bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors of Occipital Stroke in Tertiary Eye Center in Yogyakarta, Indonesia
Authors: BUDHI HARTIWI SATYAWATI  , INDRA TRI MAHAYANA  , HARTONO
Published: February 2024

Abstract

Introduction & Objectives : Occipital stroke is a stroke involving occipital lobe of the brain which can impair the visual acuity in patient. Several risk factors have been identified as a predisposing conditions. Objectives The aim of this study is to investigate the risk factors for occipital stroke.

Methods : It is a cross sectional research by analyzing secondary data from medical record of patients with occipital stroke hospitalized in Dr. Yap Eye Hospital in Yogyakarta from January 2021 to December 2022 were included in this study. Demographyy, clinical data, and risk factors associated with occipital stroke was recorded. The descriptive statistic was performed to evaluate risk factors for occipital stroke.

Results : Subjects were analyzed 61, comprised of 44 males (72%) and 17 females (28%). Majority of subjects age ≥45 years old (93%). Attack occurred during activity (n=54, 89%), during wake up (n=7, 11%). The involvement right eye (n=8, 13%), left eye (n=9, 15%), & bilateral (n=44, 72%). From 122 eyes, 74 hemianopia (61%), 34 quadranopia (28%) and 14 bilateral hemianopia (11%). 29 subjects had right occipital stroke (48%), 25 subjects hadleft occipital stroke (41%) and 7 subjects had bilateral occipital stroke (11%). Most subjects had one risk factor (n=29, 48%) and two risk factors (n=23, 38%). Eight subjects had three risk factor (13%) and only one subject had four risk factors (2%).

Conclusion : The majority of risk factors of occipital stroke involved only single risk factors and double risk factors. Only minority of subjects had multiple risk factors.
A Challenging case of essensial iris atrophy ICE Syndrome with secondary angle closure glaucoma at Pasar Rebo General Hospital : A Case Report
Authors: Indrianti Dayu Fitria , Nasrudin  , Nasrudin  , Simanjuntak Dicky Budiman
Published: February 2024

Introduction : ICE syndrome is a unique ophthalmic disorder that involves an iris atrophy, irregular corneal oedema, and secondary angle-closure mainly occurs unilaterally in young and middle-aged women, with no family history. Approximately 50% of ICE syndrome patients will later develop secondary angle closure glaucoma. The following case report presents a patient with essential iris atrophy and secondary angle closure glaucoma.

Case Illustration : A 50 year old woman presented with painful and redness of the right eye (RE) since 1 week. Her visual acuity was 6/40 of RE and 6/30 of left eye (LE). Her intraocular pressure (IOP) was 61,3 mmHg and 19 mmHg for the RE and LE. On the slit lamp, we had a proper RE finding, the iris atrophy with deformity in the direction from 12 to 6 hours, with minimal corneal edema. We performed gonioscopy, fundus photographs and papillary optical coherence tomography. The patient was diagnosed with ICE syndrome with essential iris atrophy type and secondary angle closure glaucoma then was given anti glaucoma agents.DiscussionICE syndrome treatments focus on managing the corneal edema and secondary glaucoma. We treated our patient with maximal oral and topical combination therapy such as carbonic anhydrase inhibitors, beta blockers, cholinergic, prostaglandin analogs for 6 months the IOP and corneal oedema were well maintained. However, maintaining long term success can be challenging, surgical therapy with a filtering procedure can be considered if the IOP is uncontrolled.

Conclusion : We confirmed the diagnosis of essential iris atrophy based on its clinical findings and abnormalities in complementary exams.
Comparison of Visual Acuity and Defocus Curve after Cataract Surgery with Pure Extended Depth Focus Lens and Mini-Monovision - Interim Analysis -
Authors: M. Dio Syaputra  , Syska Widyawati  , Faraby Martha  , Tri Rahayu  , Aria Kekalih
Published: February 2024

Abstract

Introduction & Objectives : Presbyopia after cataract surgery is still a problem despite recent surgical techniques and intraocular lens technology development. Mini-monovision techniques and pure extended depth of focus (EDoF) lenses are alternatives to achieve good distance and intermediate visual acuity at relatively inexpensive.This study aims to compare the clinical outcome after cataract surgery with binocular mini-monovision and cataract surgery using a pure monocular EDoF lens.

Methods : Subjects were randomized into the mini-monovision group (standard monofocal lenses with -1.25 D of anisometropia) and the pure EDoF group. The blinding was achieved by masking the clinical outcome examiners.

Results : Interim analysis of 16 patients revealed the outcome of uncorrected and corrected distance visual acuity (UCDVA and BCDVA) were not significantly different between groups. Median of uncorrected intermediate visual acuity (UIVA) and mean of uncorrected near visual acuity (UNVA) of binocular mini-monovision were 0.10 (0-0.10) LogMar and 0.26 + 0.12 LogMar. Median UIVA & mean UNVA monocular EDoF were 0.19 (0.14-0.50) LogMar and 0.54 + 0.11 LogMar, respectively. The Mann- Whitney U test of UIVA between groups revealed p=0.001, and the unpaired T-test of UNVA revealed p=0.000. Mean defocus curve of -2.50 D lens were 0.31 LogMar in binocular mini- monovision group and 0.51 LogMar monocular in EDoF group (p=0.019).

