bluuebunny/crossref_metadata_2025 huggingface dataset:
Secondary Piggyback Intraocular Lens for Correcting Refractive Surprise Post Silicone Oil Removal
Authors: Juanarta Pieter , Knoch Andrew M.H. , Budiman  , Sugiarti Emmy Dwi , Tjokrovontjo Ludwig Melino
Published: February 2024

Introduction : Pseudophakic refractive error can be caused by IOL malposition and inaccurate biometric examination. Treatment consists of IOL exchange, refractive laser correction, and secondary piggyback IOL. Secondary Piggyback IOL consist of customized IOL implantation on ciliary sulcus.

Case Illustration : A Male, 62 years old, complains of blurry right eye. He underwent retinal surgery with silicone oil tamponade surgery 5 years ago and underwent silicone oil evacuation, phacoemulsification, and intraocular lens implantation one year later. The visual acuity of the right eye was 1/60 with BCVA of 0.2. He was diagnosed with Pseudophakia of both eyes and Hypermetropia Surprise of the right eye. He was planned to undergo piggyback intraocular lens implantation in the right eye (Figure 1). The visual acuity one week after operation of the patient's right eye was 0.32 (Figure 2).

Discussion : Biometric examination in eye with silicon oil tamponade have longer axial length, causing pseudophakic refractive errors. Treatments consist of IOL replacement, refractive laser correction, and piggyback IOL implantation. IOL replacement has a high risk and requires quite high operator skills. Refractive laser correction is performed in small refractive errors. Piggyback IOL implantationis easier, safer, have more accurate IOL power, and reversible.

Conclusion : Power of the intraocular lens is influenced by axial length, keratometry reading, lens thickness, and other parameters. Axial length measurement in patients with silicone oil tamponade requires greater accuracy to prevent pseudophakic refractive errors. IOL Piggyback implantation procedure is an alternative in person that can’t undergo laser correction or IOL exchange.
Corneal Rigid Gas Permeable Contact Lens in Corneal Scarring: a Case Report
Authors: Regina Ivanovna  , Umar Mardianto
Published: February 2024

Introduction : Corneal scarring is part of corneal wound healing response to injury, surgery, or infection to the cornea. Corneal scarring causes significant visual reduction. This case report highlights visual acuity (VA) improvement in patient with corneal scarring following rigid glass permeable contact lens (RGP-CL)

Case Illustration : A 25 year-old male presented blurry vision in right eye (RE) due to trauma. His VA was 3/60 on RE and 6/6 on left eye (LE). The best corrected visual acuity (BCVA) of RE was 6/45 (S-1.25 C-5.00 X 180°). Slit lamp examination of RE showed corneal scarring in central area and deep neovascularization. Keratometry readings obtained 39.50D (8.48mm) at 170 degree and vertical curvature of 44.00D (7.68mm) at 80 degree, with markedly irregular mires of RE. A trial fitting was performed for RE by using tisilfocon A lens with base curve of 8.30 mm, power S-4.00D and diameter 9.20 mm. The over-refraction with trial lens obtained a total refractive error of S-6.00 with cylindrical correction neutralize with RGP. The achieved BCVA by over-refraction was 6/45 with comfortable fit.

Discussion : Rigid permeable lens (RGP) is an option in dealing with irregular astigmatism due to corneal scarring. The RGP fitting works best especially when the corneal scarring is not in the center of visual pathway. Rigid lens works by providing tear-lens power and creating smooth surface to neutralize the irregular cornea. Good RGP-CL fitting could help patient with corneal carring gain better VA.

Conclusion : Good rigid permeable contact lens fitting could help patients with corneal scarring gain better VA.
Risk Factors of Corneal Donor Contamination and Post-Keratoplasty Infectious Complication
Authors: Tania  , Monica Matturungan  , Lukman Edwar
Published: February 2024

Introduction & Objectives : Infectious keratitis and endophthalmitis are rare yet devastating complications of corneal transplantation. Some studies have demonstrated increased incidence of infectious post-keratoplasty complications are related to contaminated corneal donor, although its risk factors remain controversial. This study provides concise review on possible risk factors of corneal donor contamination which related to post-keratoplasty infectious complications.

Methods : This literature review was conducted by searching PubMed and Proquest for “corneal donor contamination” AND (“infectious complication” OR infection OR endophthalmitis) from the period of 2018-2023. Relevant articles were reviewed and selected for further understanding regarding various risk factors of corneal donor contamination leading to post-keratoplasty infectious complications and its preventive strategies.

Results : The rate of corneal contamination varied between studies, ranging from 1,3 to 7,8%. The most common risks of contamination are donor’s diseases (e.g. cardiovascular, cerebrovascular accident) and prolonged time between death and donor retrieval. Longer preservation time (>5 days), environmental situation (temperature and humidity), and prolonged treatment duration on intensive care unit (>4 days) are also considered as its risk factors. Corneoscleral rim culture, addition of antifungal and antibacterial to corneal storage medium, and shortening of corneal processing time should be considered as probable preventive strategies.

