Proliferatif Diabetik Vitreoretinopatide PPV

Transkript

ø67$1%8/h1ø9(56ø7(6ø
ø67$1%8/7,3)$.h/7(6ø*g=+$67$/,./$5,$1$%ø/ø0'$/,
352/ø)(5$7ø)
'ø<$%(7ø.5(7ø123$7ø
'U%$5,ù<(1ø$'
'Ro'U781d29$/,
&$.
$6ø67$16(0ø1(5/(5ø
352/ø)(5$7ø)'ø<$%(7ø.5(7ø123$7ø
'L\DEHWHVPHOOLWXVNOLQLNYHJHQHWLNKHWHURMHQELUGL]LER]XNOX÷XQQHGHQROGX÷X
LQVOLQPHWDEROL]PDYHUHWLPLQGHNLGHJLúLNOLNOHUHED÷OÕRODUDNOLSLGNDUERQKLGUDWYH
SURWHLQPHWDEROL]PDVÕQGDRUWD\DoÕNDQER]XNOXNODULOHNDUDNWHUL]HVLVWHPLNELU
KDVWDOÕNWÕU
'L\DEHWHVPHOOLWXVXQELUoRNRNXOHUNRPSOLNDV\RQXROPDNODEHUDEHUHQ|QHPOL
YHVÕNNRPSOLNDV\RQXUHWLQDGDPDU\DSÕVÕQGDPH\GDQDJHWLUGL÷LGH÷LúLNOLNOHUGLU
'L\DEHWLNUHWLQRSDWLWHPHORODUDNLNLJUXEDD\UÕOÕU
D 1RQSUROLIHUDWLIGL\DEHWLNUHWLQRSDWL
E 3UROLIHUDWLIGL\DEHWLNUHWLQRSDWL
1RQSUROLIHUDWLIGL\DEHWLNUHWLQRSDWLPLNURDQHYUL]PDODUVHUWYH\XPXúDN
HNVGDODUGDPDUODUGDPLNURYDVNXOHUDQRUPDOOLNOHUYHUHWLQDLoLNDQDPDODULOH
NDUDNWHUL]HGLU1RQSUROLIHUDWLIGL\DEHWLNUHWLQRSDWL]DPDQODKDVWDOÕ÷ÕQúLGGHWLDUWWÕNoD
YHoHúLWOLIDNW|UOHULQHWNLVLLOHSUROLIHUDWLIGL\DEHWLNUHWLQRSDWL\HG|QúHELOLU
3UROLIHUDWLIGL\DEHWLNUHWLQRSDWLUHWLQDYH\DRSWLNGLVNGHQND\QDNODQDQUHWLQDLo
\]H\LER\XQFDYH\DYLWUHXVNDYLWHVLQHGR÷UXX]DQDQ\HQLROXúPXúGDPDUYHYH\D
ILEU|]GRNXLOHWDQÕPODQÕU
(3ø'(0ø<2/2-ø
'L\DEHWHVPHOOLWXV¶OXKDVWDODUGDELUoRNIDNW|UKDVWDOÕ÷ÕQJHOLúLPLQLYHLOHUOH\LúLQL
HWNLOHPHNWHGLU+DVWDOÕ÷ÕQLOHUOH\LúLQLKÕ]ODQGÕUDQULVNIDNW|UOHULNÕVDFDúXúHNLOGH
|]HWOHQHELOLU
<NVHNNDQJOXNR]X
*OLVHPLNRQWUROYHGL\DEHWLQNURQLNNRPSOLNDV\RQODUÕDUDVÕQGD\DNÕQGDQELU
LOLúNLPHYFXWGXU<R÷XQLQVOLQWHGDYLVLLOHNDQJOXNR]XQXQNRQWUROGL\DEHWLN
UHWLQRSDWLROXúXPXJHFLNWLULUYHSURJUHV\RQXQX\DYDúODWÕU6RQKDIWDOÕNRUWDODPD
NDQúHNHULG]H\LQLJ|VWHUHQJOLNROL]HKHPRJORELQ+E$FVHYL\HVLUHWLQRSDWL
SURJUHV\RQXLOHSDUDOHOOLNJ|VWHUPHNWHGLU
+RUPRQDOGH÷LúLNOLNOHU
'L\DEHWLNUHWLQRSDWLQLQJHOLúLPLQGHKRUPRQDOGH÷LúLNOLNOHUoHúLWOLúHNLOOHUGHURO
R\QDU3XEHUWHGL\DEHWLNUHWLQRSDWLROXúXPXQXLQVOLQE\PHIDNW|U,*)G]H\LQL
HWNLOH\HUHNKÕ]ODQGÕUÕU,*)ELUE\PHKRUPRQXGXUYHYDVNOHUHQGRWHOEDúWDROPDN
]HUHELUoRNKFUHGHSUROLIHUDV\RQXDUWWÕUÕU<DSÕODQoDOÕúPDODUGDKLSRIL]EH]LQLQ
DEODV\RQXVRQUDVÕ,*)PLNWDUODUÕQGDGúPHYHSUROLIHUDWLIGL\DEHWLNUHWLQRSDWLGH
UHPLV\RQVD÷ODQPÕúWÕU
+LSHUWDQVL\RQYHQHIURSDWL
3ULPHURODUDNYH\DQHIURSDWL\HVHNRQGHUJHOLúHQKLSHUWDQVL\RQGL\DEHWLN
UHWLQRSDWLSURJUHV\RQXQXKÕ]ODQGÕUPDNWDGÕU +LSHUWDQVL\RQXRODQKDVWDODUGD
PLNURYDVNXOHUNRPSOLNDV\RQODUYHSUROLIHUDWLIGH÷LúLNOLNOHUGDKDVÕNJ|UOPHNWHGLU
*HQHWLNIDNW|UOHU
+FUH\]H\LQGH\HUDODQ+/$DQWLMHQOHULLOHGL\DEHWLNUHWLQRSDWLROXúXPX
DUDVÕQGDNLLOLúNLELOLQPHNWHGLU5DQGYH DUNDGDúODUÕQÕQ\DSWÕ÷ÕoDOÕúPDGD+/$'5
YH;;IHQRWLSOHULQLQSUROLIHUDWLIGL\DEHWLNUHWLQRSDWLLOHNXYYHWOLELULOLúNLVLROGX÷X
J|VWHULOPLúWLU
'L÷HUIDNW|UOHU
*ORNRPKLSHUOLSLGHPLJHEHOLNNDURWLVKDVWDOÕ÷ÕYHNDWDUDNWFHUUDKLVLGL\DEHWLN
UHWLQRSDWLQLQSURJUHV\RQXQXKÕ]ODQGÕUÕU
'L\DEHWHVPHOOLWXV¶GD\XNDUÕGDVD\ÕODQULVNIDNW|UOHULQLQ\DQÕVÕUDKDVWDOÕ÷ÕQ
LOHUOH\LúLQL\DYDúODWDQNRUX\XFXIDNW|UOHUGHPHYFXWGXUgUQH÷LQPL\RSLGHUHWLQDQÕQ
LQFHROPDVÕYHNRURLGGHQGDKDID]ODRNVLMHQLQUHWLQD\DJHoPHVLQHGHQLLOHGL\DEHWLN
UHWLQRSDWLJHOLúLPLGDKDD]GÕU.RULRUHWLQDODWURILOHUUHWLQDQÕQRNVLMHQLKWL\DFÕQÕD]DOWÕS
UHWLQDOPHWDEROL]PD\Õ\DYDúODWWÕ÷ÕQGDQGL\DEHWLNUHWLQRSDWLQLQROXúXPXQXYH
SURJUHV\RQXQXD]DOWÕU
'DKD|QFHGHEDKVHGLOGL÷LJLELNURQLNKLSHUJOLVHPLGL\DEHWLNUHWLQRSDWLQLQ
WHPHOROXúXPQHGHQOHULQLQEDúÕQGDJHOLU+LSHUJOLVHPLQLQVUHVLKHPWLSHUNHQ
EDúODQJÕoOÕLQVOLQHED÷ÕPOÕKHPGHWLSJHoEDúODQJÕoOÕGL\DEHWHVPHOOLWXV¶GD
UHWLQRSDWLJHOLúLPLLOH\DNÕQGDQLOLúNLOLGLU+HULNLGL\DEHWWLSLQGHGHLON\ÕOLoLQGH
UHWLQRSDWLJHOLúPHVLQDGLUGLU<DSÕODQoDOÕúPDODUGDKHUKDQJLELUUHWLQRSDWLQLQJ|UOPH
VÕNOÕ÷ÕKHULNLGL\DEHWWLSLQGHGH\ÕOGDQVRQUDKÕ]ODDUWPDNWDGÕU\ÕOGDWLS
GL\DEHWGHWLSGL\DEHWGHLVHRUDQÕQGDUHWLQRSDWLJ|UOPHNWHGLU
7LSGL\DEHWLNOHUGHUHWLQRSDWLVÕNOÕ÷Õ.OHLQYHDUNDGDúODUÕ$UFK2SKW
\ÕOGDSUROLIHUDWLIGL\DEHWLNUHWLQRSDWLJ|UOPHVÕNOÕ÷ÕWLSGL\DEHWGH
LNHQEXRUDQWLSGL\DEHWGH¶GLU%XQXQQHGHQLWLSGL\DEHWLNOHUGHVÕNOÕNOD
UDVWODQDQX]XQVUHoRN\NVHNYHG]HQVL]NDQúHNHULG]H\OHULGLU
7LSGL\DEHWLNOHUGHUHWLQRSDWLVÕNOÕ÷Õ.OHLQYHDUNDGDúODUÕ$UFK 2SKW
%DFNJURXQGGL\DEHWLNUHWLQRSDWLGHHQVÕNJ|UPHND\EÕQHGHQLPDNXOD
|GHPLGLU3UROLIHUDWLIGL\DEHWLNUHWLQRSDWLGHGHPDNXOD|GHPL|QHPOLELUJ|UPHND\EÕ
QHGHQLGLUgGHPSULPHURODUDNUHWLQDONDSLOOHUHQGRWHOGHRODQLoNDQUHWLQDEDUL\HULQLQ