Conclusion : UIVA, UNVA and defocus curve of -2.50 D lens in the mini-monovision group were better than the EDoF group.
The Relationship between Characteristics and Underlying Eye Disorders with Optical Aid Selection and Visual Acuity Status Differences in Children with Low Vision Before and After Optical Aid Selection
Authors: Sidohutomo Andityo , Deneska Ria Sandy , Loebis Rozalina
Published: February 2024

Background: Low vision is a vision disorder that can have a significant impact on a person's independence, especially in children. According to WHO data from 2019, 246 million people suffer from low vision. Ophthalmologists must prioritize low-vision services such as refractive correction and low-vision assessment. This study aims to learn more about the relationship between characteristics and underlying eye disorders with optical aid selection, as well as differences in visual acuity status in children with low vision before and after optical aid selection.

Methods: This study was an analytic observational retrospective cohort using medical records of children with low vision in RSUD Dr. Soetomo Surabaya. This study analyzed the relationship between characteristics (gender, age, education level, intervention history) and underlying eye disorders with optical aid selection using the Chi-Square test, while visual acuity status differences before and after optical aid selection were analyzed using the Wilcoxon test.

Results: There were no relationships between characteristics (gender, age, education level, intervention history) and underlying eye disorders with optical aid selection (p > 0.05). There were differences in visual acuity status before and after optical aid selection (p < 0.05) with a minimum decrease of 0.1 logMAR which means an increase in visual acuity in all 72 samples of children with low vision after optical aid selection.

Conclusion: These data provide new evidence of essential links between visual acuity status before and after optical aid selection. However, characteristics (gender, age, education level, intervention history) and underlying eye disorders were not associated with optical aid selection.
CLINICAL PROFILE OF PTOSIS PATIENTS IN DR. M. DJAMIL HOSPITAL PADANG
Authors: Putri Amanda
Published: February 2024

Abstract

Introduction & Objectives : Ptosis is one of the most common upper eyelid abnormalities. Ptosis surgery is indicated when there is visual compromise. Patient clinical profile is important in diagnosing and planning treatment for ptosis correction. The aim of this study is to describe the clinical profile of ptosis surgery patient in Dr. M. Djamil Hospital Padang.

Methods : This study was conducted in descriptive and retrospective manner. This research has been approved by the Medical Faculty of Andalas University research ethics committee No: 332/UN.16.2/KEP- FK/2021. All patients that were diagnosed with ptosis in Dr. M. Djamil Hospital Padang from January 2016 to December 2021 were included.

Results : There were 33 patients included in this study. Most common age range was 11-20 years old (51.5%), patients were dominantly female (51.5%). According to laterality, the most common was unilateral ptosis, 21 cases (63.6%). Congenital ptosis comprises 51.5% of the cases with myogenic as the most common etiology. Severe ptosis was found in 20 cases (57.6%), poor levator function was found in 17 cases (51.5%). Levator resection was performed in 19 cases (57.6%). Thirty patients (90.9%) had MRD1 ≥2 mm post-surgery.

Conclusion : Levator function is important in determining the surgical method. In severe ptosis with poor levator function, frontalis suspension is the surgery of choice. Appropriate surgical procedure in accordance to accurate pre-operative evaluation will show a good surgical result.
A Case of Malignant Glaucoma Following a Trabekulectomy
Authors: Rumampuk Irene M. A. , Kasih Franky
Published: February 2024

Introduction : Malignant Glaucoma (MG) is characterized by a shallow anterior chamber (AC) associated with a raised intraocular pressure (IOP) usually following a filtration surgery in eyes with angle closure.

Case Illustration : A 56-year-old female patient presented on the second day post trabeculectomy with a shallow AC. The patient experienced ocular pain on the 2nd day post-op. Visual acuity was 6/40 and NCT was 57 mmHg in her LE. Slit lamp examination showed an absent peripheral AC the patient was treated with oral acetazolamide, topical timolol, topical brimonidine, and topical cycloplegics. 24 hours later, the IOP was 34 mmHg, absent AC with mild corneal edema. The diagnosis was Glaucoma Maligna post Trabeculectomy ec Acute attack PACG. After a month, corneal edema has resolved, visual acuity was 6/12, IOP was 27.6mmHg.

Discussion : The exact mechanism of MG remains unclear. There is likely to be an anatomical interaction between the ciliary processes, lens, and anterior vitreous face which causes the diversion of aqueous backwards into the vitreous cavity and causing the anterior rotation of the cilliary processes therefore blocking the aqueous outflow. Although, in our case this problem was moderated by cycloplegics and glaucoma medications, literature describes interventions such as lens extraction, posterior capsulotomy, anterior vitrectomy and pars plana vitrectomy was necessitated in some cases to decrease IOP.