Conclusion : Donor diseases, prolonged donor retrieval time from death, and longer donor preservation and hospitalization duration, are associated with higher rates of corneal donor contamination. Rapid retrieval and donor handling time, together with corneoscleral rims culture, at least for fungus regarding its better predictive values, should be taken into consideration by corneal donors providing eye banks.
Can Optical Coherence Tomography Angiography be a Useful Adjunctive Diagnostic Tool in Patient with Non Arteritic Ischaemic Optic Neuropathy?
Authors: Laura Agnestasia Djunaedi  , Syntia Nusanti  , M. Sidik  , Salmarezka Dewiputri  , Sita Paramita
Published: February 2024

Abstract

Introduction : Perfusion deficiency of the optic nerve head is presumed to have an immense role in the pathogenesis of non-arteritic ischaemic optic neuropathy (NAION). Optical coherence tomography angiography (OCTA) is a non-invasive method that can assess posterior pole vasculature at multiple levels. Thus, these case series want to compare the OCTA in the acute (before four weeks) and chronic phases (after six weeks) of NAION with their fellow unaffected eyes to give an overview of vasculature changes in NAION.

Case Illustration : This case series consists of four patients with NAION. Half of them came with a sudden painless blurry vision, and the remaining presented with an abrupt visual field defect. All of them have diabetes mellitus and hypertension. None of them have superimposed vascular pathology. The first OCTA was taken within seven days of the first symptoms, and the second OCTA was taken more than six weeks after.

Discussion : The high percentage of systemic vascular risk factors and the acute onset supported the vascular occlusive hypothesis in the pathogenesis of NAION. Meanwhile, the OCTA provides an actual overview of the vasculature changes. Microvasculature is more likely to expand in the acute phase, and a more significant expansion was found in greater optic disc edema. On the other hand, microvascular tend to attenuate in the chronic phase, representing the pruning of capillaries. A swept-source OCTA with deeper penetration might give a better peripapillary choriocapillaris image in the acute phase.

Conclusion : OCTA is a promising adjunctive tool for diagnosing and monitoring progression in patients with NAION.
Ab Externo Scleral-Fixated Intraocular Lens As A Management in Aphakic Eye
Authors: Sudjana Briska , Knoch Andrew M.H. , Budiman  , Sugiarti Emmy Dwi , Melino Ludwig
Published: February 2024

Introduction : Varied technique of secondary intraocular lens (IOL) implantation are exist. Scleral-fixated IOL implantation become popular both with or without sutures. The one of sutures technique is ab externo

Case Illustration : A 68 year old man came with blurry vision on left eye (LE) since one month ago. He had history of primary angle closure suspect and posterior subcapsular cataract on LE and managed with Intracapsular Cataract Extraction in January 2021. Ophthalmology examination of LE revealed uncorrected visual acuity (UCVA) 1/60, irregular updrawn pupil with diameter 7.4mm x 5.3 mm, and aphakic lens. The best corrected visual acuity (BCVA) with S+12.00 C-0.75 x 80 was 0.4f. The patient underwent secondary IOL by using 3 pieces IOL with ab externo scleral- fixated on his left eye (Figure 1). Power IOL determined was +24.00 diopter with target of refraction was emmetropia. One day postoperatively, the UCVA was 0.08 pinhole 0.125 with good centration of scleral fixation IOL. First month postoperatively, BCVA with S-1.75 C-1.00 x 50 was 0.4 on snellen chart.

Discussion : Aphakia with inadequate capsular support can be seen in several conditions. Technique of introducing two suture loops for scleral fixation of an IOL by ab externo procedure, which proved safe and effective. Scleral fixation of IOL in the posterior chamber, although technically demanding, allows good visual outcomes.

Conclusion : Ab externo scleral-fixated IOL implantation is an effective rescue procedure for eyes with deficient capsular support.
Microperimetric Acoustic Biofeedback Training (MABFT) in Macular Dystrophy: A Case Report
Authors: KARMELITA SATARI  , Elfa Ali Idrus  , Fikri Barran
Published: February 2024

Introduction : Microperimetry (MP3) measures local retinal sensitivity for retinal functional assessment and uses the result for a biofeedback training exam for low vision patients. It can relocate the preferred retinal locus to the most sensitive area from central visual field diseases. This paper is to report the MABFT effect on reading speed and visual acuity in young, low-vision macular dystrophy patients.

Case Illustration : A 34-year-old Caucasian male has been diagnosed with macular dystrophy since childhood. He has difficulties reading and recognizing small items at school because of his central visual field defect. He has MABFT six times a week and reading practice at home. His best corrected visual acuity improved from 1.1 to 1.0 logMAR and his reading speed from 20 to 30 wpm with spectacles. His right eye fixation became worse, but the left eye remained unstable. Clinically, it is still not significant for the patient. His near-visual acuity remains the same.

Discussion : 

Conclusion : Microperimetric Acoustic Biofeedback Training increases reading speed and visual acuity in low vision macular dystrophy patients.
Cicatricial Ectropion After Maxillofacial Surgery
Authors: Lisa Berliani Tanaya  , Sari Marina
Published: February 2024

Introduction : cicatricial ectropion is a malposition lower eyelid by shortening and/ or scarring of the anterior lamella of eyelid but it can occur in the upper eyelid. Ocular manifestations in cicatricial ectropion occurred epiphora, redness eyes, foreign body sensation, dry eyes due to direct exposure to the outside. In severe case may occur ulceration and loss of vision

Case Illustration : A 33 year old male patient was being came to ophthalmologist department at Bali Mandara General Hospital with complaints that the right eye could not close completely, the felt dry eyes, foreign body sensation, and sometimes redness eyes after maxillofacial surgery one month ago before admitted to hospital. The physical examination the patient was normal. The ophthalmological examination visual acuity 6/6 for both eyes, intraocular pressure was normal for both eyes. The movement of the eyeballs was normal. The segment anterior examination was a scar on the lower right eyelid, inferior palpebral retraction, lagophthalmos 4 mm. The segment anterior examination of the left eye was normal.

