,ak *asi%
mulai masuk k dalam kama' *m'iksaa% dok"'. Pm'iksaa% da*a" di!daka% dalam > P%#ama"a% Dilakuka% s,ak *asi% masuk 'ua%#a%+ dili(a" a*aka( di!im!i%# klua'#a+ a"au d%#a% mm#a%# sa"u sisi k*ala+ da% s!a#ai%a. Pm'iksaa% G,ala *%aki" a"au klai%a% 3
4.6.4.1. Pm'iksaa% Fisik Ma"a 1. Pm'iksaa% "a,am *%#li(a"a% 7*m'iksaa% ;isus sa"u ma"a:
15
Pada *m'iksaa% "a,am *%#li(a"a% di*akai ka'"u !aku a"au s"a%da'+ misal%a ka'"u !a&a S%ll% a%# s"ia* (u'u/%a mm!%"uk sudu" 3 m%i" *ada ,a'ak "'"%"u s(i%##a (u'u/ *ada !a'is "a%da =5+ !'a'"i (u'u/ "'s!u" mm!%"uk sudu" 3 m%i" *ada ,a'ak =5 m"' da% *ada !a'is "a%da ?5+ !'a'"i (u'u/ "'s!u" mm!%"uk sudu" 3 m%i" *ada ,a'ak ?5 m"'. Hu'u/ *ada !a'is "a%da = adala( (u'u/ a%# mm!%"uk sudu" 3 m%i" *ada ,a'ak = m"'+ s(i%##a (u'u/ i%i *ada o'a%# %o'mal aka% da*a" dili(a" d%#a% ,las. D%#a% ka'"u S%ll% i%i da*a" di"%"uka% "a,am *%#li(a"a% a"au kmam*ua% mli(a" sso'a%#+ s*'"i> Bila "a,am *%#li(a"a% == maka !'a'"i ia da*a" mli(a" (u'u/ *ada ,a'ak = • •
m"'+ a%# ol( o'a%# %o'mal (u'u/ "'s!u" da*a" dili(a" *ada ,a'ak = m"'. Bila *asi% (a%a da*a" mm!a&a *ada (u'u/ !a'is a%# m%u%,ukka% a%#ka
•
?5+ !'a'"i "a,am *%#li(a"a% *asi% adala( =?5. Bila *asi% (a%a da*a" mm!a&a (u'u/ *ada !a'is a%# m%u%,ukka% a%#ka
•
35+ !'a'"i "a,am *%#li(a"a% *asi% adala( =35. Bila "a,am *%#li(a"a% adala( ==5 !'a'"i ia (a%a da*a" "'li(a" *ada ,a'ak =
•
m"' a%# ol( o'a%# %o'mal (u'u/ "'s!u" da*a" dili(a" *ada ,a'ak =5 m"'. Bila *asi% "idak da*a" m%#%al (u'u/ "'!sa' *ada ka'"u S%ll% maka dilakuka% u,i (i"u%# ,a'i. Ja'i da*a" dili(a" "'*isa( ol( o'a%# %o'mal *ada
•
,a'ak =5 m"'. Bila *asi% (a%a da*a" mli(a" a"au m%%"uka% ,umla( ,a'i a%# di*'li(a"ka% *ada ,a'ak ? m"'+ maka di%a"aka% "a,am ?=5. D%#a% *%#u,ia% i%i "a,am *%#li(a"a% (a%a da*a" di%ilai sam*ai 1=5+
a%# !'a'"i (a%a da*a" m%#(i"u%# ,a'i *ada ,a'ak 1 m"'. D%#a% u,i lam!aia% "a%#a%+ maka da*a" di%a"aka% "a,am *%#li(a"a% *asi% a%# l!i( !u'uk da'i*ada 1=5. O'a%# %o'mal da*a" mli(a" #'aka% a"au lam!aia% "a%#a% *ada ,a'ak ?55 m"'. Bila ma"a (a%a da*a" mli(a" lam!aia% "a%#a% *ada ,a'ak 1 m"'+ !'a'"i "a,am *%#li(a"a%%a adala( 1?55. Kada%#0kada%# ma"a (a%a da*a" m%#%al ada%a si%a' sa,a da% "idak da*a" mli(a" lam!aia% "a%#a%. Kadaa% i%i dis!u" s!a#ai "a,am *%#li(a"a% 10. O'a%# %o'mal da*a" mli(a" ada%a si%a' *ada ,a'ak "idak !'(i%##a. Bila *%#li(a"a% sama skali "idak m%#%al ada%a si%a' maka dika"aka% *%#li(a"a%%a adala( 5 7%ol: a"au !u"a "o"al. Bila sso'a%#
16
di'a#uka% a*aka( *%#li(a"a%%a !'ku'a%# aki!a" klai%a% '/'aksi+ maka dilakuka% u,i *i%(ol. Bila d%#a% *i%(ol *%#li(a"a% l!i( !aik+ maka !'a'"i ada klai%a% '/'aksi a%# masi( da*a" diko'ksi d%#a% ka&ama"a. Bila *%#li(a"a% !'ku'a%# d%#a% dil"akka%%a *i%(ol di d*a% ma"a !'a'"i
ada
klai%a%
o'#a%ik
a"au
kk'u(a%
mdia
*%#li(a"a%
a%#
m%#aki!a"ka% *%#li(a"a% m%u'u%. = 4. Pm'iksaa% la*a%# *a%da%# Pm'iksaa% la*a%#a% *a%da%# s&a'a "'a"u' !'*'a% *%"i%# dalam dia#%osis da% "i%dak la%,u" #laukoma. P%u'u%a% la*a%#a% *a%da%# aki!a" #laukoma i"u s%di'i "idak s*si/ik ka'%a #a%##ua% i%i "',adi aki!a" d/k !'kas s'a" sa'a/ a%# da*a" di,um*ai *ada smua *%aki" %';us o*"ikus %amu%+ *ola klai%a% la*a%#a% *a%da%#+ si/a" *'o#'si;i"as+ da% (u!u%#a%%a d%#a% klai%a%0klai%a% diskus o*"ikus m'u*aka% &i'i k(as *%aki" i%i. 4+2 Ga%##ua% la*a%#a% *a%da%# aki!a" #laukoma "'u"ama m%#%ai ?55 la*a%#a% *a%da%# !a#ia% s%"'al. P'u!a(a% *ali%# di%i adala( smaki% %a"a%a !i%"ik !u"a. Da'a(0da'a( *%u'u%a% la*a%#a% *a%da%# a%# l!i( *a'a( di dalam da'a( B,''um dik%al s!a#ai sko"oma Sidl. La*a%#a% *a%da%# *'i/' "'%*o'al da% 350155 s%"'al !a'u "'*%#a'u( *ada s"adium la%,u" *%aki". K"a,ama% *%#li(a"a% s%"'al !uka% m'u*aka% *"u%,uk *'km!a%#a% *%aki" a%# da*a" dia%dalka%.8 Sala( sa"u &a'a u%"uk mm'iksa la*a%#a% *a%da%# *ada #laukoma d%#a% !aik adala( d%#a% *'im"'. Ala" i%i !'!%"uk s"%#a( !ola d%#a% ,a'i0,a'i ?5 &m+ da% *ada *usa" *a'a!ola i%i ma"a *%d'i"a dil"akka% u%"uk di*'iksa. Ma"a !'/iksasi *ada !a#a% s%"'al *a'a!ola *'im"'. O!k di#s' *'la(a%0la(a% da'i "*i k a'a( "i"ik "%#a(. Di&a'i !a"as0!a"as *ada slu'u( la*a%#a% *ada saa" ma%a !%da mulai "'li(a". 3 Ba"as la*a%# *a%da%#a% *'i/' <5 d'a,a" "m*o'al+ 85 d'a,a" i%/'io'+ =5 d'a,a" %asal+ da% 35 d'a,a" su*'io'. Dik%al *'im"'i> 0 P'im"' ki%"ik a%# dis!u",u#a *'im"' iso*"ik da% "o*o#'a/ik+ dima%a *m'iksaa% dilakuka% d%#a% o!,k di#'akka% da'i da'a( "idak "'li(a" 0
