kistoid makula ödemi - İstanbul Tıp Fakültesi
Transkript
kistoid makula ödemi - İstanbul Tıp Fakültesi
.ø672ø'0$.8/$ g'(0ø 'Ro'U1LOIHU*|]P 'UùHQD\<ÕOPD] $VLVWDQ6HPLQHUOHUL± 1LVDQ øhøVWDQEXO7ÕS)DNOWHVL*|]+DVWDOÕNODUÕ$QDELOLP'DOÕ .ø672ø'0$.8/$g'(0ø 0DNXOD$QDWRPLVL 0DNXOD DUND NXWXSWD EXOXQDQ \DNODúÕN PP oDSÕQGD RYDO ELU DODQGÕU 0DNXOD WHULPL PDFXOD OXWHD VDUÕ QRNWD VDUÕ NVDQWRILOLN SLJPHQWLQ DUND NXWXSWD GHSRODQPDVÕ QHGHQL\OH YHULOPLúWLUøNLYH\DGDKDID]ODJDQJOLRQKFUHWDEDNDVÕLoHULU 8PER IRYHROD IRYHD SDUDIRYHD YH SHULIRYHD PDNXOD\Õ ROXúWXUPDNWDGÕU )RYHD PP oDSÕQGDGÕURSWLNGLVNPHUNH]LQLQPPWHPSRUDOLQGHYHPPDOWÕQGD\HUDOÕU )RYHDGD YH Q|URQODUÕQ \DQD LWLOPHVLQH ED÷OÕ RODUDN GHUHFHOLN ELU NRQNDYLWH ROXúXU FOLYXV)RYHDNHQDUÕQGDJDQJOLRQKFUHWDEDNDVÕYHLoQNOHHUWDEDNDNDOÕQODúÕU )RYHDGDVLQLUOLILJDQJOLRQKFUHYHLoSOHNVLIRUPWDEDNDODU\RNWXUUHWLQDNDOÕQOÕ÷ÕPP NHQDUÕQGDNL NDOÕQOÕN LVH PP¶GLU )RYHD NHQDUÕ ELRPLNURVNRSLN RODUDN Lo OLPLWDQ PHPEUDQÕQÕQROXúWXUGX÷XKDONDúHNOLQGHNLUHIOHRODUDNJ|]OHQLU )RYHROD\DNODúÕNPPoDSÕQGDGÕU<DOQÕ]FDIDUNOÕODúPÕúYHX]DPÕúNRQLOHUGHQROXúXU 8PER IRYHD PHUNH]LQGH RIWDOPRVNRSLN RODUDN J|UOHQIRYHRODU UHIOHGLU%XUDVÕ UHWLQDQÕQ HQ LQFH ROGX÷X \HUGLU PP YH HQ NHVNLQ J|UPH\L VD÷OD\DQ E|OPGU .RQL GDQVLWHVL \NVHNWLUPPNRQLPHYFXWWXU )RYHDODYDVNOHU]RQIRYHDLoLQGHYH\DNODúÕNPPoDSÕQGDGÕU 3DUDIRYHD IRYHD\Õ oHYUHOH\HQ YH PP JHQLúOL÷LQGH ELU E|OJHGLU %XUDGD Lo QNOHHU JDQJOLRQKFUHOHULYHVLQLUOLIOHULWDEDNDVÕROGXNoDNDOÕQGÕU 3HULIRYHDSDUDIRYHD\ÕoHYUHOH\HQPPJHQLúOL÷LQGHELUNXúDNWÕU%XUDGDJDQJOLRQKFUHOHUL SHULIHULNUHWLQDGDROGX÷XJLELWHNELUKFUHWDEDNDVÕQDLQHU.RQLURGRUDQÕ¶GLU .DQ5HWLQD%DUL\HUL 'Õú NDQUHWLQD EDUL\HUL NRPúX UHWLQD SLJPHQW HSLWHOL KFUHOHUL DUDVÕQGD \HU DODQ VÕNÕ ED÷ODQWÕNRSOHNVOHULQGHQ]RQXODRFFOXGHQVYH]RQXODDGKHUHQVROXúPDNWDGÕU øo NDQUHWLQD EDUL\HUL UHWLQDGDNL NDSLOOHU HQGRWHO KFUHOHUL DUDVÕQGDNL VÕNÕ ED÷ODQWÕODUGDQ ROXúPDNWDGÕU .DQUHWLQDEDUL\HULQGHSHUPHDELOLWHDUWÕúÕ 5HWLQDNDSLOOHUHQGRWHOKFUHOHULQGHKDVDUROGX÷XQGD 5HWLQDSLJPHQWHSLWHOKFUHOHULQGHKDVDUROGX÷XQGD .DQDNÕPÕQGDRWRUHJODV\RQND\EÕROGX÷XQGDPH\GDQDJHOLU .LVWRLG0DNXODgGHPL .LVWRLG PDNXOD |GHPL .0g SDUDIRYHDO UHWLQDO YH RSWLN VLQLU NDSLOOHUOHUGHQ ROXúDQ VÕ]ÕQWÕ VRQXFXQGD IRYHDGD UHWLQDQÕQ GÕú SOHNVLIRUP +HQOH YH Lo QNOHHU WDEDNDODUÕQGD VÕYÕ WRSODQPDVÕ LOH ROXúPDNWDGÕU 'Õú SOHNVLIRUP YH Lo QNOHHU WDEDNDODUÕQGD HR]LQRILOLN HNVGD ELULNLPLJ|UOPHNWHGLU)RYHDoXNXUOX÷XND\EROPXúYHPDNXODLQWUDUHWLQDONLVWRLGERúOXNODUOD NDOÕQODúPÕúWÕU +HQOH¶QLQ GÕú SOHNVLIRUP WDEDNDVÕQGD JHQLúOHPH\H PVDLW E\N KFUH GÕúÕ ERúOXNODU EXOXQGX÷XQGDQ NDSLOOHUOHUGHQ VÕYÕ VÕ]PDVÕ\OD E\N VDQWUDO NLVW YH EXQXQ HWUDIÕQGD oRN VD\ÕGD NoN NLVW JHOLúLU .URQLN ROJXODUGD LVH NLVWRLG ERúOXNODU ELUOHúLU YH RUWD\DoÕNDQE\NIRYHDONLVWLQLoGXYDUÕQÕQDoÕOPDVÕ\ODODPHOOHUYH\DWDPNDWPDNXODGHOL÷L JHOLúLU 3DWRJHQH] .LVWRLG PDNXOD |GHPLQLQ QHGHQL WDP RODUDN J|VWHULOHPHPHNOH EHUDEHU LQIODPDWXDU PHGLDW|UOHU VXoODQPÕúWÕU øUULWH LULVWHQ SURVWDJODQGLQOHU VDOÕQPDNWDGÕU 6DOÕQDQ SURVWDJODQGLQOHUYLWUHXVNDYLWHVLQHYHUHWLQD\DGLII]HROPDNWDSHULIRYHDOUHWLQDONDSLOOHUOHUGH VÕNÕ ED÷ODQWÕODUÕ ER]PDNWD YH SHUPHDELOLWH DUWÕúÕQD QHGHQ ROPDNWDGÕU 3URVWDJODQGLQ \DSÕPÕ UHWLQDYHXYHDGDGDJ|VWHULOPLúWLU6XEUHWLQDOVÕYÕGDSURVWDVLNOLQYH7;$GHJ|UOPúWU 3DWRORML (OHNWURQPLNURVNREXLOHHUNHQHYUHGH0OOHUKFUHOHULQVLWRSOD]PDVÕQGDVÕYÕELULNLPLROGX÷X