Discussion : The patient was treated to repair the cicatricial ectropion with surgery under general anesthesia with postauricular full thickness skin graft, antibiotic eye ointment, antibiotic oral, and lubricant eye drop.

Conclusion : Cicatricial ectropion is a complication that occurs due to trauma or surgery. Reconstructive surgery to repair eyelid function, improve cosmetic appearance and minimize complications of further eye damage such as keratitis to blindness. Knowing the etiology along with the progression of the disease is necessary for early diagnosis and prompt treatment.
Customized Prosthetic Management for Post Orbital Exenteration Patient: A Case Report
Authors: Uray Nabila Yuna  , Raden Angga Kartiwa  , Yudhistira Knoch
Published: February 2024

Introduction : Orbital exenterations are performed to treat malignancies, orbital injury or other chronic conditions unresponsive to conservative therapy. Exenteration can result in depression, difficulties in daily activities, and aesthetic problems. Orbital prosthetic is an alternative therapy for aesthetic rehabilitation and protection of the orbital cavity.

Case Illustration : A 46-year-old woman came with a chief complain of a black mass on the left lower eyelid ten years ago. Patient was diagnosed with basal cell carcinoma and underwent extirpation of the mass with skin graft reconstruction. On histopathological examination, it was discovered that the incision base was not free of tumor. Patient came two years later with recurrent black mass invaded cornea and sclera, and then underwent exenteration of the left eye (Figure 1). Patient completed 40 cycles of radiotherapy and then used spectacle retained orbital prosthetic (Figure 2 & 3).

Discussion : Orbital prosthetics are synthetic replacement after exenteration that can restores orbit, eyelid, eye and periorbita anatomy. Orbital prosthetic retention can be aided by attachment to spectacle, use of magnets, adhesives or osseointegrated implants. Spectacle retained orbital prosthetic is the easiest and the most affordable prosthetic to construct.

Conclusion : Orbital defects rehabilitation improves physical and psychological well-being. Due to the complexity of prosthetic fabrication and production cost, retention of the orbital prosthetic with spectacles is the most suitable alternative treatment option in some cases, it is also the easiest prosthetic to construct and inexpensive.
MULTIPLE GIANT CHALAZIA IN HYPERIMMUNOGLOBULINEMIA E SYNDROME: A CASE REPORT
Authors: Lily Raudah Putri  , Florentina Priscilia  , Dany Petra Pranata Barus  , Annisa Windyani  , Muhammad Shafiq Advani  , Lukman Edwar
Published: February 2024

Abstract

Introduction : Hyperimmunoglobulinemia E syndrome (HIES) is a rare primary immunodeficiency disorder that manifests as elevated level of serum immunoglobulin E (IgE) higher than 1.000 IU/mL and multisystem disorder characterized by recurrent skin and pulmonary abscesses caused by autosomal dominant or recessive disorder with gene mutation. We present a case of multiple giant chalazion ina patient with HIES.

Case Illustration : A 15-year-old boy was referred to Ophthalmology Department with multiple giant lumps on the left eyelid for the last 2 weeks. He had a history of recurrent multiple lumps on the left lower eyelid in the last 1 year. He was diagnosed with HIES since 8 years ago. He had normal visual acuity of both eyes. Multiple giant chalazion were observed on the left upper and lower eyelid. The patient also presented with scalp and neck infection. Laboratory studies showed elevated total serum IgE level of 53,032 IU/mL and eosinophilia.

Discussion : Ocular manifestations in HIES patients are not common. Some cases reported chalazia, keratoconus, and blepharitis. Surgical incision drainage was performed in our patient. Medications and surgical intervention had produced only transient improvement. The patient was treated conservatively. Riskof chalazia recurrence remains unknown as reported cases presented with diverse clinical presentation and follow-up serum IgE evaluation is not routinely performed.

Conclusion : Recurrent multiple giant chalazia may occur as an ophthalmic feature of HIES. HIES should be considered and investigated in patients presenting with recurrent giant chalazia.
SCREENING ON CATARACT APPLICATION (SERIOC)
Authors: Wulansari Sriana , Sungkono Henry Santosa , Akbar Muhamad Hassanul
Published: February 2024

Introduction & Objectives : West Nusa Tenggara is a province that has the second highest prevalence of blindness at the national level according to the results of the 2014 Rapid Assessment of Avoidable Blindness (RAAB) survey. During the covid-19 period the offline cataract screening is not permitted, as a result it’s difficult to reach underprivileged and isolated areas, also people with disabilities. In 2021 West Nusa Tenggara Eye Hospital launched a smartphone-based eye health examination application Screening On Cataract namely SERIOC, while still paying attention to service standards clinically and in management. SERIOC can be used by public health as the nearest public health facility.

Methods : The waterfall method is used in the development of this application, The waterfall methodology is a project management approach that emphasizes a linear progression from beginning to end of a project. This methodology, is front-loaded to rely on careful planning, detailed documentation, and consecutive execution.