\ÕNÕOPDVÕLOHVÕYÕYHSODVPDLoHUL÷LQLQoHYUHUHWLQDGDELULNPHVLLOHROXúXU0DNXOD|GHPL
WDKPLQHGLOHELOHFH÷LJLELKDVWDOÕ÷ÕQúLGGHWLDUWWÕNoDGDKDVÕNJ|UOPHNWHGLU*|UOPH
VÕNOÕ÷ÕWLSGL\DEHWOLOHULOHWLSGL\DEHWOLOHUGHIDUNOÕGÕU7LSGL\DEHWOLOHUGHPDNXOD
|GHPLGDKDVÕNYHGDKDHUNHQJ|UOPHNWHGLU7LSGL\DEHWOLKDVWDODUGD\ÕOGDQ|QFH
PDNXOD|GHPLQHJ|UOPHVLoRNQDGLULNHQWLSGL\DEHWOLOHUGH|]HOOLNOHLQVOLQDODQ
JUXSWDPDNXOD|GHPLWDQÕDQÕQGDGDUDVWODQDELOLU
7LSYHGL\DEHWLNOHUGHGL\DEHW\DúÕLOHPDNXOD|GHPLVÕNOÕ÷Õ
3$72*(1(=
3UROLIHUDWLIGLDEHWLNUHWLQRSDWLGHJHOLúLPVUHFLNÕVDFDú|\OH|]HWOHQHELOLU
<HQLGDPDUODUÕQ ROXúXPXSUROLIHUDV\RQXYHUHJUHV\RQX
)LEU|]GRNXSUROLIHUDV\RQX
$UNDYLWUH\]H\OHULLOHILEU|]SUROLIHUDV\RQODUÕQDGH]\RQX
$UNDYLWUH\]H\LQLQNRQWUDNVL\RQXYHVRQXFXQGDWUDNVL\RQHOYHUHJPDWRMHQ
UHWLQDGHNROPDQÕYLWUHLoLKHPRUDMLJLELNRPSOLNDV\RQODUÕQJHOLúLPL
<HQL'DPDU2OXúXPX
%LUoRN\D]DU\HQLGDPDUROXúXPXYHHQGRWHOSUROLIHUDV\RQXQGDQHGHQLQUHWLQD
GDPDUODUÕQGDNLRNO]\RQYHVRQXFXQGDJHOLúHQUHWLQDOLVNHPLROGX÷XQX
GúQPHNWHGLU2NO]\RQXQROPDGÕ÷ÕE|OJHOHUGHNLYDVNOHU\DWD÷ÕQGLODWDV\RQX
LOH\HQLGDPDUROXúXPXQXWHWLNOH\LFLE\PHIDNW|UOHULQLQVDOÕQÕPÕHQGRWHO\DO
SUROLIHUDV\RQYH\HQLGDPDUROXúXPXQD\RODoDU$QMLRJHQH]LPRGXOHHGHQ
ELUoRNIDNW|ULQYLWURRODUDNNOWUHHGLOPLúHQGRWHO\DOKFUHOHUGHLQYLYRRODUDN
LVHFLYFLYNRULRDOODQWRLNPHPEUDQÕQGDJ|VWHULOPLúWLU*ODVHUYHDUNDGDúODUÕEXJLEL
WHNQLNOHULOHLQVDQYHWDYúDQUHWLQDVÕQGDDQMLRJHQLNDNWLYLWH\LJ|VWHUPLúOHUGLU
$\UÕFDSUROLIHUDWLIGLDEHWLNUHWLQRSDWLOLKDVWDODUÕQYLWUHXVXQGDQDOÕQDQ|UQHNOHUGH
LQYLWURRODUDNHQGRWHO\DOKFUHE\PHVLVD÷ODQPÕúWÕU
%XIDNW|UOHUDUDVÕQGDKFUHKDVDUÕLOHHNVWUDVHOOOHURUWDPDVDOÕQDQYH
LQWUDVHOOOHURODUDNGDDNWLYLWHJ|VWHUHELOHQILEUREODVWE\PHIDNW|UUHWLQDLo
OLPLWDQPHPEUDQÕ'HVFHPHPHPEUDQÕ/HQVNDSVOYHYDVNXOHUHQGRWHOLQ
ED]DOPHPEUDQÕQDED÷ODQDELOPHNWHGLU$\UÕFDILEUREODVWE\PHIDNW|U
HQGRWHO\DOKFUHOHUHGH\NVHNDILQLWHJ|VWHULU7UDQVIRUPLQJJURZWKIDNW|UD YH
E LQYLYRYHLQYLWURRODUDNDQMLRJHQH]PRGODW|URODUDNVDSWDQPÕúODUGÕUdHúLWOL
SURVWDJODQGLQOHUPDNURIDMODUÕHWNLOH\HUHNDQMLRJHQH]GHHWNLOLRODELOLUOHU
$JUHJDV\RQVÕUDVÕQGDWURPERVLWOHUGHQVDOÕQDQWURPERVLWIDNW|UDQMLRJHQH]LLQ
YLYRRODUDNLQKLEHHGHUYHLQYLWURRUWDPGDKFUHSUROLIHUDV\RQXQX|QOHU5HWLQD
SLJPHQWHSLWHOLQLQDQMLRJHQH]LLQKLEHHGHQIDNW|UOHUVDOJÕODGÕ÷ÕLQYLYRRODUDN
FLYFLYNRULRDOODWRLNPHPEUDQÕQGDJ|VWHULOPLúWLU%XQXQ\DQÕQGDUHWLQDSLJPHQW
HSLWHOLQLQNRULRNDSLOODULV]HULQGHWURILNHWNLVLROGX÷XYHGHVWUXNVL\RQXLOH
NRULRNDSLOODULVLQDWURIL\HROGX÷XJ|UOPúWU
<HQLGDPDUODUSUROLIHUDV\RQ\DSDQHQGRWHO\DOKFUHWEOOHULGLU3HUI]HYH
QRQSHUI]HE|OJHOHUDUDVÕQGDNLVÕQÕUE|OJHGHUHWLQDYHQOOHULQGHQND\QDNODQDQ
\HQLGDPDUODULoOLPLWDQPHPEUDQÕGHOHUHNUHWLQDLo\]H\LLOHDUNDK\DORLGGÕú
\]H\LDUDVÕQGD\R÷XQELUNDSLOOHUSOHNVXV\DSDUODU%X\HQLGDPDUODUDúÕUÕ
IUDMLOLWHYHJHoLUJHQOLN|]HOOL÷LQHVDKLSWLU
<HQLGDPDUODUUHWLQDGDNLKHUKDQJLELU\HUGH19(RODELOPHNOHEHUDEHUHQVÕN
RSWLNGLVNYHoHYUHVLQGHNLGHUHFHOLNDoÕLoHULVLQGHROXU19'19'µQLQ
ROXúPDVÕLoLQSUDWLNRODUDNUHWLQDQÕQó¶QQQRQSHUI]HROPDVÕJHUHNWL÷LNDEXO
HGLOLU2SWLNGLVNGHVÕNQHRYDVNXODUL]DV\RQODUÕQJHOLúPHVLQLQQHGHQLRODUDN
LQWHUQDOOLPLWDQPHPEUDQÕQEXE|OJHGHROPDPDVÕJ|VWHULOLU19'GLVN\]H\LQGH
YH\DIL]\RORMLNFXS¶ÕQVWQGHQJHoHQ GDPDUED÷ODQWÕODUÕúHNOLQGHJ|UOU19'
ELQRNXOHURIWDOPRVNRSODNROD\FDWDQÕQVDGDHUNHQVDIKDODUGDWDQÕGDJoON
\DúDQDELOLU%XGXUXPGD))$¶GDSUHUHWLQDO\HQLGDPDUODUÕQGLII]VÕ]ÕQWÕ\DSPDVÕ
LOHWDQÕNRQXU
19(¶QLQHUNHQWDQÕVÕLOHELUOLNWHEXQODUÕQ,50$¶GDQD\ÕUÕPÕGD|QHPOLGLU
19(¶GHWHNHUOHNEHQ]HULED÷ODQWÕODUÕQROPDVÕDOWWDNLUHWLQDOGDPDUD÷ÕQÕQKHP
DUWHUKHPGHYHQGDOODUÕER\XQFD\D\ÕOPDVÕYHILEU|]SUROLIHUDV\RQODU
J|VWHUPHVLD\ÕUÕFÕWDQÕGD\DUGÕPFÕROXU))$¶GD\HQLGDPDUODUER\D
VÕ]GÕUÕUODUNHQ,50$¶GDER\DVÕ]ÕQWÕVÕJ|UOPH]
<HQLGDPDUODUÕQE\PHVLoRNGH÷LúNHQGLU%D]HQD\ODUFDoRND]LOHUOHPH
ROXUNHQED]ÕGXUXPODUGDKDIWDGDoRNKÕ]OÕLOHUOHUOHU7HPHORODUDN\HQL
GDPDUODUoHYUHGHJHOLúLUOHUøONHYUHJHOLúLPHYUHVLGLUYHEXHYUHGHGDPDUODUÕQ
NDOÕQELUGXYDUÕLQFHELUOPHQLYDUGÕU'DPDUODULNLQFLHYUHRODQPDWUDV\RQ
HYUHVLQHJLUGLNOHULQGHGDPDUGXYDUODUÕLQFHOLUYHOPHQOHULJHQLúOHU(÷HUYLWUHXV
YHILEURYDVNXOHUSUROLIHUDV\RQNRQWUDNWHROPD]LVH\HQLGDPDUODULONLNLHYUH\L
JHoWLNWHQVRQUDKLoELUJ|UPHSUREOHPL\DUDWPDGDQLQYROXV\HQHOHYUH\H
JLUHUOHU<HQLGDPDUODUÕQJHOLúLPLGL\DEHWWLSOHULQGHIDUNOÕOÕNJ|VWHUPHNWHGLU7LS
GL\DEHWGHWPHYUHOHUJ|UOUNHQWLSGL\DEHWGHJHOLúLPHYUHVLQHGDKDQDGLU
UDVWODQÕUNHQPDWUDV\RQYHJHULOHPHHYUHVLGDKDVÕNJ|UOU
