bluuebunny/crossref_metadata_2025 huggingface dataset:
OCULAR INVOLVEMENT IN SNAKEBITE PATIENT: A CASE TO REMEMBER
Authors: Novianti  , Elisa Yopitasari
Published: February 2024

Introduction : Snake bite cases in Indonesia are not rare with mild to catastrophic consequences on the bitten subject due to its hemolytic and neurotoxic effects. This case represents a rare ocular neurotoxic effect of snake’s venom that cause binocular diplopia and ptosis in a child.

Case Illustration : A 9 year-old boy was consulted to ophthalmologist with chief complaint of binocular diplopia. He was hospitalized after being bitten by a snake on his right hand and had an episode of delirious state. Ophthalmologic examination revealed ptosis and exotropia of his left eye in primary position. Further examination of anterior and posterior segments showed good results. His visual acuity was unaffected. Intravenous antivenom was administered and the bite wound was taken care. The boy was discharged from the hospital with a good general condition but still an opthalmoplegia. After a week of follow up the diplopia diminished and his ocular motility was recovered.

Discussion : Ocular manifestations in snake bite case might be missed because of delirious state of the patients. Snake venom can cause ptosis and ophthalmoplegia (neurotoxic) along with uveitis, optic neuritis, central retinal artery occlusion or vitreous and retina hemorrhage due to its hemolytic effect. Time interval between the bite and treatment is one of crucial factor that indicate the patient’s prognosis.

Conclusion : Thorough examination of anterior to posterior ocular segments is needed in every snake bitten patients to rule out any further ocular complication. An early administration of intravenous antivenom is still a mandatory.
Temporary Partial Periosteal Graft for Emergency Management in Peripheral Corneal Perforation
Authors: Indah Saraswati  , Ridho Ranovian  , Yulia Aziza  , Astrianda Nadya Suryono
Published: February 2024

Introduction : Corneal perforation occurs secondary to a number of corneal abnormalities and leads to further complications if left untreated. Varies options for managing corneal perforation had been conducted, yet the data of periosteal graft in ophthalmology was still limited. This case report aims to evaluate the efficacy of periosteal graft in peripheral corneal perforation.

Case Illustration : A 77-year-old female patient came with a chief complain 14-day history of severe ocular pain and blurry vision of left eye. Initially, there were recurrent ocular redness with foreign body sensation since 6 month before admission, yet denied any history of systemic and autoimmune diseases. She was assessed as corneal infection by some hospitals and treated with some medications, yet the symptoms were not improved. The ophthalmological examination revealed a 360 degrees corneal thinning with uveal prolapse on the infero-temporal on limbus part. The perforation was treated with partial periosteal graft and conjunctival resection, as the corneal donor for tectonic keratoplasty was not available. A few months after surgery, the grafts remained in place after the surgery, even though the visual acuity was still the same.

Discussion : Because of its ease in harvesting, avascularity, strength and lack of immune reaction, autogenous periosteum is a potential grafting tissue for corneal covering in the case of corneal perforation, although it was not the gold standard treatment. This technique presented satisfactory results with low complication rates and minimum number of complications.

Conclusion : Temporary partial periosteal graft could be considered as emergency surgical options in peripheral corneal perforation.
A Rare Embryological Phenomenon: Kissing Nevus Incidence and Clinical Features
Authors: Atika syafendra  , Mardijas efendi  , Hendrianti
Published: February 2024

Introduction & Objectives : Kissing nevus is a condition where the nevus extends up to the lid margins, its edges touch or “kiss” when the eyelids are closed. Although commonly presenting at birth, there have been cases where it appeared in later life. This occurs due to a rare embryological phenomenon and thus only 30 cases have been reported worldwide until 2020. Meanwhile in M Djamil Hospital Padang we found 4 cases during 2020-2022. This paper is aim to present this so called rare cases in a modest way

