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Descolamento de retina

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Descolamento de retina

  1. 1. DESCOLAMENTO DE RETINA Marcell Leão R1 Oftalmologia-HBDF 2012
  2. 2. HISTÓRIA 1722- St.Yves 1851- Helmholtz 1920s – Jules Gonin
  3. 3. DEFINIÇÃO
  4. 4. DEFINIÇÃO
  5. 5. DEFINIÇÃO
  6. 6. DEFINIÇÃO
  7. 7. EPIDEMIOLOGIA População geral - 1:10000 Prevalência 0,3% /Míopes 5% /Afácicos 2% (10%) 40-50% - míopes 30-40% - afácicos/pseudofácicos 10-20% - história de trauma ocular direto
  8. 8. FISIOPATOLOGIA Regmatogênico ou DR primário • Tração vítreo-retiniana dinâmica + Predisposição > Ruptura • Vítreo sinequítico > DPV agudo
  9. 9. FISIOPATOLOGIA
  10. 10. FISIOPATOLOGIA
  11. 11. FISIOPATOLOGIA
  12. 12. FISIOPATOLOGIA
  13. 13. FISIOPATOLOGIA
  14. 14. FISIOPATOLOGIA
  15. 15. FISIOPATOLOGIA
  16. 16. FISIOPATOLOGIADR TRACIONAL DIABÉTICO DR TRACIONAL TRAUMÁTICO
  17. 17. FISIOPATOLOGIA DR EXSUDATIVO
  18. 18. DIAGNÓSTICO – DR REGMATOGÊNICO • Fotopsias • CorposSintomas flutuantes • Defeitos de campo visual
  19. 19. DIAGNÓSTICO
  20. 20. DIAGNÓSTICO • Pupila de Marcus Gunn • PIO reduzidaSinais • Irite • “Poeira de tabaco” • Rupturas
  21. 21. DIAGNÓSTICODR Recente DR Antigo
  22. 22. DIAGNÓSTICO
  23. 23. DIAGNÓSTICO- DR TRACIONAL Fotopsia / Corpos Flutuantes - raramente Defeito visual lento Ausência de ruptura Mobilidade diminuida Deslocamento de líquido ausente
  24. 24. DIAGNÓSTICO – DR EXSUDATIVO Fotopsia – ausente Perda visual – progressão rápida Configuração semelhante ao regmatogênico, porém superfície é lisa Deslocamento de líquido
  25. 25. Diagnóstico Diferencial RETINOSQUISE DEGENERATIVA DESCOLAMENTO DE CORÓIDE  Fotopsias/Corpos flutuantes ausentes/ PIO baixa/ CA rasa S. EFUSÃO UVEAL  Idiopática/ Homens hipermétropes/ Descolamento cileocóróide seguido de DR exsudativo
  26. 26.  Tratamento profilático Tipo Tamanho Localização Sintomas Pigmentação Afácicos/Pseudofácicos Miopia História familia Doenças sistêmicas
  27. 27. PROGNÓSTICO Duração do envolvimento macular  Sem envolvimento / 10 dias ou menos / Mais de 2 meses Altura do descolamento macular Idade
  28. 28. TRATAMENTO Retinopexia Pneumática  SF6 ou C3P8  Rápido, minimamente invasivo, ambulatorial  DR não complicado
  29. 29. TRATAMENTO Introflexão escleral
  30. 30. TRATAMENTO Introflexão escleral
  31. 31. TRATAMENTO Vitrectomia  Rupturas que não podem ser visualizadas  DR tracional ameaçando a mácula  DR tracional- regmatogênico  Prevenção de DR tracional  DR tracional tardio(envolvendo CE)
  32. 32. TRATAMENTO
  33. 33. TRATAMENTO
  34. 34. BIBLIOGRAFIA KANSKI, Jack J. Oftalmologia Clínica. 6 ed. Rio de Janeiro: Elsevier, 2008 ÁVILA, Marcos; LAVINSKY, Jacó; JÚNIOR, Carlos Augusto Moreira. Retina e Vítreo, Série Oftalmologia Brasileira 2ª ed. Rio de Janeiro : Cultura Médica : Guanabara Koogan, 2011. Retinal Detachment Treatment & Management . Author: Gregory L Larkin, MD, MS, MSPH, FACEP Professor of Surgery, Associate Director of Emergency Medicine, Department of Surgery, Section of Emergency Medicine,Yale University School of Medicine . http://emedicine.medscape.com/article/798501-overview

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