BAGIAN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
REFARAT MARET 2014
OD KERATITIS PUNGTATA
DISUSUN OLEH:
Andi Besse Fatryani C111 09 361
PEMBIMBING : dr. Andi Hasyim Hasyi m Asy’ari
SUPERVISOR: dr. Sitti Soraya Taufik, Sp., .!es
BAGIAN ILMU KESEHATAN MATA FAKULT FAKULTAS AS KEDOKTERAN KEDOKTER AN UNIVERSITAS UNI VERSITAS HASANUDDIN HASANUDDI N MAKASSAR 2014
!"#AT$T$S !"#AT$T$ S %&'(TA %&'( TAT TA 7
$. %"') %"')AH AH&* &*&A &A' '
Kornea adaa! "ar#n$an %ran&'aran (an$ )*)ran dan &%r)*%)rn(a &e+and#n$ den$an *r#&%a &e+)a! "a, %an$an *e-#. Kornea +er/)n$&# &e+a$a# ,e,+ran 'e#nd)n$ dan "endea (an$ d# a)# oe! +er*a& -a!a(a &aa% ,en)") *e re%#na. Kornea #n# d#&#&#'*an *edaa, &*era 'ada #,+)&. Kornea ,e,')n(a# ena, a'#&an (an$ +er+eda+eda (a#%) a'#&an e'#%e a'#&an +o,an &%ro,a d)a3& a(er ,e,+ran de&-e,en% dan a'#&an endo%e. La'#&an e'#%e 'ada *ornea ,er)'a*an &aar (an$ e/#&#en %er!ada' ,a&)*n(a ,#*roor$an#&,e *e daa, *ornea. Na,)n &e*a# *ornea #n# -edera&%ro,a (an$ aa&*)er dan a'#&an +o,an ,)da! %er#n/e*&# +er+a$a# ,a-a, or$an#&,e &e'er%# +a*%er# a,oe+a dan "a,)r.5126 Radan$ *ornea 5 Kera%#%#& 6 +#a&an(a d#*a&#/#*a&#*an daa, a'#& *ornea (an$ %er*ena (a#%) &e'er%# *era%#%#& &)'er/#-#a dan #n%er%#&#a a%a) 'ro/)nda. Kera%#% Kera%#%#& #& da'a% da'a% d#&e+a d#&e+a+*a +*an n oe! oe! +er+a$ +er+a$a# a# !a &e'er%# &e'er%# *)ran$ *)ran$n( n(aa a#r ,a%a ,a%a *era-)nan o+a% rea*&# aer$# %er!ada' 'en$o+a%an %o'#-a (an$ d# +er#*an dan rea*&# %er!ada' *on")n$%##%#& ,ena!)n.*era%#%#& a*an ,e,+er#*an $e"aa ,a%a ,era! ,era! ra&a ra&a &#a) &#a) dan dan ,era ,era&a &a *e# *e## #'a 'an. n. Kera Kera%# %#%# %#&& ')n$ ')n$%a %a%a %a ,e,+ ,e,+er# er#*a *an n $a,+aran &e'er%# #n/#%ra% !a)& 'ada 'er,)*aan *ornea. 576 $$. "T$+*+($ "T$+*+($
Kera%#%#& Kera%#%#& ')n$%a%a ')n$%a%a ,er)'a*an ,er)'a*an *era%#%#& *era%#%#& (an$ %er*),') %er*),') d#daera! d#daera! +o,an +o,an den$an #n/#%ra% +er+en%)* +er-a*+er-a* !a)&. Kera%#%#& ')n$%a%a d#&e+a+*an oe! !a!a (an$ %#da* &'e&#/#* dan da'a% %er"ad# 'ada ,o)&*), *on%an$#o&), a*ne ro&a&ea !er'e& 8oo&%er !er'e& &#,'e*& +e/ar#%#& *era%#%#& ne)ro'ara#%#* #n/e*&# #r)& #r)& dr( e(e& e(e& %ra),a %ra),a rad#a&# rad#a&# a$o/% a$o/%a, a,)& )& dan *era-) *era-)nan nan o+a%. o+a%. Kera%#% Kera%#%#& #& ')n$%a%a &an$a% &er#n$ d#%e,)*an ,en$#n$a% e%#oo$# dar# 'en(a*#% #n# +era&a dar# +er+a$a# /a*%or e*&o$en &e'er%# +enda a&#n$ 'ada +a$#an daa, 'a'e+ra en&a *on%a* a&a' dan a#na#n. 546
8
Kera%#%#& ')n$%a%a &)'er/#&#a &an$a% &er#n$ d#%e,)*an ,en$#n$a% e%#oo$# dar# 'en(a*#% #n# +era&a dar# +er+a$a# /a*%or e*&o$en &e'er%# +enda a&#n$ 'ada +a$#an daa, 'a'e+ra en&a *on%a* a&a' dan a#na#n. Pen(a*#% #n# ')n da'a% +er)'a $e"aa &e*)nder dar# *era%#%#& "en#& a#n. Kera%#%#& ')n$%a%a &)'er/#&#a#& #n# ')n da'a% d#&e+a+*an oe! /a*%or endo$en (a#%) Thygeson disease.596 Be+era'a 'en(e+a+ *era%#%#& ')n$%a%a &)'er/#&#a: 56 1. In/e*&# #r)& ,er)'a*an 'en(e+a+ )%a,a. V#r)& (an$ &er#n$ ,en$#na&# #aa! !er'e& 8o&%er adeno#r)& epidemic keratoconjunctivitis pharyngoconjunctival fever dan !er'e& &#,'e*&. 2. In/e*&# -!a,(d#a %er,a&)* d# daa,n(a %ra-!o,a dan *on")n$%##%#& #n*)&#. 7. Le&# %o*&#* da'a% +era&a dar# %o*&#n &%a'!(o-o--a (an$ +er!)+)n$an 4. 9. . <.