Results : SERIOC has successfully screened 2,713 patients from 2021 with 2117 patients diagnosed cataract and 593 patients diagnosed non-cataract whose data is centralized and directly connected to an ophthalmologist at the West Nusa Tenggara Eye Hospital. Patients diagnosed with cataracts will be referred to the hospital for further action.

Conclusion : Based on the information above, it can be concluded that SERIOC application in eye health screening is very effective and efficient method to avoid blindness on West Nusa Tenggara.
dr., SpM
Authors: SAWITRI BOENGAS  , Jefman Efendi Marzuki Hy  , Debora Ratri Aldora
Published: February 2024

Introduction : Cyclopentolate eye drops 1% are frequently used during the cycloplegic refraction test. Cyclopentolate 1% side effects that are neurotoxic have the potential to be fatal but are extremely rare.

Case Illustration : Thirty minutes after first drop of the cycloplegic refraction preparation, a 4-year-old kid had neurotoxic effects in the form of anxiety, disrupted communicative interactions, and hallucinations after receiving 3 drops of 1% cyclopentolate. Drug administration was stopped, and the patient was observed in the ER. After stopping the eye drops and being monitored in the ED for two hours, the condition improved.

Discussion : 

Conclusion : Discussion: A cycloplegic medication that affects muscarinic receptors is cyclopentolate 1%. Administering eye drops is supposed to have a local effect on the eyes only, but frequently systemic effects can happen if there is absorption via the mucosa of the throat, nose, and stomach due to the eye drops' flow through the nasolacrimal duct when the medicine is instilled. One of Cyclopentolate's 1% uncommon adverse effects is neurotoxic impact, which can be fatal. When cyclopentolate interacts with the central nervous system's muscarinic receptors, this syndrome may result. The severity of the side effects increases with dosage and administration frequency, age and BMI, and dose. Focusing on the Lacrimal Canal during delivery and using the lowest dose of cyclopentolate are recommended to minimize side effects. Conclusion: Cyclopentolate 1% has a rare but potentially catastrophic side effect called neurotoxicity. Reduce the dosage of cyclopentolate, administer it properly dan using it combination with other cycloplegic can reduce adverse effects.
Tenon Patch Graft in The Management of Corneal Perforations: A case series
Authors: Diba Amirah Deandra , Martha Faraby
Published: February 2024

Introduction : A full-thickness defect of the cornea that results in a rupture or opening is known as corneal perforation. Despite corneal transplant being the gold standard therapy, finding a donor remains challenging. Tenon patch graft (TPG) may be the alternative surgical procedure to repair the damaged cornea. This case series presents six cases of corneal perforations that have been effectively managed with TPG.

Case Illustration : Six cases with corneal perforations in the age range of 6-75 years old were presented with varying perforation sizes ranging from 0.5 to 8 mm. The most common complaints were vision loss, redness, and watery eyes. Ophthalmology examinations revealed five corneal ruptures and one impending corneal rupture caused by trauma, infections, corpus alienum, and post-operative. All patients underwent TPG surgery with compression/infinity sutures using 10-0 nylon, followed by bandage contact lenses, with three adjoined with amniotic membrane transplant. Post TPG, patients were followed up for 1-4 months and no complications such as glaucoma, cataract, or endophthalmitis were found.

Discussion : Corneal damage that is not treated promptly causes further erosion of the deeper corneal layers. When medication fails, other measures must be taken to preclude further damage. TPG may be an accessible and cost-effective surgical procedure of choice to preserve eye integrity both functionally and structurally.

Conclusion : This case series of tenon patch grafts for corneal perforations less than 9 mm demonstrated the effectiveness of TPG in promoting corneal healing without significant complications. Despite differences in perforation size and patient characteristics, all six cases saw closure of the perforation.
THE EFFECTIVENESS OF INTRAVITREAL ANTI-VEGF INJECTION IN EALES' DISEASE: A CASE REPORT
Authors: Khairani Azizah Ardityastiti  , Halida Wibawaty
Published: February 2024

Introduction : Eales’ Disease (ED) is an idiopathic inflammatory retinal vasculitis, affecting retinal veins of small and large caliber that results in extraretinal neovascularization with vitreous hemorrhage. The etiopathogenesis of ED is poorly understood. However, many studies have attributed inflammation as a response to mycobacterium tuberculosis. Treatment of this disease can be done with corticosteroids, anti-VEGF therapy, laser photocoagulation, and vitreoretinal surgery.

Case Illustration : We reported a patient, a 31-year-old woman with complaints of blurred vision and floaters in both eyes. An initial examination showed the visual acuity of the RE was 0,1F1 and the LE was 0,1. Examination of the posterior segment found perivascular exudate and peripheral retinal neovascularization. We performed an OCT examination on both eyes and found that there was extensive macular edema, especially in the RE. Patient was diagnosed with ED and received steroidsas an initial treatment. But there was no improvement in both eyes. In addition, patient received two anti-VEGF injections in the RE and one injection in the LE and showed good improvement. After that injection, the posterior segment showed very minimal lesions on the macula and repeated OCT results showed normal central macular thickness.

Discussion : Anti-VEGF may also play a role in the treatment and management of ED. This is because, besides inflammation, there is an increased expression of VEGF in vitreous patients with ED. Several case reported there is significant improvement in anti-VEGF injection in the management of patients with ED.

