Amblyopia (Referat)

REFERAT

REFERAT

AMBLIOPIA

AMBLIOPIA

Disusun oleh:

Disusun oleh:

Anis Lilyani (011.06.0029

Anis Lilyani (011.06.0029

Ma!ya" Ba#is (011.06.0$$

Ma!ya" Ba#is (011.06.0$$

DALAM RA%&'A

DALAM RA%&'A ME%&I'TI 'ME%&I'TI 'EPEPA%ITERAA% A%ITERAA% 'LI%I' 'LI%I' MADMAD))AA BA&IA% ILM MATA

BA&IA% ILM MATA

RMA* +A'IT MM DAERA* DR. R. +OED,O%O +ELO%& RMA* +A'IT MM DAERA* DR. R. +OED,O%O +ELO%&

FA'LTA+ 'EDO'TERA% %I-ER+ITA+ I+LAM ALA/*AR MATARAM FA'LTA+ 'EDO'TERA% %I-ER+ITA+ I+LAM ALA/*AR MATARAM

2016 2016

AMBLYOPIA DAFTAR ISI BAB I I.PENDAHULUAN...3 BAB II II.DEFINISI...4 III.EPIDEMIOLOGI...4 IV.PATOFISIOLOGI... ...4 V.KLASIFIKASI...5 VI.DIAGNOSIS...8 VII.PENATALAKSANAAN...10

VIII.KOMPLIKASI DARI PENATALAKSANAAN...13

IX.PROGNOSIS...13

BAB III X. KESIMPULAN ...15

BAB IV XI. DAFTAR PUSTAKA... ...16

BAB I

PENDAHULUAN

Am!"#$"% %&%!%' $()*+*)%) ,(-%%m%) $()/!"'%-%)%!%*$*) 2*&%' &"(+" ,#+(,2" %)/ -(+%", &%$%- *)"!%-(+%! %-%* "!%-(+%! %+%)/ %)/ -"&%, &%$%- &"'**)/,%) !%)/2*)/ &()/%) ,(!%")%) 2-+*,-*+%! m%-% m%*$*) %+%2 $()/!"'%-%) $#2-(+"#+.

K!%2"",%2" %m!"#$"% &"%/" ,( &%!%m ((+%$% ,%-(/#+" &()/%) )%m% %)/ 2(2*%" &()/%) $()(%)% %"-* %m!#$"% 2-+%"2m", ",2%2" (,2()-+", %m!#$"% %)"2#m(-+#$", %m!#$"% "2#m(-+#$"% &%) %m!#$"% &($+"7%2".

Am!#$"% &",()%! */% &()/%) "2-"!%' m%-% m%!%29 !%: (( %&%!%' m%2%!%' &%!%m  $()/!"'%-%) %)/ m(m%)/ '%)% m()/()%" ; < 3 = $#$*!%2" -%$" "!% &""%+ < "%+,%) %,%) 2%)/%- m(+*/",%) )%)-")% %/" ,('"&*$%) 2" $()&(+"-%. Am!#$"% -"&%, &%$%- 2(m*' &()/%) 2()&"+")% &%) %m!#$"% %)/ -"&%, &"-(+%$" &%$%- m()(%,%) /%)//*%) $()/!"'%-%)  $(+m%)(). >",% )%)-")% $%&% m%-% %)/ %", "-* -"m*! 2*%-* $()%,"- %-%*$*) -+%*m% m%,%  $()&(+"-% %,%) (+/%)-*)/ $%&% $()/!"'%-%) *+*, m%-% %)/ %m!#$"% #!(' ,%+()% "-*

%m!#$"% '%+*2 &"-%-%!%,2%)% 2(?($%- m*)/,").

H%m$"+ 2(!*+*' %m!#$"% "-* &%$%- &"?(/%' &%) (+2"%- +(7(+2"(! &()/%) &(-(,2" &")" &%) ")-(+7()2" %)/ -($%-. A)%, &()/%) %m!#$"% %-%* %)/ (+(2",# %m!#$"% '()&%,)% &%$%- &""&()-"",%2" $%&% *m*+ &")" &"m%)% $+#/)#2"2 ,(( +'%2"!%) -(+%$" %,%) !("' %",.

BAB II PEMBAHASAN

II. DEFINISI

Am!#$"% (+%2%! &%+" %'%2% Y*)%)" %"-* %m!#2 -*m$*! &%) #$"% $()/!"'%-%). D",()%! */% &()/%) !%: ((9 %-%* m%-% m%!%2. Am!#$"% m(+*$%,%) 2*%-* ,(%&%%) &"m%)%  $(m(+",2% -"&%, m(!"'%- %$%@%$% &%) $%2"() m(!"'%- 2%)/%- 2(&","-. Am!"#$"% %&%!%' $()*+*)%) ,(-%%m%) $()/!"'%-%) %!%*$*) 2*&%' &"(+" ,#+(,2" %)/ -(+%", &%$%- *)"!%-(+%! %-%* "!%-(+%! %+%)/ %)/ -"&%, &%$%- &"'**)/%,%) !%m/2*)/ &()/%) ,(!%")%) 2-+*?-*+%! m%-% m%*$*) %+%2  $()/!"'%-%) $#2-(+"#+.

III. EPIDEMIOLOGI

P+(7%!()2" %m!#$"% &" Am(+",% S(+",%- 2*!"- *)-*, &"-%,2"+ &%) (+(&% $%&% -"%$ !"-(+%-*+ (+,"2%+ %)-%+% 1 < 35 = $%&% %)%, %)/ 2('%- 2%m$%" 4 < 53 = $%&% %)%, &()/%)  $+#!(m% m%-%. H%m$"+ 2(!*+*' &%-% m()/%-%,%) 2(,"-%+ ; = &%+" ,(2(!*+*'%) $#$*!%2"

m()&(+"-% %m!#$"%. D" ")% m()*+*- &%-% *!%) D(2(m(+ -%'*) ;005 %)/ !%!* 2(,"-%+ 3 < 5 = %-%*  '")//% 5 *-% %)%, m()&(+"-% %m!#$"%.