$UND9LWUH'HNROPDQÕQÕQ5RO
$UNDYLWUHGHNROPDQÕJHOLúHQHNDGDU\HQLGDPDUODUDVHPSWRPDWLNGLU<HQL
GDPDUODUÕQE\\HQXFXQGDDUNDYLWUHXV\]H\LQGHNoNNDQDPDODU
J|UOHELOLUDQFDNEXQODUJHQHOGHVXEK\DORLGNDOÕUYH KDVWDWDUDIÕQGDQ
IDUNHGLOPHGHQND\EROXUODU$UNDYLWUHGHNROPDQÕNoNELUE|OJHGHPHYFXWLVH
UHWLQD\DoRN\DNÕQYHG]ELUúHNLOGHJ|UQU$QFDNDUNDYLWUHGHNROPDQÕ
\D\ÕOÕUVDDUNDYLWUHUHWLQDGDQX]DNODúDUDNNÕYUÕNELUJ|UQWROXúWXUXU.ÕYUÕODQ
E|OJH YLWUHRUHWLQDODGH]\RQE|OJHOHULQGH\HQLGDPDUODULOHELUOLNWH|QHJHOLU
$UNDYLWUHGHNROPDQÕLOHELUOLNWHYLWUHXVNRUWHNVLQLQE]OPHVLYHNHQGLLoLQGH
o|NPHVLLOHUHWLQDGDQD\UÕOÕU.RUWHNV\]H\LQH\DSÕúDQGDPDUODUYHUHWLQDGD
|QHJHOHUHNWUDNVL\RQHOUHWLQDGHNROPDQÕROXúXU
$UNDYLWUHGHNROPDQÕVÕNOÕNODDUNDNXWXS\DNÕQODUÕQGDEDúODU(QVÕN
ORNDOL]DV\RQXVWWHPSRUDOGDPDUDUNÕPDNXODQÕQWHPSRUDOYHRSWLNGLVNLQVW
YHDOWE|OJHOHULGLU'HNROPDQ]DPDQODGL÷HUE|OJHOHUHGH\D\ÕOÕUYH
\DSÕúÕNOÕ÷ÕQÕQ oRNVÕNÕROGX÷XYLWUHXVED]ÕQGDVRQODQÕU'LVNE|OJHVLQGHNL
GHNROPDQYLWUHXVYHILEURYDVNXOHUSUROLIHUDV\RQODUDUVÕQGDNLDGH]\RQODUQHGHQL
LOH|QOHQLU.XYYHWOLDGH]\RQODUQHGHQLLOHDUNDYLWUHXVGHNROPDQÕSDUVL\HO
ROXúXUYHGDPDUODUÕQUHWLQD\]H\LQGHQHOHYDV\RQXJHUoHNOHúLU=DPDQOD
ILEURYDVNXOHUGRNXDUNDYLWUH\]H\LQGHSUROLIHUHROXUYHYLWUHXVNDYLWHVLQH
GR÷UXoHNLOLU
+HPRUDML2OXúXPX
$QLYLWUHXVNRQWUDNVL\RQODUÕLOHIUDMLO\HQLGDPDUODU\ÕUWÕOÕUYHKHPRUDMLJHOLúLU
+HPRUDMLVÕNOÕNODUHWUDK\DORLGDODQDROPDNODEHUDEHUYLWUHXVNDYLWHVLLoLQHGH
RODELOLU+HPRUDMLJHOLúWL÷LQGHH÷HUHULWURVLWOHUDUNDYLWUH\]H\LQLQJHULVLQGHLVH
JHULGHJ|]QWDEDQÕQDo|NHUOHUYHNÕUPÕ]ÕQÕUHQJLQLNRUX\DUDN]DPDQODDEVRUEH
ROXUODU$QFDNYLWUHXVNDYLWHVLQHJLUHQHULWURVLWOHUMHOH\DSÕúÕUODU9LWUHXVLoLQGHNL
NDQ]DPDQODNÕUPÕ]ÕQÕUHQJLQLND\EHGHUYHEH\D]ODúÕU9LWUHXVLoLQGHNLNDQÕQ
WHPL]OHQPHVLD\ODUDOÕU
5HWLQD'HNROPDQÕ2OXúXPX
3UROLIHUDWLIGLDEHWLNUHWLQRSDWLGHILEURYDVNXOHUSUROLIHUDV\RQYHYLWUHXV
NRQWUDNVL\RQXLOHoHúLWOLúHNLOOHUGHUHWLQDGHNROPDQÕJHOLúHELOLU9LWUHXVKHPRUDMLVL
LOHELUOLNWHUHWLQDOGDPDUODUÕQDYO]L\RQXúHNOLQGHYH\DSLJPHQWHGHPDUNDV\RQ
KDWWÕLOHEHUDEHULQFHELUUHWLQDIROGXQXQHOHYDV\RQXúHNOLQGHJ|UOHELOLU$QFDN
JHQHOGHWLSLNRODUDNNRQNDYúHNLOOLWUDNVL\RQHOUHWLQDGHNROPDQÕJ|UOU%D]HQ
HNYDWRUG]H\LQGHWHNELUUHWLQDOGHOLNYHVRQXFXQGDUHJPDWRMHQUHWLQDGHNROPDQÕ
ROXúXU
7UDNVL\RQHOUHWLQDGHNROPDQÕQVÕNOÕ÷ÕYHúLGGHWLILEURYDVNXOHUSUROLIHUDV\RQXQ
WLSL\D\ÕOÕPÕYHORNDOL]DV\RQXLOHLOLúNLOLGLU7HPSRUDOGDPDUDUNODUÕGÕúÕQGDORNDOL]H
19(¶QLQROúWXUGX÷XIRNDOELUUHWLQDGHNROPDQÕYH\D\D\JÕQILEURYDVNXOHU
SUROLIHUDV\RQYDUOÕ÷ÕQGDJHQLúELUUHWLQDGHNROPDQÕJ|UOHELOLU)LEURYDVNXOHU
GRNXQXQNRQWUDNVL\RQXPDNXODQÕQGLVWRUVL\RQXYHKRUL]DQWDO\HUGH÷LúWLUPHVLQH
VHEHSRODELOLU7DQMHQVL\HO7UDNVL\RQ
5HWLQDGDNLWUDNVL\RQHONXYYHWIRNDODODQODUGDUHWLQRVNL]LVH\RODoDELOLU%X
E|OJHOHULQFHYHVD\GDPROGXNODUÕQGDQWDPNDWUHWLQDGHNROPDQODUÕQGDQD\UÕOÕUODU
3UROLIHUDWLIGLDEHWLNUHWLQRSDWLGHUHJPDWRMHQUHWLQDGHNROPDQODUÕGD
J|UOHELOLU5HWLQDO\ÕUWÕNODUJHQHOGHHNYDWRUGDYHWHNGLU<ÕUWÕNODURYDOGLUYH
SUROLIHUDWLIGRNXQXQWDQMHQVL\HOWUDNVL\RQXQDED÷OÕGÕU%XUDGDNLGHNROPDQJULPVLYH
\]H\LPDWWÕU(OHYHUHWLQDQÕQVÕQÕUODUÕRUDVHUUDWD\DNDGDUX]DQÕU6XEUHWLQDO
VÕYÕQÕQKDUHNHWLQHED÷OÕRODUDNGDOJDODQPDJ|UOU
5XEHR]LVøULGLV
3UROLIHUDWLIGLDEHWLNUHWLQRSDWLGHUXEHR]LVLULGLVUHWLQDGDYHRSWLNGLVNGH
QHRYDVNXODUL]DV\RQROVXQ\DGDROPDVÕQJHOLúHELOLUøULVGHNLQHRYDVNXODUL]DV\RQXQ
DQDQHGHQLKLSRNVLNUHWLQDGDUHWLOHQDQMLRJHQLNIDNW|UOHUGLU%XIDNW|UOHUGHQHQ
|QHPOLVLYDVNXOHUHQGRWHO\DOJURZWKIDNW|UGU9(*)%XIDNW|UUHWLQDOLVNHPL
VRQXFXVDOÕQDUDNSXSLOOD\ROXLOHLULVGHQHRYDVNXODUL]DV\RQJHOLúLPLQH\RO
DoDU5XEHR]LVLON RODUDNSXSLOODVÕQÕUÕQGDEDúODU.DUHNWHULVWLNRODUDNSXSLOOD
VÕQÕUÕQGDQDoÕ\DGR÷UXLOHUOHU$oÕGDILEURYDVNXOHUPHPEUDQROXúWXUDUDNVHNRQGHU
JORNDPDVHEHSROXU
øQYROXV\HQHO3'5
7PGLDEHWLNUHWLQRSDWLOHUHQVRQXQGDELULQYROXV\HQHOVDIKD\DHULúLUOHU*|UPH
G]H\LGH÷LúNHQGLUYHDUNDNXWXSWDNLGH÷LúLNOLNOHUHED÷OÕGÕU9LWUHXVGHNROPDQÕ
ILEURYDVNXOHUSUROLIHUDV\RQXQEXOXQGX÷XE|OJHOHUKDULFLQGHWDPDPODQÕUYH
ILEURYDVNXOHUSUROLIHUDV\RQVRQDHUHU%XID]ÕQVRQXQGDJHQHOGHPDNXOD\ÕWXWDQELU
WUDNVL\RQHOUHWLQD GHNROPDQÕNRPSRQHQWLNDOÕU)LEURYDVNXOHU\DSÕQÕQYDVNXOHU
NRPSRQHQWLND\EROXU2SWLNVLQLUVROXNODúÕUYHUHWLQDODUWHULROOHULQFHOLU5HWLQD
SLJPHQWHSLWHOG]H\LQGHSLJPHQWHUGH÷LúLPOHUEXOXQDELOLU5HWLQGDDWURILN
GH÷LúLNOLNOHUROXúXUøQYROXV\HQHOVDIKDGDJ|UPHND\EÕPDNXODGHNROPDQÕ
PDNXODULVNHPLX]XQVUHQPDNXOD|GHPLYH\DRSWLNGLVNHED÷OÕRODELOLU
./ø1ø.
