r.prabowo profesi dokter fk.ugm 2007 (bobby) dr. rinanto prabowo, sp.m., m.sc.pdf · kelainan...
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![Page 1: R.Prabowo Profesi Dokter FK.UGM 2007 (Bobby) dr. Rinanto Prabowo, Sp.M., M.Sc.pdf · Kelainan refraksi tinggi (myopia ≥ - 5D, hyperopia ≥ +4D) Kornea tipis Corneal tomography](https://reader030.vdocument.in/reader030/viewer/2022013022/5f7f272e03f0fb41fd3924d1/html5/thumbnails/1.jpg)
Pembicara
Invited Speaker PIT 2016-2019
Invited Speaker Young Ophthalmologist Program 2016-2019
Invited speaker Zeiss Trifocal IOL, Jepara 2017
Invited speaker 4th Biennial Meeting Inascrs 2017
Invited speaker PAO Annual Meeting, Manila 2018
Invited Speaker JECIM, Jakarta 2018
Pendidikan
Profesi Dokter FK.UGM 2007
Profesi Dokter Spesialis Mata FK.UGM 2014
Master Ilmu Kedokteran Klinik FK.UGM 2014
Instruktur Phacoemulsifikasi 2014 UGM 2014
Member of Korean College of Cosmetic Surgery 2014
Member of Asia Cornea Society 2015
Member of INAVRS 2016
Member of INASCRS 2016
Member of APACRS 2016
Member of ESCRS 2017
R.Prabowo
(Bobby)
Pembicara
Advisory board of Alcon trifocal IOL 2018
Invited Speaker Foresight, Seoul 2018
Invited speaker of Tecnis Symfony IOL, Surabaya 2018
Invited speaker of Centurion User Meeting, Bandung 2019
Invited speaker of KMU Edu, Gresik 2019
Invited speaker 5th Biennial Meeting Inascrs, Jakarta 2019
Pembicara
Invited speaker Premium IOL meeting, Jogja 2019
Invited speaker of Medical and Surgical Refraction
Seminar, Semarang
2020
Invited speaker JECIM, Jakarta 2020
Invited speaker Basic Evolution Innovative IOL
Technology, JECIM, Jakarta
2020
Invited speaker Premium IOL meeting, Bandung 2020
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“Dr.YAP”RUMAH SAKIT MATA
YOGYAKARTA
Jl. Cik Ditiro No. 5 Yogyakartawww.yap.or.id
Manajemen Kelainan
Refraksi dengan
Phakic IOL dan
Toric IOL
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LOVE THE ENDOTHELIUM
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KELAINAN REFRAKSI
Myopia
Hypermetropia
Astigmatism
Presbyopia
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METODE KOREKSI
KELAINAN REFRAKSI
Laser in situ keratomileusis (LASIK)
Photorefractive Keratotomy (PRK)
Refractive Lenticule Extraction, Small Incision Lenticule Extraction
(ReLEx SMILE)
Phakic IOL (pIOL)
Refractive Lens Exchange (RLE)
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Barsam A, Allan BDS. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database of
Systematic Reviews 2014, Issue 6. Art. No.: CD007679. DOI: 10.1002/14651858.CD007679.pub4.
![Page 8: R.Prabowo Profesi Dokter FK.UGM 2007 (Bobby) dr. Rinanto Prabowo, Sp.M., M.Sc.pdf · Kelainan refraksi tinggi (myopia ≥ - 5D, hyperopia ≥ +4D) Kornea tipis Corneal tomography](https://reader030.vdocument.in/reader030/viewer/2022013022/5f7f272e03f0fb41fd3924d1/html5/thumbnails/8.jpg)
Nanavaty MA, Daya SM. Refractive lens exchange versus phakic intraocular lenses. Curr Opin Ophthalmol 2012, 23:54 – 61
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PHAKIC IOL
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PHAKIC IOL
Lensa tambahan yang diimplantasi di kamera oculi anterior atau
posterior untuk koreksi kelainan refraksi dengan preservasi lensa
mata serta kemampuan akomodasinya
Seringkali digunakan sebagai metode koreksi kelainan refraksi
pada pasien dengan moderate to high refractive error
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KEUNTUNGAN PHAKIC IOL
Menjaga arsitektur kornea
Menjaga fungsi lensa mata (kemampuan akomodasi)
Menjaga tear film
Hasil refraksi dapat diprediksi
Reversibel
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KRITERIA INKLUSIUsia > 21 tahun
Refraksi stabil (perubahan visus <0.5D) minimal 1 tahun terakhir
Tidak dapat dikoreksi dengan prosedur laser
Toleransi buruk terhadap kacamata maupun lensa kontak
Irido-corneal angle ≥ 30o
Anterior chamber depth (ACD) ≥ 2.5-3.0 mm tergantung jenis pIOL
cECC >2.300 sel/mm2 (>2.500 sel/mm2 jika usia >21 tahun, >2.000 jika usia >40 tahun)
Tidak ada kelainan fungsi iris maupun pupil
Ukuran pupil mesopic <5-6 mm
Guell JL et al. Phakic intraocular lenses. Part 1: Historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg 2010;
36:1976–1993
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KRITERIA EKSKLUSI
Adanya penyakit pada segmen anterior
Uveitis rekuren atau kronis
Adanya katarak yang signifikan secara klinis
Riwayat operasi kornea atau intraokular
TIO >21mmHg atau glaukoma
Adanya degenerasi makular atau kelainan makula
Abnormalitas retina
Adanya penyakit sistemik (kelainan autoimun, DM, atopi)
Guell JL et al. Phakic intraocular lenses. Part 1: Historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg 2010;
36:1976–1993
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INDIKASI & KONTRAINDIKASI
INDIKASI
Kelainan refraksi tinggi (myopia ≥ -
5D, hyperopia ≥ +4D)
Kornea tipis
Corneal tomography abnormal
Dry eye
Kontraindikasi pada korneorefractive
surgery
KONTRAINDIKASI
Usia >45 tahun
ECC < 2500 sel/mm2
ACD <3.0 mm
ACA <30o
TIO > 20 mmHg
Kelainan intraokular
Sinjab MM. Five Steps to Start Your Refractive Surgery: A Case-Based Systematic Approach. Jaypee Brothers Medical Publishers: 2014.