>()"2 ,(!%m") &%) +%2 -%m$%,)% -"&%, %&% $(+(&%%). U2"% -(+%&")% %m!#$"% %"-* $%&%  $(+"#&( ,+"-"2 &%+" $(+,(m%)/%) m%-%. R(2",# m()")/,%- $%&% %)%, %)/ $(+,(m%)/%))%

-(+!%m%- $+(m%-*+ &%) C %-%* &"*m$%" %&%)% +"%%- ,(!*%+/% %m!#$"%.

IV. PATOFISIOLOGI

P%&% %m!#$"% &"&%$%-" %&%)% ,(+*2%,%) $()/!"'%-%) 2()-+%! 2(&%)/,%) &%(+%'  $()/!"'%-%) $(+"(+ &%$%- &",%-%,%) m%2"' -(-%$ )#+m%!. S-*&" (,2$(+"m()-%! $%&% ")%-%)/ 2(+-%

2-*&" ,!")"2 $%&% %" &%) %!"-% m()&*,*)/ ,#)2($ %&%)% 2*%-* $(+"#&( ,+"-"2 %)/ $(,% &%!%m (+,(m%)/)% ,(%&%%) %m!#$"%. P(+"#&( ,+"-"2 ")" 2(2*%" &()/%) $(+,(m%)/%) 2"2-(m $()/!"'%-%) %)%, %)/ $(,% -(+'%&%$ m%2*,%) %)#+m%! %)/ &"%,"%-,%) #!(' +%)/2%)/%) &($+"7%2" 2-+%"2m*2 %-%* ,(!%")%) +(+%,2" %)/ 2"/)"",%). S(?%+% *m*m $(+"#&( ,+"-"2 *)-*, %m!#$"% &($+"7%2" -(+%&" !("' ?($%- &"%)&")/ 2-+%"2m*2 m%*$*) %)"2#m(-+#$"%.

L("' !%)*- %,-* %)/ &"*-*',%) *)-*, -(+%&")% %m!#$"% ,(-",% $(+"#&( ,+"-"2 !("' 2")/,%- $%&% +%)/2%)/ &($+"7%2" &"%)&")/,%) 2-+%"2m*2 %-%*$*) %)"2#m$(-+#$".

P(+"#&( ,+"-"2 -(+2(*- %&%!%' 

1. _{P(+,(m%)/%) -%%m $()/!"'%-%) &%+" ;0C;00 6C60 '")/% ;0C;0 6C6 %"-* $%&%}

2%%-!%'"+ 2%m$%" *2"% 3 < 5 -%'*).

2. _{P(+"#&( %)/ (+(2",# 2%)/%- -")//" *)-*, -(+%&")% %m!#$"% &($+"7%2" %"-* &" *2"%}

 ((+%$% *!%) '")//% *2"%  < 8 -%'*).

3. _{P(+"#&( &"m%)% ,(2(m*'%) %m!#$"% m%2"' &%$%- &"?%$%" %"-* 2(%, -(+%&")%}

&($+"7%2" 2%m$%" *2"% +(m%% %-%* %',%) -(+,%&%)/ *2"% &(%2%.

%!%*$*) m(,%)"2m( )(*+#"2"#!#/" $()(% %m!#$"% m%2"' 2%)/%- (!*m (!%2 2-*&" (,2$(+"m()-%! m#&"",%2" $()/%!%m%) &%!%m m(!"'%- $%&% ")%-%)/ &%) $(+?#%%) !%#+%-#+"*m  $%&% m%)*2"% &()/%) %m!#$"% -(!%' m(m(+" ((+%$% m%2*,%) $%&% ")%-%)/ $(+?#%%) m()*)*,,%) /%)//*%) 2"2-(m $()/!"'%-%) *)/2" )(*+#) %)/ &%!%mC(2%+ %)/ &"%,"%-,%)  $()/%!%m%) m(!"'%- %)#+m%! &")". S(! $%&% ,#+-(,2 7"2*%! $+"m(+ &%$%- ,('"!%)/%) ,(m%m$*%)

&%!%m m()%)//%$" +%)/2%)/%) $%&% 2%-* %-%* ,(&*% m%-% &%) 2(! %)/ m%2"' +(2$#)2"  *)/2")% %,'"+)% &%$%- m()*+*). K(!%")%) */% -(+%&" $%&% )(*+#) %&%) /()",*!%-*m !%-(+%!. K(-(+!"%-%) +(-")% m%2"' (!*m &%$%- &"2"m$*!,%).

S"2-(m $()/!"'%-%) m(m*-*',%) $()/%!%m%) m(!"'%- &%) -(+*-%m% ")-(+%,2"

,#m$(-"-" %)-%+ %!*+ $()/!"'%-%) &" ,(&*% m%-% $%&% 7"2*%! ,#+-(,2 *)-*, (+,(m%)/

'")//% &(%2%. B%" 2*&%' &%$%- m(!"'%- 2(%,-* !%'"+ -%$" m(+(,% '%+*2 (!%%+ %/%"m%)% m()//*)%,%) m%-% m(+(,%. M(+(,% '%+*2 (!%%+ %/%"m%)% *)-*, #,*2 &%) %/%"m%)% ?%+% m()//*)%,%) ,(&*% m%-% (+2%m%%).

P()/!"'%-%) %)/ %", '%+*2 (+)"' %%)/%) -(+#,*2 2%m% $%&% ,(&*% m%-%. B"!%  %%)/%) ,%*+ $%&% 2%-* m%-% %-%* %%)/%) -(+2(*- -"&%, 2%m% $%&% ,(&*% m%-% m%,% %+%2  $()/!"'%-%) -"&%, &%$%- (+,(m%)/ &()/%) %", %',%) &%$%- m(m*+*,. B"!% '%! ")" -(+%&" #-%, %,%) 9m(m%-",%)9 m%-% %)/ -"&%, #,*2 &%) #+%)/ -(+2(*- %,%) (+/%)-*)/ $%&% 2%-* m%-% *)-*, m(!"'%-.