m%,adi "'li(a" ol( *asi%. P'im"' s"a"ik a"au *'im"' *'o/il da% *'im"' curve di&&erenial hreshold' di ma%a *m'iksaa% d%#a% "idak m%##'ak0ka% o!,k aka% ""a*i d%#a% m%aikka% i%"%si"as o!,k s(i%##a "'li(a" ol( *asi%. 3+8 17
?. Sli"0lam* !iomik'osko*i Pada *asi% d%#a% du#aa% kua" #laukoma+ s&a'a umum da*a" di"muka% "a%da0"a%da !'iku" Hi*'mis silia' ka'%a i%,ksi lim!al da% *m!ulu( da'a( ko%,u%#"i;a. Edma ko'%a d%#a% ;sikl *i"lial da% *%!ala% s"'uma. Bilik ma"a d*a% da%#kai d%#a% ko%"ak i%doko'%al *'i/' Fla' da% sl akuos da*a" diii(a" s"ia( dma ko'%a da*a" diku'a%#i. Pu*il o;al ;'"ikal+ ""a* *ada *osisi smi0dila"asi da% "idak ada 'aksi "'(ada* •
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•
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&a(aa da% akomodasi. Dila"asi *m!ulu( da'a( i'is. Tka%a% i%"'ao&ula' sa%#a" m%i%#ka" 7350155 mmH#: 6 2. To%om"'i To%om"'i adala( sua"u "i%daka% u%"uk mlakuka% *m'iksaa% "ka%a% •
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i%"'aokula' d%#a% ala" a%# dis!u" "o%om"'. K"!ala% ko'%a !'*%#a'u( "'(ada* kaku'a"a% *%#uku'a%. Tka%a% i%"'aokula' ma"a a%# ko'%a%a "!al+ aka% di"aksi' "'lalu "i%##i a%# ko'%a%a "i*is+ di"aksi' "'lalu '%da(. Ksuli"a% i%i da*a" dia"asi d%#a% "o%om"' ko%"u' di%amik Pas&al.. R%"a%# "ka%a% i%"'aokula' %o'mal adala( 15041 mm H#. 1+3 Pada usia la%,u"+ ''a"a "ka%a% i%"'aokula'%a l!i( "i%##i s(i%##a !a"as a"as%a adala( 42 mmH#. Pada #laukoma sudu" "'!uka *'im'+ ?40359 i%di;idu a%# "'k%a aka% mm*'li(a"ka% "ka%a% i%"'aokuia' a%# %o'mal saa" *'"ama kali di*'iksa. S!alik%a+ *%i%#ka"a% "ka%a% i%"'aokula' sma"a "idak slalu dia'"ika% !a(-a *asi% m%#ida* #laukoma sudu" "'!uka *'im' u%"uk m%#akka% dia#%osis di*'luka% !uk"i0!uk"i lai% s*'"i ada%a diskus o*"ikus #laukoma"osa a"au klai%a% la*a%#a% *a%da%#. A*a!ila "ka%a% i%"'aokuia' "'us0 m%'us m%i%##i sm%"a'a diskus o*"ikus da% la*a%#a% *a%da%# %o'mal 7(i*'"%si okula':+ *asi% da*a" dio!s';asi s&a'a !'kala s!a#ai "'sa%#ka #laukoma.1 Ca'a m%#uku' "ka%a% !ola ma"a "'s!u" dik%al ada 2 ma&am+ a%"a'a lai% ai"u> a. To%om"' di#i"al Dasa' *m'iksaa%%a adala( d%#a% m'asaka% 'aksi l%"u'a% !ola ma"a !ola 7balo"m%": dilakuka% *%ka%a% !'#a%"ia% d%#a% kdua ,a'i "a%#a%. Tka%a% !ola ma"a d%#a% &a'a di#i"al di%a"aka% d%#a% "a%da 1+ N4+ N?+ da% s!alik%a N 01 da% s"'us%a.D%#a% &a'a i%i *m'iksaa% adala( sa%#a"
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su!,k"i/ da% mm'luka% *%#alama% a%# !a%ak+ s(i%##a ku'a%# da*a" di*'&aa.3 !. To%om"' S&(io" To%om"' S&(io" m'u*aka% ala" a%# *'ak"is sed'(a%a. P%#uku'a% "ka%a% !ola ma"a di%ilai s&a'a "idak la%#su%# ai"u d%#a% tek%ik mli(a" daa "ka% ala" *ada koma. Bila sua"u !!a% "'"%"u mm!'ika% k&ku%#a% *ada koma maka aka% "'li(a" *'u!a(a% *ada skala s&(io". Maki% '%da( "ka%a% !ola maa"a maki% muda( !ola ma"a di"ka%+ a%#.*ada skala aka% "'li(a" a%#ka skala a%# l!i( !sa'. Hal i%i ,u#a !'laku s!alik%a. 3 &. To%om"' a*la%asi #oldma% Ala" i%i m%#uku' "ka%a% !ola ma"a d%#a% mm!'ika% "ka%a% a%# aka% mm!ua" 'a"a *'mukaa% ko'%a dalam uku'a% "'"%"u da% k&il. Ala" i%i sa%#a" !aik ka'%a mm!ua" sdiki" skali *'u!a(a% *ada *'mukaa% ko'%a a"au !u%#kus !ola ma"a. Ala" i%i m'u*aka% ala" a%# *ali%# s'i%# di#u%aka%. 3+6 d. To%o#'a/i D%#a% "o%o#'a/i diuku' d'a,a" *%u'u%a% "ka%a% !ola ma"a !ila di!'ika% "ka%a% d%#a% "o%om"' i%d%"asi 7s*'"i s&(io":. Ala" i%i ,a'a%# di#u%aka% da% di*'#u%aka% (a%a u%"uk kasus #laukoma a%# 'a#u0'a#u. 4 3. Go%iosko*i Sudu" !ilik ma"a d*a% di!%"uk ol( *'"mua% ko'%a *'i/' d%#a% i'is+ a%# di a%"a'a%a "'da*a" a%ama% "'a!kula'. Ko%/i#u'asi .sudu" i%i ak%i l!a' 7"'!uka:+ sm*i"+ a"au "'"u"u* mm!'i dam*ak *%"i%# *ada ali'a% klua' auous (umo'. Sudu" !ilik ma"a d*a% s!aik%a di"%"uka% d%#a% #o%iosko*i+ a%# mmu%#ki%ka% ;isualisasi la%#su%# s"'uk"u'0s"'uk"u' sudu". A*a!ila kslu'u(a% a%ama% "'a!kula'+ "a,i skl'a+ da% *'o&ssus i'is da*a" "'li(a"+ sudu" di%a"aka% "'!uka. A*a!ila (a%a #a'is S&(-al! a"au s!a#ia% k&il da'i a%ama% "'a!kula' a%# da*a" "'li(a"+ sudu" di%a"aka% sm*i". A*a!ila #a'is S&(-al! "idak "'li(a"+ sudu" di%a"aka% "'"u"u*. 1 Hal a%# "idak kala( *%"i%# ai"u mlakuka% *m'iksaa% ma"a ko%"'a0 la"'al+ a%# !iasa%a di"muka% #am!a'a% sudu" "'"u"u* la"%. Dima%a ma"a a%# m%#alami #laukoma aku" m%u%,ukka% ada%a ko%"ak *'i/' i'ido0ko'%al kom*li".6