$UNDYLWUHGHNROPDQÕQÕQSDUVL\HORODUDND\UÕOPDVÕSUROLIHUDWLIGL\DEHWLN
UHWLQRSDWLQLQSURJUHV\RQXYHNRPSOLNDV\RQODUÕDoÕVÕQGDQEHOLUOLURO R\QDU$9'
ROXúXPXLOHDúD÷ÕGDVD\ÕODQELUoRNNOLQLNWDEORRUWD\DoÕNDU
9LWUHXVLoLKHPRUDML
9LWUHXVLoLKHPRUDMLOHUJHQHOGHDUNDYLWUHGHNROPDQÕROXúXUNHQDQLYLWUHXV
NRQWUDNVL\RQODUÕLOHIUDMLO\HQLGDPDUODUÕQ\ÕUWÕOPDVÕLOHROXúXU'L\DEHWHED÷OÕYLWUHXV
KHPRUDMLOHULJHQHOGHX\NXVÕUDVÕQGDJHOLúLU%XQXQQHGHQLX\NXVÕUDVÕQGDNLKÕ]OÕJ|]
KDUHNHWOHULYH\DVDEDKROXúDQKLSRJOLVHPL\HVHNRQGHUJHOLúHQNDQEDVÕQFÕQGDNL
DUWÕúWÕU(JVHUVL]KHPRUDMLJHOLúWLUPHULVNLQLDUWWÕUPDGÕ÷ÕQGDQEXKDVWDODUDHJVHUVL]
NÕVÕWODPDVÕ\DSÕOPDVÕQDJHUHN\RNWXU+HPRUDMLOHUED÷ÕPVÕ]RODUDN|NVUNYHNXVPD
JLELGXUXPODUGDGDROXúDELOLU
9LWUHXVLoLKHPRUDMLGHHVDVSUREOHPWHGDYL\DNODúÕGÕU9LWUHXVKHPRUDMLVL
JHOLúPLúELUKDVWD\DLNLúHNLOGH\DNODúÕODELOLU%LULQFLVHoHQHNKHPRUDMLQLQUH]RUEH
ROPDVÕQÕEHNOHPHNLNLQFLVHoHQHNLVHNRPSOLNDV\RQULVNLQLGúQHUHNKHPRUDMLQLQ
UH]RUEHROPDVÕQÕEHNOHPHGHQFHUUDKLWHGDYLX\JXODPDNWÕU%XNDUDUÕYHULUNHQoHúLWOL
IDNW|UOHULJ|]|QQGHEXOXQGXUPDPÕ]JHUHNLU%XQODU
.OLQLNPXD\HQH+DVWDPXD\HQHHGLOLUNHQYLWUHXVKHPRUDMLVLQLQUH]RUEVL\RQX
DoÕVÕQGDQELOJLHGLQLOHELOLU2IWDOPRVNRSLNPXD\HQHGHJ|]GLELQHDLWD\UÕQWÕODU
VHoLOHELOL\RUVDKHPRUDMLQLQKDILIROGX÷XDQODúÕOÕU$\UÕQWÕOÕVHoLOHPL\RUDQFDNWXUXQFX
ELUJ|]GLELU|IOHVLPHYFXWLVHKHPRUDMLQLQUH]RUEHROPDRODVÕOÕ÷ÕROGXNoD\NVHNWLUYH
FHUUDKLLoLQELUNDoD\EHNOHQELOLU<LQHKDVWDQÕQRIWDOPRVNRSLNPXD\HQHVLQGDSULPHU
EDNÕúSR]LV\RQXQGDWXUXQFXU|IOHDOÕQDPÕ\RUDQFDNKDVWD\XNDUÕEDNWÕUÕOGÕ÷ÕQGD
WXUXQFXU|IOHDOÕQÕ\RUVDKHPRUDMLQLQWPYLWUHXVNDYLWHVLQH\D\ÕOPDGÕ÷ÕDQODúÕOÕUYH
KDVWDL]OHQHELOLU+LoELUúHNLOGHWXUXQFXELUU|IOHDOÕQDPÕ\RUVDFHUUDKLEHNOHQPHGHQ
\DSÕOPDOÕGÕU
'L\DEHWLQWLSLg]HOOLNOHWLSGL\DEHWOLOHUGHKHPRUDMLVSRQWDQUH]RUEVL\RQX]RU
ROGX÷XQGDQYHUHWLQRSDWLSURJUHV\RQXKÕ]OÕROGX÷XQGDQHUNHQFHUUDKL
X\JXODQPDOÕGÕU7LSGL\DEHWOLOHUGHLVHKHPRUDMLQLQVSRQWDQUH]REVL\RQXGDKDKÕ]OÕ
UHWLQRSDWLQLQSURJUHV\RQXLVH\DYDúROGX÷XQGDQFHUUDKLLoLQEHNOHQHELOLU
'L\DEHWLQVUHVL'L\DEHWLQVUHVLLOHUHWLQRSDWLSURJUHV\RQXYHNRPSOLNDV\RQODUÕ
SDUOHOOLNJ|VWHUGL÷LQGHQGL\DEHW\DúÕID]ODRODQKDVWDODUGDHUNHQFHUUDKL
GúQOPHOLGLU
'L\DEHWLQWHGDYLVL.DQúHNHULL\LUHJOHHGLOHQELUKDVWDGDUHWLQRSDWLSURJUHV\RQX
GD\DYDúRODFD÷ÕQGDQNDQúHNHULNRQWURODOWÕQGD RODQKDVWDODUGDFHUUDKLLoLQX\JXQ
]DPDQEHNOHQHELOLU
/DVHUIRWRNRDJXODV\RQWHGDYLVL'DKD|QFHODVHUIRWRNRDJXODV\RQX\JXODQPDVÕ
UHWLQDGDNLLVNHPLNE|OJHOHULD]DWDFD÷ÕQGDQUHWLQRSDWLSURJUHV\RQXYHNRPSOLNDV\RQX
RUDQÕGDD]RODFDNWÕU%X\]GHQL\LELUSDQIRWRNRDJXODV\RQX\JXODQDQKDVWDGD
FHUUDKLLoLQEHNOHQHELOLU
86*86*WHWNLNLQGHSDUVL\HOELUDUNDYLWUHGHNROPDQÕEXOXQPDVÕWUDNVL\RQHO
UHWLQDGHNROPDQÕDoÕVÕQGDQELUULVNWDúÕU$QFDNWRWDOELU$9'YDUOÕ÷ÕQGDWUDNVL\RQHO
UHWLQDGHNROPDQÕULVNLRUWDGDQNDONPÕúWÕUYHUHWLQRSDWLQLQNRPSOLNDV\RQRUDQÕGDKD
D]RODFDNWÕU%XúHNLOGH86*WHWNLNLFHUUDKLQLQNDUDUÕDoÕVÕQGDQFHUUDKDELOJLYHULU
7UDNVL\RQHOUHWLQDGHNROPDQÕ
3UROLIHUDWLIGL\DEHWLNUHWLQRSDWLGHILEURYDVNXOHUSUROLIHUDV\RQODU]DPDQODYLWUHXVXQ
DUNDNÕVPÕQDDUNDK\DORLG\]H\H\DSÕúÕUYHEX\]H\ER\XQFDLOHUOHU$UNDYLWUHXV
GHNROPDQÕPH\GDQDJHOPHVLLOHELUOLNWHUHWLQD\ÕGDEHUDEHULQGHVUNOH\HQYLWUHXV
WUDNVL\RQHOUHWLQDGHNROPDQÕQD\RODoDU
3UROLIHUDWLIGLDEHWLNUHWLQRSDWLGHWUDNVL\RQHOUHWLQDGHNROPDQÕQÕQWLSLN|]HOOLNOHUL
ú|\OHVÕUDODQDELOLU
'HNROHUHWLQDE|OJHVLJHQHOGHDUNDNXWEXLoLQHDOÕUYHQDGLURODUDNHNYDWRUD
NDGDUX]DQÕU
'HNROHUHWLQDSXSLOOD\DGR÷UXNRQNDYGÕU
6XEUHWLQDOVÕYÕGDKDUHNHWJ|]OHQPH]
'HNROHUHWLQD\]H\LSDUODNYHJHUJLQGLU
7UDNVL\RQHOGHNROPDQPDNXOD\ÕLoLQHDOÕUVDDQLELUJ|UPHND\EÕRUWD\DoÕNDELOLUYH
HUNHQFHUUDKLJHUHNLU$QFDNILEURYDVNXOHUSUROLIHUDV\RQGDPDUDUNÕER\XQFD
VH\UHGL\RUYHPDNXOD\DX]DQPÕ\RUVDFHUUDKLLoLQEHNOHQHELOLUYHKDVWDL]OHPH\H
DOÕQÕU7UDNVL\RQHOGHNROPDQÕQPDNXOD\DGR÷UXLOHUOHPHRODVÕOÕ÷Õ\ÕOGDRODUDN
NDEXOHGLOPHNWHGLU
0DNXODQÕQGHNROHNDOPDVUHVLIRQNVL\RQHOSURJQR]DoÕVÕQGDQ|QHPOLGLU\ÕOÕ
JHoHQPDNXODGHNROPDQODUÕQGDSURJQR]N|WGU
7UDNVL\RQHO5'5HJPDWRMHQ5'
3UROLIHUDWLIGLDEHWLNUHWLQRSDWLGHWUDNVL\RQoRNúLGGHWOLLVHWUDNVL\RQHOUHWLQD
GHNROPDQODUÕLOHELUOLNWHUHJPDWRMHQUHWLQDGHNROPDQODUÕGDJHOLúHELOLU5HWLQDO\ÕUWÕNODU
JHQHOGHDUNDNXWXSWDILEURYDVNXOHUGH÷LúLNOLNOHULQ\DNÕQÕQGDGÕU<ÕUWÕNODURYDOGLUYH
SUROLIHUDWLIGRNXQXQWDQMHQVL\HOWUDNVL\RQXQDED÷OÕGÕU7UDNVL\RQHOUHWLQDGHNROPDQÕ
UHJPDWRMHQUHWLQDGHNROPDQÕQÕQJ|UQPWUDNVL\RQHOUHWLQDGHNROPDQÕQGDQ
IDUNOÕGÕU'HNROPDQNRQYHNVJULPVLYHPDWELU\]H\HVDKLSWLU(OHYHUHWLQDQÕQVÕQÕUODUÕ
RUDVHUUDWD\DNDGDUX]DQÕU6XEUHWLQDOVÕYÕQÕQKDUHNHWLQHED÷OÕRODUDNUHWLQD