Am!#$"% &"%/" ,(&%!%m ((+%$% %/"%) 2(2*%" &()/%) /%)//*%)C,(!%")%) %)/ m()%&" $()(%)%.

1. AMBLYOPIA STRABISMIK

Am!"#$"% %)/ -(+%&" %,"%- *!")/ !%m% "%2%)% *!")/ ,( &%!%m $%&% %)%, 2((!*m  $()/!"'%-%) -(-%$. P%&% ,(%&%%) ")" -(+%&" 2*$+(2" $%&% m%-% -(+2(*- *)-*, m()?(/%' /%)//*%) $()/!"'%-%) &"$!#$"%. K(!%")%) ")" &"2(*- 2(%/%" %m!"#$"% 2-+%"2m",  &"m%)% ,(&*&*,%) #!% m%-% -"&%, 2(%%+ 2('")//% '%)% 2%-* m%-% %)/ &"%+%',%) $%&%  ()&% %)/ &"!"'%-.

Am!#$"% 2-+%"2m", &"&*/% &"2(%,%) ,%+()% ,#m$(-"2" %-%* -(+'%m%-)% ")-(+%,2" %)-%+% )(*+#) %)/ m(m%% ")$*- %)/ -"&%, m()%-* *2" &%+" ,(&*% m%-% %)/ %,'"+)% %,%) -(+%&" &#m")%2" $*2%- $()/!"'%-%) ,#+-",%! #!(' m%-% %)/ (+",2%2" &%) !%m% ,(!%m%%) -(+%&" $()*+*)%) +(2$#) -(+'%&%$ ")$*- &%+" m%-% %)/ -"&%, (+",2%2". P()#!%,%) ,+#)"2 &%+" m%-% %)/ (+&(7"%2" #!(' $*2%- $()/!"'%-%) ")#,*!%+ ")" -%m$%,)% m(+*$%,%) %,-#+ *-%m% -(+%&")% %m!#$"% 2-+%"2m", )%m*) $()/%*+%)  %%)/%) #7(%! #!(' ,%+()% %,#m#&%2" %)/ -"&%, 2(2*%" &%$%- */% m()%&" %,-#+ 

-%m%'%).

H%! -(+2(*- &" %-%2 -(+%&" 2(%/%" *2%'% ")'""2" %-%* 2*$+(2" *)-*, m()/'"!%)/,%) &"$!#$"% &%) ,#)*2". ,#)*2" %&%!%' m(!"'%- ; #(, 7"2*%! %)/ (+!%")%) -%$"  (+'"m$"-%) 2%-* &" %-%2 %)/ !%").

P()/#%-%). P%&% %m!"#$"% 2-+%"2m", $()/#%-%) "%!%' &()/%) m()*-*$ m%-% %)/ 2('%- &%) &"+**, $%&% &#,-(+ m%-%. Am!"#$"% 2-+%"2m", &%$%- $*!"' ,(m%!" $%&% *2"% &" %%'  -%'*) &()/%) m()*-*$ -#-%! m%-% %)/ %",.

;. AMBLIOPIA REFRAKTIF

Am!"#$"% $%&% m%-% %m(-+#$"% %-%* %)"2#m(-+#$"% %)/ -"&%, &",#+(,2" %m!"#$"% %)"2#m(-+#$" &%) m%-% &()/%) "2#%m(-+#$"% 2($(+-" $%&% '"$(+m(-+#$"% &%!%m %-%* m#$"% (+%- %-%* $%&% %2-"/m%-"2m( %m"#$"% %2-"/m%-",. Am!"#$"% %)/ -(+%&" $%&% m%-% &()/%) ,(!%")%) +(+%,2" &%!%m %)/ -"&%, &",#+(,2" %m!"#$"% %m(-+#$", %-%* -(+&%$%-)% ,(!%")%) +(+%,2" %)-%+% ,(&*% m%-% %m!"#$"% %)"2#-+#$"?. P()/!"'%-%) &%$%- %",2(-(!%' ((+%$% *!%) m(m%,%" ,%?% m%-% ,#+(,2". P()/#%-%) %&%!%' &()/%) m()*-*$ m%-% %)/ %", 2(-(!%' m%-% %)/ %m!"#$"% m()&%$%-,%) ,%?%m%-% %)/ 2(2*%".

3. AMBLYOPIA ANISOMETROPIK

Am!"#$"% %)"2#m(-+#$", -(+%&" %,"%- -(+&%$%-)% ,(!%")%) +(+%,2" ,(&*% m%-% %)/  (+(&% %*'. A,"%- %)"2#m(-+#$", m%-% %%)/%) ()&% $%&% ,(&*% -"&%, 2%m% (2%+ 

%)/ m()"m*!,%) %%)/%) $%&% +(-")% 2(?%+% +(!%-"7( &" !*%+ #?*2 &" %)&")/ &()/%) m%-% !%")% 2('")//% m%-% %,%) m(m#,*2,%) m(!"'%- &()/%) 2%-* m%-%. B%%)/%) %)/ !("' 2*+%m %,%) &" 2*$+%2 "%2%)% $%&% m%-% %)/ !("' %m(-+#$",. B(&% +(+%,2" %)/ (2%+ %)-%+% ,(&*% m%-% m()(%,%) -(+()-*, )% %%)/%) ,%*+ $%&% 2%-* m%-%. Am!"#$"% %)/ -(+%&" %,"%- ,(-"&%, m%m$*%) m%-% (+*2" %,"%- -(+&%$%-)%  $(+(&%%) +(+%,2" %)-%+% ,(&*% m%-% %2-"/m%- *)"!%-(+%! %)/ m()/%,"%-,%) %%)/%)  ()&% m()%&" ,%*+. Am!"#$"% %)"2#m(-+", -(+%&" "!% -(+&%$%- $(+(&%%) %)/

(+%-,(!%")%) +(+%,2" ,(&*% m%-%.