J|UOPú(÷HUVÕYÕELULNLPLGHYDPHGHUVH0OOHUKFUHOHULúLúHUPHPEUDQODUÕGHMHQHUHROXU YH JHo HYUHGH NLVWRLG ERúOXNODU ROXúXU +LVWRORMLN RODUDN NLVWLN ERúOXNODU GLú SOHNVLIRUP WDEDNDVÕQGDJ|UOU.0g¶GHHWNLOHQHQE|OJHGHIRWRUHVHSW|UOHUGHND\ÕSROGX÷XJ|UOU .LVWRLG0DNXODgGHPLQLQ*|UOG÷'XUXPODU 3RVWRS .DWDUDNWDPHOL\DWÕøUYLQH*DVVVHQGURPX 3HQHWUDQNHUDWRSODVWL $VWLJPDWLNNHUDWRWRPL 6NOHUDOo|NHUWPH /DVHULULGRWRPL 3DQUHWLQDOIRWRNRDJXODV\RQ .UL\RSHNVL +HUHGLWHU 5HWLQLWLVSLJPHQWR]D 2WR]RPDOGRPLQDQWJHoLúOL.0g øQIDQWLONLVWRLGPDNXOD|GHPL ;JHoLúOLMYHQLOUHWLQRVNL]LV *ROGPDQQ)DYUHVHQGURPX 7RNVLN 7RSLNDOHSLQHIULQ 1LNRWLQLNDVLW /DWDQRSURVW;DODWDQ 7P|UOHU .RURLGPHODQRPX .RURLGKHPDQMLRPX 5HWLQDONDSLOOHUKHPDQMLRP 5HWLQDSLJPHQWHSLWHOLKDPDUWRPX 'L÷HU øG\RSDWLNHSLUHWLQDOPHPEUDQ 9LWUHRPDNXOHUWUDNVL\RQVHQGURPX 6XEUHWLQDOQHRYDVNODUL]DV\RQ 3RVWSDUWXP.0g øG\RSDWLN.0g øQIODPDWXDU (DOHVKDVWDOÕ÷Õ 6LWRPHJDORYLUVUHWLQLWL 3DUVSODQLWLV %HKoHWKDVWDOÕ÷Õ %LUGVKRWNXúVDoPDVÕUHWLQRNRURLGRSDWLVL 6DUNRLGR]LV øG\RSDWLNYLWULWLV 6NOHULWLV 7RNVRSOD]PR]LV 9DVNOHU 'LDEHWLNUHWLQRSDWL 5HWLQDOYHQRNO]\RQX 2NOHULVNHPLNVHQGURP 5HWLQDO WHODQMLHNWD]LOHU øG\RSDWLN MXNVWDIRYHDO WHODQMLHNWD]L &RDWV KDVWDOÕ÷Õ /HEHU¶LQ PLO\HUDQHYUL]PDODUÕ .RURLGQHRYDVNODUL]DV\RQX $NXWKLSHUWDQVLIUHWLQRSDWL 5DG\DV\RQUHWLQRSDWLVL 5HWLQDDUWHUPDNURDQHYUL]PDVÕ .DQ5HWLQD%DUL\HULQLQ%R]XOPDVÕ 'LDEHWHV0HOOLWXV 'LDEHWLN UHWLQRSDWLGH PLNURDQHYUL]PDODUGDQ YH DQRUPDO UHWLQDO NDSLOOHUOHUGHQ VÕYÕ UHWLQDO GRNXODUD VÕ]PDNWDGÕU %X GD GLDEHWLN PDNXORSDWL\H QHGHQ ROPDNWDGÕU 6Õ]DQ VÕYÕ PDNXODQÕQ NDOÕQODúPDVÕQDNLVWRLGERúOXNODUYHVHUWHNVGDROXúXPXQDQHGHQROPDNWDGÕU'LDEHWWHNDQ UHWLQD EDUL\HULQ \ÕNÕOPDVÕQÕQ QHGHQL WDP RODUDN ELOLQPHPHNWHGLU $OGR] UHGNWD] \ROX LOH ROXúDQVRUELWRO]HULQGHGXUXOPXúWXU øVNHPLN+DVWDOÕNODU 5HWLQDO YHQ RNO]\RQXQGD DUWPÕú LQWUDYDVNOHU KLGURVWDWLN EDVÕQo NDSLOOHU HQGRWHO KDVDUÕQD QHGHQROPDNWDYHVÕ]DQVÕYÕPDNXODGDNLVWRLGERúOXNODUROXúWXUPDNWDGÕU .RURLGLQLVNHPLNKDVWDOÕNODUÕQGDUHWLQDOSLJPHQWHSLWHOLQIRQNVL\RQXER]XOXUYHGÕúNDQUHWLQD EDUL\HULQGHQ VÕYÕ VÕ]PDVÕQD QHGHQ ROPDNWDGÕU 3UHNDSLOOHU NRURLGDO DUWHULROOHUGH YH NRULRNDSLOOHUOHUGHROXúDQILEULQWÕNDFÕNRURLGLVNHPLVLQH\RO DoPDNWDUHWLQDSLJPHQWHSLWHOLQ IRQNVL\RQXQX ER]PDNWD YH NLVWRLG PDNXOD |GHPLQH QHGHQ ROPDNWDGÕU $\QÕ úHNLOGH KLSHUWDQVL\RQGD GLVVHPLQH LQWUDYDVNOHU NRDJXODV\RQGD 'ø& NROODMHQ YDVNOHU KDVWDOÕNODUGD WURPERWLN WURPERVLWRSHQLN SXUSXUDGD 773 GD NLVWRLG PDNXOD |GHPL ROXúPDNWDGÕU 0HNDQLN)DNW|UOHU 6HORIDQ PDNXORSDWL SUHPDNXOHU ILEUR]LV UHWLQDO GDPDUODUGD oHNLOPH\H YH GDPDUODUGDQ VÕYÕ VÕ]PDVÕQDQHGHQROXU øQWUDYDVNOHUPHNDQLNIDNW|UOHUGHNDQUHWLQDEDUL\HULQL \ÕNDELOLU0D\PXQODUGD \DSÕODQWDON HPEROL]DV\RQX|UQHNRODUDNJ|VWHULOHELOLU7DONHPEROL]DV\RQXQGDPDNXOD\DVÕYÕVÕ]DU +LGURVWDWLN)DNW|UOHU $UWPÕú LQWUDYDVNOHU EDVÕQo Lo YH GÕú NDQUHWLQD EDUL\HULQL ER]DELOLU øQWUDRNOHU EDVÕQFÕQ GúPHVL KLSRWRQL GXUXPXQGD GD NDQUHWLQD EDUL\HULER]XODELOLU YH PDNXOD|GHPL PH\GDQD JHOHELOLU øQIODPDV\RQ 2NOHULQIODPDV\RQYHLQIHNVL\RQVRQUDVÕNLVWRLGPDNXOD|GHPLJ|UOHELOLUøG\RSDWLNYHLW ELUGVKRWUHWLQRNRURLGRSDWLVDUNRLGR]LVWRNVRSOD]PR]LVSRVWHULRUVNOHULWYH%HKoHWKDVWDOÕ÷Õ LQWHUPHGLDWH YHLW SDUV SODQLWLV RODQ ROJXODUGD PDNXOD |GHPL J|UOU 6DOÕQDQ SURVWDJODQGLQOHULoNDQUHWLQDEDUL\HULQLER]PDNWDGÕU $IDNYHSV|GRIDNNLVWRLGPDNXOD|GHPLQGHLQIODPDWXDUPHGLDW|UOHULoNDQUHWLQDEDUL\HULQL ER]PDNWDGÕU%XROJXODUGDSHULYDVNOHUPRQRQNOHHUKFUHLQILOWUDV\RQXJ|UOPúWU .RURLGLQIODPDV\RQXQGDGDNDQUHWLQDEDUL\HULER]XOPDNWDYHPDNXOD|GHPLROXúPDNWDGÕU +DUDGDKDVWDOÕ÷ÕQGDROXúDQNRURLGLWWH.0gJ|UOU 2SWLN VLQLU LQIODPDV\RQX GD .0g QHGHQ RODELOLU %XQD |UQHN RODUDN /HEHU¶LQ VWHOODWH \ÕOGÕ]VÕPDNXORSDWLVLJ|VWHULOHELOLU +HUHGLWHU+DVWDOÕNODU 5HWLQDQÕQKHUHGLWHUKDVWDOÕNODUÕGD.0gQHGHQRODELOLU 5HWLQLWLV SLJPHQWR]D KDVWDODUÕQGD VDQWUDO J|UPH ND\EÕQÕQ QHGHQOHULQGHQ ELUL GH .0g ROXúXPXGXU 3HULIRYHDO NDSLOOHUOHUGHQ DUWPÕú SHUPHDELOLWH VRQXFXQGD ROGX÷X GúQOPHNWHGLU 2WR]RPDOGRPLQDQWJHoLúOL.0gRODQROJXODUGDWDQÕPODQPÕúWÕU 7RNVLN1HGHQOHU (SLQHIULQYHQLNRWLQLNDVLWNXOODQÕPÕ.0g¶QHQHGHQRODELOLU $IDN J|]OHUGH HSLQHIULQ LoHUHQ DQWLJORNRPDW|] GDPODODUÕQ NXOODQÕOPDVÕ LOH Lo NDQUHWLQD EDUL\HUL ER]XOPDNWD YH .0g ROXúPDNWDGÕU (SLQHIULQ SURVWDJODQGLQ VHQWH]L YH VDOÕQÕPÕQÕ DUWWÕUÕU +LSHUNROHVWHUROHPLWHGDYLVLQGHNXOODQÕODQ\NVHNGR]QLNRWLQLNDVLWJUJQ .0g¶QH QHGHQRODELOLU1LNRWLQLNDVLWNXOODQDQROJXODUÕQIRYHDE|OJHVLQGHNoNNLVWOHUJ|UOPHNWHGLU 1LNRWLQLNDVLWWHGDYLVLQLQNHVLOPHVLLOHIXQGXVEXOJXODUÕQRUPDOHG|QHU /DWDQRSURVW;DODWDQELUSURVWDJODQGLQGLU3*)YH.0g¶QHQHGHQRODELOLU .LVWRLG0DNXODgGHPLQGH.OLQLN%XOJXODU .LVWRLG PDNXOD |GHPLQLQ EDúODQJÕFÕ JHQHOOLNOH FHUUDKLGHQ VRQUD KDIWD DUDVÕQGDGÕU .0g¶QLQ DQD VHPSWRPX VDQWUDO J|UPHQLQ D]DOPDVÕGÕU %XQXQ \DQÕQGD PHWDPRUIRSVL PLNURSVL VNRWRP RNOHU LUULWDV\RQ IRWRIREL YH NRQMRQNWLYDO LQMHNVL\RQ J|UOHELOLU *|UPH NHVNLQOL÷LLOHDUDVÕQGDGH÷LúLU¶WHQGúNGHRODELOLU2OJXODUÕQ\DUÕVÕQGD |QKL\DORLGEWQO÷QND\EHWPLúWLU$UNDYLWUHXVWDLQIODPDWXDUKFUHOHURODELOLU+DILIYH\D QDGLUHQ D÷ÕU SDSLOOD |GHPL JHOLúLU .LVWRLG PDNXOD |GHPL HQ L\L úHNLOGH NRQWDNW OHQV*ROGPDQQOHQVYH\DQRQNRQWDNWOHQV''NXOODQÕODUDN\DSÕODQELRPLNURVNRSLN PXD\HQH LOH WHVSLW HGLOLU %LRPLNURVNRSLN PXD\HQHGH IRYHDO o|NQWQQ ND\EÕ UHWLQDGD NDOÕQODúPDVHQVRU\HOUHWLQDGDoRNVD\ÕGDNLVWRLGDODQODUJ|UOU )ORUHVHLQIXQGXVDQMLRJUDILVL.0g¶QGHWDQÕNR\GXUXFXGXU )ORUHVHLQIXQGXVDQMLRJUDILEXOJXODUÕ %R\DQÕQSDUDIRYHDOE|OJH\HVÕ]PDVÕDQMLRJUDPÕQDUWHU\RYHQ|]HYUHVLQGHEDúODU )RNDOVÕ]ÕQWÕRGDNODUÕGDKDVRQUDELUDUD\DJHOHUHNJHoDUWHU\RYHQ|]HYUHGH³WDo\DSUDNODUÕ´ SDWHUQLPH\GDQDJHWLULUOHU 0LNURNLVWRLG ERúOXNODUGD ER\DQÕQ J|OOHQPHVL\OH ROXúDQ KLSHUIORUHVDQV DQMLRJUDPÕQ JHo HYUHOHULQHNDGDUGHYDPHGHU )ORUHVHLQIXQGXVDQMLRJUDILVL.0gKDNNÕQGDVDGHFHNDOLWDWLIELOJLYHULU.0g¶QGHNDQWLWDWLI YHULOHURSWLNDONRKHUHQVWRPRJUDIL2&7LOHDOÕQÕU +HQOH¶QLQ GÕú SOHNVLIRUP WDEDNDVÕQGD JHQLúOHPH\H PVDLW E\N KFUH GÕúÕ ERúOXNODU EXOXQGX÷XQGDQ NDSLOOHUOHUGHQ VÕYÕ VÕ]PDVÕ\OD E\NVDQWUDO NLVW YH EXQXQ HWUDIÕQGD oRN VD\ÕGD NoN NLVW JHOLúLU 2OJXODUÕQ ¶QGH D\GD |GHP JHULOHU YH J|UPH DUWDU 'L÷HU J|]GH NDWDUDNW DPHOL\DWÕQGDQ VRQUD ROXúPD ULVNL ¶GLU 2OJXODUÕQ ¶XQGD HSLUHWLQDO PHPEUDQ JHOLúLU YH J|UPH DUWÕúÕQÕ VÕQÕUODU.URQLN ROJXODUGD LVHNLVWRLG ERúOXNODUELUOHúLU YH RUWD\DoÕNDQE\NIRYHDONLVWLQLoGXYDUÕQÕQDoÕOPDVÕ\ODODPHOOHUPDNXODGHOL÷LJHOLúLU 8]DPÕú .0g PDNXOHU IRWRUHVHSW|UOHULQ DWURILVLQH QHGHQ RODELOLU J|UPH NHVNLQOL÷L GúN ROPDVÕQD UD÷PHQ NOLQLN PXD\HQH EXOJXODUÕ YH IORUHVHLQ IXQGXV DQMLRJUDIL EXOJXODUÕ QRUPDO RODELOLU .LVWRLG0DNXODgGHPLQGH$\ÕUÕFÕ7DQÕ (YUHPDNXODGHOL÷L /DPHOOHUPDNXOHUGHOLN øG\RSDWLNHSLUHWLQDOPHPEUDQ 9LWUHRPDNXOHUWUDNVL\RQVHQGURPX 3DWWHUQGLVWURIL 6RODUUHWLQRSDWL 5HJPDWRMHQUHWLQDGHNROPDQÕ ;JHoLúOLMYHQLOUHWLQRVNL]LV 'LII]PDNXOHU|GHP $IDN.LVWRLG0DNXODgGHPLøUYLQH*DVV6HQGURPX .DWDUDNWDPHOL\DWÕQGDQVRQUDROXúDQ.0gøUYLQH*DVVVHQGURPXRODUDNELOLQLU \ÕOÕQGD øUYLQH LQWUDNDSVOHU NDWDUDNW HNVWUDNVL\RQX ø..