den$an +e'!aro*on")n$%##%#&. Le&# %ro'#* &e'er%# *era%#%#& exposure keratitis danneuroparalytic keratitis. Le&# aer$#* &e'er%# erna *era%o*on")n$%##%#&. Le&# #r#%a&# ,er)'a*an e/e* dar# +e+era'a o+a% &e'er%# #do;)r#d#ne. Gan$$)an *)#% dan ,e,+ran ,)*o&a &e'er%# a-ne ro&a-ea dan
'e,'!#$o#d. =. Dry eye syndrome &e'er%#*era%o-on")n-%##%#& &#--a >. Penyakit idiopatik &e'er%#Thygeson superficial punctate keratitis and Theodore's superior limbic keratoconjunctivitis. 10. P!o%oo'!%!a,#%#&.
$$$. A'AT+$
Boa ,a%a +er+en%)* +)a% den$an 'an"an$ ,a*&#,a 24 ,,. +oa ,a%a d#+a$#an de'an 5Kornea6 ,e,')n(a# *een$*)n$an (an$ e+#! %a"a, &e!#n$$a %erda'a% 2 +en%)**een$*)n$an (an$ +er+eda. 546 Boa ,a%a d#+)n$*)& oe! 7 "ar#n$an #*a% (a#%) :
546
1. S*era ,er)'a*an "ar#n$an #*a% *en(a dan ,e,+er#*an +en%)* 'ada ,a%a ,er)'a*an +a$#an %er)ar (an$ ,e#nd)n$# +oa ,a%a. Ba$#an %erde'an
9
&*era d#&e+)% *ornea (an$ +er&#/a% %ran&'aran &e!#n$$a ,e,)da!*an -a!a(a ,a&)* *edaa, +oa ,a%a. Keen$*)n$an 'ada *ornea e+#! +e&ar d#+and#n$*an 'ada &*era. 2. ?ar#n$an )ea ,er)'a*an "ar#n$an a&*)er (an$ %erd#r# dar# #r#& *or')& &##ar#& dan *oro#d. Pada #r#& d#da'a%*an ')'# (an$ %erd#r# oe! 7 &)&)nan o%o% da'a% ,en$a%)r "),a! &#nar (an$ ,a&)* *edaa, ,a%a. O%o% d#a%a%or d#'er&ara/# oe! &#,'a%#& &edan$*an &/#n$%er #r#& dan o%o% &##ar#& d#'er&ara/# oe! 'ara &#,'a%#&. O%o% &##ar#& (an$ %ere%a* d#+adan &##ar#& ,en$a%)r +en%)* en&a )n%)* *e+)%)!an a*o,oda&#. @or')& &##ar#& (an$ ,en$!a&#*an !),or a*)o& (an$ d#*e)ar*an ,ea)# %ra+e*)), (an$ %ere%a* 'ada 'an$*a #r#& d#+a%a& *ornea dan &*era. 7. La'#&an *e%#$a +oa ,a%a adaa! re%#na (an$ %ere%a* 'a#n$ daa, dan ,e,')n(a# &)&)&an &e+an(a* 10 a'#& ,e,+ran ne)ro&en&or#& (an$ a*an ,er)+a! &#nar ,en"ad# ran$&an$an 'ada &ara/ o'%#* (an$ d#%er)&*an *e o%a*.
Ga,+ar 1 : Ana%o,# Boa Ma%a Badan *a-a a%a) !),or #%re)& ,en$#&# ron$$a daa, +oa ,a%a dan +er&#/a% $ea%#n (an$ !an(a ,ene,'e 'ada 'a'# &ar a/ o'%#* ,a*)a dan 'ar& 'eana. Len&a %ere%a* d#+ea*an$ ')'# (an$ d#'e$an$ d# daera! e*)a%orn(a oe! 8on)a 8#n##. Len&a ,e,')n(a# 'eranan 'ada a*o,oda&# a%a) ,e#!a%
10
de*a% &e!#n$$a &#nar da'a% d#/o*)&*an d# daera! ,a*)a )%ea. Terda'a% o%o% 'en$$era* +oa ,a%a dan %erda'a% *een"ar a*r#,a (an$ %ere%a* 'ada daera! %e,'ora a%a& daa, ron$$a or+#%a. 546
A'AT+$ !+#'"A
Kornea 5La%#n cornum = &e'er%# %and)*6 adaa! &ea')% +en#n$ ,a%a ,er)'a*an +a$#an &ea')% ,a%a (an$ %e,+)& -a!a(a dan ,er)'a*an a'#&an "ar#n$an (an$ ,en)%)' +oa ,a%a &e+ea! de'an. Kornea ,er)'a*an +a$#an ,a%a (an$ %e,+)& -a!a(a dan ,en)%)' +oa ,a%a d#&e+ea! de'an. Pe,+#a&an &#nar %er*)a% d#a*)*an oe! *ornea d#,ana 40 d#o'%r# dar# 90 d#o'%r# 'e,+#a&an &#nar ,a&)* d#a*)*an oe! *ornea. Ra%a ra%a *e%e+aan *ornea 'ada oran$ dea&a adaa! &e*#%ar 092 ,, d# &en%ra dan 09 ,, d# 'er#/er. D#a,e%er !or#8on%a *ornea ra%a ra%a oran$ dea&a adaa! 11<9 ,, dan d#a,e%er er%#*an(a ra%a ra%a 10 ,,. Dar# an%er#or *e 'o&%er#or *ornea ,e,##*# a'#&an (an$ &a#n$ +er!)