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Ma"a mio*ia a%# !sa' mmiliki sudu" l!a'+ da% ma"a (i*'o*ia k&il mmiliki sudu" sm*i". Pm!sa'a% l%sa si'i%# d%#a% usia mm*'sm*i" sudu" i%i da% !'*'a% *ada !!'a*a kasus #laukoma sudu" "'"u"u*. 1 Pm'iksaa% i%i dilakuka% d%#a% ml"akka% l%sa sudu" 7#o%io0l%s: di da"a'a% d*a% ko'%a s"la( di!'ika% lokal a%s""ikum. L%sa i%i da*a" di*'#u%aka% u%"uk mli(a" sklili%# sudu" !ilik ma"a d%#a% mmu"a'%a ?=5 d'a,a".3 =. P%ilaia% Diskus O*"ikus Diskus o*"ikus %o'mal mmiliki &ku%#a% di !a#ia% "%#a(%a 7d*'si s%"'al: &a-a% /isiolo#ik a%# uku'a%%a "'#a%"u%# %ada (umlah relai& sera %enusu% %';us o*"ikus "'(ada* uku'a% lu!a%# skl'a a%# (a'us dil-a"i ol( s'a"0s'a" "'s!u"* A"'o/i o*"ikus aki!a" #laukoma m%im!ulka% klai%a%0klai%a% diskus k(as a%# "'u"ama di"a%dai ol( !'ku'a%#%a su!s"a%si diskus a%# "'d"ksi s!a#ai *m!sa'a% &a-a% diskus o*"ikus+ dis'"ai d%#a% * mucaan dis#us di da'a( &a-a%. B%"uk0!%"uk lai% a"'o/i o*"ikus m%!a!ka% *mu&a"a% luas "a%*a *%i%#ka"a% *%&ku%#a% diskus o*"ikus. Pada #laukoma+ mu%#ki% "'da*a" *m!sa'a% ko%s%"'ik &a-a% o*"ik a"au *%&ku%#a% 7&u**i%#: su*'io' da% i%/'io' da% dis'"ai *m!%"uka% "akik 7%o"&(i%#: /okal di "*i diskus o*"ikus*+ Klai%a% o*"ik0disk da*a" di;aluasi d%#a% m%##u%aka% o/"aimosko* di'k+ sli"0lam* !iomik'osko*i a%# m%##u%aka% l%sa <5 Dio*"'i+ H'u! l%s , a"au l%sa ko%"ak Goldma%% da% o/"aimosko* i%di'k. Gam!a'a% /u%dus *ada #laukoma aku" s'i%# di"muka% o*"i& disk dma da% (i*'mis. 6 U,i Lai% Pada Glaukoma 1: U,i Ko*i P%d'i"a mmi%um 104 ma%#kok ko*i *ka"+ !ila "ka%a% !ola ma"a %aik 130 45 mmH# ssuda( mi%um 45025 m%i" m%u%,ukka% ada%a #laukoma. 3 4: U,i Mi%um Ai' Mi%um ai' !a%ak aka% m%#aki!a"ka% "u'u%%a "ka%a% osmo"ik s(i%##a ai' aka% !a%ak masuk k dalam !ola ma"a+ a%# aka% m%aikka% "ka%a% !ola ma"a. S!lum maka% *a#i "ka%a% !ola ma"a diuku' da% kmudia% *asi% disu'u( mi%um d%#a% &*a" 1 li"' ai'. Tka%a% !ola ma"a di uku' s"ia* 13 m%i". Bila "ka%a% !ola ma"a %aik 6013 mmH# dalam -ak"u 23 m%i" *'"ama
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m%u%,ukka% *asi% m%d'i"a #laukoma+ Biasa%a !'samaa% d%#a% %aik%a "ka%a% !ola ma"a aka% "',adi *%#u'a%#a% ou"/lo- o/ /a&ili".3 ?: U,i S"'oid 7m'u*aka% u,i u%"uk #laukoma ('di"': Pada *asi% a%# di&u'i#ai ada%a #laukoma "'u"ama d%#a% 'i-aa" #laukoma sim*lks *ada klua'#a+ di""ska% !"am"aso% a"au 7dksam"aso% 5.19 ?02 kali s(a'i. Tka%a% !ola ma"a di*'iksa s"ia* mi%##u. Pada *asi% !'!aka" #laukoma maka "ka%a% !ola ma"a aka% %aik s"la( 4 mi%##u. 3 2: U,i @a'iasi Diu'%al Pm'iksaa% i%i dilakuka% ka'%a dik"a(ui "ka%a% !ola ma"a !'si/a" i%"'mi"% a"au !';a'iasi da'i -ak"u k -ak"u. P'u!a(a% "ka%a% i%i aka% l!i( ,las *ada ma"a d%#a% #a%##ua% ou&lo" o& &acili. Tka%a% !ola ma"a da*a" %o'mal *ada -ak"u dilakuka% *m'iksaa% sda%# *%d'i"a saa" i"u m%d'i"a #laukoma. Pm'iksaa% dilakuka% u%"uk m%#"a(ui a*aka( "ka%a% !ola ma"a *%d'i"a m%i%##i *ada sa"u saa" dalam sa"u (a'i a%# m%im!ulka% #,ala #laukoma%a. Pm'iksaa% d%#a% mlakuka% "o%om"'i s"ia* 40? ,am s(a'i *%u(+ slama ? (a'i. Biasa%a *asi% di'a-a". Nilai ;a'iasi (a'ia% *ada ma"a %o'mal adala( a%"a'a 40? mmH#+ sda%# *ada ma"a #laukoma sudu" "'!uka ;a'iasi da*a" m%&a*ai 130 45 mmH#. P'u!a(a% 203 mmH# suda( di&u'i#ai kadaa% *a"olo#ik. Biasa%a "ka%a% !ola ma"a %aik di *a#i (a'i. Bila "'da*a" *'!daa% a%"a'a kdua ma"a aka% m%am!a( k&u'i#aa%. Tu'u%%a "ka%a% !ola ma"a -ak"u *a#i (a'i da*a" dis!a!ka% ko%"'aksi o"o" da% akomodasi. Tka%a% !ola ma"a "'%da( !iasa%a *ada malam (a'i. 3 3: U,i Kama' Gla* Bila *asi% d%#a% sudu" "'"u"u* !'ada di kama' #la* a"au "'da*a" mid'iasis *ada *u*il%a maka aka% "',adi *%u"u*a% sudu" !ilik ma"a. Pada u,i i%i di lakuka% *%#uku'a% "ka%a% !ola ma"a da% kmudia% *asi% dimasukka% k dalam kama' #la* da% duduk d%#a% k*ala "'l"ak d%#a% muka m%#(ada* m,a slama =50<5 m%i". Pada ak(i' <5 m%i" "ka%a% !ola ma"a diuku'. 339 *asi% #laukoma sudu" sm*i" aka% m%u%,ukka% (asil a%# *osi"i/ a"au %aik "ka%a% !ola ma"a s"la( masuk kama' #la* 6 mmH#. Pada saa" *m'iksaa% i%i *asi% "idak !ol( "idu'+ *ada ak(i' *m'iksaa% dilakuka% *m'iksaa% ula%# kadaa% sudu" !ilik ma"a a"au #o%iosko*i. 3 21
4.6.4.4. Pm'iksaa% P%u%,a%# 1. Ul"'aso%o#'a/i Ul"'aso%o#'a/i di#u%aka% s&a'a luas dalam !ida%# o/"almolo#i u%"uk m%diaka% i%/o'masi "%"a%# ;i"'ous+ '"i%a+ da% la*isa% *os"'io' ma"a+ "'u"ama !ila "idak da*a" di;isualisasi d%#a% ,las 7,ika+ s!a#ai &o%"o(+ "'da*a" ka"a'ak *ada" a"au *%da'a(a% ;i"'ous:. 8 4. K'a"om"'i B%"uk ko'%a 7'adius kl%#ku%#a%: da*a" diuku' da'i !aa%#a% "a'#" a%# di'/lksika% da'i *'mukaa%%a. Hal i%i *%"i%# dalam *%ilaia% l%sa ko%"ak ' %embedahan re&ra#i&' da% *'(i"u%#a% kkua"a% im*la% l%sa a'"i&isial %ada %embedahan #aara#* Tk%ik /o"ok'a"om"'i mmu%#ki%ka% dilakuka%%a *m"aa% konur #ornea ang sanga a#ura* 8 ?. Tk%ik P%&i"'aa% Radiolo#i CT s&a% da% MRI "la( !a%ak m%##a%"ika% 'o%"#% "%#ko'ak da% o'!i"a dalam *%&i"'aa% o'!i"a da% ,alu' ;isual. Tk%ik dia#%os"ik "'!a'u "la( m%i%#ka"ka% dia#%osis *%aki" o'!i"a 7misal m%i%#ioma slu!u%# sa'a/ o*"ik: da% lsi ,alu' ;isual s*'"i "umo' (i*o/isis. Tk%ik0"k%ik "'s!u" ,u#a "la( m%,adi *m'iksaa% li%i *'"ama *ada "'auma o'!i"a. 8 2. Tk%ik P%&i"'aa% Di#i"al da% Pmi%daia% 7S&a%: Las' Tk%ik !a'u *%&i"'aa% '"i%a sda%# dikm!a%#ka% u%"uk mm*'!aiki kuali"as #am!a' '"i%a da% lm*%# o*"ik da% u%"uk m%da*a"ka% *%ilaia% kua%"i"a"i/ !!'a*a (al s*'"i a'a lm*%# o*"ik da% ma%#kuk o*"ik 7Ba! 15:. Tk%ik0"k%ik i%i aka% mm!a%"u *%ilaia% *asi% d%#a% *%aki" k'o%is s*'"i #laukoma da% dia!"s di ma%a "a"alaksa%a mm!u"u(ka% *%ilaia% *'u!a(a% *ada lm*%# mau*u% '"i%a a%# aku'a". 8 2.9. Penatalaksanaan 4.<.1 P%a%#a%a% No% Bda( P%#o!a"a% %o% !da( m%##u%aka% o!a"0o!a"a% a%# !'/u%#si m%u'u%ka% *'oduksi mau*u% sk'si da'i (umo' akuous. 4+3+8+<+15 P%#o!a"a% a%# *ali%# /k"i/ u%"uk #laukoma seroid-induced adala( *%&#a(a% mlalui *%##u%aa% a%# "*a" *ada s"'oid. Dalam (al i%i+ dukasi *asi% da% dok"' "%"a%# *o"%si kom*likasi okula' *ada s"'oid di*'luka%. K#a#ala% l;asi TIO s"la( = mi%##u "'a*i "idak m%,ami% !a(-a so'a%# i%di;idu "idak aka% !'km!a%# *ada *%i%#ka"a% TIO ,ika *m!'ia% s"'oid
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dila%,u"ka%. U%"uk alasa% i%i+ *asi% a%# m%##u%aka% s"'oid+ k(usus%a !%"uk "o*ikal+ (a'us mmiliki "i%dak la%,u" *m'iksaa% 'u"i% u%"uk m%&#a( k'usaka% sa'a/ o*"ik 1. Pma%"aua% TIO P%#"a(ua% aka% ko%disi *%i%#ka"a% TIO adala( a%# la%#ka( *ali%# *%"i%# dalam *%#lolaa% *asi%. K"ika *asi% di!'ika% s"'oid+ "'u"ama d%#a% s"'oid "o*ikal *o"%si kua" da% su%"ika%
*'iokula'+ dok"' (a'us
mma%"au m'ka s*%u(%a. I%i "'masuk *%#uku'a% %ilai !asal
TIO+
s!a#ia% !sa' u%"uk m%i%#ki'ka% #laukoma a%# suda( ada s!lum%a. *ma%"aua% TIO a-al%a (a'us dimulai *ada 4 mi%##u da% kmudia% s"ia* 20= mi%##u slama 40? !ula%+ da% kmudia% s"ia* = !ula% s"la( 's*o% a-al "la( dik"a(ui. Dalam kasus i%,ksi i;"a+ slai% *%#uku'a% "'s!u" di a"as+ TIO (a'us di*'iksa *ada (a'i saa" i%,ksi da% mi%##u *'"ama. 4. P%#(%"ia% S"'oid P%i%#ka"a% TIO a%# di*i&u s"'oid !iasa%a dalam ,a%#ka -ak"u *%dk da% ';'si!l d%#a% *%#(%"ia% "'a*i ,ika o!a" !lum di#u%aka% slama l!i( da'i sa"u "a(u%. El;asi TIO *'ma%% "',adi ,ika "'a*i s"'oid "la( dila%,u"ka% slama 16 !ula% a"au l!i(. TIO !iasa%a km!ali %o'mal dalam -ak"u 402 mi%##u s"la( m%#(%"ika% s"'oid. Dalam kasus d%#a% i%,ksi s"'oid da% TIO "i%##i+ *%##u%aa% su!&o%,u%&"i;al 'sidual a"au i%"'ao&ula' s"'oid da*a" di(ila%#ka%. ?. Su*'si *m!%"uka% (umo' akuous P%#(am!a" !"a ad'%'#ik adala( o!a" a%# *ali%# luas di#u%aka%. Da*a" di#u%aka% "'s%di'i a"au dikom!i%asi d%#a% o!a" lai%. P'*a'a" a%# "'sdia a%"a'a lai% Timolol mala" 5+439 da% 5+39+ !"aksolol 5+439 da% 5+39+ l;o!u%olol 5+439 da% 5+39 da% m"i*'a%ol 5+?9. A*'aklo%idi% 7la'u"a% 5+39 "i#a kali s(a'i da% 19 s!lum da% ssuda( "'a*i las': adala( sua"u a#o%is al/a ad'%'#ik a%# !a'u !'/u%#si m%u'u%ka% *'oduksi (umo' akuous "a%*a /k *ada ali'a% klua'. O!a" i%i "idak ssuai u%"uk "'a*i ,a%#ka *a%,a%# ka'%a !'si/a" "aki/ilaksis 7(ila%#%a /k "'a*i d%#a% !',ala%%a -ak"u: da% "i%##i%a 'aksi al'#i. E*i%/'i% da% di*i/'o% ,u#a mmiliki /k a%# s'u*a.