Conclusion : MG is a sight threatening condition caused by a raised IOP in the presence of a patent iridectomy usually occurring after an intraocular surgery. The management of this condition could vary from medications to surgical interventions.
Combined Virna Glaucoma Implant (VGI) Implantation and Pars Plana Vitrectomy for Refractory Aphakic Glaucoma
Authors: Herdian Felicia Sesih , Augiani Amani Sakinah , Lumintang Agnesstacia Vania , Iskandar Ferdy , Oktariana Virna Dwi , Djatikusumo Ari
Published: February 2024

Introduction : Glaucoma drainage devices (GDDs) implantation are frequently indicated for refractory glaucoma. The preferable anterior chamber may be inaccessible for patients with anterior chamber abnormalities.

Case Illustration : A 6-year-old boy presented with high intraocular pressure (IOP) on the right eye (RE) four months before admission. Cataract surgery on both eye was done four years prior, due to congenital cataract. On examination, the visual acuity of the RE was hand movement with IOP 61mmHg with medications. Anterior chamber was shallow, posterior synechiae was found and posterior segment was hard to be evaluated. The fellow eye was nonfunctional with IOP 31mmHg. Pars plana vitrectomy (PPV) was performed followed by implantation of GDD (Virna Glaucoma Implant) with posterior chamber sulcus tube placement without adding a new incision. Post-operatively, IOP was 3mmHg and choroidal detachment was found. With steroid medication, satisfactory IOP control was achieved within three weeks of follow-up. Visual acuity of RE was improved to 0.5/60.

Discussion : In eyes with shallow anterior segments, tube placed in the anterior chamber may increase the risk of corneal endothelial injury. Placement of the silicone tube in the posterior chamber sulcus is an effective alternative technique. Although it is relatively safe in experienced hands, vitrectomy and insertion of the tube into the posterior segment carries significant risks, including choroidal detachment. Careful monitoring and management is needed to control IOP and maintain vision.

Conclusion : Combined GDD implantation and PPV may be considered for refractory aphakic glaucoma, showing favorable outcomes with a relatively safe procedure.
Thyroid Eye Disease and Rare Manifestations of Severe Restrictive Strabismus with Large Hypertropia: A Case Report and Treatment Considerations
Authors: Akla Nurul , Bakri Annisa , Sulistyowati Balgis Desy , Janani Nazhira
Published: February 2024

Introduction : Restrictive strabismus with large hypertropia is an infrequent manifestation of thyroid eye disease that arises due to severe thickening of the superior rectus muscle. This condition can lead to losing the visual axis in the primary gaze position, and prompt management is essential.

Case Illustration : A Forty-seven-year-old man came to the hospital and presented with misalignment in both eyes, known for five months before admission. Ophthalmology examination revealed visual acuity for both eyes was 0.4—Large hypertropia with 50 prism diopters and exotropia with 20 prism diopters, and down shoot restrictions were found in both eyes. The patient had a history of hyperthyroidism since eight months ago and regularly took PTU medication. CT scan of the orbit showed hypertrophy on the extraocular muscle.

Discussion : Continued fibroblast stimulation results in collagen deposition and subsequent fibrosis, ultimately leading to restrictive strabismus in TED patients. For patients with large hypertropia, the primary surgical approach remains recession of the involved restricted muscles, with or without tendon elongation surgery. Vertical rectus muscle resection is preferred for its low inflammation and restriction risk, while hemi hang-back is another suitable option.

Conclusion : The recession of restricted muscles and tendon elongation, preferably vertical rectus muscle resection, is necessary for patients with rare manifestations of restrictive strabismus and large hypertropia in thyroid eye disease.
Ocular Toxocariasis in The Anterior Chamber of The Eye
Authors: Chandra Monica Camilla , MD Anne Umboh, , Rares, MD Laya
Published: February 2024

Introduction : Ocular toxocariasis (OT) is a zoonotic infection caused by Toxocara canis and Toxocara cati. Dogs and cats, the definitive hosts of the roundworm, pass unembryonated eggs via their feces into the environment (often into the soil). Transmission to humans occurs through ingestion of soil or contaminated food, or the fecal– oral route.

Case Illustration : A 14 years old male presented with pain and redness in the right eye 2 months prior to the visit. Complaints are redness, itching, and pain especially in the night on the right eye. The patient had habits of eating raw meat and walking around in dirt without any footwear. Ophthalmologic examination showed a toxocara sp. larvae in the anterior chamber of the right eye. This patient treated with surgical removal of the worm, given antihelminth and topical corticosteroid.

Discussion : Toxocariasis results from infection with Toxocara cati (an intestinal parasite of cats) or Toxocara canis (an intestinal parasite of dogs). Children acquire the disease by close association with pets and by eating dirt (pica) contaminated with Toxocara ova. The ingested ova form larvae that penetrate the intestinal mucosa and gain access to the systemic circulation and finally to the eye. Systemic or local corticosteroids should be given when there is evidence of significant intraocular inflammation.