Am!"#$"% %)/ -(+%&" %,"%- $(+(&%%) +(+%,2" ,(&*% m%-% %)/ -(+!%!* (2%+ %-%* !("' &%+" ;5 &"#$-+" m()/%,"%-,%) /%)//*%) *)/2" $()/!"'%-%) ")#?*!%+ -*)//%! &(m","%)  $*!% -(+%&" $%&% *)"!%-(+%! %2-"/m%-"2m( 2('")//% %%)/%) m()%&" ,%*+.

4. AMBLYOPIA ISOMETROPIA

Am!#$"% "2#m(-+#$"% -(+%&" %,"%- ,(!%")%) +(+%,2" -")//" %)/ -"&%, &",#+(,2" %)/ *,*+%))% '%m$"+ 2%m% $%&% m%-% ,%)%) &%) m%-% ,"+". D"m%)% %!%*$*) -(!%' &",#+(,2" &()/%) %", -"&%, !%)/2*)/ m(m(+" '%2"! $()/!"'%-%) )#+m%!. T%%m  $()/!"'%-%) m(m%", 2(2*&%' ,#+(,2" !()2% &" $%,%" $%&% 2*%-* $(+"#&( %,-* ((+%$%  *!%). K'%2 *)-*, %m!#$"% -"$( ")" %"-* '"!%)/)% $()/!"'%-%) +")/%) &%$%- &"%-%2" &()/%) -(+%$" $()/!"'%-%) ,%+()% ")-(+%,2" %)#+m%! ")#,*!%+ *,%) m(+*$%,%) %,-#+   $()(%. M(,%)"2m()% '%)% ,%+()% %,"%- %%)/%) +(-")% %)/ ,%*+ 2%%. P%&%

%m!#$"% "2#m(-+#$"% %%)/%) +(-")% &()/%) %-%* -%)$% ,#+(,2" !()2% 2%m% &%!%m '%! ,((!%2%)C ,((+)"'%) &%) *,*+%).

H$(+#$"% !("' &%+" 5 D &%) m#$"% !("' &%+" 10 D (+(2",# m()(%,%) "!%-(+%! %m!#$"% &%) '%+*2 &",#+(,2" 2(&")" m*)/,") %/%+ -"&%, -(+%&" %m!#$"%.

5. AMBLYOPIA DEPRIVASI

I2-"!%' !%m% %m!#$"% ( %)#$2"% %-%* 9&"2*2( %m!#$"%92(+")/ m%2"' &"/*)%,%) *)-*,  %m!#$"% &($+"7%2" &"m%)% 2(+")/ &"2(%,%) #!(' ,(,(+*'%) m(&"% ,#)/()"-%! %-%* &")" %,%) m()(%,%) -(+%&")% $()*+*)%) $(m()-*,%) %%)/%) %)/ %,'"+)% m()"m*!,%) %m!#$"%. B()-*, %m!#$"% ")" 2(&","- ,"-% *m$%" )%m*) m(+*$%,%)

%)/ $%!")/ $%+%' &%) 2*!"- &"$(+%",". Am!#$"% ()-*, ")" !("' $%+%' $%&% ,%2*2 *)"!%-(+%! &"%)&")/,%) "!%-(+%! &()/%) ,(,(+*'%) "&()-",.

A)%, ,*+%)/ &%+" 6 -%'*) &()/%) ,%-%+%, ,#)/()"-%! $%&%- C -#-%! %)/ m()(m$%-" &%(+%' 2()-+%! &()/%) *,*+%) 3mm %-%* !("' '%+*2 &"%)//%$ &%$%- m()(%,%) %m!#$"% (+%-. K(,(+*'%) !()2% %)/ 2%m% %)/ -(+%&" $%&% *2"%  6 -') !("' -"&%,   (+%'%%. Am!#$"% #,!*2" %&%!%' ()-*, %m!#$"% &($+"7%2" &"2(%,%) ,%+()%  $()//*)%%) $%-?' $()*-*$ m%-% %)/ (+!("'%). Am!#$"% (+%- &"!%$#+,%) &%$%--(+%&" 2%-* m")//* 2(-(!%' $()//*)%%) $%-?'")/*)"!%-(+%! $%&% %)%, *2"%  ; -%'*) 2(2*&%' m()%!%)" #$(+%2" +")/%) $%&% ,(!#$%, m%-%.

6. AMBLYOPIA INTOKSIKASI

I)-#,2",%2"-%)/ &"2(%,%) $(m%,%") -(m%,%* %!?#'#!. T"m%' %-%* %'%) -#,2"2 !%")% &%$%- m()/%,"%-,%) %m!"#$"%. B"%2%)% -(+%&" )(*+"-"2 #$-"? -#,2", %,"%- ,(+%?*)%) &"2(+-%" -(+&%$%- -%)&%@-%)&% !%$%)/ $%)&%)/%) %)/ (+*%'@+*%'. H"!%)/)% -%%m  $()/'(!"%-%) 2()-+%! "!%-(+%! %)/ &" &*/% %,"%- ,(+%?*)%) m(-"!%!,#'#! %)/ &%$%- */% -(+%&" %,"%- /":" *+*,.

VI. DIAGNOSIS

Am!#$"% &"&"%/)#2"2 "!% -(+ $()*+*)%) -%%m $()/!"'%-%) %)/ -"&%, &%$%-&"(!%2,%) &"m%)% '%! -(+2(*- %&% ,%"-%) &()/%) +"%%- %-%* ,#)&"2" %)/ &%$%- m()(%,%) %m!#$"%. • ANAMNESIS • PEMERIKSAAN AMBLIOPIA P(m(+",2%%) 2(+-% m()/(-%'*" $(+,(m%)/%) -%%m $()/(!"'%-%) 2(%, %" 2('")//% 2%m$%" *2"%  -%'*) %&%!%' $(+!* *)-*, m()?(/%' ,(%&%%) -(+!%m%- *)-*,  m(m(+",%) $(+%%-%).