Methods : This is a descriptive study related to kissing nevus cases in M Djamil Hospital Padang during 2020-2022. We diagnosed it clinically based on ophthalmology examination. The data were collected into master table and being analyzed. We put patient’s identity (name, age, and gender), nevus location, size, gross anatomy of the nevus and surgical procedure

Results : Four patients were discussed in this study. Most of the patients (75%) is a woman. We found more cases in the first 2 decades of life (50%). The predilection location is at the temporal eyelid (50%), it’s size is equal, both (10-19 mm and 20-29 mm) is 50%. In study we only found a melanotic lesion (100%). Most of the patient were treated with excision biopsy + skin flap (75%)

Conclusion : The prevalence of kissing nevus in M Djamil Hospital is high. Kissing nevus mostly suffered by young women, most cases affected temporal eyelid, the size 10-29 mm so that skin flap is the most suitable surgical procedure
THE RELATIONSHIP BETWEEN DRY EYE SYNDROME AND THE USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) IN HOSPITAL MEDICAL WORKERS)
Authors: NUR SHANI MEIDA  , Prifina Windy Aulia  , Yunani Setyandriana
Published: February 2024

Introduction & Objectives : Background: The need to wear personal protective equipment (PPE) during a pandemic can cause dry eye syndrome. It will increase sweating so reduce tear production and the use of masks increase air flow to the eye area so that tear evaporation increases. Objective: To determine the relationship between the incidence of dry eye syndrome and the use of PPE in hospital medical personnel.

Methods : Methods: This was an analytic observational study with a cross-sectional design using the OSDI (Ocular Surface Disease Index) questionnaire. The research was carried out at the Cilacap Hospital in 2021. There were 49 samples (51% male and 49% female), with an age range of 20-50 years. The data was analyzed by using the Spearmans test.

Results : Results: The incidence of dry eye syndrome was 69.5% (mild 18.4%, moderate 18.4%, severe 32.7%). As many as 53.1% of the incidence of dry eye syndrome occurred in wearing PPE for more than 4 hours and was more common in the use of PPE level 1 (40.8%), followed by level 3 (36.7%) and level 2 (22.5%). In the Spearman's test, it was found that there was a significant association between the incidence of dry eyes syndrome and the use of PPE (duration and level of PPE) (p<0.05) but had a weak relationship strength (r=0.3).

Conclusion : Conclusion: There is a significant relationship between the incidence of dry eyes syndrome and the use of PPE (duration and level of PPE use) but has a weak relationship strength.
Anterior Orbitotomy with Transcutaneous Approach as Management of Orbital Cavernous Hemangioma
Authors: Sheilla Selvina  , M. Rinaldi Dahlan  , Shanti F Boesoirie  , R. Angga Kartiwa  , Niluh Putu Ayu Dewi
Published: February 2024

Introduction : Orbital cavernous hemangioma is the most common benign orbital lesion in adults. Management of cavernous hemangioma depends on the presented symptoms. Visual impairment is indication of surgical management. Anterior orbitotomy is the preferred surgical technique for cavernous hemangioma.

Case Illustration : A 34-years-old male came with chief complaint of mass in the inferior palpebra left eye (LE) accompanied with double vision for three years. Visual acuity of the right eye (RE) was 1.0 and LE was 0.8. Ophthalmology examination revealed hypertropia, non-axial proptosis, mass lesion sized 4 x2 cm in the left inferior palpebra and RAPD grade I in the LE (Figure 1). Funduscopy examination in both eyes was within normal limit. CT-Scan examination showed intraconal and extraconal inhomogen mass lobulated in the left inferomedial which obliterate inferior and medial rectus muscle (Figure 2). Patient was diagnosed with proptosis and compressive optic neuropathy in LE caused by suspected orbital cavernous hemangioma. Anterior orbitotomy with transcutaneous approach was done (Figure 3). Histopathological examination showed proliferation of large blood vessels lined with endothelial cells as characteristic of cavernous hemangioma (Figure 4). There was improvement of visual acuity and no RAPD after surgery (Figure 5).