Conclusion : This case described a patient who was diagnosed with a living worm as foreign bodies in the right eye.
Characteristics of Premature Retinopathy Patients who underwent surgery at dr. Kariadi General Hospital Semarang
Authors: CANDA ARDITYA  , Arnila Novitasari Saubig
Published: February 2024

Abstract

Introduction & Objectives : Introduction: Retinopathy of prematurity (ROP) represents a leading cause of childhood blindness. The management of ROP can be challenging in preterm babies, those with very low birth weight and multiple risk factors. The characteristic and risk factors of ROP is essential to acknowledge. Objective: To describe the characteristic of patients with ROP who underwent surgery in Dr. Kariadi Hospital and to identify the risk factors of the disease

Methods : A retrospective study held from the medical record of patients with diagnosis ROP from January 2020-January 2023 in Dr. Kariadi Hospital, Semarang. The clinical characteristics: sex, gestation age, birth weight, maternal risk factors, neonatal risk factors, and ROP Stage. Type of surgery: laser, intravitreal injection, vitrectomy were also collected.

Results : There were 19 ROP patients with 8 (42.1%) gestational age between 29-30 weeks, 8 (42.1%) birth weight 1000-1500gr, 7 (36.8%) had maternal risk: hypertension, 12 (63), 15%) of patients with ROP stage 3, 8 (42,1%) had a combined management of laser surgery and intravitreal injection. Among all the patients at risk had at least one neonatal risk factor with history of oxygenation being the most common (100%).

Conclusion : Characteristics of ROP patients underwent surgery at Dr. Kariadi General Hospital are mostly patients with gestational age between 29-30 weeks and have the most oxygenation history factors. The most common type of surgical procedure performed is a combination of laser and intravitreal injection.
DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE
Authors: Wardani Sabrina Indri , Rifada R. Maulana , Prahasta Andhika , Gustianty Elsa , Umbara Sonie
Published: February 2024

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important.

Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery.

Discussion : Age older than 60 years old, female gender, short axial length (<23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals.

Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.
Spontaneous Globe Rupture due to Neglected Glaucoma: How can it be?
Authors: Firdausi Asri Ayu , Kunhermawan Cosmas Hascaryanto , Lestari Chindhia Rima Rochmatika Bunga
Published: February 2024

IntroductionGlobe rupture is usually associated with spontaneous traumatic processes with the worst prognosis.The occurrence without prior trauma is only reported in small numbers of cases. This paper willdescribe a globe rupture in glaucomatous eye and share our experience with its management.

Case IllustrationA 66-year-old male presented to the emergency department (ED) with reddish and progressive painin the right eye (RE) followed by severe headaches for the last three days. On history taking, thepatient complained of a progressive blurry vision to total blindness of his RE for 1 year. The patientadmitted to having a history of glaucoma on previous primer examination but did not routinelycontrol it. On initial examination, the patient was hypertensive , and suddenly began bleeding within10 minutes upon arrival at ED. The diagnosis of globe rupture was made and he underwentemergency evisceration.

DiscussionSpontaneous globe rupture is very rare, with an incidence of 3 per 100.000 in the United States,while no definite number is found in Indonesia due to the rarity. In glaucoma patients, spontaneousglobe rupture is postulated to occur due to suprachoroidal hemorrhage. Our patients had multiplerisk factors such as advanced age, systemic hypertension, and chronic untreated glaucoma.Evisceration went down to reduce pain, stop bleeding and prevent the spread of infection.Performing surgery within 10 days of the initial injury suggests a lower risk of post-operativeendophthalmitis or sympathetic ophthalmia.

ConclusionSpontaneous globe rupture in neglected chronic glaucoma has a very poor outcome but preventable.
SUCESSFULL MANAGEMENT OF CHILDHOOD BASIC-TYPE ESOTROPIA IN ADULT PATIENT
Authors: VITRIANA ANISA , M. Feti Karfiati , Caesarya Sesy , Amiruddin Primawita O. , Kuntorini Mayasari Wahyu , Irfani Irawati
Published: February 2024

Introduction : Strabismus in adults may indicate other pathological causes, such as neurological disorders or trauma. Diagnosis of esotropia in adult patients has to be made carefully to determine the right treatment. Management’s goal of strabismus in adult patients is mainly cosmetic by diminishing deviation.

Case Illustration : A 46-year-old woman, complaint of inward deviation of both eyes since childhood. There were no complaints of double vision, headaches, nor trauma history. Visual acuity of right eye was 0.4 with BCVA and left eye was 0.8 with BCVA 0.8. Hirschberg test was 45o (Figure 2A). Prism cover test was 75 PD base out in near and distance. Patient was diagnosed with basic-type esotropia. The patient already given spectacles but the deviation persisted so she underwent bilateral medial rectus recess surgery (Figure 2B). Ocular alignment without spectacles 1 week after surgery showed orthotropia and small esophoria. (Figure 2C).

Discussion : Each esotropia types has a different treatment approach. Basic-type esotropia with large deviation usually needs surgical treatment. Management of childhood onset strabismus in adult patients is challenging because those patients have lesser ability to maintain fusion. Older patients and large deviation are poor prognostic factors to achieve good functional and cosmetics outcome after strabismus surgery.