+)n$an (a#%) a'#&an e'#%e 5(an$ ,er)'a*an *ean")%an dar# e'#%e d#*on")n$%#a +)+a6 ,e,+rana +o,an &%ro,a a'#&an d)a3& ,e,+rana de&-e,en% dan endo%e.546 1. E'#%e %erd#r# a%a& 9 a'#&an &e %#da* +er%and)* (an$ &a#n$ %),'an$ %#nd#! 1 a'#& &e +a&a &e 'o#$ona dan &e $e'en$. Pada &e +a&a &er#n$ %er#!a% ,#%o&#& &e dan &e ,)da #n# %erdoron$ *e de'an ,en"ad# ,en"ad# a'#& &e &a(a' dan &e,a*#n ,a") *e de'an ,en"ad# &e $e'en$ &e +a&a +er#*a%an era% den$an &e +a&a d#&a,'#n$n(a dan &e 'o#$ona d#de'ann(a
,ea)#
der,o&o, dan
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e*)den #*a%an
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,en$!a,'a% 'en$a#ran a#r ee*%ro#% dan $)*o&a (an$ ,er)'a*an +arr#er. Se +a&a ,en$!a&#*an ,e,+ran +a&a (an$ ,ee*a% era% *e'adan(a. B#a %er"ad# $an$$)an a*an ,en$a*#+a%*an ero&# re*)ren. 2. Me,+rane Bo,an %ere%a* d# +aa! e'#%e *ornea (an$ ,er)'a*an *oa$en (an$ %er&)&)n %#da* %era%)r &e'er%# &%ro,a dan +era&a dar# +a$#an &%ro,a. La'#&an #n# %#da* ,e,')n(a# da(a re$enera&#. 7. S%ro,a %erd#r# a%a& a,e (an$ ,er)'a*an &)&)na *oa$en (an$ &e"a"ar 1 den$an a#nn(a 'ada 'er,)*aan %er#!a% a(a,an (an$ %era%)r &edan$ d# +a$#an 'er#/er &era% *oa$en #n# +er-a+an$ %er+en%)*n(a *e,+a# &era%
11
*oa$en ,e,a*an a*%) a,a (an$ *adan$ *adan$ &a,'a# 19 +)an. S%ro,a #n# adaa! ,er)'a*an &e*#%ar >0 dar# *e%e+aan *ornea. 4. La'#&an D)a3& %a!)n 2017 oe! Har,#nder S. D)a dan re*anre*ann(a d# Un#er&#%( o/ No%%#n$!a,. ,er)'a*an &e+)a! a'#&an d# *ornea ,an)&#a. Te+an(a !an(a 19 ,#*ron dan %ere%a* an%ara &%ro,a *ornea dan ,e,+ran De&-e,e%. Me&*# %#'#& a'#&an #n# &an$a% *)a% dan *eda' )dara. 9. Me,+rane De&-e,en% ,er)'a*an ,e,+ran a&e)er dan ,er)'a*an +a%a& +ea*an$ &%ro,a *ornea (an$ d#!a&#*an dar# &e endo%e dan ,er)'a*an ,e,+ran +a&an(a. Me,+rane #n# +er&#/a% &an$a% ea&%#- dan +er*e,+an$ %er)& &e),)r !#d)'. . Endo%e %erd#r# a%a& 1 a'#&an &e den$an +en%)* !e;a$ona +e&arn(a &a,'a# 40 0 ,,. endo%e %#da* ,e,')n(a# da(a re$enera&#.
Ga,+ar 2 : La'#&an Kornea Nor,a
12
S)'a# dara! *ornea +era&a dar# 'e,+))! 'e,+))! dara! *on")n$%#/a e'#&*era dan &*era (an$ +era*!#r d# &e*#%ar #,+)& *orneo&*era. Kornea #%) &end#r# +er&#/a% aa&*)er.5<6
$. F$S$+*+($ !+#'"A
F)n$&# )%a,a *ornea adaa! &e+a$a# ,e,+rane 'ro%e*%#/ dan &e+)a! C"endea (an$ d#a)# -a!a(a )n%)* ,en-a'a# re%#na. Tran&'aran&# *ornea d#,)n$*#n*an oe! &#/a%n(a (an$ aa&*)er ,e,##*# &%r)*%)r (an$ )n#/or, (an$ &#/a% de%)r$e&-en-e n(a. Tran&'aran&# &%ro,a d#+en%)* oe! 'en$a%)ran /#&#& &'e-#a dar# *o,'onen *o,'onen /#+r#. aa)')n #nde*& re/ra*&# dar# ,a&#n$ ,a&#n$ /#+r# *oa$en +er+eda dar# &)+&%an&# #n/#+r#ar d#a,e%er (an$ *e-# 5700 A6 dar# /#+r# dan "ara* (an$ *e-# d#an%ara ,ere*a 5700 A6 ,en$a*#+a%*an 'e,#&a!an dan re$)ar#%a& (an$ ,en(e+a+*an &ed#*#% 'e,+#a&an -a!a(a d#+and#n$*an den$an #n!o,o$en#%a& o'%#*an(a. S#/a% de%)r$e&-en-e d# "a$a den$an 'o,'a +#*ar+ona% a*%#/ dar# endo%e dan /)n$&# +ar+#er dar# e'#%e dan endo%e. Kornea d# "a$a a$ar %e%a' +erada 'ada *eadaan C+a&a! den$an *ada a#r &e+an(a* <=.