Discussion : Orbital cavernous hemangioma can compress optic nerve which will cause visual disturbances. Anterior orbitotomy with transcutaneous approach provides wider space when surgeon take out hemangioma completely. It will reduce bleeding caused by truncated mass of hemangioma and increase successful rate of surgery.

Conclusion : Anterior orbitotomy with transcutaneous approach can correct globe displacement and visual disturbances caused by orbital cavernous hemangioma.
From Trauma to Triumph: A Successful Outcome of Intraocular Foreign Body
Authors: Primasakti Pattih , Helvanda Weni
Published: February 2024

Introduction : Intraocular foreign body (IOFB) is a medical condition characterized by the presence of a foreign object within the eye. IOFBs can cause significant damage to the eye, leading to vision loss, ocular inflammation, and even blindness.

Case Illustration : We present a case report of a 37-year-old male patient who presented to the emergency department with a history of sudden-onset eye pain and decreased vision in the right eye after a gravel had struck him in the eye while working in a field. Slit-lamp examination revealed a 4mm corneal rupture, iris damage, and traumatic cataract. Computed tomography confirmed the presence of the foreign body in inferonasal quadrant of the retina. The patients underwent vitrectomy and silicone oil tamponade was placed to support the retina. Foreign body had shattered into small pieces and aspirated during vitrectomy. Endolaser photocoagulation was performed to contain the injury site. Lens was removed and iris claw was implanted. Visual acuity improved from hand movement to 20/100. No signs of endophthalmitis, retinal detachment, or other complications were noted during the follow-up period. ultrasound confirmed the absence of foreign body.

Discussion : IOFBs is a sight-threatening condition that can result from various occupational or recreational activities, as well as accidental trauma. Depending on the size, shape, and composition of the foreign body, it can cause damage to the cornea, iris, lens, vitreous, and retina, leading to vision loss or permanent visual impairment.

Conclusion : The management of IOFBs depends on the location, size, IOFB composition, and severity of ocular trauma. Vitrectomy is an effective approach
MANAGEMENT EALES’ DISEASE GRADE III B: A RARE CASE
Authors: Evasha Agung Putra , Amin Ramzi , Ansyori AK
Published: February 2024

Introduction : Eales' disease is an idiopathic occlusive retinal vasculopathy that mostly affects the peripheral retina bilaterally in young, predominately male patients. A hallmark of eales disease is recurrent vitreous hemorrage can all cause some patients to experience severe vision loss

Case Illustration : A 39-year-old male with vitreous hemorrhage caused by Eales Disease grade III B with initial visual acuity 1/300. Ultrasound imaging showed the membrane like lesion with 1/2 retinal reflectivity, after moderate movement and vitreous hemorrhage on both eyes. The photo-fundus showed there is decreased fovea reflex and perimacular exudate with visible contours of sclerotic blood vessels, visible cotton wall spot, and macroaneurysm. There is also haze grade 3 on media, visible folds in the inferior part, visible shadows of cotton wall spots. The patient was managed with pars plana vitrectomy with endolaser

Discussion : In this case, patient was diagnosed as vitreous hemorrhage caused by Eales Disease grade III B on both eyes but it getting worse on left eye further. We chose to perform PPV with endolaser on right eye. The outcome was good on right eye based on better visual acuity and decreased hemorrhage, but in the left eye, which not treated, worsen outcome occurred

Conclusion : The management of this patient’s case showed good results in both anatomic and functional outcomes for right eye, but unfortunately left eye is on serious problem
COMPARATIVE VALIDITY OF LEA CONTRAST SENSITIVITY CHART TO PELLI-ROBSON CONTRAST SENSITIVITY CHART IN NEURO-OPHTHALMOLOGY PATIENTS
Authors: Valencia Lovenia , Prihatningtias Riski
Published: February 2024

INTRODUCTION AND OBJECTIVEThe Pelli-Robson and LEA contrast sensitivity chart are widely used to measure clinical contrastsensitivity. The Pelli-Robson is a gold standard with the limitation of its bulky size. The LEAcontrast sensitivity chart offers a reliable test in a way more practical and portable chart. Thiscondition led to a question of whether we can predict Pelli-Robson score based on the LEA score.This study developed a conversion method to facilitate the transition from the LEA to the PelliRobson and validating the conversion score.