Conclusion : Establishing a definite diagnosis in adult strabismus patients, including esotropia, is challenging. Careful diagnosis and management decision will determine the outcome of the patient’s condition.
Immediate Bilateral Sequential Cataract Surgery (IBSCS): Special Procedure for Specific Patients
Authors: GEORGE ADE NOVRA SITANAYA  , Ronald Phoniary
Published: February 2024

Abstract

Introduction & Objectives : Immediate Bilateral Sequential Cataract Surgery (IBSCS) are still controversial topic in Ophthalmology. This paper aims to report the outcome and the efficacy of Immediate Bilateral Sequential Cataract Surgery in writer’s experience.

Methods : This paper collects datas from 150 patients that underwent IBSCS. The procedure was done if patient have one or more from these criteria: live far away from hospital, difficult to mobilize to hospital, extreme urgency to return to work as fast as possible (daily paid worker), and if general anesthesia was used. The exclusion criterias were if there was intraoperative complication during the 1st eye, any posterior segment abnormality, and in complicated cataract cases (bad cornea, glaucoma eyes, small pupil eye, zonular loss / weakness, post uveitic eye). During intraoperative, after the 1st eye was finished all instruments and consumable was changed before proceed to the second eye.

Results : From 150 patients, there were 0 (zero) case of endophthalmitis. At 7th days post op results all patients achieve normal range pressures, quiet anterior chamber, and good visual acuity improvement.

Conclusion : Immediate Bilateral Sequential Cataract Surgery is not less safe than traditional delayed sequential cataract surgery. IBSCS definitely should be considered when encountered with specific patients and specific needs.
EFFECT OF ORAL CURCUMIN ADMINISTRATION ON NMDA RECEPTOR EXPRESSION AND RETINAL GANGLION CELL DENSITY
Authors: SALMAH ALAYDRUS  , RISKI PRIHATNINGTIAS  , ARNILA NOVITASARI  , HERMAWAN ISTIADI
Published: February 2024

Abstract

Introduction & Objectives : To prove the effect of oral curcumin on NMDA receptor expression and retinal ganglion cell density.

Methods : Wistar rats model of traumatic optic neuropathy were divided into 2 groups. The treatment group was given oral curcumin 150mg/kgBW/24 hours for 14 days 1 hour after trauma. NMDA receptor expression was examined by IHC staining and retinal ganglion cell density was examined by HE staining. Data were collected and analyzed.

Results : NMDA expression was found to be significantly lower in the treatment group compared to the control group (p = 0.046). The mean of ganglion density in the control and treatment group was 12.88 ± 2.44 and 17.92 ± 6.95, respectively. The treatment group had a significantly higher ganglion density (p = 0.043). There was a significant relationship between NMDA receptor expression and retinal ganglion density (p = 0.043, r = -0.591).

Conclusion : Curcumin can suppress the expression of NMDA receptors to maintain retinal ganglion density in rat models of optic neuropathy
Management of Hypotony Maculopathy
Authors: Nanditya Sri Astri , Ayudianingrum Asti , Sulastiwaty Rini
Published: February 2024

Introduction : Hypotony is a common complicatons after glaucoma filtering surgery. Hypotony maculopathy is a serious condition that related to the significant decrease in visual acuity. This case report is to show the case of hypotony maculopathy and the risk factors.

Case Illustration : A 28 yo female with juvenile glaucoma undergone trabeculectomy on her left eye. One day post surgery show significant inflamation forming fibrin in pupil area. POD 1 IOP decreased to 2 mmHg and remains hypotony after 2 weeks post surgery. Visual acuity decreased significantly even when the anterior chamber inflamation has resolved. Funduscopy showed typical appearance of hypotony maculopathy. Oral steroid of methylprednisolon 1 mg/kg per body weight, and topical prednisolon was administered since POD 1. Visual acuity gained and iop rised to 14 after 3 weeks with theraphy with oral and topical steroid.

Discussion : Sudden drop of intraocular pressure may lead to many complications such as hipotony maculopathy. It was a frightening as it may decreased the visual acuity permanently. Young age and severe post operative inflamation are risk factors found in this patient.

Conclusion : Hypotony after glaucoma filtering surgery may caused hypotony maculopathy. Young age and high inflamation are risk factors for developing hypotony maculopathy. Risk factors considerations and early treatment of hypotony is essential to prevent the sight threatening complications such as hypotony maculopathy.
Development and application of targeted multiplex polymerase chain reaction to help diagnose infectious uveitis
Authors: Rachel Ethelind
Published: February 2024

Abstract

Introduction & Objectives : Clinical pattern recognition is paramount in uveitis diagnosis. Pathogen detection from ocular fluid samples is often necessary to support infectious uveitis diagnosis, particularly in cases presenting with atypical clinical appearance. This study aims to present the process of developing targeted multiplex PCR and its application in infectious uveitis.