Conclusion : Intravitreal anti-VEGF injection shows good results in ED that did not improve with steroid treatment.
THE DIFFERENCES OF MAXIMUM BLINK INTERVAL IN HYPERTENSION PATIENTS WITH AND WITHOUT DRY EYE DISEASE
Authors: I NYOMAN CAHYA SETIABUDI  , I Gusti Ayu Made Juliari  , Cokorda Intro Dewiyani Pemayun
Published: February 2024

Abstract

Introduction & Objectives : Hypertension and the use of antihypertensive drugs are thought to be one of the risk factors for dry eye disease due to a decrease in tear production. Maximum blink interval (MBI), which is the time during which the eye can remain unblinking, can be an easy method for assessing dry eye disease because local conditions in the eye can affect blinking patterns. This study aims to determine the difference in the average MBI in hypertensive patients with dry eye disease and hypertensive patients without dry eye disease.

Methods : This study is a cross-sectional analytic study which was conducted in January 2022-June 2022. The sample of the study was hypertensive patients with dry eye disease and without dry eye disease who were treated at the Internal Medicine Polyclinic, Kidney-Hypertension Division at Sanglah Hospital (Prof I.G.N.G. Ngoerah Hospital). The sample selection technique was consecutive sampling and the total sample in the study was 81 people. Data were collected using the OSDI questionnaire and TBUT and Schirmer examinations to assess dry eye disease, blood pressure tests to assess hypertension, and MBI examination.

Results : The results showed that the average MBI in hypertensive patients with dry eye disease twice shorter than in hypertensive patients without dry eye disease (p<0.001).

Conclusion : This shows that MBI can be used as a modality for screening and screening for dry eye disease in hypertensive patients. MBI can be an alternative for practitioners to objectively assess dry eye disease in primary health care where there is no complete ophthalmological facility.
SUCCESSFUL DIFFERENT TREATMENT IN INTERMITTENT EXOTROPIA: CASE SERIES
Authors: NASIKA CELIA DENDY  , Sesy Caesarya  , Primawita O. Amiruddin  , Mayasari Wahyu Kuntorini  , Feti Karfiati
Published: February 2024

Introduction : In intermittent exotropia, management's goals are to diminish deviation by improving fusion control.

Case Illustration : Case 1: A 19-year-old woman has complained of squinting and blurred vision since the age of 3 years. The visual acuity of both eyes (OU) was 0.05, with a BCVA of 0.63. Hirschberg's test was exotropia 15o . The exotropia after the cover test (Figure 1A) improved without blinking. The prism cover test was 35 D in near and distance. Patient was diagnosed with exotropia, an intermittent basic type with good control, astigmatism, and myopia compositus OU. Three months after, with refraction correction and occlusion, the Hirschberg test revealed orthotropia (Figure 1B). Case 2: A 7-year-old boy has suffered of squinting and blurred vision from the age of 6 years. The visual acuity of both eyes was 0.63 with a BCVA of 1.0. Hirschberg's test was exotropia 30° (Figure 2A). The prism cover test was 50 D in near and distance. Exotropia intermittent basic type, poor control, and bilateral astigmatism were diagnosed in the patients. The patient had surgery for bilateral lateral rectus recession. Hirschberg test 1 day Postoperatively, orthotropia was present (Figure 2B).

Discussion : In exodeviation, control mechanisms relate to therapy compliance and different deviation angles. Intermittent exotropia can be progressive due to loss of fusion control and cause persistent deviation.

Conclusion : For patients with exotropia with intermittent good control, non-surgical management can give good results. Surgical management is considered for large angle deviations in patients with poor control.
DIAGNOSING OCULAR MALINGERING IN CHILDREN WITH SIMPLE TEST: IS IT POSSIBLE?
Authors: KEVIN ANGGAKUSUMA HENDRAWAN  , NI MADE AYU SURASMIATI  , I WAYAN EKA SUTYAWAN  , ANAK AGUNG DEWI ADNYA SWARI  , MADE KUSUMA WARDANI
Published: February 2024

Introduction : Malingering is a condition in children which need a thorough and meticulous examination to diagnose the condition. According to several publication, simple test can be done to diagnose this condition without necessarily performing imaging and electrophysiologic tests.

Case Illustration : An 8-year-old male patient, came to eye clinic with sudden visual loss on both eyes for the last 3 days, following pain on both eyes and headache which fluctuating over the last 3 weeks. Patient insisted on wearing black glasses during examinations. Preliminary examination revealed visual acuity no light perception on both eyes. Slit lamp examination and pupillary reflex were normal, fundus examination revealed normal fundus. We tried to do surprise test by suddenly swaying hand towards patient’s eyes and record a visual response. Afterwards we asked patient’s parent to wait outside while performing LEA test which revealed visual acuity 6/6 on both eyes. Further history taking revealed that patient got bullied on school that makes him try to avoid attending school.

Discussion : Patient with malingering usually come with decreased vision but seldomly come with blindness. Though it was quite challenging, doing some simple test available in daily practice such as surprise test can help us to diagnose the suspicion. Handling such patient needs a cautious analysis towards patient’s condition and gentle approach towards the patient. It is crucial to rule out organic condition before diagnosing patient with malingering.