PRELOGLU%X|]HOOLNNRPELQHGHNROPDQÕWUDNVL\RQHOGHNROPDQGDQD\ÕUDQ|QHPOLELU
|]HOOLNWLU
3URJUHVLIILEURYDVNXOHUSUROLIHUDV\RQ
g]HOOLNOHLQVOLQHED÷ÕPOÕWLSGL\DEHWLNOHUGHJ|UOHQSURJUHVLIILEURYDVNXOHU
SUROLIHUDV\RQL\LX\JXODQPÕúELUSDQIRWRNRDJXODV\RQDUD÷PHQILEURYDVNXOHU
GH÷LúLNOLNOHULQDUWDUDNGHYDPHWWL÷LYHJ|UPHND\EÕQDQHGHQRODELOHFHN
NRPSOLNDV\RQODUD\RODoDQELUNOLQLNGXUXPGXU%XKDVWDODUGDNDOÕFÕ ELUJ|UPHND\EÕQÕ
|QOHPHNDPDFÕLOHSDUVSODQDYLWUHNWRPLX\JXODQPDOÕGÕU
1HRYDVNXOHUJORNRP
1HRYDVNXOHUJORNRPSUROLIHUDWLIGLD\EHWLNUHWLQRSDWLQLQHQ|QHPOL|QVHJPHQW
NRPSOLNDV\RQXGXU5XEHR]LVDQJLRJHQLNIDNW|UOHULQSXSLOOD\ROXLOH|QHJHOPHVLQGHQ
GROD\ÕLONRODUDNSXSLOODVÕQÕUÕQGDEDúODU.DUHNWHULVWLNRODUDNSXSLOODVÕQÕUÕQGDQDoÕ\D
GR÷UXLOHUOHU$oÕGDNLGDPDUODUVLOLHUFLVLPYHVNOHUDOVSXUDGR÷UXLOHUOHUgQVHJPHQW
QHRYDVNXODUL]DV\RQXQHUNHQVDIKDVÕQGDJ|]LoLEDVÕQFÕQRUPDOGLU
<HQLGDPDUODUDoÕGDILEURYDVNXOHUPHPUDQROXúWXUDUDNVHNRQGHUDoÕNDoÕOÕ
JORNRPROXúWXUXUODU)LEURYDVNXOHUPHPEUDQÕQNRQWUDNVL\RQXLOHSHULIHULNLULV
WUDEHNXOHUD÷]HULQHGR÷UXoHNLOLUYHVLQHúL\HODoÕNDSDQPDVÕROXU(NWURSLRQXYHDYH
KLIHPDVÕNOÕNODHúOLNHGHQEXOJXODUGÕU(NWURSLRQXYHDLULV\]H\LQGHNLUDGLDOWUDNVL\RQD
ED÷OÕRODUDNJHOLúLU+DVWDODUNOLQL÷HD÷UÕOÕNRUQHD|GHPLYH|QNDPDUDUHDVL\RQXLOH
VH\UHGHQ\NVHNJ|]LoLEDVÕQFÕLOHEDúYXUXUODU
1HRYDVNXOHUJORNRPGDWHGDYLRODUDNLVNHPL\L|QOHPHNDPDFÕLOHODVHU
IRWRNRDJXODV\RQD÷UÕOÕROJXODUGDHNYDWRU\DONUL\RWHUDSLYHVLNORNUL\RWHUDSL
X\JXODQÕU7HUPLQDOVDIKDGDNLROJXODUGDSDUVSODQDYLWUHNWRPLYHWSLPSODQWDV\RQ\
X\JXODQPDNWDGÕU
7('$9ø
3UROLIHUDWLIGLDEHWLNUHWLQRSDWLWHGDYLVLQGHLNLDPDoYDUGÕUELULQFLVL\HQLGDPDU
ROXúXPXQXQ|QOHQPHVLLNLQFLVLILEURYDVNXOHUSUROLIHUDV\RQXQ\DSWÕ÷ÕNRQWUDNVL\RQXQ
\RNHGLOPHVLGLU
<HQLGDPDUROXúXPXQXQ|QOHQPHVL
ø\LNDQúHNHULNRQWURO
+LSRIL]HUDEODV\RQ
)RWRNRDJXODV\RQ
.RQWUDNVL\RQXQ\RNHGLOPHVL
3DUVSODQDYLWUHNWRPL\|QWHPOHULLOHVD÷ODQÕU
7DULKoH
*QP]GHGL\DEHWLNUHWLQRSDWLQLQWHGDYLVLQGHPRGHUQIRWRNRDJXODV\RQYHFHUUDKL
\|QWHPOHUNXOODQÕOPDNWDGÕU*QP]HJHOHQHNDGDUoRNoHúLWOLWHGDYL\|QWHPOHUL
GHQHQPLúWLU%X\|QWHPOHULNÕVDFD|]HWOHUVHN
D(UNHQ/DVHU'HQHPHOHUL'LUHNW$EODV\RQ
0H\HU6FKZLFKNHQDWKYH6FKRWWLONRODUDNGLDEHWLNUHWLQRSDWLWHGDYLVLQGH
\ÕOÕQGDIRWRNRDJXODV\RQXNXOODQPÕúODUGÕU.XOODQÕODQIRWRNRDJXODV\RQ;HQRQDUF
ROPXúWXU;HQRQDUFLOHGDPDUODUGLUHNWRODUDN REOLWHUHHGLOHELOLUG]QHRYDVNXOHU
ROXúXPODUGLODWHUHWLQDONDSLOOHUOHUPLNURDQHYUL]PDODUYH|GHPOLUHWLQDWHGDYL
HGLOHELOLU.DEDUÕNGDPDUODUGDKDID]ODHQHUMLJHUHNWLUGL÷LQGHQ;HQRQDUF
IRWRNRDJXODV\RQJHQLúUHWLQDOGHVWUXNVL\RQODUD\RODoDELOPHNWHGLU%X\]GHQ$LHROOR
YHDUNDGDúODUÕDUNDNXWXSWDNoNPXOWLSO]DUDUVÕ]NRULRUHWLQDOVNDUODUÕQ\DSÕOPDVÕ
JHUHNWL÷LQLELOGLUPLúOHUYHUXE\/DVHULQJHOLúWLULOPHVLLOHEXQX
JHUoHNOHúWLUPLúOHUGLU5XE\/DVHUQPGDOJDER\XQGDNLÕúÕ÷Õ\D\DUDNUHWLQD
SLJPHQWHSLWHOLWDUDIÕQGDQL\LHPLOLUYHYLWUHXVKHPRUDMLVLGXUXPXQGDGDGRNX\D
XODúDELOPHNWHGLUDQFDNGDPDUODUDRODQHWNLQOL÷LD]DOPDNWDGÕU$LHROORYHDUNDGDúODUÕ
NXOODQGÕNODUÕ\|QWHPOHQHRYDVNXOHU\DSÕODUÕQND\EROGX÷XQXQRNWDVDONDQDPDODUÕQ
D]DOGÕ÷ÕQÕRSWLNGLVNLQVROXNODúWÕ÷ÕQÕILEU|]SUROLIHUDV\RQODUGDGH÷LúLNOLNROPDGÕ÷ÕQÕYH
UHWLQDOYHQOHULQ))$¶GDGDKDD]VÕ]GÕUGÕ÷ÕQÕELOGLUPLúOHUGLU
E+LSRIL]%H]L$EODV\RQX
+LSRIL]HUDEODV\RQSUROLIHUDWLIGLDEHWLNUHWLQRSDWLGHWDUWÕúPDOÕELUWHGDYL
\|QWHPLGLU+RXVVDOLONRODUDN\ÕOÕQGDKLSRIL]HNWRPLQLQN|SHNOHUGHGLDEHWLQ
úLGGHWLQLD]DOWWÕ÷ÕQÕJ|VWHUPLúWLU/XIWYHDUNDGDúODUÕ\ÕOÕQGDEÕWHNQL÷LLQVDQODUGD
WDQÕWPÕúODUGÕU<DNÕQYHX]XQG|QHPVRQXoODUÕQGDSLWXDWDU\DEODV\RQDX÷UD\DQ
KDVWDODUGDYL]\RQXQVWDELOL]DV\RQXVD÷ODQPÕúHNVGDYHKHPRUDMLOHUGHD]DOPD
ROGX÷XJ|VWHULOPLúWLU$QFDNSRVWXUDOKLSRWDQVL\RQKLSRJOLVHPLYH|OPJLEL
NRPSOLNDV\RQODUD\RODoDELOGL÷LQGHQIRWRNRDJXODV\RQYHYLWUHNWRPL\|QWHPOHUL
JHOLúWLULOGLNWHQVRQUDWHGDYL\|QWHPLROPDNWDQoÕNPÕúWÕU
0RGHUQ)RWRNRDJXODV\RQ7HGDYLVL
<XNDUÕGDGDEHOLUWLOGL÷LJLEL0H\HU6FKZLFNHUDWK¶ÕQJHOLúWLUGL÷L[HQRQDUFODVHU
LOHUHWLQD\]H\LQGHNL\HQLGDPDUODUÕQGLUHNWWHGDYLVLPPNQGU%X\|QWHPLOH
\DYDúJHQLúYHRUWDúLGGHWGH\DQÕNODUROXúWXUDUDNGLUHNWRODUDN\HQLGDPDUODUÕQ
GDUDOPDVÕYHJHULOHPHVLVD÷ODQÕU$QFDN;HQRQDUFIRWRNRDJXODV\RQYLWUHXVYH\D
RSWLNGLVNGH53(HSLWHOLQGHQX]DN\HQLGDPDUODUÕQWHGDYLVLQGHHWNLVL]NDOPDNWDGÕU
oQNEXGDPDUODUÕQGHVWUNVL\RQXLoLQNÕVDVUHGH\R÷XQELUHQHUMLND\QD÷Õ
JHUHNPHNWHGLU%XOH]\RQODUÕQWHGDYLVLJQP]GHNXOODQÕODQPDYL\HúLODUJRQODVHU
LOHPPNQROPXúWXU
3DQUHWLQDOIRWRNRDJXODV\RQHWNLPHNDQL]PDVÕ
)RWRUHVHSW|U53(NRPSOHNVLUHWLQDGDNLWRWDORNVLMHQWNHWLPLQLQoWHLNLVLQGHQ
VRUXPOXWXWXOPDNWDGÕU1RUPDONRúXOODUDOWÕQGDRNVLMHQLQNRULRNDSLOODULVGHQLoUHWLQD