5126
Kornea ,ener#,a &)'a# &en&or#& dar# +a$#an o/%a,#* ner)& %r#$e,#n)&. Sen&a&# %a*%# (an$ %er*e-# ')n da'a% ,en(e+a+*an re/e*& 'en)%)'an ,a%a. Se%#a' *er)&a*aan 'ada *ornea 5ero&#
'ene%ra&# +enda
a&#n$
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*era%o*on")n$%##%#& )%ra#oe%6 ,en$e*&'o&e )")n$ &ara/ &en&or#* dan ,en(e+a+*an n(er# (an$ #n%en& d#&er%a# den$an re/e*& a*r#,a&# dan 'en)%)'an +oa ,a%a #no)n%er. Tr#a& (an$ %erd#r# a%a& 'en)%)'an ,a%a #no)n%er 5+e'!aro&'a&,e6 re/e*& a*r#,a&# 5e'#'!ora6 dan n(er# &ea) ,en$ara!*an *e'ada *e,)n$*#nan adan(a -edera *ornea. 56 Se'er%# !an(a en&a &*era dan +adan #%reo)& *ornea ,er)'a*an &%r)*%)r "ar#n$an (an$ +rad#%ro/#* ,e%a+o#&,en(a a,+a% d#,ana #n# +erar%# 'en(e+)!ann(a ")$a a,+a%. Me%a+o#&,e *ornea 5a&a, a,#no dan $)*o&a6 d#'eroe! dar# 7 &),+er (a#%): • •
56
D#/)&# dar# *a'#er*a'#er d#&e*#%arn(a D#/)&# dar# !),or a)o&
13
•
D#/)&# dar# /#, a#r ,a%a
Kornea ,enda'a%*an 'e,a'aran *on&%an dar# ,#*ro+a dan 'en$ar)! #n$*)n$an oe! &e+a+ #%) )n%)* ,e#nd)n$#n(a *ornea ,e,##*# +e+era'a ,e*an#&,e 'er%a!anan. Me*an#&,e 'er%a!anan %er&e+)% %er,a&)* re/e*& +er*ed#' /)n$&# an%#,#*ro+a /#, a#r ,a%a 5#&o&#,6 e'#%e !#dro/o+#* (an$ ,e,+en%)*
+arr#er
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+ere$enera&# &e-ara -e'a% dan en$*a'.56 Ke%#*a 'a%!o$en %ea! ,en$#na&# "ar#n$an ,ea)# e&# *ornea &)'er/#&#a +e+era'a ran%a# *e"ad#an %#'#*a a*an %er"ad# (a#%): 56 • • •
Ter"ad# e&# 'ada *ornea Pa%o$en a*an ,en$#na&# dan ,en$*oon#&a&# &%r),a *ornea An%#+od# a*an ,en$#n/#%ra&# o*a&# #na&# 'a%!o$en Ha&#n(a a*an %a,'a* $a,+aran o'a&#%a& 'ada *ornea dan %#%#* #na&# 'a%!o$en a*an ,e,+)*a e+#! )a& dan ,e,+er#*an $a,+aran #n/#%ra&#
•
• •
*ornea. Ir#%a&# dar# +##* ,a%a de'an den$an !#'o'#on 5),)n(a +er)'a ')& (an$ a*an +era*),)a&# 'ada an%a# dar# +##* ,a%a de'an6. Pa%!o$en a*an ,en$#na&# &e)r)! *ornea Ha&#n(a &%ro,a a*an ,en$aa,# a%ro'# dan ,ee*a% 'ada ,e,+rana de&-e,e% (an$ rea%#/ *)a% dan a*an ,en$!a&#*an de&-e,a%o-ee (an$ d#,ana !an(a ,e,+rana de&-e,en% (an$
•
#n%a*. Ke%#*a 'en(a*#% &e,a*#n 'ro$re&#/ 'er/ora&# dar# ,e,+ran de&-e,en% %er"ad# dan !),or a)o& a*an *e)ar. Ha #n# d#&e+)% )*)& *ornea 'er/ora%a dan ,er)'a*an #nd#*a&# +a$# #n%eren&# +eda! &e-e'a%n(a. Pa&#en a*an ,en)n")**an $e"aa 'en)r)nan #&)& 'ro$re&#/ dan +oa ,a%a a*an ,en"ad# )na*.
. !*AS$F$!AS$ Kera%#%#& da'a% d# +a$# +erda&ar*an : 1. *esi !ornea !eratitis epit-eia
14
E'#%e *ornea %er#+a% 'ada *e+an(a*an "en#& *on")n$%##%#& dan *era%#%#& dan 'ada *a&)&*a&)& %er%en%) ,er)'a*an &a%)&a%)n(a "ar#n$an (an$ %er#+a% 5,#&an(a 'ada *era%#%#& ')n$%a%a &)'er/#&#a#&6. Per)+a!an 'ada e'#%e &an$a% +erar#a&# dar# ede,a +#a&a dan a*)oa&# &a,'a# ero&# *e-#*e-# 'e,+)n%)*an /#a,en% *era%#n#&a&# 'ar&#a dan a#na#n. Le&#e&# #%) ")$a +erar#a&# o*a&#n(a 'ada *ornea. Se,)a ar#a&# #n# ,e,')n(a# ,a*na d#a$no&%#* (an$ 'en%#n$ dan 'e,er#*&aan +#o,#*ro&*o'#* den$an dan %an'a ')a&an /)oro&e#n (an$ ,er)'a*an +a$#an dar# &e%#a' 'e,er#*&aan ,a%a +a$#an )ar.546
!eratitis Stroma
Re&'on &%ro,a *ornea %er!ada' 'en(a*#% %er,a&)* #n/#%ra&# (an$ ,en)n")**an a*),)a&# &e &e radan$ ede,a ,)n-) &e+a$a# 'ene+aan *ornea 'en$*er)!an a%a) 'ar)% 'en#'#&an dan 'er)na*an (an$ da'a% +era*#+a% 'er/ora&# dan a&*)a&r#&a&#. Pada re&'on #n# *)ran$ &'e&#/#* +a$# 'en(a*#% #n# %#da* &e'er%# 'ada *era%#%#& e'#%!e#a dan do*%er &er#n$ !ar)& ,en$anda*an #n/or,a&# *#n#* dan 'e,er#*&aan a+'ra%or#), )n%)* ,ene%a'*an 'en(e+a+n(a. 546 !eratitis "ndoteia
D#&/)n$&# endo%!e#), *ornea a*an +era*#+a% eder,a *ornea (an$ ,)a ,)a ,en$ena# &%ro,a dan e'#%e. In# +er+eda dar# ede,a *ornea (an$ d#&e+a+*an oe! 'en#n$*a%an %e*anan #n%rao*)er (an$ ,)a# 'ada e'#%e *e,)d#an &%ro,a. Sea,a *ornea %#da* %era) &e,+a+ &er#n$ ,a&#! ,)n$*#n d##!a% *ea#nan ,or/oo$#* endo%e *ornea den$an &#%a,'. Se&e radan$ 'ada endo%e 5enda'an *era%#* a%a) keratik precipitat 6 %#da* &ea) ,enanda*an adan(a 'en(a*#% endo%e *arena &e radan$ ")$a ,er)'a*an ,an#/e&%a&# dar# )e#%#& an%er#or (an$ da'a% a%a) %#da* ,en(er%a# *era%#%#& &%ro,a.546
/. +ranisme %enyea !eratitis Bakteria
Le+#! dar# >0 #n/a,a&# *ornea d#&e+a+*an oe! +a*%er#. Se"),a! +a*%er# (an$ da'a% ,en$#n/e*&# *ornea (a#%) S%a'!(o-o--)& e'#der,#& S%a'!(o-o--)& a)re)& S%re'%o-o--)& 'ne,on#ae *o#/or,#& '&e)do,ona& dan
15
!ae,o'!#)&. Ke+an(a*an +a*%er# %#da* da'a% ,ene%ra&# *ornea &e'an"an$ e'#%e *ornea ,a&#! #n%a*. Han(a +a*%er# $ono-o--# dan d#/%er# (an$ da'a% ,ene%ra&# e'#%e *orea (an$ #n%a*. Ge"aa $e"aan(a an%ara a#n (a#%) n(er# /o%o/o+#a #&)& e,a! a*r#,a&# dan &e*re% ')r)en. Se*re% ')r)en *!a& )n%)* *era%#%#& +a*%er# &edan$*an *era%#%#& #r)& ,e,')n(a* &e*re% (an$ +era#r.5196 Tera'# *on&era%#/ 'ada *era%#%#& +a*%er# adaa! an%#+#o%#* %o'#*a 5o/o;a-#n dan 'o(,#;#n6 (an$ +er&'e*%r), )a& )n%)* +a*%er# $ra, 'o&#%#/ dan +a*%er# $ra, ne$a%#e &a,'a# !a&# *)%)r 'a%!o$en dan re&#&%en&# d#*e%a!)#. I,,o+##&a&# +adan &##ar dan #r#& oe! %era'# ,#dr#a&#& d##nd#*a&#*an "#*a ada #r#%a&# #n%rao-)ar. Kera%#%#& +a*%er# da'a% d#%era'# 'er%a,a *a#n(a den$an %e%e& ,a%a a%a)')n &ae'. Tera'# 'e,+eda!an +er)'a *era%o'a&%# e,er$en-( d#a*)*an "#*a %erda'a% de&-e,a%o-e a%a) )*)& *ornea (an$ 'er/ora&#.596
Keratitis Bateri
!eratitis ira
16
!eratitis Herpes Simpe2
Terda'a% d)a +en%)* *era%#%#& !er'e& &#,'e; (a#%) 'r#,er dan re*)ren&. Kera%#%#& "en#& #n# ,er)'a*an 'en(e+a+ )*)& (an$ 'a#n$ ),), dan 'en(e+a+ *e+)%aan *ornea (an$ 'a#n$ ),),. Ge"aan(a (a#%) &an$a% n(er# photophobia !#'era*r#,a&# dan 'e,+en$*a*an 'ada *eo'a* ,a%a. Ben%)* *era%#%#& #r)& !er'e& &#,'e*& d#+eda*an +erda&ar*an o*a&# e&# 'ada a'#&an *ornea. Kera%#%#& dendr#%#- ,e,')n(a# *!a& e&# e'#%e (an$ +er-a+an$ &en&#%#/#%a& *ornea ,en)r)n dan da'a% +er*e,+an$ ,en"ad# *era%#%#& &%ro,a. Kera%#%#& &%ro,a #n# ,e,')n(a# e'#%e (an$ #n%a* 'ada 'e,er#*a&aan &#%a,' ,en)n")**an #n/#%ra%e *ornea d#&#r/or,#& &en%ra. Sedan$*an *era%#%#& endo%!e#), %er"ad# *arena #r)& !er'e& &#,'e*& %erda'a% 'ada !),or a)o& (an$ ,en(e+a+*an 'e,+en$*a*an &e endo%e. Dan &#ndro, ne*ro&#& re%#na a*)% ,en$ena# +oa ,a%a +a$#an 'o&%er#or (an$ %er#+a% 'ada 'a&#en #,)no*o,'ro,#& 5AIDS6. 596 Pen$o+a%an da'a% d#+er#*an #r)&%a%#*a &e'er%# IDU %r#/)or#%#,#d#n dan a&#*o#r. Pe,+er#an &%rero#d 'ada 'ender#%a !er'e& &an$a% +er+a!a(a *arena $e"aa a*an &an$a% +er*)ran$ a*an %e%a'# 'ro&e& +er"aan %r)& *arena da(a %a!an %)+)! (an$ +er*)ran$. 596
!eratitis Herpes ooster
Kera%#%#& !er'e& 8o&%er ,er)'a*an ,an#/e&%a&# #n/e*&# #r)& !er'e& 8o&%er 'ada -a+an$ 'er%a,a &ara/ %r#$e,#n)& %er,a&)* ')n-a* !#d)n$ dan de,#*#an
17
')a den$an *ornea a%a) *on")n$%#a. B#a %er"ad# *ea#nan &ara/ %r#$e,#n)& #n# ,a*a a*an ,e,+er#*an *e)!an 'ada daera! (an$ d#'er&ara/#n(a dan 'ada !er'e& 8o&%er a*an ,en$a*#+a%*an %erda'a%*an e&#*e 'ada *)#%. Pada ,a%a a*an %era&a &a*#% den$an 'era&aan (an$ +er*)ran$ 5ana&%e&#a dooro&a6. Pen$o+a%an adaa! &#,%o,a%#* &e'er%# 'e,+er#an ana$e%#*a #%a,#n dan an%#+#o%#* %o'#-a a%a) ),), )n%)* ,en-e$a! #n/e*&# &e*)nder. 596
!eratitis 4amur
Pa%!o$en (an$ e+#! &er#n$ adaa! A&'er$#)& dan @and#da a+#-an&. Me*an#&,e (an$ &er#n$ adaa! %ra),a %er*ena +a!an +a!an or$an#- (an$ ,en$and)n$ "a,)r &e'er%# ran%#n$ 'o!on. Pa&#en 'ada ),),n(a ,en$e)!*an $e"aa (an$ &ed#*#%. Pada #n&'e*&# d#da'a%*an ,a%a ,era! )*)& (an$ +er+a%a& %e$a& dan da'a% ,e)a& ,en"ad# )*)& *ornea &er'#$#n)o)&. Pada 'e,er#*&aan &#%a,' ,en)n")**an #n/#%ra%e &%ro,a (an$ +erarna ')%#! *ea+)an *!)&)!n(a "#*a 'en(e+a+n(a adaa! -and#da a+#-an&. Le&# e&# (an$ e+#! *e-# +er*eo,'o* ,en$###n$# e&# (an$ +e&ar ,e,+en%)* e&# &a%e#%. Inden%#/#*a&# ,#*ro+#oo$# "a,)r &)#% dan ,e,a*an a*%). Pen$o+a%an *on&era%#/ +er)'a an%# n#*o%#* %o'#*a &e'er%# na%a,(-#n n(&%a%#n dan a,'!o%er#&#n B &edan$*an %#nda*an 'e,+eda!an +er)'a *era%o'a&%# "#*a den$an 'en$o+a%an *on&era%#/ $a$a dan *eadaan ,a*#n ,e,+)r)* daa, 'eraa%an. 596
18
$.