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Do'olamid (d'o&(lo'id la'u"a% 49 da% !'i%olamid 19 7dua a"au "i#a kali s(a'i adala( *%#(am!a" a%(id'as "o*i&al a%# "'u"ama /k"i/ !ila di!'ika% s!a#ai "am!a(a%+ -alau*u% "idak s0/k"i/ *%#(am!a" a%(id'as ka'!o%a" sis"mik. Do'olamid ,u#a "'sdia !'sama "imolol dalam la'u"a% a%# sama. •
Fasili"asi ali'a% klua' (umo' akuous A%alo# *'os"a#la%di% !'u*a la'u"a% !imas"o*'os" 5+55?9+ la"a%o*'os"
5+5539 da% "'a;o*'os" 5+5529 masi%#0masi%# skali s"ia* malam da% la'u"a% u%o*'os"o% 5+139 dua kali s(a'i a%# !'/u%#si u%"uk m%i%#ka"ka% ali'a% klua' (umo' akuous mlaului u;oskl'a. Smua a%alao# *'os"a#la%di% da*a" m%im!ulka% *'"um!u(a%
(*'mia !ola
ma"a
ko%,u%#"i;a+ da%
(i*'*i#m%"asi
*%##la*a%
i'is
a%#
kuli"
*'io'!i"a+
*'ma%%.
O!a"
*a'asim*a"omim"ik s*'"i *ilo&a'*i% m%i%#ka"ka% ali'a% klua' (umo' akuous d%#a% !k',a *ada a%ama% "'a!kula' mlalui ko%"'aksi o"o" silia'is. O!a" i%i di!'ika% dalam !%"uk la'u"a% 5+30=9 a%# di""ska% (i%##a m*a" kali s(a'i a"au !%"uk #l 29 a%# di!'ika% s!lum "idu'. O!a"0o!a" *a'asim*a"omim"ik m%im!ulka% miosis dis'"ai *%#li(a"a% su'am.
O!a"0o!a"a% sis"mik I%(i!i"o' ka'!o%a" a%(id'as sis"mik as"oolamid di#u%aka% a*a!ila
"'a*i "o*ikal "idak mm!'ika% (asil mmuaska%. O!a" i%i mam*u m%ka% *m!%"uka% (umo' akuous s!sa' 250=59. As"oolamid da*a" di!'ika% *'o'al dalam dosis 1430435 m# sam*ai m*a" kali s(a'i a"au s!a#ai Diamo suls 355 m# skali a"au dua kali s(a'i+ da*a" di!'ika% s&a'a i%"'a;%a 7355 m#:. P%#(am!a" a%(id'as ka'!o%a" m%im!ulka% /k sam*i%# sis"mik mao' a%# mm!a"asi k#ua%aa%%a u%"uk "'a*i ,a%#ka *a%,a%#.
4.<.4. P%a%#a%a% Bda( da% Las'
24
I%dikasi *%a%#a%a% !da( *ada *asi% #laukoma sudu" "'!uka *'im' adala( ai"u "'a*i o!a"0o!a"a% "idak adkua" s*'"i 'aksi al'#i+ *%u'u%a% *%#li(a"a% aki!a" *%m*i"a% *u*il+ %'i+ s*asm silia'is da% *"osis. P%a%#a%a% !da( mli*u"i> 4+<+15
T'a!kulo*las"i las' T'a!kulo*las"i las' di#u%aka% dalam "'a*i a-al #laukoma sudu" "'!uka
*'im'. J%is "i%daka% i%i ai"u *%##u%aa% las' u%"uk m%im!ulka% luka !aka' mlalui sua"u #%iol%sa k ,ali%a% "'a!kula' s(i%##a da*a" mm*'muda( ali'a% klua' (umo' akuous ka'%a /k luka !aka' "'s!u". Tk%ik i%i da*a" m%u'u%ka% "ka%a% okula' =06 mmH# slama dua "a(u%.
T'a!kulk"omi T'a!kulk"omi adala( *'osdu' a%# *ali%# s'i%# di#u%aka% u%"uk
mmi%"as salu'a%0salu'a% d'ai%as %o'mal s(i%##a "'!%"uk akss la%#su%# (umo' akuous da'i !ilik ma"a d*a% k ,a'i%#a% su!ko%,u%#"i;a da% o'!i"a. alau*u% suli" u%"uk m%%"uka% "a'#" "ka%a% i%"'aokula'+ !!'a*a *a%dua% m%!u"ka% ko%"'ol TIO s!a#ai !'iku"> 1. Pasi% d%#a% k'usaka% di%i diskus o*"ikus da% d/k la*a%#a% *a%da%# a"au di !a-a( /iksasi s%"'al+ TIO (a'us di !a-a( 16 mmH#. 4. Pasi% d%#a% k'usaka% mod'a" diskus o*"ikus 7CDR 5+6: "'da*a" sko"oma a'kua"a su*'io' da% i%/'io' d/k la*a%#a% *a%da%#+ (a'us di*'"a(a%ka% TIO di !a-a( 13 mmH#. ?. Pasi% d%#a% k'usaka% dikus o*"ikus la%,u" 7CDR 5+<: da% d/k la*a%#a% *a%da%# a%# mluas+ (a'us di*'"a(a%ka% TIO di !a-a( 14 mmH#. .!*.
Kom+likasi
Ko%"'ol "ka%a% i%"'aokula' a%# ,lk aka% m%!a!ka% smaki% 'usak%a %';us o*"ik da% smaki% m%u'u%%a ;isus sam*ai "',adi k!u"aa%. <
.!!.