NDWODUÕQDGLI]\RQXID]ODPLNWDUGDRNVLMHQWNHWLPL\DSDQEXNRPSOHNVWDUDIÕQGDQ
VÕQÕUODQGÕUÕOPÕúWÕU)RWRNRDJXODV\RQEXNRPSOHNVLWDKULSHGHUHNLoUHWLQDNDWODUÕQD
GDKDID]ODPLNWDUGDRNVLMHQXODúPDVÕQÕYHUHWLQDOLVNHPL\LHQJHOOH\HUHNDQMLRJHQHWLN
IDNW|UOHULQUHWLPLQLEDVNÕODU
3DQUHWLQDOIRWRNRDJXODV\RQHWNLOHUL
5HWLQDLoNDWODUÕQDRNVLMHQGLI]\RQXDUWDU
$QMLRJHQHVLVVWLPXOXVXQXD]DOWÕU
1HRYDVNXUL]DV\RQLQKLELW|UOHULQLDNWLYHHGHU
)RWRUHVSW|U53(NRPSOHNVLQLQRNVLMHQWNHWLPLQL
D]DOWÕU
9DVNXODUHQGRWHO\DOJURZWKIDNW|U9(*)UHWLQDOLVNHPLGHYHLQUDRNXODU
QHRYDVNXODUL]DV\RQGDEDúOÕFDVRUXPOXWXWXODQDQMLRJHQHWLNSHSWLGGLU3UROLIHUDWLI
GL\DEHWLNUHWLQRSDWLOLJ|]OHUGHGDKD\NVHNEXOXQDQ9(*)¶QIRWRNRDJXODV\RQLOH
D]DOGÕ÷ÕoHúLWOLoDOÕúPDODUGDJ|VWHULOPLúWLU
$\UÕFDIRWRNRDJXODV\RQUHWLQDSLJPHQWHSLWHOLQGH\DUDWWÕ÷ÕGH÷LúLNOLNOHULOHGH
QHRYDVNXODUL]DV\RQXD]DOWPDNWDGÕU)RWRNRDJXODV\RQLOH53(¶QLQUHWWL÷L
QHRYDVNXODUL]DV\RQXD]DOWDQLQKLELW|UPDGGHOHUGHDUWÕúROPDNWDGÕU
7HNQLN
*QP]GH/DVHU).;HQRQDUFIRWRNRDJXODV\RQXQ\HULQLDOPÕúWÕU$UJRQ
\HúLOLQPUHWLQDSLJPHQWHSLWHOLWDUDIÕQGDQHPLOGL÷LQGHQX\JXQELUODVHUGLU$UJRQ
PDYL\HúLOQPVH\UHNNXOODQÕOVDGD'56JUXEXQXQVWDQGDUWWHGDYLVLGLU'\H
\HOORZODVHUQPNDQWDUDIÕQGDQL\LHPLOLUYH\HQLGDPDUODUÕQGLUHNWWHGDYLVLQGH
X\JXQGXU+HPRJODELQDILQLWHVLODVHUOHULoLQGHHQ\NVHNRODQÕGÕU.U\SWRQNÕUPÕ]ÕVÕ
QPVNOHURWLNNDWDUDNWYHYLWUHXVKHPRUDMLVLGXUXPODUÕQGDNXOODQÕúOÕGÕU.VDQWRILO
SLJPHQWLWDUDIÕQGDQPLQLPDOHPLOLU$QFDNNU\SWRQNÕUPÕ]ÕVÕID]ODSHQHWUDV\RQ
J|VWHUGL÷LQGHQKDVWDODULoLQD÷UÕOÕGÕUYHVÕNOÕNODUHWUREXOEHUDQHVWH]L\HLKWL\Do
GX\DU'LRGODVHULQIUDUHGVSHNWUXPGDÕúÕN\D\GÕ÷ÕQGDQIRWRIRELVLRODQKDVWDODUGD
WHUFLKHGLOHELOLU$QFDNGLRGODVHUGHD÷UÕOÕROGX÷XQGDQJHQHOOLNOHUHWUREXOEHUDQHVWH]L
JHUHNWLULU.RURLGDOUSWUYHKHPRUDMLJLELNRPSOLNDV\RQODUÕYDUGÕU
.XOODQÕODQVSRWE\NO÷NXOODQÕODQOHQVHJ|UHGH÷LúLUYHPP¶OLN\DQÕN
HOGHHWPHNLoLQ*ROGPDQQOHQVLQGHPP9RONTXDGULVIHULNOHQVLQGHPP
NXOODQÕOÕU6UHWLSLNRODUDNVDQL\HGLU2UWDPEXODQÕNOÕ÷ÕQGDX]XQVUHOHU
NXOODQÕOÕU/DVHULQJFJULEH\D]ELU\DQÕNROXúWXUDFDNúHNLOGHD\DUODQPDOÕGÕU
)RWRNRDJXODV\RQSDUDPHWOHUL
'56SURWRNROQHJ|UHPPE\NO÷QGHLOHVSRW
X\JXODQPDOÕGÕU<DQÕNODUDUDOÕNODUODROXúWXUXOPDOÕGÕU7HPSRUDONDGUDQD/DVHU).
X\JXODQÕUNHQPDNXODPHUNH]LQHGLVNoDSX]DNOÕ÷ÕQGDELUVÕQÕU
EÕUDNÕOPDOÕGÕU7HGDYLWHNYH\DPXOWLSOVHDQVODUGDX\JXODQDELOLUWHGDYLHWNLQOL÷L
DoÕVÕQGDQIDUN\RNWXUDQFDNWHNX\JXODQÕPGDNRPSOLNDV\RQRUDQÕGDKDID]ODGÕU
)RWRNRDJXODV\RQ(QGLNDV\RQODUÕ
)RWRNRDJODV\RQODWHGDYL|QHULOHULLNLE\NoDOÕúPDJUXEXQXQ'LDEHWLF
5HWLQRSDWK\6WXG\'56YH(DUO\7UHDWPHQW'LDEHWLF5HWLQRSDWK\6WXG\(7'56
JUXSODUÕQÕQVRQXoODUÕLOHLOLúNLOLGLU
'56JUXEXGL\DEHWLNUHWLQRSDWLGHFLGGLJ|UPHND\EÕDoÕVÕQGDQULVNIDNW|U
VDSWDPÕúWÕUEXQODU
<HQLGDPDUROXúXPODUÕ
'LVN]HULQGH\DGDGLVNGHQSDSLOODoDSÕX]DNOÕNWDNLDODQLoLQGH\HQLGDPDU
ROXúXPX
9LWUHXVLoLYHYH\DSUHUHWLQDOKHPRUDML
2UWD\DGDD÷ÕUGHUHFHGH\HQLGDPDUROXúXPX
D GLVNDODQÕQGDQE\N19'
E 19'\RNOX÷XQGDòGLVNDODQÕQGDQE\N19(
%XULVNIDNW|UOHULQGHQo\DGDG|UGQQYDUOÕ÷ÕFLGGLJ|UPHND\EÕDoÕVÕQGDQ
\NVHNULVNJUXEXQGDROXQGX÷XQXJ|VWHULU5LVNIDNW|UOHULQGHQLNLYH\DGDKDD]ULVN
IDNW|UEXOXQPDVÕGXUXPXQGDFLGGLJ|UPHND\EÕRODVÕOÕ÷Õ\ÕOOÕNWDNLSVUHVLQGH
YH\DGDKDID]ODULVNIDNW|UEHUDEHUEXOXQGX÷XQGDD\QÕ]DPDQGLOLPLVRQXQGD
¶GLU)RWRNRDJXODV\RQUHWLQRSDWLQLQHYUHVLJ|]|QQGHEXOXQGXUXOPDNVÕ]ÕQFLGGL
J|UPHND\EÕULVNLQLRUDQÕQGDD]DOWPDNWDGÕU%X\]GHQ\NVHNULVNJUXEXQGD
RODQKDVWDODUDIRWRNRDJXODV\RQX\JXODQPDOÕGÕU
(7'56JUXEXQXQoDOÕúPDVÕQDEDNÕOGÕ÷ÕQGDHUNHQSDQUHWLQDOIRWRNRDJXODV\RQ
X\JXODQDQJ|]OHUGHRUWDGHUHFHJ|UPHND\EÕGDKDID]ODRUDQGDJHOLúPLúWLU%XGXUXP
|]HOOLNOHGHIRWRNRDJXODV\RQ|QFHVLPDNXOD|GHPLEXOXQDQROJXODUGDJ|UOG÷QGHQ
HUNHQSDQUHWLQDOIRWRNRDJXODV\RQX\JXODPDVÕQÕQPDNXOD|GHPLLoLQIRNDO\DGDJULG
IRWRNRDJXODV\RQX\JXODPDVÕQGDQVRQUD\DEÕUDNÕOPDVÕRUWDGHUHFHYL]\RQND\EÕQÕ
HQJHOOH\HFHNWLU%LUOLNWHPDNXOD|GHPLEXOXQDQROJXODUGDSDQUHWLQDO
IRWRNRDJXODV\RQXQHUWHOHQPHVLQLQX\JXQJ|UOPHGL÷LGXUXPODUGDLONVHDQVGDQD]DO
NDGUDQÕQSDQUHWLQDOIRWRNRDJODV\RQXQYHPDNXOD|GHPLLoLQIRNDO\DGDJULGODVHU
WHGDYLVLGL÷HUVHDQVODUGDLVHSDQIRWRNRDJXODV\RQXQWDPDPODQPDVÕX\JXODQDELOLU
3DQIRWRNRDJXODV\RQXQJHFLNWLULOPHVLYLWUHXVLoLNDQDPDYHQHRYDVNXOHU JORNRP
JLEL\NVHNULVNWDúÕ\DQELUJ|]GHKHPHQKHU]DPDQPPNQROPD\DELOLU(7'56
oDOÕúPDJUXEXQXQSURWRNROQHJ|UHE|\OHELUGXUXPGDPDNXODQÕQGXUXPXQD
EDNÕOPDNVÕ]ÕQSDQIRWRNRDJXODV\RQDFLOHQ\DSÕOPDOÕGÕU(7'56oDOÕúPDVRQXoODUÕQGD
KHUQHNDGDUHUNHQODVHUWHGDYLVL\NVHNULVNSUROLIHUDULIGLDEHWLNUHWLQRSDWLJHOLúLPLQL
RUDQÕQGDD]DOWPDNWDLVHGHHUNHQIRWRNRDJXODV\RQX\JXODQDQROJXODUYH