("4A*A !*$'$S
Pada ana,ne&#& 'a&#en +#&a d#da'a%*an +e+era'a $e"aa *#n#& 'ada 'a&#en (an$ %er*a#% den$an 'er"aan 'en(a*#% *era%#%#& ')n$%a%a &)'er/#&#a. Pa&#en da'a% ,en$e)!*an adan(a ra&a n(er# 'en$e)aran a#r ,a%a +ere+#!an /o%o/o+#a 'en)r)nan #&)& &en&a&# +enda a&#n$ ra&a 'ana& #r#%a&# o*)er dan +e/aro&'a&,e. Oe! *arena *orea ,e,##*# +an(a* &era% &era% &ara/ *e+an(a*an e&# *ornea +a#* &)'er#&#a a%a)')n 'ro/)nda da'a% ,en(e+a+*an n(er# dan /o%o/o+#a. N(er# 'ada *era%#%#& d#'er'ara! de$an 'er$era*an dar# 'a'e+ra 5),)nn(a 'a'e+ra &)'er#or6 %er!ada' *ornea dan +#a&an(a ,ene%a' !#n$$a %er"ad# 'en(e,+)!an *arena *ornea +er&#/a% &e+a$a# "endea ,a%a dan ,ere/ra*&#*an -a!a(a e&# *ornea &er#n$ *a# ,en$a*#+a%*an 'en$#!a%an ,en"ad# *a+)r %er)%a,a *e%#*a e&#n(a +erada d#+a$#an Sen%ra. 546 Pada *era%#%#& ')n$%a%a &)'er/#&#a d#da'a%*an e&# *ornea +er)'a e&# e'#%!e#a ,)%#'e &e+an(a* 1 90 e&# 5ra%a ra%a &e*#%ar 20 e&# d#da'a%*an6. Le&# e'#%!e#a (an$ d#da'a%*an 'ada *era%#%#& ')n$%a%a &)'er/#&#a +er)'a *),')an +#n%#* +#n%#* *ea+) (an$ +er+en%)* oa a%a) +)a% dan -ender)n$ +era*),)a&# d# daera! ')'#. O'a&#%a& 'ada *ornea %er&e+)% %#da* %a,'a*
19
a'a+#a d# #n&'e*&# &e-ara an$&)n$ %e%a'# da'a% d##!a% den$an &#%a,' a%a)')n o)' &e%ea! d#+er# /o)re&en%. 576 Sen&#%#/#%a& *ornea ),),n(a nor,a a%a) !an(a &ed#*#% +er*)ran$ %a'# %#da* 'erna! ,en$!#an$ &a,a &e*a# &e'er%# 'ada *era%#%#& !er'e& &#,'e*&. aa)')n ),),n(a re&'on& *on")n$%#a %#da* %a,'a* 'ada 'a&#en a*an %e%a'# rea*&# ,#n#,a &e'er%# #n"e*&# *on")n$%#a +)+ar da'a% d##!a% 'ada 'a&#en. 546
$$.