- Uji Crowding Phenomenon

P()&(+"-% %m!#$"% ,*+%)/ m%m$* *)-*, m(m%?% ()-*, C '*+* %)/ +%$%- &%) m()/()%!" $#!% %$% %)/ &"()-*, #!(' /%m%+ %-%* '*+* -(+2(*-. T%%m  $()/!"'%-%) %)/ &")"!%" &()/%) ?%+% ,#)7()2"#)%! %)/ (+&%2%+ ,($%&% ,(&*% *)/2" -%&" 2(!%!* 2*)#+m%!. T(!%' &",(-%'*" %'% $()&(+"-% %m!#$"% 2*!"- *)-*,  m()/"&()-"",%2" '*+* %)/ -(+2*2*) !")(%+ 2(%+"2 &"%)&")/,%) &()/%) '*+*  %)/ -(+"2#!%2". B"!% -(+%&" $()*+*)%)) -%%m $()/!"'%-%) &%+" '*+* "2#!%2" ,( '*+* 

&%!%m %+"2 m%,% ")" &"2(*- %&%)% ()#m()% ?+#&")/ $%&% m%-% -(+2(*-. M%-% ")" m()&(+"-% %m!"#$"%.

- Uji Densiti Filter netrl

D%2%+ *" %&%!%' &",(-%'*" %'% $%&% m%-% %)/ %m!"#$"% 2(?%+% "2"#!#/", (+%&% &%!%m ,(%&%%) (+&%$-%2" /(!%$ 2('")//% "!% $%&% m%-% %m!"#$"% &"!%,*,%) *"  $()/'(!"%-%) &()/%) ")-()2"-%2 2")%+ %)/ &"+()&%',%)  m(m%,%" "!-(+ &()2"- )(-+%!  -"&%, %,%) -(+%&" $()*+*%) -%%m $()/'(!"%-%). D"!%,*,%) &()/%) m(m%,%" "!-(+  %)/ (+!%'%)@!%'%) &"/(!%$,%) 2('")//% -%%m $()/(!"%-%) $%&% m%-% )#+m%!-*+*) 50= $%&% m%-% %m!"#$"% *)/2"#)%! -"&%, %,%) %-%* '%)% 2(&","- m()*+*),%) -%%m  $()/!"%-%) $%&% $(m(+",2%%) 2((!*m)%.

D"*%- -(+!("' &%'*!* /%*)/%) "!-(+  K#&%,J6N.D.;.00 &()/%) 050  2('")//% -%%m $()/(!"%-%) $%&% m%-% %)/ )#+m%! -*+*) &%+" ;0C;0 m()%&" ;0C40 %-%* -*+*) ;  %+"2 $%&% ,%+-* $(m(+",2%%) /%*)/%) "!-(+ -(+2(*- &" -%+*' $%&% m%-% %)/ &"

&*/% %m!"#$"%.

@ Uji !orth"s Fo#r Dot

U" *)-*, m(!"'%- $()/(!"%-%) ")#?*!%+ %&%)% *)/2" ,#+(2$#) &()2" +(-")% %)#+m%! 2*$+(2" $%&% 2%-* m%-% &%))*!")/. P()&(+"-% m(m%,%" ,%?%m%-% &()/%) "!-(+ m(+%' $%&% m%-% ,%)%) &%) "!-(+ "+* m%-% ,"+" &%) m(!"'%- $%&% #(, 4 -"-",  &"m%)% 2%-* (+%+)% m(+%' ; '"%* 2%-* $*-"'. L%m$* %-%* -"-", $*-"' %,%) -(+!"'%-m(+%' #!(' m%-% ,%)%) &%) '"%* #!(' m%-% ,"+". L%m$* (+%' '%)% &%$%- &"!"'%- #!(' m%-% ,%)%) &%) !%m$* '"%* '%)% &%$%- &"!"'%- #!(' m%-% ,"+". B"!% *2" %", m%,% %,%) -(+!"'%- 4 -"-", &%) 2(&%)/ !%m$* $*-"' -(+!"'%- 2(%/%" %+)% ?2m$*+%) '"%* &%) m(+%'. 4 -"-", */% %,%) &"!"'%- #!(' m%-% *!")/ %,%) -(-%$" -(!%' -(+%&" ,#+(2$#)&()2" +(-")% %)/ -"&%, )#+m%!. B"!% -(+&%$%- 2*$+(2" m%,%) %,%) -(+!"'%-'%)% ; m(+%' "!% m%-% ,%)%) &#m")%) %-%* 3 '"%* "!% m%-% ,"+" %)/ &#m")%). B"!% -(+!"'%- 5 -"-", 3 m(+%' &%) ; '"%* %)/ (+2"!%)/%) (+%+-" m%-% &%!%m ,(&*&*,%) (,2#-+#$"% &%) "!% -"&%, (+2"!%)/%) (+%+-" m%-% (+,(&*&*,%) (2#-+#$"%. VII. PENATALAKSANAAN

Am!#$"% $%&% ,(%)%,%) ,%2*2 &%$%- &"-%-%!%,2%)% &()/%) ((,-" 2(!%m% 2%-* &(,%&( $(+-%m%. L("' ?($%- -")&%,%) -(+%$(*-", &"!%,*,%) m%,% %,%) 2(m%,") (2%+ $*!%  $(!*%)/ ,((+'%2"!%))%. B"!% $%&% %%! -(+%$" 2*&%' (+'%2"! '%! ")" -"&%, m()%m")  $()/!"'%-%) #$-"m%! %,%) -(-%$ (+-%'%).