Methods : This was a cross sectional study to evaluate the diagnostic performance of targeted multiplex PCR in infectious uveitis. We obtained ocular fluid samples and reviewed medical records of uveitis patients who underwent ocular fluid analysis at Cipto Mangunkusumo Hospital from February 2022 to March 2023. PCR detection threshold values (DNA copies/mL) were 10.9 for Mycobacterium tuberculosis (Mtb), 672 for Epstein-Barr virus, 4.77 for Cytomegalovirus, 6.37 for Toxoplasma gondii, and 5.53 for Herpes simplex virus. With every two-fold increase of pathogen selection, this method requires a half volume of extracted DNA template from aqueous/vitreous samples than uniplex PCR. The ophthalmologist selected the pathogen combination to be detected, allowing for a tailored examination.

Results : Forty-seven aqueous or vitreous samples were analyzed. The positivity rate was 23.4% (11/47) with Mtb yielded the highest positivity (7/34; 20.6%). With final diagnosis as a reference, targeted multiplex PCR resulted in 32.3% sensitivity, 93.8% specificity, 90.9% positive predictive value and 19.2% negative predictive value.

Conclusion : With its high specificity, targeted multiplex PCR is useful as a confirmatory but not screening tool in uveitis diagnosis. Ocular fluid analysis is an important part of stepwise diagnostic approach in uveitis.
Exploring the Impact of Low-Concentration Atropine Eye Drops on the Progression of Myopia: A Systematic Review
Authors: Stella Nathania  , Gabriella Hafidha Badruddin  , Jovita Jutamulia
Published: February 2024

Abstract

Introduction & Objectives : Low-concentration atropine eye drops have emerged as a promising therapy for the management of myopia. However, the effectiveness of atropine for myopia has not been widely studied. This paper aims to analyze the efficacy of low-concentration atropine eye drops for progression of myopia.

Methods : A comprehensive literature search was performed on 3 online databases: PubMed, Cochrane, and ProQuest. We used 'Low-concentration atropine eye drops’, ‘Atropine’, ‘Eye Drops’, ‘Myopia’, and their MeSH terms as keywords. All studies included in analysis were available in English and full text format. We analyzed children myopia progression rates from all studies. We used Rayyan, an online-based tool, to conduct the screening process.

Results : Three randomized control trials (RCTs), two cohort studies, and three case report studies with a total of 1389 participants were analyzed. Most studies were done in Asia, except one RCT in Australia. The participants range from 4-12 years old. Atropine eye drops concentrations that had been used were 0,01%, 0,025%, 0,05%, 0,1%, 0,125%, and 0,2%. All studies showed slower progression rate of myopia compared to the control group (-0,31 D vs -0,90 D; -0,05 D vs -1,05 D; -0,27 D vs -0,81 D; -0,28 D vs -0,54 D; -0,18 D vs -0,45 D;−0.31 D vs −0.76 D; -0.91 vs -1.00 D; -0,38D vs -0,55 D) with P < 0,05, except one study P = 0,94.

Conclusion : Low-concentration atropine eye drops have shown promising effects in slowing progression of myopia. However, further research is needed, particularly in non-Asian countries.
REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY
Authors: Alexander Herdyanto
Published: February 2024

Abstract

Introduction & Objectives : Introduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.

Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power >1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.

Results : Day-1 follow-up keratometry shown that corneal astigmatism was still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism was better in 600um incision depth.

Conclusion : When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.
COMPARISON OF HSP90 EXPRESSION IN CONJUNCTIVAL INTRAEPITHELIAL NEOPLASIA AND CONJUNCTIVAL SQUAMOUS CELL CARCINOMA
Authors: TRISSA WULANDA PUTRI  , IBRAHIM
Published: February 2024

Abstract

Introduction & Objectives : Heat shock protein 90 (HSP90) participates in stabilizing and activating client proteins involved in malignant transformation. This study aims to determine whether there are different values for the expression of HSP90 in Conjunctival Intraepithelial Neoplasia (CIN) and Conjunctival Squamous Cell Carcinoma (CSCC).

Methods : A total of 24 OSSN samples, including 15 cases of CIN and 9 cases of CSCC were evaluated. The immunohistochemical expression of HSP90 was assessed using a scoring system based on the percentage of positive staining of nuclear and cytoplasmic cells, then the intensity of staining was evaluated using the German Immunoreactive Score.

Results : In the study, the average cytoplasmic Immunoreactive Score in CIN was 9.87 and CSCC was 16.89 with a significant result (p=0.007), while the average nuclear Immunoreactive Score in CIN was 11.30 and CSCC was 14.50 with insignificant results (p=0.274). The results of the correlation test showed that the cytoplasmic expression groups with low categories were all in CIN as much as 6 (100%) so they had a ratio of 6:0. and the high category of HSP90 cytoplasmic expression group was only found in CSCC as many as 2 (100%) samples with a ratio of 0:2. The results of the correlation test using the Pearson test obtained a significant correlation value (p=0.006) with a moderate correlation strength (r=0.545).