\NVHNULVN3'5JHOLúLPLQHNDGDUIRWRNRDJXODV\RQX\JXODPDVÕJHFLNWLULOHQROJXODUGD
FLGGLJ|UPHND\EÕULVNLDoÕVÕQGDQDQODPOÕIDUNOÕOÕNVDSWDQPDPÕúWÕU2UWDGHUHFHJ|UPH
ND\EÕYHJ|UPHDODQÕGDUDOPDVÕQÕQHQJHOOHQPHVLLoLQEXWUKDVWDODUÕQ\DNÕQWDNLELYH
IRWRNRDJXODV\RQXWHUFLKHQGL\DEHWLNUHWLQRSDWLQLQ\NVHNULVNOLVDIKD\D\DNODúWÕ÷Õ
YH\D\NVHNULVNOLSUROLIHUDWLIGL\DEHWLNUHWLQRSDWLJHOLúWL÷LQGHJHFLNWLULOPHGHQDFLOHQ
X\JXODQPDVÕ|QHULOPHNWHGLU
<XNDUÕGDEHOLUWLOHQHQGLNDV\RQODUGDQEDúNDGXUXPODUGDGDIRWRNRDJXODV\RQ
X\JXODQPDVÕ|QHULOPHNWHGLUgUQH÷LQ|QNDPDUDDoÕVÕQGD\D\JÕQQHRYDVNXODUL]DV\RQ
HQ|QHPOLIRWRNRDJXODV\RQHQGLNDV\RQODUÕQGDQELULGLU)RWRNRDJXODV\RQLOHDoÕGDNL
\HQLGDPDUODUÕQUHJUHV\RQXVD÷ODQÕUYHQHRYDVNXOHUJORNRPXQJHOLúLPL|QOHQLU
<NVHNULVNNDUDNWHULWDúÕPD\DQDQFDN\D\JÕQUHWLQDOKHPRUDMLOHUYHQ|]
EHDGLQJYH\XPXúDNHNVGDODUÕQYDUOÕ÷ÕLOHFLGGLUHWLQDOLVNHPLVLRODQROJXODUGDGD|Q
VHJPHQWQHRYDVNXODUL]DV\RQXRODELOHFH÷LQGHQIRWRNRDJXODV\RQX\JXODPDVÕ
\DSÕOPDOÕGÕU
<NVHNULVNOLKDVWDODUGDIRWRNRDJXODV\RQVÕUDVÕQGDILEU|]SUROLIHUDV\RQ
NRQWUDNVL\RQXQGDLOHUOHPHYH\DWUDNVL\RQHO UHWLQDGHNROPDQÕQÕQPDNXOD\ÕLoLQH
DOPDVÕJLELNRPSOLNDV\RQODUJHOLúHELOLU<DSÕODQoDOÕúPDODUEXWUROJXODUGDGD
IRWRNRDJXODV\RQXQX\JXODQPDVÕJHUHNWL÷LQLDQFDNWUDNVL\RQE|OJHVLQGHQX]DN
GXUXOPDVÕJHUHNWL÷LQLLIDGHHWPHNWHGLU
/DVHUIRWRNRDJXODV\RQNRPSOLNDV\RQODUÕ
9L]\RQEXODQÕNOÕ÷Õ
1LNWDORSL
*|UPHDODQÕQGDGDUDOPD
*|]LoLEDVÕQFÕQGDDUWÕú
*HoLFLPL\RSL
$NRPRGDV\RQER]XNOXNODUÕ
.RUQHDODQRUPDOOLNOHU
øULVYHSXSLOOHUDQRUPDOOLNOHU
0DNXOD|GHPL
0DNXOD\DQÕNODUÕ
.RURLGGHNROPDQÕYHYH\D
HI]\RQX
9LWUHXVKHPRUDMLVL
/HQVRSDVLWHOHUL
2SWLNQ|URSDWL
<NVHNULVNOLSUROLIHUDWLIGL\DEHWLNUHWLQRSDWLGHODVHUIRWRNRDJXODV\RQJ|UPH
ND\EÕQÕD]DOWPDNWDGÕUDQFDN\DQHWNLOHULGHPHYFXWWXU
3DQIRWRNRDJXODV\RQVRQUDVÕYL]\RQGDoHúLWOLGHUHFHOHUGHER]XNOXNODU
J|UOHELOLU%XQODUD|UQHNRODUDNDNDPRGDV\RQGDJoONUHQNOLJ|UPHDQRUPDOOLNOHUL
J|UPHDODQÕQGDGDUDOPDYHJHFHJ|UPHVLQGHER]XNOXNJ|VWHULOHELOLU
.RUQHDGDLVHNRUQHDO\DQÕNHUH]\RQYH\]H\HOSXQNWDWNHUDWLWJLEL
NRPSOLNDV\RQODUJ|UOHELOLU$QFDNEXNRPSOLNDV\RQODUoRNFLGGLGH÷LOGLU
3DQIRWRNRDJXODV\RQVRQUDVÕJ|]LoLEDVÕQFÕQGDGH÷LúLNOLNOHUL]OHQPHNWHGLU
*HoLFLJ|]LoLEDVÕQFÕDUWÕúÕ|QNDPDUDGDGDUDOPDYHDoÕNDSDQPDVÕQDED÷OÕRODUDN
ROXúXUgQNDPDUDGDNLGDUDOPDVLOLHUFLVPLQURWDV\RQXYH|QHKDUHNHWLQHGHQL\OH
ROXUgQNDPDUDGDNLYHDoÕGDNLGH÷LúLNOLNOHUJHQHOGHIRWRNRDJXODV\RQWHNVHDQVWD
X\JXODQGÕ÷ÕQGDJHOLúLUYHIRWRNRDJXODV\RQPXOWLSOVHDQVODUGD\DSÕOGÕ÷ÕQGDJ|UOPH
VÕNOÕ÷ÕD]DOÕU)RWRNRDJXODV\RQVRQUDVÕJHOLúHQDoÕNDSDQPDVÕJORNRPXPHGLNDO
WHGDYL\HL\L\DQÕWYHULU
øULVYHSXSLOOHUDQRUPDOOLNOHULULVHX\JXODQDQODVHU\DQÕNODUÕQGDYH\DÕVÕ\DED÷OÕ
JHOLúHQLULVVLILQWHULQLQSDUDVHPSDWLNLQHUYDV\RQER]XNOX÷XQGDQLOHULJHOLU3XSLOOD
VÕQÕUÕQGDKLSHUSLJPHQWDV\RQDWURILSRVWHULRUVLQHúLD]DOPÕúSXSLOOHUUHDNWLYLWH
PLGULD]LVPL\R]LVDNRPRGDV\RQSDUDOL]LVLUDVWODQDELOHQNRPSOLNDV\RQODUGÕU
/DVHUIRWRNRDJXODV\RQVRQUDVÕVWDELOQRQSURJUHVLIOHQVRSDVLWHOHULQH
UDVWODQDELOLU/HQWLNOHURSDVLWHOHUJHQHOGHPXOWLSOJULEH\D]VLUNOHUYH\DRYDOYH|Q
NRUWHNVLOHQXNOHXVELUOHúPH\HULQGHJ|UOUg]HOOLNOHNDWDUDNWÕRODQYHEX\]GHQ
\NVHNHQHUMLLOHX]XQVUHOLODVHUIRWRNRDJXODV\RQX\JXODQDQROJXODUGDGDKDVÕN
UDVWODQÕU%XWUGXUXPODUGDGDKDL\LSHQHWUDV\RQJ|VWHUHQNUL\SWRQNÕUPÕ]ÕVÕ
NXOODQÕODELOLU
/DVHUWHGDYLVLQLQDUNDVHJPHQWNRPSOLNDV\RQODUÕPDNXODGD\DQÕNPDNXOD
|GHPLQLQJHOLúLPLYH\DDOHYOHQPHVLVLOLRNRURLGDOHI]\RQYHQHRYDVNODUL]\RQ
WUDNVL\RQHOUHWLQDGHNROPDQÕQÕQ\D\ÕOPDVÕYHRSWLNQ|URSDWLGLU
/DVHUIRWRNRDJXODV\RQVRQUDVÕJHOLúHQDQLJ|UPHND\EÕQÕQELUVHEHELHNVGDWLI
PDNXODGHNROPDQÕGÕU%XNRPSOLNDV\RQODVHUIRWRNRDJXODV\RQXQ\R÷XQOX÷XYH
\D\JÕQOÕ÷ÕLOHLOLúNLOLGLU$QFDNHNVGDWLIPDNXODGHNROPDQÕJHoLFLELUGXUXPGXUYHELU
LNLKDIWDLoLQGHNHQGLOL÷LQGHQG]HOLU
/RNDOL]HJHOLúHQVLOLRNRURLGDOGHNROPDQVÕNUDVWODQDQELUNRPSOLNDV\RQGXUYH
LNLoKDIWDLoLQGHVSRQWDQG]HOLU
/DVHUIRWRNRDJXODV\RQ%UXFKPHPEUDQÕQGDoDWODNODUDQHGHQRODUDN
QHRYDVNODUL]DV\RQD\RODoDELOLU*HQHOGHPDNXOD\DX\JXOD\DQ
ODVHUIRWRNRDJXODV\RQVRQUDVÕJHOLúPHNWHGLU
/RNDOL]HWUDNVL\RQHOUHWLQDGHNROPDQODUÕQÕQODVHUIRWRNRDJXODV\RQVRQUDVÕ
\D\ÕODELOGL÷LJ|UOVHGHVRQXoODUÕDoÕVÕQGDQ\NVHNULVNOLSUROLIHUDWLIGL\DEHWLN
UHWLQRSDWLYHWUDNVL\RQHOUHWLQDGHNROPDQÕRODQKDVWDODUGDODVHUIRWRNRDJXODV\RQX
\JXODQPDOÕGÕU
2SWLNQ|URSDWLSHULSDSLOOHUE|OJH\HX\JXODQDQODVHUIRWRNRDJXODV\RQVRQUDVÕ
JHOLúHELOLUgQHVUOHQPHNDQL]PD53(¶GHQ\DQVÕ\DQÕVÕHWNLVL\OHRSWLNVLQLUYHVLQLU
NDWÕKDVDUÕGÕU
/DVHUIRWRNRDJXODV\RQVRQUDVÕHOHNWURIL]\RORMLNGH÷LúLPOHURODELOPHNWHGLU