• M()/'"!%)/,%) "!% m*)/,") 2(m*% $()/'%!%)/ $()/!"'%-%) 2($(+-" ,%-%+%,

K%-%+%, %)/ &%$%- m()(%,%) %m!#$"% '%+*2 2(/(+% &"#$(+%2" -"&%, $(+!* &"-*)&% P()/%)/,%-%) ,%-%+%, ,#)/()"-%! $%&% *2"% ;@3 *!%) $(+-%m% ,('"&*$%) 2%)/%- $()-")/ &"!%,*,%) %/%+ $()/!"'%-%) ,(m%!" $*!"' &()/%) #$-"m%!. P%&% ,%2*2 ,%-%+%, "!%-(+%! ")-(+7%! #$(+%2" $%&% m%-% %)/ $(+-%m% &%) ,(&*% 2(%",)% -"&%, !("' &%+" 1@; m")//*. T(+()-*,)% ,%-%+%, -+%*m%-",% (+%- &%) %,*- $%&% %)%, &"%%' *m*+ 6 -%'*) '%+*2 &"%)/,%- &%!%m ((+%$% m")//* 2(-(!%' ,(%&"%) -+%*m% "!% m(m*)/,"),%). Y%)/ m%)% ,%-%+%, -+%*m%-",% "-* 2%)/%- (+2"%- %m!#$"#/()",. K(/%/%!%) &%!%m 9m()(+)"',%)9 m(&"% m(m$(+%"," #$-",%! &%) $()//*)%%) +(/*!(+  m%-% %)/ -(+!*,% %,%) m()/%,"%-,%) %m!#$"% (+%- &%!%m ((+%$% *!%) 2(!%m%-!%m%-)% $%&% *2"% 6 '")//% 8 -%'*).

• K#+(,2" ,(!%")%) +(+%,2"

B"!% %m!#$"% &"2(%,%) ,(!%")%) +(+%,2" %-%* %) "2#m(-+#$"% m%,% &%$%- &"-(+%$" &()/%) ,%?%m%-% %-%* !()2% ,#)-%,.. U,*+%) ,%?% m%-% *)-*, m%-% %m!#$"% &"(+" &()/%) ,#+(,2" $()*' &()/%) $()//*)%%) 2",!#$!(/"%.

B"!% &"*m$%" m#$"% -")//" *)"!%-(+%! !()2% ,#)-%, m(+*$%,%) $"!"'%) ,%+()% "!% m(m%,%" ,%?%m%-% %,%) -(+%2% (+%- &%) $()%m$"!%))% (2-(-",% *+*,. K%+()% ,(m%m$*%) m%-% %m!#$"% *)-*, m()/%-*+ %,#m#&%2" ?()&(+*)/ m()*+*) m%,% "% -"&%, &%$%- m()/,#m$()2%2" '$(+#$"% %)/ -"&%, &",#+(,2" 2($(+-" $%&% m%-% %)%,  )#+m%!. K#+(,2" %$'%,"% $%&% %)%, &"!%,*,%) 2(/(+% m*)/,") *)-*, m()/'")&%+,%) -(+%&")% &($+"7%2" $()/!"'%-%) %,"%- ,(+*')% !()2% m()%&" &("2"- #$-",%! (+%-. Am!#$"% %)"2#m(-+#$", &%) %m!#$"% "2#m(-+#$", %,%) 2%)/%- m(m%", %!%* '%)% &()/%) ,#+(,2" ,%?%m%-% 2(!%m% ((+%$% *!%).

• O,!*2" &%) &(/+%&%2" #$-",%!

@ O,!*2"

T(+%$" #,!*2" 2*&%' &"!%,*,%) 2(%, %%& ,(@18 3 &%) m(+*$%,%) -(+%$" $"!"'%)14 %)/ ,((+'%2"!%))% %", &%) ?($%- &%$%- &"!%,*,%) #,!*2" $()*' %,-* *!! -"m( %-%* $%+*' %,-* $%+-@-"m(. %. O,!*2" F*!! T"m( P()/(+-"%) #,!*2" *!!@ -"m($%&% m%-% %)/ !("' %", %&%!%' #,!*2" *)-*,  2(m*% %-%* 2(-"%$ 2%%- ,(?*%!" 1 %m %,-* (+%/%.O??!*2"#) #+ %!! #+ %!!  *- #)( %,")/ '#*+ %+-" ")" 2%)/%- $()-")/ &%!%m $()-%!%,2%)%%) %m!#$"% &()/%) ?%+% $()//*)%%) m%-% %)/ 9+*2%,9. B"%2%)% $()*-*$ m%-% %)/ &"/*)%,%) %&%!%' $()*-*$ %&(2" %&'(2"7( $%-?'(2 %)/ -(+2(&"% 2(?%+% ,#m(+2"%!.

P()*-*$ $%-?' &%$%- &""%+,%) -(+$%2%)/ $%&% m%!%m '%+" %-%* &"*,% 2(%,-* -"&*+. K%?%m%-% #,!*&(+ 2$(?-%?!( m#*)-(& #?!*&(+ %-%* !()2% ,#)-%, #$%, %-%* A))"2%2 F*) P%-?'(2 G%m%+  &%$%- */% m()%&" %!-(+)%-" *!!@-"m( $%-?'")/ "!% -(+%&" "+"-%2" ,*!"- %-%* $(+(,%- $%-?'@)% ,*+%)/ !()/,(-. F*!!@-"m( $%-?'")/ %+* &"!%,2%)%,%) '%)% "!% 2-+%"2m*2 ,#)2-%) m()/'%m%- $()/!"'%-%) ")#,*!%+ ,%+()% *!!@-"m(  $%-?'")/m(m$*)%" 2(&","- +(2",# %"-* ")/*)/ &%!%m '%! $()/!"'%-%)  ")#?*!%+.