)$A('+S$S
Ke-)r#$aan a*an adan(a *era%#%#& 'ada 'a&#en da'a% %#,+) 'ada 'a&#en (an$ da%an$ den$an %r#a& *e)!an *era%#%#& (a#%) $e"aa ,a%a ,era! ra&a &#a) 5/o%o/o+#a6 dan ,era&a *e##'an 5+e/aro&'a&,a6. Ada')n radan$ *ornea #n# +#a&an(a d#*a&#/#*a&#*an daa, a'#&an *ornea (an$ %er*ena &e'er%# *era%#%#& &)'er/#&#a dan #n%er&%#&#a a%a) 'ro/)nda. Kera%#%#& &)'er/#&#a %er,a&)* e&# #n/a,a&# dar# e'#%e *ornea dan ,e,+ran +o,an &)'er/#&#a %er*a#%. 526 F)ore&e#n adaa! 'earna *!)&)& (an$ d#'a*a# )n%)* ,e,)a& *ornea dan ,enon"o*an &e%#a' *e%#da*%era%)ran 'ada 'er,)*aan e'#%en(a. F)ore&e#n %o'#*a ,er)'a*an ar)%an 'earna !ater-soluble (an$ non%o*&#* dan%er&ed#a daa, +er+a$a# +en%)* -on%o!n(a d#&er%a# den$an o+a% ane&%e%#* 5+eno;#na%e or 'ro'ra-a#ne6 a%a) den$an an%#&e'%#* 5'o#done#od#ne6. Se-ar#* *er%a& &%er# den$an /)ore&e#n d#+a&a!# den$an &a#ne &%er# a%a) ane&%e%#* o*a dan d#%e,'e*an 'ada 'er,)*aan daa, 'a'e+ra #n/er#or )n%)* ,e,#nda!*an 'earna *e*)n#n$an #%) *e daa, a'#& a#r ,a%a.52=6 Fo)ren&-e#n da'a% ,ea*)*an 'ene%ra&# 'ada #n%ra&e)er *ornea na,)n "#*a a'#&an e'#%e *ornea #n%a* ,a*a ar)%an /o)ren&-e#n& #n# %#da* +#&a ,ene,+)& e'#%e. Lar)%an /o)ren&-e#n #n# e+#! ,)da! d#o+&era&# 'ada *ornea d#+and#n$*an 'ada *on")n$%#a ,a*a 'e,er#*&aan /o)ren&-e#n #n# ,er)'a*an 'e,er#*&aan (an$ d#+)%)!*an daa, ,en$ea)a&# *ea#nan d# *ornea. Lar)%an /ore&en& d#%e%e&*an 'ada ,a%a dan ,a%a d#'er#*&a den$an ,en$$)na*an &#% a,' a%a)')n den$an #),#na&# %eran$ dan ,e#!a% ,en$$)na*an o)'. Ha %er&e+)% da'a% ,e,+er#*an $a,+aran de/e* e'#%!e#a. Poa d#&%r#+)&# /o)re&en&# (an$
20
&'e&#/#* da'a% &e+a$a# #n/or,a&# (an$ +er$)na daa, ,ene$a**an *e,)n$*#nan e%#oo$# dan *era%#%#& ')n$%a%a &)'er/#&#a.5>6 Pe,er#*&aan a+ora%or#), den$an ,ea*)*an *)%)r dar# /ora *ornea d#a*)*an &ea,a %er"ad# #n/a,a&# a*%#/ da'a% ,e,+an%) daa, 'ene#%#an &ean")%n(a a*an %e%a'# !a %er&e+)% %#da* +e$#%) &#$n#/#*an daa, 'ene$a*an d#a$no&#& dan 'ena%aa*&ana 'en(a*#% *era%#%#& ')n$%a%a &)'er/#&#a. Pe,er#*&aan 'en-#%raan den$an ,en$$)na*an /o%o$ra/# &#% a,' )n%)* ,endo*),en%a&#*an #n/a,a&# a*%#/ dan 'er#ode #na*%##%a& da'a% d#a*)*an %a'# !a %er&e+)% ")$a %#da* +e$#%) 'en%#n$ daa, 'ene$a*an d#a$no&#& ,a)')n 'enan$anan 'en(a*#%. 56
$$$. )$A('+S$S )$F"#"'T$A* &5eitis Ue#%#& adaa! 'eradan$an (an$ %er"ad# 'ada #r#& -or')& -##are a%a)
*oro#d. Ue#%#& da'a% ")$a %er"ad# &e*)nder a*#+a% *era%#%#& a%a) &*er#%#&. Ue#%#& +#a&an(a %er"ad# 'ada )&#a 2090 %a!)n. Ue#%#& da'a% d# +a$# ,en"ad# 7 +en%)* (a#%) )e#%#& an%er#or #n%er,ed#e% dan 'o&%er#or. Ge"aa 'ada )e#%#& an%er#or adaa! n(er# /o%o/o+#a dan 'en$#!a%an *a+)r. Ue#%#& an%er#or +#a&an(a %er"ad# )n#a%era dan on&e%n(a a*)%. Tanda dar# )e#%#& #n%er,ed#e% adaa! 'eradan$an #%re)&. Ue#%#& #n%er,ed#e% ,e,##*# $e"aa *!a& (a#%) floaters dan 'en$#!a%an *a+)r. N(er# /o%o/o+#a dan ,a%a ,era! +#a&an(a %#da* ada. Sedan$*an $e"aa 'ada )e#%#& 'o&%er#or adaa! floaters *e!#an$an a'an$an 'andan$ a%a) 'en)r)nan %a"a, 'en$#!a%an (an$ ,)n$*#n 'ara!. 516
21
Ga,+ar 9. )e#%#&
(aukoma akut sudut tertutup Ga)*o,a &)d)% %er%)%)' a*)% 5$a)*o,a a*)%6 %er"ad# +#a +en%)* #r#&
+o,+e (an$ ,en(e+a+*an o*)&# &)d)% +##* ,a%a de'an oe! #r#& 'er#/er. Ha #n# a*an ,en$!a,+a% a#ran *e)ar a)eo)& dan %e*anan #n%rao*)ar ,en#n$*a% den$an -e'a% ,en#,+)*an n(er# !e+a% *e,era!an dan 'en$#!a%an *a+)r.516
22
Ga,+ar . Ga)*o,a a*)%
+ftamika Simpatika
O/%a,#*a S#,'a%#*a ,er)'a*an 'eradan$an +#a%eraden$an $e"aa *#n#& 'en$#!a%an ,en)r)n dan ,a%a ,era!. B#a&an(a %er"ad# a*#+a% %ra),a %e,+)& a%a) +eda! ,a%a #n%rao*)ar. Tanda d#n# dar# 'en(a*#% #n# adaa! $an$$)an +#no*)ar a*o,oda&# a%a) %anda radan$ r#n$an )ea an%er#or a%a)')n 'o&%er#or. Tanda (an$ %er#!a% adaa! ,a%a &a*#% dan /o%o/o+#a 'ada *ed)a ,a%a.