Prognosis
A*a!ila "'d"ksi di%i+ s!a#ia% !sa' *asi% #laukoma da*a" di"a%#a%i d%#a% !aik s&a'a mdis. Ta%*a *%#o!a"a%+ #laukoma sudu" "'!uka da*a" !'km!a%# s&a'a *'la(a% s(i%##a ak(i'%a m%im!ulka% k!u"aa% "o"al.
25
A*a!ila o!a" ""s a%"i0#laukoma da*a" m%#o%"'ol "ka%a% i%"'aokula' *ada ma"a a%# !lum m%#alami k'usaka% #lauma"osa luas+ *'o#%osis aka% !aik 7-alau*u% *%u'u%a% la*a%#a% *a%da%# da*a" "'us !'la%,u":. 4+< ,. 1.
Kortikosteroid D/i%isi
Ko'"ikos"'oid adala( sua"u klom*ok (o'mo% s"'oid a%# di(asilka% di!a#ia% ko'"ks kl%,a' ad'%al s!a#ai 's*o% a"as (o'mo% ad'%oko'"iko"'o*ik 7ACTH: a%# dil*aska% ol( kl%,a' (i*o/isis+ a"au a"as a%#io"%si% II. Ho'mo% i%i !'*'a% *ada !a%ak sis"m /isiolo#is "u!u(+ da% *%#a"u'a% i%/lamasi+ m"a!olism ka'!o(id'a"+ *m&a(a% *'o"i%+ kada' lk"'oli" da'a(+ s'"a "i%#ka( laku. Ko'"ikos"'oid di!a#i m%,adi 4 klom*ok !'dasa'ka% a"as ak"i;i"as !iolo#is a%# m%o%,ol da'i%a+ ak%i #lukoko'"ikoid 7&o%"o(%a ko'"isol: a%# !'*'a% m%#%dalika% m"a!olism ka'!o(id'a"+ lmak+ da% *'o"i%+ ,u#a !'si/a" a%"i i%/lamasi d%#a% &a'a m%#(am!a" *l*asa% /os/oli*id+ s'"a da*a" *ula m%u'u%ka% ki%',a osi%o/il. Klom*ok lai% da'i ko'"ikos"'oid adala( mi%'aloko'"ikoid 7&o%"o(%a aldos"'o%:+ a%# !'/u%#si m%#a"u' kada' lk"'oli" da% ai'+ d%#a% &a'a *%a(a%a% #a'am di #i%,al. B!'a*a ko'"ikos"'oid m%u%,ukka% kdua ,%is ak"i;i"as "'s!u" dalam !!'a*a d'a,a"+ da% lai%%a (a%a m%#lua'ka% sa"u ,%is /k. Ho'mo% ko'"ikos"'oid di(asilka% da'i kols"'ol di ko'"ks kl%,a' ad'%al a%# "'l"ak di a"as #i%,al. Raksi *m!%"uka%%a dika"alisis ol( %im #olo%#a% si"ok'om P235. Dalam !ida%# /a'masi+ o!a"0o!a"a% di si%"sis s(i%##a mmiliki /k s*'"i (o'mo% ko'"ikos"'oid alami mmiliki ma%/aa" a%# &uku* *%"i%#. Dksam"aso% da% "u'u%a%%a "'#olo%# #lukoko'"ikoid+ sda%#ka% *'d%iso% da% "u'u%a%%a mmiliki k',a mi%'aloko"ikoid. O!a"0o!a" #olo%#a% ko'"ikos"'oid s*'"i *'d%iso%+ dam"(aso% da% (id'oko'"iso% mmiliki *o"%si /k "'a*i a%# &uku* am*u( dalam *%#o!a"a% !'!a#ai *%aki" s*'"i asma+ lu*us+ '(uma"oid a'"('i"is da% !'!a#ai kasus i%/lamasi lai%%a. Ta*i
ko'"ikos"'oid
,u#a
mmiliki
!'!a#ai
/k
sam*i%#
a%#
"idak
m%%a%#ka%.
26
4.
Mka%ism K',a Ko'"ikos"'oid !k',a d%#a% mm*%#a'u(i k&*a"a% si%"sis *'o"i%.
Molkul (o'mo% mmasuki sl ml-a"i mm!'a% *lasma s&a'a di/usi *asi/. Ha%a ,a'i%#a% "a'#" (o'mo% i%i !'aksi d%#a% 's*"o' *'o"i% a%# s*si/ik dalam si"o*lasma sl da% mm!%"uk kom*lks 's*"o' s"'oid. Kom*lks i%i m%#alami *'u!a(a% ko%/o'masi+ lalu !'#'ak m%u,u %uklus da% !'ika"a% d%#a% k'oma"i%. Ika"a% i%i m%s"imulasi "'a%sk'i*si RNA da% si%"sis *'o"i% s*si/ik. I%duksi si%"sis *'o"i% i%i a%# aka% m%#(asilka% /k /isiolo#ik s"'oid. Pada !!'a*a ,a'i%#a%+ misal%a (*a'+ (o'mo% s"'oid m'a%#sa%# "'a%sk'i*si da% si%"sis *'o"i% s*si/ik *ada ,a'i%#a% lai%+ misal%a sl lim/oid da% /i!'o!las" (o'mo% s"'oid m'a%#sa%# si%"sis *'o"i% a%# si/a"%a m%#(am!a" a"au "oksik "'(ada* sl0sl lim/oid+ (al i%i m%im!ulka% /k ka"a!olik. ?.