Conclusion : Simple test such as surprise test can be done in assisting malingering diagnosis when carefully done with the support of thorough history taking and physical
Shave Excision Of Marginal Lower Eyelid Nevus
Authors: Rika Karim Chan  , Prof. Dr. dr. Rodiah Rahmawaty Lubis, M.Ked(Oph), SpM(K)
Published: February 2024

Introduction : INTRODUCTION: Nevus is a common benign melanocytic lesion and may appear in palpebral region. It may appear congenitally or acquired. Such lesions contain melanocyte derived from neural crest. Palpebral nevus is a group of heterogenous lesion with varying clinical and histological presentation depending on age and nevus stage. PURPOSE: To report shave excision procedure of the left inferior palpebral nevus located in the palpebral margin using local anesthesia.

Case Illustration : CASE REPORT: A 43-years old woman came to the hospital with a solitary mass in the lower right eyelid. The mass was experienced since 2 year ago and slowly increasing in size and most notably 3 months prior. The mass was round, tender, painless, black-greyish colored, with a smooth surface, mobile, and measured 0,5 cm x 0,5 cm in size. The lesion was located in the middle portion of right lower palpebral margin without extension to the tarsal or bulbar conjunctiva. No bleeding or discharge was found. No history of trauma, use of medication, family history, previous ocular and systemic disease was found. Histopathological examination concluded the lesion was nevus pigmentosus. The nevus was excised entirely using shave excision technique with local anesthesia. Follow-up examination revealed an excellent result with no complications.

Discussion : 

Conclusion : CONCLUSION: Palpebral nevus pigmentosus are common benign tumor with wide range of clinical and histological manifestation. Not all palpebral nevus required surgical intervention. The most effective treatment is complete excision of the nevus and recurrence rate is generally low.
The Importance of Initial Management in Ocular Chemical Burn: A Case Series
Authors: Dr. ANDREAS SURYA ANUGRAH, Sp.M  , Dr. Reny Setyowaty, Sp.M
Published: February 2024

Introduction : Ocular chemical injuries are true emergency which requires immediate intervention. Delayed management may result in severe eye injuries. This report aims to describe the effectivity of initial management and medical treatment of ocular chemical burns.

Case Illustration : We reported four cases of ocular chemical injuries due to alkaline, acidic, and unspecified chemical compound. All subjects were men, aged 30 to 50 years old. They had injuries at work and none of them used eyewear protector. Each was brought to emergency unit in less than 2 hours. They were given initial timely irrigation until pH neutralized. Ocular damages were evaluated using Roper-Hall Classification, three cases were Roper-Hall 2 and other was Roper-Hall 3. After initial management, all cases were treated with medical treatment and showed significant improvement. After 6 months follow up, there weren’t any long-term sequelae in all subjects.

Discussion : Serious eye damage results from strongly alkaline or acidic compounds. Most critical factor is timely delivery of irrigating fluid. Irrigation should ideally be performed with isotonic saline or lactate ringer solution and continued until the pH neutralized to a physiological level. Any method of irrigating the eye is preferable than delay in elimination of the destructive chemical. Medical treatments in acute management of severe ocular chemical burns are anti-inflammatory therapy, halting epithelial and stromal breakdown, promoting re-epithelialization and promoting corneal stromal healing.

Conclusion : Timely irrigation of the eye effectively reduces severity of chemical burns, reduces need for surgical intervention, and improves final visual acuity if combined with medical treatment in golden period.
PENETRATING EYELID INJURY DUE TO FISHING HOOK : AN UNUSUAL
Authors: BIMA RYANDRA PUTRA  , RIANI ERNA
Published: February 2024

Introduction : Ocular penetrating injury due to fishing hook is rarely reported. Identifying organ structures involved and determining appropriate approach will affect the outcome. This special case explained penetrating eyelid injury due to fishing hook without ocular involvement.

Case Illustration : R, boy, 12y.o, came to M.Hoesin ED in January 2023 with complaint of left eye was exposed to fishing hook one hour before admission. Patient was experiencing mild pain with pain scale of three, no blurry vision, excessive tears nor blood. History of immunization was uncomplete.There was no significant visual disturbance. On left superior palpebra, there was a fishing hook penetrated into the medial superior palpebra (partial thickness) without any marginal involvement, no active bleeding, and corneal abrasion in central-paracentral nasal 6-9 o’clock direction. Patient was diagnosed with penetrating eyelid injury due to fishing hook. Intraoperatively back-out technique were performed to extract the fishing hook. Patient was prescribed with 250IU Tetagam injection, chloramphenicol eye ointment, and oral analgetic.

Discussion : Ocular penetrating fishing hook injury could cause severe complications. In this patient, it only penetrates the eyelid until the dermis layer without marginal involvement. Complications occurred were only corneal erosion with minimal pain. After the operative procedure, topical antibiotic and analgetic were administered. There was no decreased levator palpebra function and corneal erosion was resolved in three days after topical antibiotics were administered.

Conclusion : Management of ocular penetrating fishing hook injury is challenging. Determining the best technique to extract the fishing hook depends on the depth and type of fishing hook.
What To Expect In An Unexpected Spontaneous Bilateral Ectopia Lentis
Authors: Yudakusuma Cheryll , Susyono Maria Larasati
Published: February 2024

Introduction : Ectopia lentis is present in 50% to 80% of Marfan syndrome sufferers. In many people the position of lens is fixed, some individuals’ lens experience subluxation which took amount of time. This case presents a young patient with rare manifestation of spontaneous bilateral ectopia lentis, both lens luxated within two days after admission due to secondary glaucoma.