METHODSThis study retrospectively examined the relationship between LEA and Pelli-Robson ContrastSensitivity Test. There were 120 eyes included in this study. We produced a conversion tableusing the equipercentile equating method. Then, we evaluated the reliability and accuracy of thisalgorithm to convert the LEA to the Pelli-Robson contrast sensitivity score.

RESULTSLEA scores were converted to Pelli-Robson scores according to a conversion table that achieveda reliability of 0.91 based on intraclass correlation. The accuracy of this algorithm was 81.6%within 1 point difference from the raw score.

CONCLUSIONSThis study reported a reliable and comparable conversion algorithm for transforming LEA scoresinto converted estimated Pelli-Robson scores. This method will enhance the utility of existing datain clinical and research settings.
Unusual Presentation of Lipemia Retinalis Presented with Visual Field Defect
Authors: Regina Ivanovna  , Irma Suwandi Sadikin  , Dearaini  , Eduard Jordi Luminta  , Rina La Distia Nora  , Yulia Aziza
Published: February 2024

Introduction : Lipemia retinalis is an ocular presentation that associated to hypertriglyceridemia. Most cases are usually asymptomatic, with changes detected only from fundus examination. This case report highlights a case of lipemia retinalis with decreased peripheral visual field.

Case Illustration : Thirty four year-old female came with complaint of blurry right eye (RE) 3 months before hospital visit, especially on inferotemporal part of her right eye. She had history of diabetes mellitus and hypertriglyceridemia. Her sister also has known history of hypertriglyceridemia. Ophthalmological examination revealed 6/6 visual acuity on both eyes, with normal anterior segment of both eyes. Fundus examination showed creamy retinal vessels on both eyes. Humphrey perimetry result showed inferotemporal visual field defect of RE. At time of visit, triglyceride level was 1440 mg/dL. Patient was prescribed fenofibrate 1x300 mg daily by Endocrinology Department. After 6 months of fenofibrate therapy, serum triglyceride level was decreasing to 185 mg/dL. Ophthalmology exam revealed a significant decrease of creamy white vessel on right eye and normal vessel of left eye. Humphrey perimetry showed decreased visual field defect

Discussion : Hypertriglyceridemia can result from familial or secondary to systemic diseases. Creamy vessel appearance in lipemia retinalis is resulted from presence of triglyceride-laden chylomicrons in the plasma. Lipemia retinalis rarely manifests with reduced peripheral vision, which is presented in this case.

Conclusion : Lipemia retinalis is often overlooked due to its asymptomatic nature. Prompt recognition might be live saving from life-threatening condition resulting from hypertriglyceridemia. Triglyceride- lowering drug therapy is very useful in improving peripheral field defect as presented in our case report.
Devastating Mooren Ulcer Halt by Timely Aggressive Treatment - A Case Report
Authors: Florentina Priscilia  , Lily Raudah Putri  , Annisa Windyani  , Ferdy Iskandar  , Triana Hardianti Gunardi  , Yulia Aziza
Published: February 2024

Introduction : Mooren ulcer is a progressive and painful peripheral ulcerative keratitis of unknown cause. Study aims to show effective aggressive treatment for Mooren ulcer.

Case Illustration : A 43-year-old man was admitted with a marked clinical worsening of the white tissue covering the cornea, accompanied by pain, redness, and blurry vision of the left eye. Initial examination showed visual acuity of 6/21cc. Peripheral corneal ulcer was found from 6 to 2 clock hours with superficial vascularization and epithelial defect. Patient underwent ancillary examinations with unremarkable findings. Patient was diagnosed with Mooren Ulcer and treated with artificial tears and steroid topical. Patient had no significant improvement; therefore conjunctival resection with immunosuppressive therapy were performed. At follow up, no pain was reported, vision improved to 6/15cc, and the ocular surface inflammation resolved.