A&% 2*%-* %-*+%) C 2-%)&%+ m()/%-%,%) *!!@-"m( $%-?'")/ &"(+" 2(!%m% 1 m")//* *)-*, 2(-"%$ -%'*) *2"% m"2%!)% $()&(+"-% %m!#$"% $%&% m%-% ,%)%) (+*2"% 3 -%'*) '%+*2 m(m%,%" *!!@-"m( $%-?' 2(!%m% 3 m")//* !%!* &"(7%!*%2" ,(m%!". H%! ")" *)-*, m()/'")&%+,%) -(+%&")% %m!#$"% $%&% m%-% %)/ %",.

 . O,!*2" P%+-@-"m(

O,!*2" $%+-@-"m(%&%!%' #,!*2" 2(!%m% 1@6 %m $(+ '%+" %,%) m(m(+" '%2"! 2%m% &()/%) #,!*2" *!!@-"m(. D*+%2" ")-(+7%! *,% &%) -*-*$ $%-?'@)% -(+/%)-*)/ &%+" &(+%%- %m!#$"%.

Am!#$"% T+(%-m()- S-*&"(2 ATS -(!%' m(m%)-* &%!%m $()(!%2%)  $(+%)%) *!!@-"m( $%-?'")/ &"%)&")/ $%+-@-"m(. S-*&" -(+2(*- m()*)*,,%)  $%2"() *2"% 3@ -%'*) &()/%) %m!#$"% (+%- -%%m$()/!"'%-%) %)-%+% ;0C100  6C30 &%) ;0C400  6C1;0  *!!@-"m( $%-?'")/m(m(+" ((, 2%m% &()/%) $()*-*$%) 2(!%m% 6 %m $(+ '%+". D%!%m 2-*&" !%") $%-?'")/ ;  %mC'%+" m()*)*,,%) ,(m%*%) -%%m $()/!"'%-%) '%m$"+ 2%m% &()/%)  $%-?'")/6%mC'%+" $%&% %m!#$"% 2(&%)/ C m#&(+%-( -%%m $()/!"'%-%) !("'  %", &%+" ;0C100 $%2"() *2"% 3 <  -%'*). D%!%m 2-*&" ")" $%-?'")/ &",#m")%2" &()/%) %,-"7"-%2 m(!"'%- &(,%- 2(!%m% 1 %mC '%+". I&(%!)% -(+%$" %m!#$"% &"-(+*2,%) '")//%-(+%&" ",2%2" %!-(+)%- %-%* -%%m  $()/!"'%-%) &()/%) S)(!!() !")(%+ ;0C;0 6C6 $%&% m%2")/ < m%2")/ m%-%. H%2"! ")" -"&%, 2(!%!* &%$%- &"?%$%". S($%)%)/ -(+%$" -(+*2 m()*)*,,%) ,(m%*%) m%,% $()%-%!%,2%)%%) '%+*2 -(-%$ &"-(+*2,%).

M(-#&( !%") *)-*, $()%-%!%,2%)%%) %m!#$"% %&%!%' &()/%) m()*+*),%) ,*%!"-%2  %%)/%) &(/+%&%2" #$-",%! $%&% m%-% %)/ !("' %", '")//% m()%&" !("' *+*, 

&%+" m%-% %)/ %m!#$"% 2(+")/ */% &"2(*- $()%!"2%2"  penalization. S",!#$!(/",  "%2%)% %-+#$")( -(-(2 1= %-%* '#m%-+#$")(-(-(2 5= &"(+" 2%-* ,%!" &%!%m 2('%+"  $%&% m%-% %)/ !("' %", 2('")//% -"&%, &%$%- (+%,#m#&%2" &%) ,%*+ "!%

m(!"'%-&(,%- m(!"'%-&(,%-.

ATS m()*)*,,%) m(-#&( ")" m(m(+" '%2"! %)/ 2%m% ((,-")% &()/%) $%-?'")/ *)-*, %m!#$"% 2(&%)/ -%%m $()/!"'%-%) !("' %", &%+"$%&% ;0C100. ATS -(+2(*- &"!%,*,%) $%&% %)%, *2"% 3 <  -%'*). ATS */% m(m$(+!"'%-,%) %'%  $(m(+"%) %-+#$")( $%&% %,'"+ m")//* ((,()& m(m(+" $(+%",%) -%%m  $()/!"'%-%) 2%m% &()/%) $(m(+"%) %-+#$")( '%+"%) %)/ &"!%,*,%) $%&% ,(!#m$#, 

%)%, *2"% 3 <  -%'*) &()/%) %m!#$"% 2(&%)/. A&% */% 2-*&" -(+%+* %)/ m(m%)&")/,%) %-+#$")( &()/%) $%-?'")/ $%&% 41 #+%)/ %)%, *2"% 3@ -%'*)m()*)*,,%) %-+#$")( m(+*$%,%) $"!"'%) ((,-". S('")//% %'!" m%-% %)/ -%&")% m%2"' +%/* < +%/* m(m"!"' %-+#$")( 2(%/%" $"!"'%) $(+-%m% &%+"$%&%  $%-?'")/.

P()&(,%-%) ")" m(m$*)%" ((+%$% ,(*)-*)/%) &"%)&")/ &()/%) #,!*2" %"-* -"&%,  m()/"+"-%2" ,*!"- &%) !("' %$", &"!"'%- &%+" 2(/" ,#2m(-"2. D()/%) %-+#$")"2%2" %)%,  2*!"- *)-*, 9m()//%/%!,%)9 m(-#&( ")". E7%!*%2")% */% -"&%, $(+!* 2(2(+")/ #,!*2". M(-#&( $"!"'%) !%") %)/ $+")2"$)% 2%m% %&%!%' &()/%) m(m(+",%) !()2% $#2"-"  &()/%) *,*+%) -")//" #//")/ %-%* "!-(+. M(-#&( ")" m()?(/%' -(+%&")% ((,  2%m$")/ %+m%,#!#/", %-+#$")(. K(*)-*)/%) !%") &%+" m(-#&( %-+#$")"2%2" &%) m(-#&( )#)@#,!*2" $%&% $%2"() &()/%) m%-% %)/ !*+*2 -"&%, 2-+%"2m*2 %&%!%' ,(&*% m%-% &%$%- (,(+%2%m% %&" m(m*)/,"),%) $()/!"'%-%) ")#,*!%+.