Conclusion : There are differences in the expression of cytoplasmic and nuclear HSP90 but only the cytoplasmic expression of HSP90 is significantly associated with CIN and CSCC.
OSDI Score Comparison between Sodium Hyaluronate, Carboxymethylcellulose and Polyvinylpirrolidone for Dry Eye in Medical Student during Online Learning
Authors: ARIANI RATRI DEWI
Published: February 2024

Abstract

Introduction & Objectives : Online learning during COVID pandemic increase medical students’ screen time. Prolonged screen time is known as a risk factor for dry eye. Health problems during online learning such as those induced by dry eye could affect students’ academic performance. This study aim to find the best solution for dry eye in medical student during online learning by comparing three artificial tears eye drops, namely sodium hyaluronate, carboxymethylcellulose and polyvinylpirrolidone.

Methods : This is an experimental study with 48 respondents divided into three treatment groups : sodium hyaluronate (SH), carboxymethylcellulose (CMC) and polyvinylpirrolidone (PVP). Each group consists of 16 respondents. Each respondents use their eyedrops six times daily in both eyes for two weeks. This study use Ocular Surface Disease Index questionnaire to evaluate dry eye. Data were analyzed using SPSS software, with p<0,05 is considered significant.

Results : In SH group, mean OSDI score before treatment were 37,52 and after treatment 13,84 (p=0,001). In CMC group, mean OSDI score before treatment were 35,28 and after treatment 12,54 (p=0,000). In PVP group mean OSDI score before treatment were 38,17 and after treatment 13,15 (p=0,000). No significant differences of OSDI score was found between groups before treatment and after treatment (p=0,237).

Conclusion : Sodium hyaluronate, carboxymethylcellulose and polyvinylpirrolidone eye drops could similiary improve dry eye symptoms significantly as measured by OSDI score in medical students during online learning.
Inhibition of Caspase-3 Provides Neuroprotection for Retina Ganglion Cells againts NMDA-induced Exitotoxicity in Wistar Rats
Authors: Widyarini Andriati Nadhilah , Maharani  , Rahmi Fifin L , Nugroho Trilaksana , Saubig Arnila Novitasari , Istiadi Hermawan
Published: February 2024

Introduction & ObjectivesGlaucoma is a disorder characterized by the presence of optic neuropathy. Visual impairment inglaucoma is caused by retinal ganglion cell (RGC) apoptosis associated with N-methyl-D-aspartate(NMDA)-mediated excitotoxicity. Excitotoxicity causes an increase in calcium in cells as well asactivation of caspase-3. Glaucoma therapy is currently given to reduce intraocular pressure (IOP),but the damage is still progressing progressively. Hesperidin is known as a neuroprotector that cansuppress calpain overactivation in NMDA-treated retina, thereby reducing the upregulation of TNF-,an inflammatory cytokine, inhibiting calpain activation by suppressing oxidative stress, andattenuating caspase-3 activation. The aim of this study to proving the effect of oral Hesperidin on theexpression of caspase-3 Retinal Ganglion Cell in Wistar rats model of NMDA-induced glaucoma.

MethodsExperimental research with post test design only randomized control trial Wistar rats with NMDAinduction were divided into 2 treatment and control groups. The treatment group was given oralHesperidin at a dose of 100mg/kg/day while the control group was given Na-CMC 182 mg/kg/day for3 weeks. Retinal caspase-3 expression was examined by immunohistochemical staining. Data werecollected and processed and then the Mann- Whitney test was performed. (significant p<0.05)

ResultsThe mean percentage and intensity of RGC caspase-3 expression in the treatment group were 4.29 ±0.49 it was significantly lower than the control group 6.29 ± 0.95 (p value = 0.003).

ConclusionHesperidin provides neuroprotection for RGC againts NMDA- induced exitotoxicity by inhibition ofcaspase-3.
GLAUCOMA SECONDARY TO NONSPECIFIC ORBITAL INFLAMMATION: A DIAGNOSIS NOT TO OVERLOOK
Authors: Prakoeswa Camilla Amanda , Komaratih Evelyn , Fatmariyanti Susy
Published: February 2024

Introduction : Nonspecific Orbital Inflammation (NSOI) is an inflammatory condition of unknown etiology manifesting as pain, ocular motility disturbances, eyelid edema, chemosis, and increased intraocular pressure (IOP). We illustrate a case of glaucoma secondary to NSOI and the importance of understanding the cause-effect relationship between the two conditions.

Case Illustration : An eighteen-year-old girl presented with severe pain, ptosis, chemosis, ophthalmoplegia, and increased IOP (38 mmHg) despite a leaking trabeculectomy bleb, on the left eye. She was referredwith the diagnosis of primary angle-closure glaucoma (PACG) and a history of twice trabeculectomy surgeries done elsewhere two months before she came to our hospital. She could not move her lefteye nasally five months before the first surgery and felt joint pains for a year. After thorough diagnostics, she was assessed with left eye NSOI and secondary glaucoma with spondyloarthropathy. Oral prednisone 30 mg/day was given to manage the inflammation and the resultant glaucoma. One week follow-up showed an improved condition with decreased IOP (16 mmHg) despite the same anti-glaucoma therapy regimen.