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PEMERIKSAAN PRE-OP
Pemeriksaan visus
uncorrected & corrected
Pemeriksaan slit-lamp
Tonometri
Motilitas okular
Ukuran, bentuk, dan lokasi
pupil
Specular biomicroscopy
Corneal tomography
Biometri
White-to-white measurement
Pemeriksaan fundus
Penghitungan pIOL power
Guell JL et al. Phakic intraocular lenses. Part 1: Historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg 2010;
36:1976–1993
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JENIS PHAKIC IOL1. Anterior Chamber Intraocular Lenses
(ACIOL)
• Angle-supported ACIOL
• Iris-fixated ACIOL
2. Posterior Chamber Intraocular Lenses
(PCIOL)
• Sulcus-supported PCIOL
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ANGLE-SUPPORTED ACIOL
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IRIS-FIXATED ACIOL
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IRIS-CLAW IOL ANTERIOR
1. Buat irisan 5.5 mm sklerokorneal/kornea
2. Buat dua parasentese 45o dari insisi utama
3. Masukkan iris claw di anterior chamber
4. Injeksi 2% HPMC
5. Pegang optic lensa dengan lensa forcep
6. Kaitkan iris perifer ke haptic dengan sinsky
hook/chopper/jarum udara
7. Lakukan pada haptic berikutnya
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IRIS-CLAW IOL ANTERIOR
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SULCUS-SUPPORTED PCIOL
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KOMPLIKASI
Angle-supported resiko dekompensasi endotel
Iris-fixated teknik implantasi cukup rumit
Posterior chamber meningkatkan resiko katarak
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TORIC IOL
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METODE KOREKSI
ASTIGMATISMA
Limbal relaxing incisions/arcuate keratotomy
Laser in situ keratomileusis (LASIK)
Photorefractive Keratotomy (PRK)
Pemasangan toric IOL
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TORIC IOL
Toric IOL adalah lensa intraokular yang bertujuan mengkoreksi
astigmatisma yang dapat terjadi post operasi katarak
Pada 1/3 pasien katarak, sudah terdapat astigmatisma 1 D atau
lebih
22% memiliki astigmatisma >1.5 D
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Yamauchi et al. Comparison of visual performance of toric vs non-toric intraocular lenses with same material. Clinical Ophthalmology 2018:12 2237–2243
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Yamauchi et al. Comparison of visual performance of toric vs non-toric intraocular lenses with same material. Clinical Ophthalmology 2018:12 2237–2243
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Visser N et al. Toric intraocular lenses: Historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J
Cataract Refract Surg 2013; 39:624–637
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INDIKASI
INDIKASI
Sesuai indikasi tindakan ekstraksi
katarak
Astigmatisma pre-op ≥ 1-1.5 D
KONTRAINDIKASI
Astigmatisma irregular akibat ulkus
kornea atau ectasia
Instabilitas zonular
Dehisensi kapsul posterior
Dilatasi pupil buruk
Riwayat operasi mata (prosedur
vitreoretina)
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PEMERIKSAAN PRE-OP
Pemeriksaan pre-op katarak
Keratometry penting untuk menentukan IOL power dan axis
Penghitungan toric IOL power
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JENIS TORIC IOL
Monofocal toric IOL
Multifocal toric IOL
Toric phakic IOL
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PERSIAPAN PRE-OP
Salah satu persiapan pre-op terpenting adalah marking kornea
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PROSEDUR
TORIC MONOFOCAL IOL
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PROSEDUR
TORIC MULTIFOCAL IOL
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TOP 4 ERROR
PEMASANGAN TORIC IOL
1. Kesalahan pengukuran pre-op
2. Kesalahan marking kornea
3. Kesalahan peletakan IOL
4. Tidak memperhitungkan surgically induced astigmatism
membutuhkan kemahiran dan ketelitian operator
Roach L. Toric IOLs: Four Options for Addressing Residual Astigmatism.
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REFERENSI
Barsam A, Allan BDS. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD007679. DOI: 10.1002/14651858.CD007679.pub4.
Nanavaty MA, Daya SM. Refractive lens exchange versus phakic intraocular lenses. Curr Opin Ophthalmol 2012, 23:54 – 61
Guell JL et al. Phakic intraocular lenses. Part 1: Historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg2010; 36:1976–1993
Kohnen et al. Phakic intraocular lenses. Part 2: Results and complications. J Cataract Refract Surg 2010; 36:2168–2194
Sinjab MM. Five Steps to Start Your Refractive Surgery: A Case-Based Systematic Approach. Jaypee Brothers Medical Publishers: 2014.
Pineda II R, Chauhan T. Phakic Intraocular Lenses and their Special Indications. J Ophthalmic Vis Res 2016; 11 (4): 422–428.
Yamauchi et al. Comparison of visual performance of toric vs non-toric intraocular lenses with same material. Clinical Ophthalmology 2018:12 2237–2243
Roach L. Toric IOLs: Four Options for Addressing Residual Astigmatism.
Visser N et al. Toric intraocular lenses: Historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J Cataract Refract Surg 2013; 39:624–637
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“Dr Yap” eye hospital Cold Phacoemulsification Cataract Surgery
2014
Terima kasih