546
"ndoftamitis
Mer)'a*an 'eradan$an +era% daa, +oa ,a%a +#a&an(a a*#+a% #n/e*&# &e%ea! %ra),a a%a) +eda! a%a) endo$en a*#+a% &e'&#&. Endo/%a,#%#& %er+a$# d)a (a#%) endo/%a,#%#& e*&o$en a*#+a% %ra),a a%a) #n/e*&# &e*)nder &e%ea! 'ro&e& 'e,+eda!an dan endo/%a,#%#& endo$en %er"ad# a*#+a% 'en(e+aran +a*%er# "a,)r a%a)')n 'ara&#% dar# /o*)& #n/e*&# d# daa, %)+)!. Peradan$an a*#+a% +a*%er# a*an ,e,+er#*an $a,+aran *#n#* ra&a &a*#% (an$ &an$a% *eo'a* ,era! dan +en$*a* *eo'a* &)*ar d# +)*a *on")n$%#a *er)! dan ,era! *ornea *er)! BMD *er)! (an$ *adan$*adan$ d# &er%a# !#'o'#on. 546
23
Endo/%a,#%#&
$.
%"'ATA*A!SA'AA'
Pena%aa*&aan dar# *era%#%#& +#a&an(a &#,'%o,a%#* : 546 1. Ar%#/#-#a %ear& ,e,+an%) ,a%a ,en$e)ar*an +enda a&#n$ 2. S'e-#/#- %rea%,en% da'a% d#%a,+a!*an 'ada 'a&#en ,#&an(a an%##ra "#*a 'en(e+a+n(a adaa! #r)& Re&'on -e'a% a,+a%n(a *ornea 'ada a$en #n/e*&#n(a +er$an%)n$ 'ada 'en(e+a+n(a ,a*a d#+er#*an 'en$o+a%an +er)'a ar%#/#-#a %ear& )n%)* ,e,+an%) ,a%a ,en$e)ar*an a$en 'en(e+a+ #r#%a&# 'ada *ornea. Se*#%ar >0 dar# #n/a,a&# *ornea d#&e+a+*an oe! +a*%er#. Sea#n #%) e'#%e (an$ %#da* #n%a* da'a% &e+a$a# "a)r 'ene%ra&# dar# +a*%er# *e daa, *ornea. Penan$anan d#aa# den$an an%#+#o%#* %o'#*a den$an a*%##%a& +road &'e-%r), %er!ada' *e+an(a*an or$an#&,e Gra,'o&#%#/ dan Gra,ne$a%#e !#n$$a !a&# *)%)r dan %e& &en&#%#/#%a& d#*e%a!)#. Re$#,en aa (an$ d#+er#*an %er,a&)* a,#no$(-o&#de den$an -e'!ao&'or#n $enera&# 'er%a,a &e%#a' 1970 ,en#%. Ser#n$*a# d#$)na*an -#'ro/o;a-#n 07 (an$ ,e+er#*an 'er-e'a%an a*%) ra%a ra%a 'en(e,+)!an dan 'en)r)rnan %era'# d#+and#n$*an %era'# *onen&#ona.eo/o;a-#n ,a)')n
24
o/o;a-#n ,e,##*# 'ene%ra&# a)eo)& dan #%re)& (an$ +a#* den$an 'e,+er#an ora.5246
. %#+('+S$S
Se-ara ),), 'ro$no&#& dar# *era%#%#& ')n$%a%a &)'er/#&#a adaa! +a#* "#*a %#da* %erda'a% &#*a%r#*& a%a)')n a&*)ar#&a&# dar# *ornea. Se&)a# den$an ,e%ode 'enan$anan (an$ d#a*&ana*an 'ro$no&#& daa, !a #&)& 'ada 'a&#en den$an *era%#%#& ')n$%a%a &)'er/#-#a &an$a% +a#*. S#*a%r#*& 'ada *ornea da'a% %#,+) 'ada *a&)&*a&)& den$an *era%#%#& ')n$%a%a &)'er/#&#a (an$ +eran$&)n$ a,a. 596
)AFTA# %&STA!A 1!
Va)$!an DA&+)r( TR#ordanEa P. $enera O'!%!a,oo$(. 1<%!
2.
ed#%#on. @onne-%#-)% A''e%on an$e 1>>>. '. 17> R#ordanEa. Ana%o,( and e,+r(oo$( o/ T!e E(e. In : Va)$!an DA&+)r( TR#ordanEa P. $enera O'!%!a,oo$(. 19%! ed#%#on.
7.
@onne-%#-)% A''e%on an$e 1>>>. '. 12 Do$$ar% ?H. S)'er/#-#a P)n-%a%e Kera%#%#& on#neJ. 1>77 -#%ed 2011
7.
?)(J 1&-reenJ. $yas S. ata era- denan %eni-atan Turun endadak. )aam 8 $yas S. $mu%enyakit ata. "disi ketia. 4akarta 8 Baai
9.
%enerit F!&$ /00:. H 17;<;: K!)rana KA. D#&ea&e& o/ %!e @ornea. In: K!)rana KA ed#%or&.
@o,'re!en&#e O'!%!a,oo$( 4%! ed. Ne De!#: Ne A$e 6.
In%erna%#ona. 200<. '. 91 =2. *an (!. Cornea. $n 8 *an (!. +p-t-amooy A %o=ket Te2took Atas. /nd edition. Stuttart t-ieme /00;. p. 11><60
25
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PaanLan$&%on D. @ornea and E;%erna De&ea&e. In: PaanLan$&%on D. Man)ao/ O-)ar D#a$no&#& and T!era'!(. 9 %! ed#%#on.
=.
P!#ade'!#a L#''#n-o%% ##a,& #*#n& 2002. '. <12> T!e E(e M.D. A&&o-#a%#on. E;%erna D#&ea&e& and @ornea #n Ba&#- and @#n#-a S-#en-e @o)r&e A,er#-an A-ade,( o/ O'%!a,oo$(.
9.
L#/eon$ Ed)-a%#on /or %!e O'%!a,oo$#&%. 20112012. '. %fufeder, Step-en C. Beuerman, #oer ?. Stren, i=-ae S. )ry "ye and +=uar Surfa=e )isorder. ar=e )ekker. /007. p. /:><9>
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