Discussion : NSOI can mimic various diseases, making diagnosis challenging. The raised IOP in NSOI is often caused by extraocular muscles and orbital tissue swelling, which compresses the superior and inferior ophthalmic veins, resulting in choroidal circulation problems. The IOP was quickly reduced once the inflammation was managed. This is a case of secondary glaucoma caused by an overlooked NSOI, aggravated by the immunological process in the orbit after trabeculectomy surgeries.

Conclusion : Secondary glaucoma should be considered as a differential diagnosis of PACG in patients with NSOI.
Searching The New Culprit of Optic Neuritis: The Role of Vitamin D
Authors: ANAK AGUNG MAS PUTRAWATI TRININGRAT  , Made Paramita Wijayati  , Putu Ayu Wulansari
Published: February 2024

Abstract

Introduction : Low vitamin D status has long been associated in multiple sclerosis patient with higher risk of disease progression and frequent relapses. Vitamin D plays an important role in modulating the immune process responsible for demyelination. To this date, the study on vitamin D deficiency in optic neuritis case is still rare.

Case Illustration : Female, 20 years old, presenting with bilateral sudden visual loss since 1 week prior. The patient looked relatively pale and complained of accompanying headache and myalgia. Visual acuity in both eyes were light perception with dilated pupils and posterior segment showing optic disc swelling. CBC, infection and autoimmune screening came within normal limit and brain MRI further confirmed the presence of optic neuritis. The patient was given high dose intravenous steroid but showed no improvement. Later, she was screened for nutrient deficiency and found sign of low serum 25-hydroxyvitamin D. After one week of oral supplementation and neuroprotective agents, her vision drastically improved to 6/6 in both eyes.

Discussion : Vitamin D deficiency nowadays is getting more prevalent in high risk individuals with low dietary intake and sunlight exposure. Recent study found that mean serum vitamin D level were significantly lower in autoimmune optic neuritis (ON) and were associated with ON attack severity. Vitamin D sufficiency is associated with better inflammatory outcome and long term neurodegenerative measures in demyelinating diseases, as shown by improvement in RNFL thickness after attack.

Conclusion : Screening for vitamin D deficiency is essential to consider in managing patient with atypical optic neuritis.
Epibulbar Choristoma, Dermolipoma
Authors: Maykel Sondak  , Samuel Samatara
Published: February 2024

Introduction : Choriostoma is a tissue anomalie distinguished by distinct cell types that are not typically present at the affected region. Dermolipoma is one type of choriostoma.

Case Illustration : A twenty three year old woman is presented with epibulbar mass in the left eye since birth. She wished to remove the mass for cosmetic purposes. She denied any underlying medical condition and ocular history. Her visual acuity was 6/6 in both eyes and intraocular pressure was normal. Slit lamp examination revealed a yellowish white lesion of the external canthus of the left eye, no redness, and no discharge. The mass was 5 x 10 mm. Fundus examination was unremarkable. Patient underwent mass excision with cosmetic indication and has a satisfactory result.

Discussion : A dermolipoma is an epibulbar choriostoma made of thick connective tissue and adipose tissue. The benign tumor is rare and makes up 4.2% of all conjunctival lesions. Dermolipoma can be very large, involving the extraocular muscle, lacriminal gland, and orbital tissue. Dermolipoma may be connected to epidermal nevus syndromes, Goldenhar syndrome, or coloboma. The majority of the time, these tumors don't need to be treated unless they are larger or have an unfavorable appearance.

Conclusion : Dermolipoma is not cosmetically acceptable may be treated with excision of the mass.
Platelet Rich Fibrin as a Potential Treatment for Corneal Neovascularization due to Infective Keratitis: An Experimental Study
Authors: NANDANG SUDRAJAT
Published: February 2024

Abstract

Introduction & Objectives : Platelet-rich fibrin (PRF) as a source of growth factor has been widely used in various therapeutic fields so that it could accelerate the wound healing process. This study investigated the effect of platelet-rich fibrin PRF in inhibiting neovascularization, inhibiting the expression of vascular endothelial growth factor (VEGF) and stimulating pigment epithelial-derived factor (PEDF) in the infective keratitis animal model.

Methods : A total of 12 New Zealand white rabbits (Oryctalogus cuniculus) were subjected to keratitis induction by inoculation of Pseudomonas aeruginosa. The rabbits were divided into two groups, the first group as control was treated antibiotic-only, and the second as treatment group was treated with antibiotic and PRF graft. The corneal neovascularization area was clinically measured before and after treatment. Expression of VEGF and PEDF in the corneal epithelium, stroma, and endothelium were evaluated by immunohistochemical examination on day 10 after keratitis induction.

Results : There were significant differences in VEGF expression between groups in the epithelial layer (p=0.008), but no significant difference in the stromal (p=0.934) and endothelial (p=0.935) layers. PEDF expression showed a significant difference between groups in the epithelial (p = 0.004) and stroma layers (p = 0.029) but no significant difference in the endothelial layer (p = 0.157). However, there was no significant difference in clinical neovascularization between the two groups (p=0.526).

Conclusion : PRF could inhibit VEGF expression and stimulate PEDF expression in the cornea of Pseudomonas aeruginosa keratitis animal model that potentially reduces the corneal neovascularization in the longer observation.