<DSÕODQ|OoPOHUGHDYHEGDOJDODUÕQÕQDPSOLWGQGHD]DOPDVDSWDQÕU
3DUV3ODQD9LWUHNWRPL
9LWUHNWRPLUH]RUEHROPD\DQYLWUHXVKHPRUDMLVLLoLQLONRODUDN\ÕOÕQGD
0DFKHPHUWDUDIÕQGDQWDULIHGLOPLúWLU=DPDQODWHNQLNYHLQVWUXPHQWDV\RQXQJHOLúPHVL
LOHHQGLNDV\RQODUGDJHQLúOHPLúWLU
'56JUXEXQXQ\DSWÕ÷ÕoDOÕúPD\DJ|UH7LSGLDEHWOLKDVWDODUGDHUNHQ
YLWUHNWRPLYL]\RQDUWÕúÕVD÷ODQGÕ÷ÕQGDQ|QHULOPHNWHGLU7LSGLDEHWOLKDVWDODUGDYH
PLNVWWLSKDVWDODUGDLVHHUNHQYLWUHNWRPLYH\ÕOLoLQGHX\JXODQDQYLWUHNWRPLVRQXoODUÕ
EHQ]HUGLU
7DEOR9LWUHNWRPLHQGLNDV\RQODUÕ
*HULOHPH\HQYLWUHXV
KHPRUDMLVL
7UDNVL\RQHOUHJPDWRMHQUHWLQD
GHNROPDQÕ
3UHPDNXODUILEUR]LV
0DNXOHUKHWHURWRSL
1HRYDVNXOHUSUROLIHUDV\RQ
+HPROLWLNJORNRP
øULVQHRYDVNXODUL]DV\RQX
1HRYDVNXOHUJORNRP
.DWDUDNWYH
QHRYDVNXODUL]DV\RQ
0DNXOD|GHPL
gQK\DORLGILEURYDVNXOHU
SUROLIHUDV\RQ
*HULOHPH\HQ9LWUHXV+HPRUDMLVL
¶OL\ÕOODUGDHQVÕNSDUVSODQDYLWUHNWRPLHQGLNDV\RQXRODQYLWUHXV
KHPRUDMLVLJPP]GHWUDNVL\RQHOGHNROPDQVRQUDVÕQGDLNLQFLVÕUD\ÕDOPDNWDGÕU7LS
GL\DEHWLNOHUGH\R÷XQYLWUHXVKHPRUDMLVLQLQVSRQWDQUH]ROV\RQJ|VWHUPHVLQDGLUGLU
YHILEU|]SUROLIHUDV\RQDLOHUOHU%X\]GHQ7LSGL\DEHWLNOHUGHX\JXODQDQHUNHQ
YLWUHNWRPLKHPRUDMLGHQ\ÕOYHVRQUDVÕQGD\DSÕODQYLWUHNWRPL\HJ|UHDQDWRPLNYH
IRQNVL\RQHODoÕGDQGDKDEDúDUÕOÕVRQXoODUDOÕQPDNWDGÕU
7LSGL\DEHWLNOHUGHLVHILEU|]SUROLIHUDV\RQJHOLúLPLGDKD\DYDúROGX÷XQGDQYH
KHPRUDMLNROD\UHVRUEHROGX÷XQGDQHUNHQYHJHoYLWUHNWRPLDUDVÕQGDDQDWRPLNYH
IRQNVL\RQHODoÕGDQDQODPOÕIDUN\RNWXU
7UDNVL\RQHO5HWLQD'HNROPDQÕ5HJPDWRMHQ5HWLQD'HNROPDQÕ
3UROLIHUDWLIGL\DEHWLNUHWLQRSDWLGHWUDNVL\RQHOUHWLQDGHNROPDQÕPDNXOD\ÕWHKGLW
HWPL\RUVDL]OHQHELOLUDQFDNPDNXOD\ÕWHKGLWHGHQWUDNVL\RQHOUHWLQDGHNROPDQÕYH\D
EHUDEHULQGH|]HOOLNOHDUNDNXWXSWDVÕNJ|UOHQ\ÕUWÕNQHGHQL\OHROXúDQUHJPDWRMHQ
UHWLQDGHNROPDQÕPHYFXWVD339HQGLNDV\RQXYDUGÕU0DNXOD\ÕWXWDQUHWLQDGHNROPDQÕ
D\GDQGDKDD]ELUVUHLoLQGHROXúPXúLVHEDúDUÕúDQVÕGDKD\NVHNWLU
0DNXOHU+HWHURWRSL
%D]ÕJ|]OHUGHDQWHURSRVWHULRUYLWUHRUHWLQDOWUDNVL\RQDHNRODUDNWDQMHQVL\HO
WUDNVL\RQGDPHYFXWGXU7DQMHQVL\HOWUDNVL\RQRODQJ|]OHUGHPDNXOHUKHWHURWRSL
JHOLúHELOPHNWHGLU0DNXOHUKHWHURWRSLJ|UPH\LHWNLOL\RUVDFHUUDKL
X\JXODQPDOÕGÕU<DSÕODQoDOÕúPDODUPDNXODUKHWHURWRSLVLLoLQ\DSÕODQYLWUHNWRPLOHULQ
PDNXOD\ÕWXWDQWUDNVL\RQHOUHWLQDGHNROPDQODUÕQGDX\JXODQDQYLWUHNWRPL\HJ|UHGDKD
EDúDUÕOÕROGX÷XQXJ|VWHUPLúWLU
3URJUHVLI)LEURYDVNXOHU3UROLIHUDV\RQ
%D]ÕGXUXPODUGDDNWLIUHWLQDOQHRYDVNXODUL]DV\RQROXúXPXQXRUWDGDQ
NDOGÕUPDNLoLQYLWUHNWRPLX\JXODQDELOLU%XX\JXODPDQÕQDPDFÕNRPSOHWDUNDYLWUH
GHNROPDQÕRODQROJXODUGDQHRYDVNXODUL]DV\RQXQD]J|UOPHVLPDQWÕ÷ÕQDGD\DQDUDN
QHRYDVNXOHUSURoH]LQJHOLúHELOHFL÷LYLWUHXVXQRUWDGDQNDOGÕUÕOPDNWÕU
*KRVW&HOO*ORNRP
9LWUHXVKHPRUDMLOLYHIDNLNJ|]OHUGHJKRVWFHOOJORNRPVÕNUDVWODQDQELUGXUXP
GH÷LOGLU$QFDNSVHXGRIDNLNYHDIDNJ|]OHUGHDUNDNDSVOGHVWH÷L\RNOX÷XQGD\DSÕVÕ
ER]XOPXúHULWURVLWOHUHED÷OÕJHOLúHQJORNRPGDYLWUHNWRPLX\JXODQDELOLU
1HRYDVNXOHU*ORNRP
1HRYDVNXOHUJORNRPGDLONWHGDYLVHoHQH÷LSDQUHWLQDOIRWRNRDJXODV\RQGXU3DQ
).LOHLULVQHRYDVNXODUL]DV\RQXROXúPDVÕQÕVD÷OD\DQDQJLRJHQLNVWLPXOXVRUWDGDQ
NDOGÕUÕOÕU
2UWDPEXODQÕNOÕ÷ÕRODQJ|]OHUGHNUL\RWHUDSLDOWHUQDWLIWHGDYLVHoHQH÷LGLU%XQXQ
\DQÕQGDYLWUHNWRPLRUWDPEXODQÕNOÕ÷ÕQÕRUWDGDQNDOGÕUÕOÕSHNIRWRNRDJXODV\RQYH\D
NUL\RSHNVLX\JXODQPDVÕQDRODQDNYHUPHVLQHGHQLLOHQHRYDVNXOHUJORNRPGDWHGDYL
VHoHQH÷LGLU
0DNXODgGHPL
9LWUHNWRPLHQGLNDV\RQODUÕDUVÕQGDHQD]HQGLNDV\RQQHGHQLGLUg]HOOLNOH
LQNRPSOHW$9'YHPDNXODWUDNVL\RQXEXOXQDQPDNXOD|GHPOHULQGHYLWUHNWRPL
X\JXODQDELOLU
7HNQLN
3UROLIHUDWLIGLDEHWLNUHWLQRSDWLGHX\JXODQDQYLWUHNWRPLQLQDPDFÕRUWDP
RSDVLWHOHULQLWHPL]OHPHNYLWUHXVWUDNVL\RQXQXRUWDGDQNDOGÕUPDNWÕU'LVHNVL\RQ
X\JXODQGÕNWDQVRQUDYLVXDOL]DV\RQXVD÷ODPDNLoLQKHPRDVWD]LVVD÷ODQPDOÕYH
HQGRIRWRNRDJXODV\RQLOHUHWLQDODEODV\RQVD÷ODQPDOÕGÕU.XOODQÕODQYLWUHNWRPL
WHNQLNOHULQLNÕVDFDVÕUDODUVDN
6HJPHQWDV\RQWHNQL÷L
'HODPLQDV\RQWHNQL÷L
(QEORFNHNVL]\RQWHNQL÷L
9LWUHNWRPL.RPSOLNDV\RQODUÕ
$øQWUDRSHUDULINRPSOLNDV\RQODU
D6XUDNRURLGDODQDYHUHWLQDDOWÕQDLQI]\RQ
E5HWLQDO\ÕUWÕNYHUHWLQDGHNROPDQÕ
F9LWUHXVYHUHWLQDLQNDUVHUDV\RQX
G/HQVNRPSOLNDV\RQODUÕ
%(UNHQSRVWRSHUDULINRPSOLNDV\RQODU
D.RUQHDNRPSOLNDV\RQODUÕ
EøQWUDRNXOHUEDVÕQoDUWÕúÕ
F3RVWRSHUDWLINDQDPD
G(QGRIWDOPL
&*HoSRVWRSHUDWLINRPSOLNDV\RQODU
D.RUQHDNRPSOLNDV\RQODUÕ
E.DWDUDNW
F*ORNRP
G9LWUHXVLoLNDQDPD
H5HWLQDGHNROPDQÕ

Proliferatif Diabetik Vitreoretinopatide PPV

Transkript

Benzer belgeler

kistoid makula ödemi - İstanbul Tıp Fakültesi

SARS Associated Corona Virus (SCV)

Retinaya Toksik Etkisi Olan İlaçlar ve Takibi