Case Illustration : A 14 years old patient came to the emergency department with acute glaucoma like symptoms: pain and redness in both eyes, along with headache and nausea. The patient appeared highly suspectedof Marfan syndrome appearance with tall stature, and arachnodactyly; both eyes shown visual acuityof 1/300, low digital palpation, ectopia lentis and anteriorly subluxated lens in both eyes, positive fundus reflex. Posterior segment USG B-scan is normal. Patient then prescribed with oral Acetazolamide, Timolol Maleate eye drop, and Prednisolone eye drop, then scheduled for lensectomy. Just within 2 days after admission, right eye shown lens anteriorly luxated with 20/100 visual acuity, while left eye appears aphakic with ectopia lentis at vitreous with 1/60 visual acuity. The physician immediately sent the patient to higher referral hospital then received secondary implant on right eye and secondary implant with vitrectomy procedure on left eye.

Discussion : Drastic measure took place given the presence of both lenses' dislocation, one into anterior chamber, another into vitreous cavity. Collaboration with cardiologist is necessary to perceived other potential comorbid.

Conclusion : Physician do need always to be prepared for even the uncommon complications to occur, hence have to be prepared for the unexpected.
CHOPPING METHODS IN APPROACHING HARD CATARACT: OPTIONS AND RECOMMENDATION
Authors: MUHAMMAD IQBAL  , Haikal Hamas Putra Iqra
Published: February 2024

Abstract

Introduction & Objectives : Mature cataracts with hard-nuclear and soft-nuclear cataracts were different in their anatomical features and their management approach. Degeneration of zonules, loss of capsule and cortical liquefaction are often found in hard cataracts. Therefore, different approaches are required in this condition. Chopping methods have several advantages in managing the nucleus which plays a major part in cataract surgery. It lessened phaco power which minimized endothelial damage. The risk of intraoperative zonular dehiscence may also be lowered with chopping methods. Several chopping methods are widely accepted in approaching hard cataracts such as vertical chop, horizontal chop, crater and chop, drill and chop, stop and chop, and multilevel chop. Burst mode which requires high vacuum and power to chop and flow rates must be adequately comprehended by the surgeon in achieving the optimal result. This review discussed chopping methods in cataract surgery.

Methods : Several chopping methods are widely accepted in approaching hard cataracts such as vertical chop, horizontal chop, crater and chop, drill and chop, stop and chop, and multilevel chop.

Results : Burst mode which requires high vacuum and power to chop and flow rates must be adequately comprehended by the surgeon in achieving the optimal result.

Conclusion : This review discussed chopping methods in cataract surgery.
Axenfeld Rieger Syndrome: an unusual case report
Authors: RAHMADIANSYAH MUHAMMAD FADHIL , SAYUTI KEMALA
Published: February 2024

Introduction : Axenfeld-Rieger Syndrome (ARS) is a rare autosomal dominant disorder that characterized by ocular manifestation, especially the cornea, iris, glaucoma, and systemic abnormalities in teeth, face, abdomen, heart and genitals.

Case Illustration : A 7-year-old boy patient presented to policlinic with complaint of blurry vision in both eyes. No other abnormalities in history. On examination, visual acuity of right eye 5/60 and left eye 4/60. Slit lamp examination revealed hypoplasia iris, corectopia, and polycoria. Intraocular pressure (IOP) on right eye 25 mmHg and left eye 24 mmHg. Non ocular manifestation were flat face and teeth deformity. This patient was diagnosed ARS with secondary glaucoma. We managed the patient together with the dental and pediatric department in order to confirm and treat any systemic abnormality. Patient underwent cycloplegic refractive correction to achieve best corrected visual acuity right eye 20/200 and left eye 20/150 (LEA chart). Timolol 0,25% eye drop was given twice a day with IOP right eye 19 mmHg and left eye 20 mmHg after 2 weeks.

Discussion : The diagnosis of patient was ARS with secondary glaucoma. The patients with ARS have a 50% lifetime risk of glaucoma. Comprehensive management to confirm and treat the systemic abnormalities from dental and pediatric departments was important. Management in our department includes correction of refractive errors and lowering of IOP.

Conclusion : Axenfeld Rieger Syndrome that manifest ocular and non-ocular need to investigated thoroughly. Multidisciplinary contribution of this case is necessary to maintain the ocular stabilization and prevent any harm from systemic abnormalities.
EFFECT OF CORTICOSTEROID ON OCULAR TUBERCULOSIS: A SYSTEMATIC REVIEW
Authors: Rahmah Amran  , Dr. Dicky Stevano Zukhri, Sp.M
Published: February 2024

Introduction & Objectives : There are still some disagreements between experts regarding the use of corticosteroids as an adjunctive treatment for ocular tuberculosis. Even though corticosteroid is important for controlling the inflammation to reduce further damage to the eye, some evidence claim that corticosteroid may interfere with ATT and causes more damage. This study aims to summarize and assess the role of corticosteroids on ocular tuberculosis.

Methods : This study reviews papers from PubMed and Ophthalmologica Indonesiana database published in English or Indonesia between the years 2017 and 2022. The search terms used are a combination of treatment or therapy, corticosteroid, and ocular tuberculosis.

Results : A total of 8 studies are included in this review with a total of 992 patients. Ocular TB can be further differentiated into anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis, retinitis and retinal, vasculitis, neuroretinitis, and optic neuropathy. Corticosteroids are delivered through different routes depending on the site and severity of the inflammation. Generally, patients treated with ATT and corticosteroids have a positive response but improper timing, dosage, or route may actually worsen the infection and inflammation.