E/k Ko'"ikos"'oid Ko'"isol da% a%alo# si%""ik%a da*a" m%&#a( a"au m%ka% "im!ul%a
#,ala i%/lamasi aki!a" 'adiasi+ i%/ksi+ a" kimia+ mka%ik a"au al'#%. G,ala i%i umum%a !'u*a km'a(a%+ 'asa saki" da% *a%as+ *m!%#kaka% di "m*a" 'ada%#. S&a'a mik'osko*ik o!a" i%i m%#(am!a" /%om%a i%/lamasi di%i ai"u dma+ d*osi" /i!'i%+ dila"asi *'i/'+ mi#'asi lukosi" k "m*a" 'ada%# da% ak"i;i"as /a#osi"osis. Slai% i"u ,u#a da*a" m%#(am!a" ma%i/s"asi i%/lamasi a%# "la( la%,u" ai"u *'oli/'asi ka*il' da% /i!'o!las"+ *%#um*ula% kola#% da% *m!%"uka% sika"'iks. P%##u%aa% kli%ik ko'"ikos"'oid s!a#ai a%"i0i%/lamasi m'u*aka% "'a*i *alia"i/+ ai"u (a%a #,ala%a a%# di(am!a" sda%#ka% *%!a! *%aki" ""a* ada. S!%a'%a (al i%ila( a%# m%!a!ka% o!a" i%i !a%ak di#u%aka% u%"uk !'!a#ai *%aki"+ !a(ka% s'i%# dis!u" li/ sa;i%# d'u#+ ""a*i (al i%i ,u#a a%# m%im!ulka% 'aksi a%# "idak dii%#i%ka% ka'%a #,ala i%/lamasi i%i s'i%# di#u%aka% s!a#ai dasa' ;aluasi "'a*i i%/lamasi+ maka *ada *%##u%aa%
27
#lukoko'"ikoid kada%#0kada%# "',adi
mas#ing e&&ec + da'i lua' *%aki"
%am*ak%a suda( sm!u( ""a*i i%/ksi di dalam masi( "'us m%,ala'. Ko%s* "'!a'u mm*'ki'aka% !a(-a /k imu%osu*'sa% da% a%"i0i%/lamasi a%# slama i%i dia%##a* s!a#ai /k /a'makolo#i ko'"ikos"'oid ssu%##u(%a s&a'a /isiolo#is *u% m'u*aka% mka%ism *'o"k"i/. Ba%ak mdia"o' 'aksi imu% a%# "'kai" d%#a% 'aksi i%/lamasi ssu%##u(%a aka% m%!a!ka% kola*s%a sis"m ka'dio;askul' !ila "idak ada ko'"ikos"'oid a%# mla-a%%a. Hi*o"sis i%i di"u%,a%# ol( "i%##i%a *'oduksi ko'"ikos"'oid dalam kadaa% s"'ss ai"u !isa sam*ai 15 kali li*a". Ju#a "'%a"a smua /k /a'makolo#i dida*a" mlalui mka%ism k',a di 's*"o' a%# sama d%#a% a%# "',adi s&a'a /isiolo#is. Ko'"ikos"'oid da*a" mm*%#a'u(i sl0sl mlalui 's*"o'0's*"o' #lukoko'"ikoid%a d%#a% mka%ism k',a s!a#ai !'iku"> ko'"ikos"'oid !'di/usi k dalam sl ml-a"i mm!'a% sl da% sla%,u"%a !'ika"a% d%#a% 's*"o'. Kom*lks ko'"ikos"'oid0's*"o' masuk k dalam %uklus dalam !%"uk ak"i/+ da% aka% m%#ika" DNA s'"a m%i%#ka"ka% si%"sis mss%#' RNA 7mRNA:. Mss%#' RNA i%i aka% m%im!ulka% si%"sis *'o"i% a%# !a'u. P'o"i% !a'u i%i aka% m%#(am!a" /u%#si sl0sl lim/oid d%#a% *%#(am!a"a% u*"ak #lukosa. P%#a'u( ko'"ikos"'oid a%# "'*%"i%# *ada ma%usia adala( *%#(am!a"a% akumulasi mak'o/a# da% %"'o/il di "m*a" 'ada%#. Slai% i"u ko'"ikos"'oid ,u#a m%!a!ka% !'ku'a%#%a ak"i;i"as mak'o/a#+ !aik a%# !'da' dalam da'a( 7mo%osi": mau*u% a%# "'/iksi' dalam ,a'i%#a% 7sl Ku*//':. P%#a'u( "'s!u" di*'ki'aka% aki!a" *%#(am!a"a% k',a /ak"o'0/ak"o' lim/oki% a%# dil*aska% ol( sl0T s%si"i/ *ada mak'o/a#. P%#(am!a"a% akumulasi %"'o/il di "m*a" 'ada%# adala( aki!a" k',a ko'"ikos"'oid m%#u'a%#i daa lka" %"'o/il *ada di%di%# %do"l *m!ulu( da'a(+ !uka% aki!a" *%#(am!a"a% kmo"aksis a%# (a%a da*a" di(am!a" ol( ko'"ikos"'oid *ada kada' su*'a/a'makolo#ik. S&a'a 'i%#kas da*a" dika"aka% !a(-a !ila ko'"ikos"'oid aka% di#u%aka% u%"uk ,a%#ka *a%,a%#+ (a'us di!'ika% dalam dosis mi%imal a%# masi( /k"i/. Dosis i%i di"%"uka% s&a'a "'ial a%d ''o'. U%"uk kadaa% a%# "idak m%#a%&am
28
,i-a *asi%+ ko'"ikos"'oid dosis !sa' da*a" di!'ika% u%"uk -ak"u a%# si%#ka" slama "idak ada ko%"'ai%dikasi s*si/ik.14 2.
P%##u%aa% S"'oid *ada Ma"a Ko'"ikos"'oid !iasa%a di#u%aka% u%"uk m%#o!a"i !%#kak da% #a"al
*ada ma"a a%# dis!a!ka% ka'%a al'#i+ "'auma+ a"au i%/ksi. I%/lamasi a%# "',adi *ada ma"a da*a" di"'a*i d%#a% *%#o!a"a% "o*ikal d%#a% i%,ksi lokal a"au sis"mik.
a:
Glukoko'"ikoid S"'oid di#u%aka% s&a'a "o*ikal u%"uk m%&#a( a"au m%ka% *'oss
i%/lamasi a%# "',adi *ada ma"a aki!a" "'auma da% u;i"is. Pada i%,ksi su!ko%,u%#"i;a da% i%,ksi '"'o!ul!a'+ s"'oid di#u%aka% u%"uk "'a*i kasus s*'"i i%i a%# "'#olo%# !'a" aki!a" "',adi i%/lamasi *ada ma"a. T'a*i sis"mik s"'oid di#u%aka% u%"uk "'a*i *%aki" sis"m imu% s*'"i i%/lamasi *ada ma"a a%# !'a" a%# suda( 'sis"% d%#a% "'a*i "o*ikal. M"il0*'d%isolo% i%"'a;%a m%,adi *ili(a% *ada "'a*i dmili%isasi sa'a/ o*"ik a%# "'i%/ksi da% "'auma *ada sa'a/ o*"ik. Glukoko'"ikoid m%#i%duksi /k sl s*si/ik dalam lim/osi"+ mak'o/a#+ *olimo'/o%ukla' lukosi"+ sl %do"l ;askul'+ /i!'o!las"+ da% sl0sl lai%%a. 3.
Fa'makolo#i ko'"ikos"'oid "o*ikal Ko'"ikos"'oid "o*ikal di#u%aka% *ada aksi a%"i0i%/lamasi. As*k da'i
*'oss i%/lamasi s*'"i (i*'mia+ i%/il"'asi slul'+ ;askula'isasi da% *'oli/'asi /i!'o!las"ik di"ka%. S"'oid m%#(am!a" 's*o%s i%/lamasi u%"uk m'a%#sa%# a#%0a#% mka%is+ kimia a"au imu%olo#i alami. Ko'"ikos"'oid "o*ikal /k"i/ di#u%aka% *ada ko%disi i%/lamasi aku" *ada ko%,u%#"i;a+ skl'a+ ko'%a+ klo*ak ma"a+ i'is+ !ada% silia'+ da% s#m% a%"'io' da'i !ola ma"a+ da% dalam ko%disi al'#i !ola ma"a. Mka%ism da'i aksi a%"i i%/lamasi di*'ki'aka% u%"uk m%,adi *o"%si da'i ;asoko%s"'iksi *i%/'i%+ s"a!ilisasi da'i mm!'a% lisosom+ '"a'dasi *'#'aka% mak'o/a#+ *%&#a(a% da'i *l*asa% ki%i%+ i%(i!isi da'i lim/osi" da% /u%#si %u"'o/il+ i%(i!isi da'i si%"sis *'os"a#la%di% da% *ada *%##u%aa% ,a%#ka *a%,a%# m%u'u%ka% *'oduksi a%"i!odi. Ham!a"a% *'oli/'asi /i!'o!las" da*a"
29
m%&#a( "',adi%a /o'masi sim!l/a'o% *ada "'auma kimia da% "'auma *a%as. P%#u'a%#a% s&a' 7!kas luka dalam !%"uk ,a'i%#a% ika": d%#a% ko'%a a%# l!i( ,'%i( s"la( *m!'ia% ko'"ikos"'oid "o*ikal adala( (asil da'i i%(i!isi *'oli/'asi /i!'o!las" da% ;askula'isasi. =.