( JHoLUHQ ROJXODUGD J|UOHQ QHGHQL ELOLQPH\HQ YL]\RQ D]DOPDVÕQÕ WDULI HWPLúWLU %X VHQGURPXQ EXOJXODUÕ DQL ROXúDQ NRQMRQNWLYDO LQMHNVL\RQ IRWRIREL VDQWUDO J|UPHQLQ D]DOPDVÕ DUWPÕú DN|] IODUH DQWHULRU KL\DORLG PHPEUDQÕQ USWUGU .RPSOLNDV\RQ J|UOPH\HQ ø..( DPHOL\DWÕQGDQ VRQUD ROJXGD L\L YL]\RQ HOGH HGLOPLúWLU 3RVWRSHUDWLI D\ VRQUD ROJXGD VHPSWRP YH EXOJXODU RUWD\DoÕNDU ¶GD øOLII¶LQ WHRULVLQH J|UH øUYLQH VHQGURPX SXSLOODQÕQ GDUDOÕS JHQLúOHPHVL YLWUHXV OLIOHULQLQoHNLOPHVLQHYHSXSLOODLoLQGHQ|QHLWLOPHVLQHQHGHQROXU%XQDGDYLWUHXVWUDNVL\RQ VHQGURPXDGÕQÕYHUPLúWLU ¶GD *DVV YH 1RUWRQ¶D J|UH EX VHQGURPGDNL VDQWUDO J|UPHQLQ D]DOPDVÕQÕQ QHGHQL PDNXODGDNL |GHPGLU %X |GHP ))$ LOH J|VWHULOPLúWLU øUYLQH VHQGURPX øUYLQH ±*DVV VHQGURPXDGÕQÕDOPÕúWÕU .RPSOLNDV\RQVX] LQWUDNDSVOHU NDWDUDNW HNVWUDNVL\RQXQGDQ VRQUD LON KDIWD LoLQGH DQMLRJUDILN NLVWRLG PDNXOD |GHPL RUDQÕQGD J|UOU (NVWUDNDSVOHU NDWDUDNW HNVWUDNVL\RQXQGDQVRQUDJ|UOPHRUDQÕLVHFLYDUÕQGDGÕU7PROJXODUÕQ¶XQGDLVH NOLQLN.0gJ|UOU\DQL J|UPHD]DOÕUYHWLSLNIORUHVHLQDQMLRJUDILNJ|UQPRUWD\DoÕNDU )DNRHPXOVLILNDV\RQGD LVH .0g J|UOPH RUDQÕ ¶WHQ D]GÕU <$* NDSVORWRPLGH .0g J|UOPHULVNL¶GLU *|UPH NHVNLQOL÷LQ D]DOPDVÕ LOH ELUOLNWH RODQ NOLQLN .0g LQVLGDQVÕ LQWUDNDSVOHU FHUUDKLGH HNVWUDNDSVOHUFHUUDKLGHDUNDNDSVOEWQO÷ER]XOPDGÕ÷ÕROJXODUGD¶GHQD]GÕU *|UPH ND\EÕ EX ROJXODUGD FHUUDKLGHQ D\ VRQUD ROXúXU YH ELUNDo KDIWD LOH ELUNDo D\ VUHELOLU6ÕNOÕNODVSRQWDQUH]ROV\RQJ|UOU$QFDNLQWUDNDSVOHUFHUUDKLGHQVRQUDNDOÕFÕ J|UPHND\EÕVDSWDQÕU øULVH WDNÕOPD LQWHUPLWWDQW NRUQHD WHPDVÕ SXSLOODQÕQ \DNDODQPDVÕ SXSLO FDSWXUH NoN |Q NDPDUDOHQVLYH\DLPSODQWDED÷OÕYHLWJHOLúHQROJXODUGDLQVLGDQV\NVHNWLU9LWUHXVXQNHVL\H \DSÕúWÕ÷Õ YH YLWUHXV ND\EÕ RODQ ROJXODUGD GD .0g J|UOHELOLU (SLUHWLQDO PHPEUDQ YH YLWUHRPDNXOHUWUDNVL\RQVHQGURPXQGDGD.0gJ|UOPHNWHGLU $IDNYH3V|GRIDN.LVWRLG0DNXODgGHPLQL$oÕNOD\DQ7HRULOHU 9LWUHXV7UDNVL\RQ7HRULVL 3XSLOODQÕQ VUHNOL GDUDOÕS JHQLúOHPHVL |Q YLWUHXV OLIOHULQLQ oHNLOPHVLQH QHGHQ ROXU 9LWUHXV SRVWHULRUKL\DORLGYHPDNXOD\]H\LLOHLOLúNLOLGLUGROD\ÕVÕ\ODYLWUHXVXQoHNLOPHVLLOHPDNXOD HWNLOHQLU øQIODPDV\RQ7HRULVL øUYLQH*DVVVHQGURPXRODQJ|]OHULQWUDRNOHULQIODPDV\RQEXOJXODUÕJ|VWHULU NRQMRQNWLYDOLQMHNVL\RQ DN|]YHYH\DYLWUHXVWDIODUHYH KFUHOHU IRWRIREL SDSLOOD|GHPL SHULYDVNOHUNÕOÕIODQPD IORUHVHLQ DQMLRJUDILN EXOJXODU PDNOD LQWUDUHWLQDO NDSLOOHUOHUGHQ YH GLVN NDSLOOHUOHUGHQ VÕ]ÕQWÕ .LVW2OXúXPX øQWUDVHOOOHU 7HRUL <DQRII )LQH YH %UXFNHU¶D J|UH NLVWOHU GHMHQHUH ROPXú 0OOHU KFUHOHUGHQ N|NHQ DOPDNWDGÕU %X KFUHOHUGHNL |GHP JLWWLNoH DUWPDNWD YH VLWRSOD]PDGD YDNXROOHU ROXúPDNWDGÕU gGHPDW|] KFUHOHULQ GXYDUÕ NÕUÕOPDNWD E\N NDYLWHOHU ROXúPDNWD E|\OHFH.0gPH\GDQDJHOPHNWHGLU (NVWUDVHOOOHU7HRUL *DVV$QGHUVRQYH'DYLV¶HJ|UHNLVWOHUGÕúSOHNVLIRUPYHLoQNOHHU WDEDNDODULoLQGHNLHNVWUDVHOOOHUERúOXNODUÕQVHU|]VÕYÕLOHJHQLúOHPHVLLOHROXúPDNWDGÕU .LVWRLG0DNXODgGHPLQLQ7HGDYLVL $IDN YH SV|GRIDN .0g¶QLQ DQD VHEHEL LQWUDRNOHU LQIODPDV\RQGXU %X GD NDQUHWLQD EDUL\HULQLQ ER]XOPDVÕQD YH PDNXOD\D VÕYÕ VÕ]PDVÕQD QHGHQ ROXU 2NOHU