Jumat, 02 Juli 2010

Keratitis

Keratitis umumnya mengganggu penglihatan jika terletak di sentral. Ada 2 tipe = infektif dan noninfektif. Klasifikasinya rata-rata sama dengan konjungtivitis (lihat di bagian konjungtivitis). Bagaimana membedakan keratitis infektif berdasarkan penyebab?
















Orang yang berisiko kena keratitis:
  • Ada riwayat trauma.
  • Pemakai lensa kontak (baru pakai tidak tahu caranya; atau sudah lama pakai tapi tidak tahu cara merawatnya).
  • Pakai tetes mata steroid dalam waktu yang lama.
  • Riwayat mata merah dan mata buram hilang timbul.
  • Kadang mata silau, berair, belekan, dan kelilipan

Tanda yang ditemukan KORNEA KERUH, VISUS TURUN, dan INJEKSI SILIAR dengan palpebra hiperemis. Keratitis noninfektif yang penting yaitu keratitis punctata dan ulkus Mooren.

Terapi keratitis
Medikamentosa

1. Terapi kausal sesuai penyebab
a. Bakteri: salep sefuroksim-gentamisin atau salep siprofloksasin
b. Herpes: salep asiklovir 3% tiap 4 jam
c. Herpes zoster: minum asiklovir 5 kali 800 mg selama 7-10 hari. Ditambah analgesik per oral dan steroid.
d. Jamur: salep natamisin 5% tiap 1-2 jam
e. Acanthamoeba: poliheksametilen biguanid + propamidin isetionat atau salep klorheksidin glukonat 0.02%.

2. Sikloplegik atau midriatikum
3. Antiglaukoma peroral untuk mencegah komplikasi
4. Steroid topikal (tapi tidak untuk ulkus!)

Nonmedikamentosa
1. Patching pelindung
2. Debridemen jaringan nekrosis
3. Terapi laser untuk nekrotomi
4. Keratoplasti jika kerusakan sudah berat

Ulkus Mooren
Ulkus Mooren jarang ditemukan dan termasuk salah satu keratitis ulseratif perifer akibat proses autoimun. Berkaitan dengan hepatitis C. Bentuk ulserasi biasanya seperti bulan sabit di limbus dengan infiltrat kekuningan di pinggirnya. Ada 2 macam tipe:
1. Tipe limited: unilateral, sering menyerang orang tua (>40 tahun), dan prognosisnya lebih baik.
2. Tipe resisten: bilateral, sangat nyeri, sering menyerang orang muda, dan prognosis buruk.

Penatalaksanaannya:
1. Terapi lokal dengan kortikosteroid topikal diikuti reseksi konjungtiva, dengan siklosporin topikal, atau injeksi heparin subkonjungtiva.
2. Terapi imunosupresi sistemik (siklofosfamid, azatioprin) baru diberikan jika reseksi gagal atau penyakit termasuk tipe resisten.
3. Operasi keratoplasti lamelar, epikeratoplasti, atau pembuatan flap.

2 komentar:

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