I%dikasi Pada kadaa% i%/lamasi+ ko%disi *%#o!a"a% d%#a% m%##u%aka% s"'oid
's*o%si/ i%/lamasi *ada *al*!'a da% ko%,u%#"i;a !ul!a'+ klo*ak ma"a+ ko'%a+ da% s#m% a%"'io' !olama"a s*'"i > ko%,u%#"i;i"is al'#i+ k'a"i"is su*'/i&ial %o%s*si/ik+ k'a"i"is su*'/i&ial *u%&"a"a+ k'a"i"is ('*s os"'+ i'i"is+ sikli"is+ ko%,u%#"i;i"is aki!a" i%/ksi !ak"'i k"ika *%##u%aa% s"'oid d%#a% 'siko a%# "idak !isa di*isa(ka% di"'ima u%"uk m%#u'a%#i "',adi%a dma da% i%/lamasi. Rimolo% ,u#a dii%dikasika% ,ika "',adi i%/lamasi *os" o*'asi a%# m%#iku"i *ada o*'asi !ola ma"a. S'"a di#u%aka% *ada &d'a ko'%a aki!a" !a(a% kimia+ 'adiasi a"au "'auma *a%as a"au "'auma !%da asi%#. Da*a" ,u#a di#u%aka% dalam m%ka% 'aksi *%olaka% "'a%s*la%"asi s"la( k'a"o*a"i.
8.
Ko%"'ai%dikasi K'a"i"is ('*s sim*lks su*'/i&ial aku" *%aki" a%# dis!a!ka% ol(
,amu' *ada s"'uk"u' !ola ma"a ;aksi%asi+ ;a'isla da% !a%ak la#i *%aki" a%# dis!a!ka% ol( ;i'us *ada ko'%a da% ko%,u%#"i;a+ i%/ksi miko!ak"'ium *ada ma"a 7&o%"o( "u!'&ulosis ma"a:+ *%aki" a%# dis!a!ka% ol( mik'oo'#a%ism+ (i*'s%si"i;i"as+ s"la( *mi%da(a% a%# "idak u"u( *ada !ada% asi%# su*'/i&ial ko'%a. Md'so% "idak di#u%aka% *ada i'i"is da% u;i"is (asil%a !lum di u,i &o!a. 6.
E/k Sam*i%# Ko'"ikos"'oid da*a" m%!a!ka% "',adi%a #laukoma. Pada #laukoma
"',adi *%i%#ka"a% "ka%a% i%"'a okul' 7TIO: d%#a% k'usaka% sa'a/ o*"ik. Pada *makaia% ko'"ikos"'oid "o*ikal !iasa%a m%i%#ka"ka% TIO dalam -ak"u 4 sam*ai = mi%##u+ sda%#ka% *%##u%aa% sis"mik da*a" m%i%#ka"ka% TIO dalam du'asi a%# l!i( lama a%# !lum dik"a(ui -ak"u *as"i%a. Hal i%i
30
dis!a!ka% ka'%a *makaia% s"'oid sis"mik m%i%#ka"ka% TIO s&a'a !'"a(a* da% "idak m%im!ulka% #,ala+ s(i%##a *a'a *makai s"'oid sis"mik dalam ,a%#ka -ak"u lama da*a" "'lam!a" "'dia#%osis.1?
31
DAFTAR PUSTAKA
1.
Su(a',o SU+ Su%da'i S+ Saso%#ko MB. Klai%a% Pal*!'a+ Ko%,u%#"i;a+ Ko'%a+ Skl'a da% Sis"m Lak'imal. Dalam Su(a'd,o SU+ Ha'"o%o. Ilmu Ks(a"a% Ma"a. Fakul"as Kdok"'a% U%i;'si"as Gad,a( Mada. 4514. (.11102?.
4.
@au#(a%+ Da%il G+ MD+ As!u'+ Talo'+ MD+ da% Rio'da%0E;a+ Paul+ FRCS+ FRCO*("(. Edi"o' Dia%a Susa%"o. O/"almolo#i Umum. EGC.
?.
Jaka'"a. 455<. (al 14 da% 414044<. K(u'a%a+ A.K. Com*'(%si; O*"(almolo#. 2 "( di"io%. N- A#
2.
I%"'%a"io%al 7P: limi"d. N- Dl(i. 4558. Hal 4530456 Ba'!a'a C + Ma's(+ Louis B + Ca%"o'. The s%eah $oniosco%ic $rading Ssem.
Las"
u*da"d
,u%
4553.
A;aila!l
/'om >(""*>---.#lau&oma"oda.&oma'"5353&li%s"'a".*d/. 3.
Ilas HS. ,emeri#saan Anaomi dan isiologi !aa sera .elainan %ada ,emeri#saan !aa.. Ilmu P%aki" Ma"a. Edisi k"i#a. Jaka'"a> Balai
=.
P%'!i" FKUI 455<. (.28031 Ilas HS. Ta(am ,englihaan dan .elainan Re&ra#si ,englihaan /arna . Ilmu P%aki" Ma"a. Edisi k"i#a. Jaka'"a> Balai P%'!i" FKUI 455<.
8.
(.=3085 Jams B+ C(- C+ B'o% A. Anamnesis dan ,emeri#saan isi# . L&"u'
6.
No"s> O/"almolo#i. Edisi <. Jaka'"a> P%'!i" E'la%##a 4553. (.16 ?50? Am'a AA. P%a"alaksa%aa% Glaukoma Aku". Mda%> Fakul"as Kdok"'a%
<.
U%i;'si"as Suma"'a U"a'a 4558. Koo%' KS. ,rimar O%en Angle $laucoma* I% > Cli%i&al Pa"(-a o/
15.
Glau&oma. N-o'k > T(im 4555. Mo''iso% JC+ Polla&k IP. ,rimar O%en Angle $laucoma. I% > Glau&oma
11.
S&i%& a%d P'a&"i&. N-o'k > T(im 455?. M. Ra Ra#(i%,ad. Seroid-Induced Iarogenic $laucoma. Glau&oma S';i& a" ills E I%s"i"u"> P(iladl*(ia. USA 4511.
32