VIII. KOMPLIKASI DARI PENATALAKSANAAN

S(m*% ()-*, $()%-%!%,2%)%%) %m!#$"% m(m*)/,"),%) *)-*, -(+%&")% %m!#$"% $%&% m%-% %)/ %",.O,!*2" *!!@-"m( %&%!%' %)/ $%!")/ (+(2",# -")//" &%) '%+*2 &"$%)-%* &()/%) ,(-%- -(+*-%m% $%&% %)%, %!"-%.

F#!!#@*$ $(+-%m% 2(-(!%' $(m(+"%) #,!*2" &"!%,*,%) 2(-(!%' 1 m")//* $%&% %" &%) 1 m")//* $(+ -%'*) *2"% $%&% %)%, m"2%!)%  4 m")//* *)-*, %)%, *2"% 4 -%'*). O,!*2"

 $%+-@-"m(&%) &(/+%&%2" #$-",%! #2(+7%2")% -"&%, $(+!* 2(2(+")/ #,!*2" *!!@-"m( -%$" #!!#@*$ +(/*!(+ -(-%$ $()-")/.

H%2"! %,'"+ -(+%$" %m!#$"% *)"!%-(+%! %&%!%' -(+()-*,)% ,(m%!" ",2%2" %!-(+)%- -%%m $()/!"'%-%) &()/%) S)(!!() !")(%+ -"&%, (+(&% !("' &%+" 2%-* %+"2 %)-%+% ,(&*% m%-%.

IX. PROGNOSIS

S(-(!%' 1 -%'*) 2(,"-%+ 3= $%2"() m()*)*,,%) ,((+'%2"!%) 2(-(!%' -(+%$" #,!*2" $(+-%m%. B"!% $()%-%!%,2%)%%) &"m*!%" 2((!*m *2"% 5 -%'*) 7"2*2 )#+m%! &%$%--(+?%$%". H%! ")" 2(m%,") (+,*+%)/ 2("+")/ &()/%) $(+-%m%'%) *2"%. H%)% ,(2(m*'%) $%+2"%! %)/ &%$%- &"?%$%" "!% *2"% !("' &%+" 10 -%'*).

F%,-#+ +(2",# /%/%!)% $()%-%!%,2%)%%) %m!#$"% %&%!%' 2(%/%" (+",*- 

• >()"2 Am!#$"%  P%2"() &()/%) %)"2#m(-+#$"% -")//" &%) $%2"() &()/%) ,(!%")%)

#+/%)", $+#/)#2"2)% $%!")/ *+*,. P%2"() &()/%) %m!#$"% 2-+%"2m",   $+#/)#2"2)% $%!")/ %",.

• U2"% &"m%)% $()%-%!%,2%)%%) &"m*!%"  S(m%,") m*&% $%2"() m%,% $+#/)#2"2

2(m%,") %",.

• D%!%m)% %m!#$"% $%&% 2%%- -(+%$" &"m*!%"  S(m%,") %/*2 -%%m $()/!"'%-%)

BAB III $ESIMPULAN

Am!"#$"% %&%!%' 2*%-* ,(%&%%) m%-% &"m%)% -%%m $()/(!"'%-%) -"&%, m()?%$%" #$-"m%! 2(2*%" &()/%) *2"% &%) ")-(!(/()2")% %!%*$*) 2*&%' &" ,#+(,2" ,(!%")%) +(+%,2")%. Am!"#$"% &%$%- -%)$% ,(!%")%) #+/%)"? &%) &%$%- $*!% &()/%) ,(!%")%) #+/%)"? %)/ -"&%,  2(%)&")/ &()/%) 7"2*2 %)/ %&%. B"%2%)% %m!"#$"% &"2(%,%) #!(' ,*+%)/)% +%)/2%)/%) *)-*, m()")/,%-,%) $(+,(m%)/%) $()/!"'%-%). P()(% %m!"#$"% %&%!%' %)"2#m(-+#$"% *!")/ #,!*2" &%) ,%-%+%, %-%* ,(,(+*'%) m(&*% $()/!"'%-%) !%"). P()%-%!%,2%)%%) %m!#$"% m(!"$*-" ((+%$% !%)/,%' %"-* M()/'"!%)/,%) "!% m*)/,") 2(m*% $()/'%!%)/ $()/!"'%-%) 2($(+-" ,%-%+%, K#+(,2" ,(!%")%) +(+%,2" &%) P%,2%,%) $()//*)%%) m%-% %)/ !("' !(m%' &()/%) m(m%-%2" $()//*)%%) m%-% %)/ !("' %",.

BAB IV

DAF%A& PUS%A$A

1 V%*/'%) D%)"(! G  A2*+ T%!#+ %)& E7% $%*! R"#+&%). ;00. O-%m#!#/" Um*m 14-'

(&. >%,%+-%  "&% M(&",%.

; S*'%+&#  H%+-#)#. ;00. I!m* K(2('%-%) M%-%. Y#/%,%+-%. B%/"%) I!m* P()%,"-M%-% F%,*!-%2 K(&#,-(+%) U)"7(+2"-%2 G%&%' M%&%.

3 Am(+"?%) A?%&(m # O$'-'%!m#!#/ P(&"%-+"? O$'-'%!m#!#/ '%$-(+ 5  Am!#$"% S(?-"#) 6 B%2"? %)& !")"?%! S?"()?( #*+2( ;004 < ;005 $.63 < 0

4 Y() K.G  Am!#$"%. A7%"!%!( %-  '--$CC.(m(&"?")(.?#mCOPHC-#$"?316.'-m 5 Am!#$"% ") #mm#) E( #)&"-"#)2 D"2#+&(+2 %)& D"2(%2(2. A7%"!%!( %-

'--$CC.m"&&!(2(((.?#mC((?#)&"-"#)2.'-m