LQIODPDV\RQ SURVWDJODQGLQYH\DO|NRWULHQVDOÕQÕPÕQÕQDUWÕúÕQDYH\DEXPHGLDW|UOHULQYLWUHXVNDYLWHVLQGHQ X]DNODúWÕUÕOPDODUÕQGDD]DOPD\DQHGHQROXU 3XSLOODGLVWRUVL\RQXYHYH\D|QLULVYHVLO\HUFLVPHEDVÕQoX\JXODPDVÕDIDNYHSV|GRIDN.0g WHWLNOH\HELOLU0DNXOD]HULQGHNLYLWUHXVWUDNVL\RQXGD.0gQHGHQRODELOLU $IDN .0g \ÕO YH\D GDKD X]XQ VUPúVH PDNXODGD LUUHYHUVLEO \DSÕVDO YH IRQNVL\RQHO GH÷LúLNOLNOHUH QHGHQ ROXU 7DQÕ NRQXQFD WHGDYL\H KHPHQ EDúODQPDOÕGÕU YH DIDN .0g RODQ ROJXQXQLNLQFLJ|]QHGHSURILODNWLNWHGDYLX\JXODQPDOÕGÕU .DWDUDNW DPHOL\DWÕQGDQ |QFH \DSÕODQ SURILODNWLN WHGDYL DQMLRJUDILN .0g LQVLGDQVÕQÕ D]DOWÕU 16$øøGLNORIHQDNIOXUELSURIHQNHWRURODNSURILODNWLNWHGDYLGHWHUFLKHGLOLU .0g PHGLNDO WHGDYLVL SURVWDJODQGLQ DNWLYLWHVLQL LQKLEH HWPHN DUDúLGRQLN DVLW ROXúXPXQX LQKLEHHWPHNNRUWLNRVWHURLGLOHYH\DSURVWDJODQGLQROXúXPXQXHQJHOOHPHNWLU16$øøLOH .0gJ|UOPHLQVLGDQVÕVRQ\ÕOODUGDJLWWLNoHD]DOPDNWDGÕU1HGHQOHUL &HUUDKLVUHNÕVDOGÕ *|]LoLEDVÕQoR\QDPDODUÕoRND] $UNDNDSVOQNRUXQPDVÕ .DSVOLoLOHQV\HUOHúLPLGLU $\UÕFD SRVWRSHUDWLI WHGDYLGH DQWLLQIODPDWXDU WHGDYLQLQ G]HQOL NXOODQÕOPDVÕ YH \HQL QHVLO OHQVOHULQNXOODQÕOPDVÕLOH.0gHQGHUELUDQWLWHROPXúWXU 3RVWRSHUDWLILONKDIWD\R÷XQWRSLNDONRUWLNRVWHURLGWHGDYLVLV[YH\DV[VDDWWH ELUVRQUDNLKDIWDV[RODUDNNXOODQÕOÕUWRSODPD\ 5LVN WDúÕ\DQ ROJXODU GL÷HU J|]QGH .0g JHoLUPLú RODQ ROJXODU NDQJ|] EDUL\HULQGH ER]XNOX÷X RODQ ROJXODU '0 YLWUHNWRPL JHoLUPLú RODQODU NURQLN HQIODPDV\RQ SV|GRHNVIROLDV\RQHSLUHWLQDOPHPEUDQROXúPXúRODQODUDUNDNDSVOUSWUYLWUHXVND\EÕ J|] LoLQGH OHQV PDWHU\DOL NDOPDVÕGÕU %X ROJXODUGD SRVWRSHUDWLI LON KDIWD WRSLNDO 16$øø $FXODU 9ROWDUHQ VWHURLGOH ELUOLNWH NXOODQÕODELOLU 'L÷HU J|]GH .0g RODQ ROJXODUGD NRPSOLNDV\RQVX] J|]GH ROPXúVD DPHOL\DW |QFHVL ELUNDo JQ VWHURLG YH 16$øø NXOODQÕPÕ JHUHNHELOLU .0gSRVWRSHUDWLINRPSOLNDV\RQXROPD\DQROJXODUGDQDGLUJ|UOU 16$øø.XOODQÕPÕ 16$øøVLNORRNVLMHQD]ÕLQKLEHHGHUHNDUDúLGRQLNDVLGLQHQGRSHURNVLWOHUHG|QúPQHQJHOOHU YH E|\OHFH SURVWDJODQGLQ VHQWH]LQL LQKLEH HGHU .OLQLN RODUDN 16$øø NDSLOOHU VÕ]ÕQWÕ\Õ D]DOWÕUODU 7RSLNDO$QWLSURVWDJODQGLQ$MDQODUÕ .HWRURODNWURPHWKDPLQH$FXODUV[ øQGRPHWKD]LQV[YH\DV[ 'LNORIHQDNVRG\XP9ROWDUHQøQIODVHG V[ 2UDO$QWLSURVWDJODQGLQ$MDQODUÕ øQGRPHWKD]LQPJV[ 6XSURIHQPJV[ )HQRSURIHQPJV[YH\DV[ .RUWLNRVWHURLG.XOODQÕPÕ .RUWLNRVWHURLGOHU IRVIROLSD] $¶\L LQKLEH HGHUHN PHPEUDQ OLSLGOHULQ DUDúLGRQLN DVLGH G|QúPQHQJHOOHUOHU/RNDORODUDNLQWUDVHOOOHUYHLQWHUVHOOOHU|GHPLD]DOWÕUODUPDNURIDM DNWLYLWHVLQLVXSUHVHHGHUOHUYHOLPIRNLQ\DSÕPÕQÕD]DOWÕUODU6LVWHPLNRODUDNSROLPRUIRQNOHDU O|NRVLWOHULQHQ]LPDWLNYHIDJRVLWLNDNWLYLWHVLQLD]DOWÕUODU 7RSLNDO NRUWLNRVWHURLGOHUGHQ RODQ SUHGQL]RORQXQ OLSRILOLN DVHWDW VVSDQVL\RQX LQWDNW NRUQHD HSLWHOLQLSHQHWUHHGHUYH|QNDPDUDGD\NVHNNRQVDQWUDV\RQDXODúÕU 7RSLNDO6WHURLG 3UHGQL]RORQDVHWDW3UHG)RUWHV[ 3UHGQL]RORQVRG\XPV[ 6XE7HQRQ(QMHNVL\RQX 7ULDPVLQRORQDVHWRQLG.HQDFRUWPJJQ 0HWLOSUHGQL]RORQDVHWDW'HSRPHGUROPJJQ 2UDO6WHURLGOHU 3UHGQL]RQYH\DSUHGQL]RORQPJKHUJQYH\DJQDúÕUÕ $VHWD]RODPLG.XOODQÕPÕ $VHWD]RODPLG NDUERQLN DQKLGUD] LQKLELW|UGU 6XEUHWLQDO ERúOXNODUGDNL VÕYÕQÕQ UHWLQD SLJPHQW HSLWHOLQGHQ NRURLGH GR÷UX WUDQVSRUWXQX VD÷ODU 5HWLQLWLV 3LJPHQWR]D YH RWR]RPDO GRPLQDQWJHoLúOL.0g¶QGHID\GDOÕEXOXQPXúWXU +LSHUEDULN2NVLMHQ.XOODQÕPÕ +LSHUEDULNRNVLMHQPDNXODNDSLOOHUOHULQGDUDOPDVÕQDQHGHQROXUDWPDOWÕQGDNLRNVLMHQ VDDWJQGHLNLGHIDJQYHULOLUVRQUDJQGHVDDWER\XQFDJQYHULOHELOLU .LVWRLG0DNXODgGHPLQGH%DVDPDN7HGDYLVL 7RSLNDONHWRURODNWURPHWKDPLQHV[KDIWD .DWDUDNWDPHOL\DWÕQGDQ|QFHYHVRQUDSURILODNWLNRODUDNYHULOHELOLU 7RSLNDOSUHGQL]RORQDVHWDWVVDDWWHELUKDIWD (÷HUFHYDS\RNVDSRVWHULRU6XE7HQRQHQMHNVL\RQX\DSÕOÕU PHWLOSUHGQL]RORQPJ WULDPVLQRORQPJ %LUD\]DUIÕQGDPDNVLPXPoHQMHNVL\RQ\DSÕODELOLU (÷HUFHYDS\RNVD± VLVWHPLNWHGDYL\HJHoLOLUSUHGQL]RQPJJQRUDOKDIWD KDIWDJLWWLNoHD]DODQGR]ODUGDYHULOLU 6LVWHPLNNRUWLNRVWHURLGNXOODQDQKDVWDODUD5DQLWLGLQPJRUDOV[YHULOPHOLGLU 16$øø WRSLNDONHWRURODNV[KDIWDWRSLNDONRUWLNRVWHURLGOHULQ\HULQHYH\DRQODUOD ELUOLNWHSHUVLVWDQ.0g¶QLQWHGDYLVLQGHNXOODQÕODELOLU SUHGQL]RORQDVHWDWV[NHWRURODNWURPHWKDPLQHV[ *|]LoLEDVÕQFÕQÕWDNLSHWH÷HUDUWDUVDWRSLNDO16$øøLOHGHYDPHW 2UDODVHWD]RODPLGPJJQWRSLNDONRUWLNRVWHURLG 2UDODVHWD]RODPLGPJJQWRSLNDO16$øø 3URJQR] $IDNYHSV|GRIDN.0gRODQROJXODUGDYL]\RQSRVWRSHUDWLID\VRQUDYH\DGDKDL\L ROXU3RVWRSHUDWLILON\ÕOODUGDROJXODUÕQE\NNÕVPÕQGDJ|UPHNHVNLQOL÷LQGHVSRQWDQL\LOHúPH YH .0g¶QGH UH]ROV\RQ J|UOPHNWHGLU $OWÕ D\ VRQUD SHUVLVWDQ .0g RODQ ROJXODUGD NDOÕFÕ J|UPHND\EÕJHOLúHELOLU%XKDVWDODUGDODPHOOHUPDNXOHUGHOLNYH\DSLJPHQWHSLWHOGH÷LúLNOL÷L JHOLúHELOLU $IDNYH3V|GRIDN.LVWRLG0DNXODgGHPLQLQ&HUUDKL.ULWHUOHUL $OWÕD\GÕUEHOJHOHQPLúDIDNYH\DSV|GRIDN.0gYHWRSLNDOPHGLNDOWHGDYLNHVLOGL÷LQGHQNV J|VWHUHQ.0g øNL\ÕOGDQGDKDX]XQROPDPDNND\GÕ\ODYH\DGDKDN|WJ|UPH (QL\LG]HOWLOPLúJ|UPHNHVNLQOL÷LQLQYH\DDOWÕQGDROPDVÕ $÷UÕYHYH\DIRWRIRELQLQoD\YH\DGDKDID]ODGHYDPHWPHVL gQXYHDGDGLVWRUVL\RQNRPSUHV\RQYH\DNURQLNDúÕQPDQÕQVUWQPHQLQROPDVÕ <DUD\HULQGHYLWUHXV .LVWRLG0DNXODgGHPLYHgQ.DPDUD*ø/ 3DWRIL]\RORML gQ NDPDUDGDNL OHQV LULV |Q \]QH YH\D VLO\HU FLVPH EDVÕQo X\JXODU $\QÕ ]DPDQGD LQWUDRNOHU\DEDQFÕFLVLPJLELGDYUDQDUDNXYHDLQIODPDV\RQXQDGDQHGHQROXU &HUUDKL7HGDYL &HUUDKLWHGDYLJHQoOHUGHWHUFLKHGLOLUgQVHJPHQWWHQOHQVLoÕNDUPDNYHDIDNGXUXPXNRQWDNW OHQVLOHG]HOWPHN|QHULOPLúWLU .LVWRLG0DNXODgGHPLYH$UND.DPDUD*ø/ 3DWRIL]\RORML .0g¶QLQ VHEHEL LQIODPDWXDU PHGLDW|UOHULQ VDOÕQÕPÕ YH\D EX PHGLDW|UOHULQ J|]GHQ X]DNODúWÕUÕOPDVÕQGDNL D]DOPDGÕU %X ROJXODUGD LULV YH *ø/ DUDVÕQGDNL SRVWHULRU VLQHúL |Q NDSVO NDOÕQWÕVÕ SHULIHULN DQWHULRU VLQHúL YH VLO\HU VXONXV LoLQGHNL KDSWLN¶LQ XYHD ]HULQH EDVÕQoX\JXODPDVÕ|QXYHDLUULWDV\RQXQDQHGHQROXU 3URVWDJODQGLQ YH O|NRWULHQOHU UHWLQDGDNL NDSLOOHU SHUPHDELOLWH DUWÕúÕQD QHGHQ ROXUODU %X PHGLDW|UOHUVLO\HUFLVPLQSLJPHQWVL]HSLWHOLWDUDIÕQGDQJ|]GHQX]DNODúWÕUÕOÕUODU 3XSLOOD'LVWRUVL\RQX ø\L \HUOHúWLULOPLú DUND NDPDUD *ø/ RODQ YH SXSLOOD GLVWRUVL\RQX ROPD\DQ ROJXODUGD .0g LQVLGDQVÕGúNWU(÷HUSXSLOODGLVWRUVL\RQXYDUVD YHOHQVLOHLULVLQDUND\]DUDVÕQGDVLQHúL YDUVD.0gLQVLGDQVÕDUWDU .0gSXSLOODGLVWRUVL\RQXQXQQHGHQROGX÷XXYHDLUULWDV\RQXVRQXFXQGDROXúXU .URQLN$IDNYH3V|GRIDN.0g¶QGH&HUUDKL7HGDYL øULVH VWUO OHQVL RODQ ROJXODU OHQVLQ oÕNDUWÕOPDVÕ YH HVQHN |Q NDPDUD *ø/ LOH GH÷LúWLULOPHVLYH\DDUNDNDPDUD*ø/VNOHUD\DILNVHHGLOPHVL gQ NDPDUD *ø/ SXSLOOD GLVWRUVL\RQX YH |Q NDPDUDGD YLWUHXV OLIOHUL RODQ ROJXODU YLWUHNWRPL *ø/ H÷HU HVQHNVH \HULQGH EÕUDNÕOPDVÕ GH÷LOVH oÕNDUÕOPDVÕ YH\D *ø/¶WHQ YD]JHoLOPHVL gQNDPDUD*ø/RODQSXSLOODGLVWRUVL\RQXYH|QNDPDUDGDYLWUHXVROPD\DQROJXODUGD*ø/ ULMLGLVHoÕNDUÕSHVQHN*ø/LOHGH÷LúWLULOPHVLJHUHNLUVH\HULQHNRQWDNWOHQVNXOODQÕOPDVÕDUND NDPDUD*ø/VWULOHILNVHHGLOPHVL 3XSLOODGLVWRUVL\RQXQDQHGHQRODQYLWUHXVSURODSVXVXYH|QNDPDUDYH\DDUNDNDPDUD*ø/ RODQROJXODU<$*ODVHUYLWUHROL]LV 9LWUHXVYH\D|QNDPDUDGDKFUHOHULQYDUOÕ÷Õ 3HULYDVNOHU NDoDN YH\D GLVNWHQ NDoDN LOH ELUOLNWH YH\D ELUOLNWH ROPDNVÕ]ÕQ .0g¶QLQ DMLRJUDILNYDUOÕ÷Õ $UND NDPDUD *ø/ YH SXSLOOD \DNDODQPDVÕ SXSLO FDSWXUH RODQ ROJXODUGD SXSLOODQÕQ VHUEHVWOHúWLULOPHVL $UNDNDPDUD*ø/YHYLWUHXVOLIOHULQLQQHGHQROGX÷XSXSLOODGLVWRUVL\RQXRODQROJXODUGD|Q YLWUHNWRPLYHOHQVLQ\HULQGH EÕUDNÕOPDVÕ $UNDNDPDUD*ø/VXONXVILNVDV\RQXYHQRUPDOSXSLOODVÕRODQROJXODU*ø/¶LQoÕNDUÕOPDVÕ YHHVQHN|QNDPDUD*ø/LOHGH÷LúWLULOPHVLYH\DDUNDNDPDUD*ø/VWULOHILNVHHGLOPHVL .DSVO LoL DUND NDPDUD *ø/ QRUPDO SXSLOOD RODQ ROJXODU PDNXOD ]HULQGH YLWUHXV WUDNVL\RQXQDGDLUEXOJXYDUVDQDGLUGLUSDUVSODQDYLWUHNWRPL\DSÕOPDVÕGÕU øQIODPDWXDU+DVWDOÕNODU6RQXFX.0g2ODQ2OJXODUGD9LWUHNWRPL hYHLWOHUGH J|UPH NHVNLQOL÷LQLQ D]DOPDVÕQÕQ HQ VÕN QHGHQL .0g¶GLU 7HNUDUOD\DQ VWHURLG WHGDYLVLQHFHYDSYHUHQIDNDWVWHURLGLQWROHUDQVÕRODQROJXODUGDYLWUHNWRPL|QHULOLU &HUUDKLGH DPDo YLWUHXVWD GHSRODQPÕú RODQ VLWRNLQOHULQ YH VHUEHVW RNVLMHQ UDGLNDOOHUL JLEL HQIODPDV\RQ VXEVWDQVODUÕQÕ X]DNODúWÕUPDNWÕU &HUUDKL VRQXFX .0g UH]ROV\RQX RUDQODUGDELOGLULOPHNWHGLU 9LWUHXVWUDNVL\RQVHQGURPXYHHSLUHWLQDOPHPEUDQJHOLúLPLUHWLQDGDPDU\DSÕODUÕQDPHNDQLN IDNW|UOHUOH WUDNVL\RQ VRQXFX NDoD÷D YH .0g¶QH QHGHQ RODELOLU %X KDVWDOÕNODUGD FHUUDKL JLULúLPID\GDVD÷ODU (W\RORML\H*|UH7HGDYL 'LDEHWLN0DNXORSDWL 'LDEHWLNUHWLQRSDWLRODQROJXODUGDLoNDQUHWLQDEDUL\HULER]XOPDNWDUHWLQDKHPRUDMLOHULVHUW HNVGDODUYHUHWLQD|GHPLJ|UOUgGHPPLNURDQHYUL]PDODUGDQVÕ]ÕQWÕ\DED÷OÕRODUDNIRNDO YH\DGLII]ROXU'LDEHWLNPDNXORSDWLWLSLNRODUDNIRYHDoHYUHVLQGH\HUOHúPLúVHUWHNVGDODU XIDNUHWLQDLoLKHPRUDMLOHUYH|GHPOHNHQGLQLJ|VWHULUgGHP]DPDQLoHULVLQGHIRYHDGDNLVWLN GH÷LúLNOLNOHULQROXúPDVÕQDQHGHQRODELOLU 7HGDYL 'LDEHWLQUHJODV\RQX /DVHUIRWRNRDJXODV\RQ ± IRNDOYH\DJULG ))$¶\H J|UH VÕ]ÕQWÕ GLII] LVH ± JULG IRWRNRDJXODV\RQ VÕ]ÕQWÕ IRNDO LVH ± IRNDO IRWRNRDJXODV\RQX\JXODQÕU 3URJQR] 9L]\RQ YH VÕ]ÕQWÕ IRNDO LVH L\L YL]\RQ ¶Q DOWÕQGD VÕ]ÕQWÕ GLII] NLVWLN ROXúXPODUYDUVDSURJQR]N|WGU <DúD%D÷OÕ0DNXOD'HMHQHUHVDQVÕ 6XEUHWLQDOQHRYDVNODUL]DV\RQYH\DUHWLQDSLJPHQWHSLWHOL\ÕUWÕ÷ÕRODQROJXODUGDGÕúNDQUHWLQD EDUL\HULER]XOPDNWDYH.0gROXúPDNWDGÕU/DVHUIRWRNRDJXODV\RQLOH.0gWHGDYLHGLOHELOLU 5HWLQD9HQ7ÕNDQPDVÕ 6DQWUDOUHWLQDYHQYHUHWLQDYHQGDOWÕNDQPDVÕQGDLQWUDYDVNOHUKLGURVWDWLNEDVÕQFÕQDUWPDVÕ\OD NDSLOOHUHQGRWHOKDVDUODQÕUYHPDNXOD\DVHU|]VÕYÕVÕ]DU'úNJ|UPHNHVNLQOL÷LQDQDVHEHEL NLVWRLG PDNXOD |GHPLGLU *|UPH NHVNLQOLNOHUL YH\D GDKD DOWÕQGD GúPú RODQ ED]Õ ROJXODUD ODVHU IRWRNRDJXODV\RQ X\JXODQDELOLU 7HGDYL WDYVL\HVLQGH EXOXQPDGDQ |QFH J|UPH ND\EÕQÕQ PDNXOHU LVNHPLGHQ GH÷LO GH PDNXOHU |GHPGHQ ND\QDNODQGÕ÷ÕQÕ QHW ELU úHNLOGH RUWD\DNR\PDNJHUHNLU 5HWLQD YHQ GDO WÕNDQPDVÕQGD IXQGXV IORUHVHLQ DQMLRJUDP PDNXOHU |GHP YH L\L PDNXOHU SHUI]\RQJ|VWHULUVHJ|UPHNHVNLQOL÷LoD\VRQUDVÕQGDVHYL\HVLQGHYH\DGDKDDOWÕQGD NDOPD\DGHYDPHWWL÷LWDNGLUGHDUJRQODVHUIRWRNRDJXODV\RQXGúQOPHOLGLU )RWRNRDJXODV\RQXQ WHUDS|WLN HWNLVL WDP RODUDN ELOLQPHPHNWH UHWLQD SLJPHQW HSLWHOL IRQNVL\RQX]HULQGHHWNLOLROGX÷XGúQOPHNWHGLU 6DQWUDO UHWLQD YHQ GDO WÕNDQÕNOÕ÷ÕQGD ROXúDQ .0g JULG WLS PDNXOHU IRWRNRDJXODV\RQD FHYDS YHUPH] %D]Õ J|]OHUGH ± WÕNDQPD \HULQLQ HWUDIÕQGD GRODQDFDN úHNLOGH ODVHULQ ROXúWXUGX÷X NRU\RUHWLQDO YHQ|] DQDVWDPR]ODU IXQGXV EXOJXODUÕQÕQ ND\EROPDVÕ YH J|UPH NHVNLQOL÷LQGH L\LOHúPH\OHELUOLNWHID\GDOÕELUHWNLVD÷OD\DELOPHNWHGLU +LSHUWDQVL\RQ .0gQDGLUHQJ|UOU+LGURVWDWLNYHLVNHPLNIDNW|UOHULoQDGLUHQGÕúNDQUHWLQDEDUL\HULQ ER]XOPDVÕQDQHGHQROPDNWDGÕU+LSHUWDQVLIPDNXOD|GHPLQDQDWHGDYLVLNDQEDVÕQFÕQNRQWURO DOWÕQDDOÕQPDVÕGÕU (SLQHIULQ0DNXORSDWLVL .0g¶QLQWHGDYLVLHSLQHIULQNXOODQÕPÕQÕQNHVLOPHVLGLU 1LNRWLQLN$VLW0DNXORSDWLVL +LSHUNROHVWHUROHPLWHGDYLVLQGHNXOODQÕODQ\NVHNGR]QLNRWLQLNDVLWJUJQ.0g¶QH QHGHQRODELOLU.0g¶QLQWHGDYLVLLODoNXOODQÕPÕQÕQNHVLOPHVLGLU 5DG\DV\RQ5HWLQRSDWLVL .0g¶QLQWHGDYLVLIRNDOYH\DJULGODVHUIRWRNRDJXODV\RQGXU 'RPLQDQW.LVWRLG0DNXODgGHPL %XUDGDDVHWD]RODPLGNXOODQÕPÕ|QHULOPLúWLU 5HWLQLWLV3LJPHQWR]D 5HWLQD SLJPHQW HSLWHOL YH SHULIRYHDO NDSLOOHUOHUGH SHUPHDELOLWHQLQ DUWPÕú ROGX÷X J|UOPú .0g¶QLQ WHGDYLVL JULG WLS PDNXOHU IRWRNRDJXODV\RQGXU $\UÕFD VLVWHPLN DVHWD]RODPLG NXOODQÕPÕID\GDOÕEXOXQPXúWXU hYHLW 0DNXOD |GHPL ± SDUV SODQLWLV YH %HKoHW KDVWDOÕ÷ÕQGD J|UOPHNWHGLU 16$øø WRSLNDO SHULRNOHU YH VLVWHPLN NRUWLNRVWHURLG NXOODQÕPÕ LOH PDNXOD |GHPL JHULOHU YH VDQWUDO J|UPH NHVNLQOL÷LDUWDU .RURLG7P|UOHUL .0g PDOLJQ PHODQRP NDSLOOHU KHPDQMLRP YH NRURLG QHYVQGH J|UOHELOLU 7P|UQ UDG\DV\RQ YH\D GL÷HU WHGDYL \|QWHPOHUL LOH WHGDYLVL PDNXOD |GHPLQ JHULOHPHVLQH QHGHQ RODELOLU (SLUHWLQDO0HPEUDQ (SLUHWLQDO PHPEUDQ NRQWUDNWH ROPDVÕ\OD LQWUDUHWLQDO NDSLOOHUOHULQ GLVWRUVL\RQXQD \RO DoDU YH .0g ROXúXU 6DQWUDO J|UPH NHVNLQOL÷LQ LOH DUDVÕQGD ROGX÷XQGD LUUHYHUVLEO PDNXOHU GH÷LúLNOLNOHULQ ROXúXPXQX HQJHOOHPHN DPDFÕ\OD YLWUHNWRPL LOH ELUOLNWH HSLUHWLQDO PHPEUDQoÕNDUÕOÕU %LUGVKRWNXúVDoPDVÕ5HWLQRNRURLGRSDWLVL 1DGLUHQ J|UOHQ YH KHU LNL J|] WXWDQ NURQLN VH\LUOL NOLQLN ELU GXUXPGXU +/$$ YH $¶ODUÕSR]LWLIRODQRUWD\DúOÕNDGÕQODUÕHWNLOHPHNWHGLU+DVWDOÕNYLWUHXVWD\]HQSDUoDFÕNODUÕQ ROJX WDUDIÕQGDQ KLVVHGLOPHVL\OH YH\D PDNXOHU |GHPH ED÷OÕ JHOLúHQ PHUNH]L J|UPHQLQ D]DOPDVÕ\ODRUWD\DoÕNDU$NXWOH]\RQODUÕNHQDUODUÕQHWROPD\DQELODWHUDOVDUÕUHQNOLGHULQ RYRLG VSRWODUGDQ ROXúPDNWDGÕU .0g¶QLQ WHGDYLVL VLVWHPLN VWHURLG YH\D LPPXQRVXSUHVLI NXOODQÕPÕGÕU 5HWLQD'HNROPDQÕYH9LWUHNWRPL&HUUDKLVL .0g UHWLQD GHNROPDQÕ FHUUDKLVL YH\D YLWUHNWRPL VRQUDVÕ J|UOHELOLU 7RSLNDO LQGRPHWKD]LQ NXOODQÕPÕDQMLRJUDILN.0gROXúXPXQXHQJHOOHU 3HULIRYHDO5HWLQDO7HODQMLHNWD]LOHU /HEHU¶LQ PLO\HU DQHYUL]PDODUÕ YH &RDWV KDVWDOÕ÷ÕQGD GLODWH YH NÕYUÕPODUÕ DUWPÕú UHWLQD NDQ GDPDUODUÕ EXOXQXU $UWHU\ROOHU YH YHQOOHULQ HWNLOHQPH LKWLPDOL EXOXQVD GD UHWLQDO WHODQMLHNWD]LOHU GDLPD NDSLOOHU YDVNOHU \DWD÷Õ WXWDUODU .URQLN VÕ]ÕQWÕ .0g¶QLQ ROXúXPXQD QHGHQ ROXU 7HGDYLGH YDVNOHU DQRPDOLOHUH NUL\RWHUDSL YH\D IRWRNRDJXODV\RQ LOH DEODV\RQ X\JXODQPDVÕID\GDVD÷OD\DELOLU
Benzer belgeler
Porphyromonas (P. gingivalis )
daha fazla vezikül, tripsin benzeri proteazlar, alkaline phosphatase, ve N-acetyl-Bglucosaminidase gibi enzimler salarlar. Fakat bu veziküllerinin ve enzimlerinin litik etkileri
E\N |OoGH ND\Õ...
Konjenital katarakt
3+392SWLNGLVNLOHOHQVDUND\]DUDVÕQGDNLK\DORLGDUWHUNDOÕQWÕVÕGÕU/HQVDUND\]QGHJOLDO
ELU]DUROXúWXUXUdR÷XJ|]GHOHQVEDúODQJÕoWDVD\GDPVDGDVRQUDGDQNHVLIOHúPHJHOLúLUOHQVLQ|...
Proliferatif Diabetik Vitreoretinopatide PPV
3UROLIHUDWLIGL\DEHWLNUHWLQRSDWLGHILEURYDVNXOHUSUROLIHUDV\RQODU]DPDQODYLWUHXVXQ
DUNDNÕVPÕQDDUNDK\DORLG\]H\H\DSÕúÕUYHEX\]H\ER\XQFDLOHUOHU$UNDYLWUHXV
GHNROPDQÕPH\GDQDJHOPHVLL...