Conclusion : Corticosteroids are needed as adjunctive treatment to control the inflammation from further damaging the eye. However, further studies regarding the specificity of the usage should be done as there are still limited studies about the factors affecting the outcome
RE-TRABECULECTOMY + 5-FLUOROURACIL IN PRIMARY ANGLE CLOSURE GLAUCOMA PATIENTS AGGRAVATED BY CONSUMPTION OF SCHIZOAFFECTIVE DRUG
Authors: Syafridon M Fadhil , Fidalia  , Sari Prima Maya
Published: February 2024

Introduction : PACG occurs when the anterior chamber angle is occluded by the iris thus reducing aqueous humor outflow. Most schizoaffective patients use anticholinergic drugs which may result in iridocorneal angle closure through deposition. This article reported a Re-Trabeculectomy + 5 FU surgery in PACG which was aggravated by the use of schizoaffective drugs

Case Illustration : A 43 year old woman, underwent Re-Trabeculectomy + 5 FU on LE after increasing IOP and regularly took schizoaffective drugs. Tapering of schizoaffective therapy was done 1 month preoperatively. Patient presented with LE UCVA of 3/60 and LE IOP is 30.9 mmHg with three anti- glaucoma medications. LE examinations revealed VH1 AC, bayonet sign and cupping on funduscope, closed angle on gonioscope, nasal step defect on humphrey and diffuse RNFL thinning on OCT. On the first postoperative day LE IOP is 18.5 mmHg. The schizoaffective therapy was re-initiated from psychiatric and evaluation was done weekly

Discussion : Re-trabeculectomy surgery have been done considering the failure of the first trabeculectomy and administration of 5-Fluorouracil as an anti-fibrosis. The benefits of reducing preoperative dose of schizoaffective drugs for a month due to having an anticholinergic effect and reduces IOP by 5 mmHg. Psychiatrists and ophthalmologists work together to try to administer basic schizoaffective drug doses and evaluate IOP to keep it under control.

Conclusion : The re-operative action was carried out by adding anti-fibrosis and cooperating with psychiatry for postoperative tapering of schizoaffective drugs. Long-term use of antidepressant drugs and benzodiazepines increases PACG.
Moxifloxacin Treatment for Contact Lens-Related Corneal Ulcer: A Case Report
Authors: Gek Ayu Krismayogi  , AA Sagung Mirah Prabandari  , Harumi Purwa Prahesthy
Published: February 2024

Introduction : A corneal ulcer is an ophthalmological emergency that can threaten vision. It is characterized by inflammation or infection involving the corneal epithelium and stroma. Prolonged use of contact lenses is more likely to cause corneal ulcers. The purpose of this paper is to report on the management of corneal ulcers.

Case Illustration : A 30-year-old female complained of blurred vision, redness, pain, swelling, and sensitivity to light in both eyes for the last two days. She reported falling asleep in her contact lenses two nights before the visit. The patient had compound myopic astigmatism before and her visual acuity was decreased to 3/60 in the right eye and 5/60 in the left eye, examinations showed palpebral edema and conjunctival hyperemia in both eyes. The use of fluorescein in both eyes highlighted the area of the defect. The patient was diagnosed with corneal ulcers. Treatments were Moxifloxacin Eye Drop every hour and Ibuprofen 2x400 mg by intravenous infusion. On the last visit, the corneas were clear with visual acuity 6/15 in both eyes.

Discussion : According to the study by Kishor et al., ophthalmic eye drop is the most effective treatment and fourth-generation fluoroquinolones represent the most frequently used strategies in Corneal Ulcer.Conclusion : Antibiotics and analgesics are effective for the management of corneal ulcers in this patient. Education regarding contact lenses is important to prevent the occurrence of corneal ulcers.
Stargardt Disease: A Rare Case Report
Authors: Masloman Anugrah Handini , Kambey Dave Abraham , Sumual Gideon , Nursalim Ade John
Published: February 2024

Introduction : To report a stargardt disease case

Case Illustration : A 14 year young boy presented with chief complaints of blurry vision in both eyes since childhood. Progressive loss in his ability to differentiate between faces, colors and point out details of objects. On ocular examination, his visual acuity was 1/60 with retinoscopy value revealed +2.00 Dsph and was unable to read plates of Ishihara chart in both eyes. On indirect ophthalmoscopy optic disc were normal with sharp margins and orange color and absent foveal reflex in both eyes. Numerous small whitish flecks were seen around the macula in both the eyes with an ill-defined circular lesion was seen at the macula with beaten bronze appearance. Supportive therapy such as correction with low vision aids or the provision of sun protective glasses can help in the daily lives of patients.

Discussion : Stargardt disease is an inherited macular degeneration that typically presents in the first two decades of life. The prevalence is in the region of 1 in 8–10,000 individuals. Study reported an annual incidence of 0.127 per 100,000. This case was also rarely reported in Indonesia. The age of onset and rate of progression vary greatly, with most experiencing symptoms in their teens or earlier.

Conclusion : Stargardt disease case has been reported in a 14 year young boy. Progressive vision loss can be the only vision complaint from the patient. Supportive therapy such as correction with low vision aids or the provision of sun protective glasses can help in the daily lives of patients.