Discussion : Mooren ulcer is usually misdiagnosed since the clinical signs are similar to other differential diagnoses. The examination must be performed carefully to rule out autoimmune and corneal infection. Treatment goals are to halt the destructive process and promote reepithelization. The stepwise aggressive approach of Mooren Ulcer treatments is crucial. It starts directly with topical steroid to control the progression of inflammation. However, when used alone, topical steroid usually cannot prevent the rapid progression so conjunctival resection is needed to remove the source of collagenase production by cutting the perilimbal blood vessels’ access to the area of the ulcer. Combination with an immunosuppressant will effectively maintain a stable condition.

Conclusion : Early diagnosis and aggressive treatment for Mooren ulcer are needed to prevent the rapid progression.
Ocular Gnathostomiasis in A Farmer From South Sulawesi, Indonesia
Authors: Dian Trisnawaty M
Published: February 2024

Introduction : Ocular Gnathostomiasis is a rare parasitic infection caused by the third-stage larvae of the spiruroid nematode. It is a food-borne zoonosis caused by the consumption of raw or undercooked freshwater species of fish, amphibians, reptiles, birds, and mammals.

Case Illustration : A 37-year-old farmer complained of seeing moving objects in his left eye accompanied by blurred vision. The patient had a history of red left eye with increased intraocular pressure. The visual acuity of the left eye was 20/30. Slit lamp examination showed slight hyperemia of the conjunctiva and a live worm moving in the anterior chamber. The worm was immediately removed using corneal clear incision and sent for parasitological examination. By finding four rows of hooks on the head and fine spines covering the body, the worm was identified as a stage 3 larva of gnathostome sp.

Discussion : Surgical removal of the larvae is considered the most effective treatment. In this case, the patient was then treated with Albendazole 400 mg daily for 21 days and Prednisolone 50 mg for 7 days with reduced doses of 10 mg weekly for three weeks

Conclusion : Ocular Gnathostomiasis by third-stage larvae of spiruroid nematode was found at the eye of a man from Siwa, South Sulawesi. The intracameral worm was successfully extracted from the eye. Patients with complaints of recurrent redness of the eyes accompanied by increased intraocular pressure and a history of living in an area with a habit of eating raw freshwater fish should be considered the possibility of harboring helminth in the eye.
Fuchs’ uveitis syndrome in dark-colored eyes: a case report
Authors: RINA WULANDARI  , FRISMA SAGARA BRILLIYANTO
Published: February 2024

Introduction : The prevalence of Fuchs’ uveitis syndrome (FUS), or Fuchs’ heterochromic iridocyclitis, tends to be higher in light colored-eyes population of developed countries, with iris heterochromia as one of the main features. That classic iris finding does not usually present in dark colored-eyes population like Indonesia, in such manner that FUS is often overlooked.

Case Illustration : A 38-year-old male presented with decrease vision of right eye four months before admission. There was minimal anterior chamber reaction, dispersed non-pigmented stellate keratic precipitates (KP), moth-eaten iris, posterior subcapsular (PSC) cataract without posterior synechiae and grade 0.5 of vitreous cells. A diagnosis of FUS was made by presenting signs, then cataract surgery was safely performed, and vision significantly improved without exacerbation.

Discussion : FUS is a typically mild unilateral uveitis, with iris heterochromia, cyclitis, and cataract without posterior synechiae as its classic findings. Otherwise, iris heterochromia is probably absent in dark- colored eyes, that iris may appear with nodules and or small diffuse atrophy called moth-eaten appearance. Misdiagnosis is mostly caused by holding that iris heterochromia should always be presented and inflammation should be limited in the anterior segment only. FUS responds poorly to steroid and mistreatment with it causes further complication. In addition, cataract surgery is considered safe in FUS.

Conclusion : This case shows the importance of evaluating FUS’ atypical signs. Iris heterochromia is sometimes overvalued, and its absence often leads to misdiagnosis. Steroid treatment is controversial, moreover, cataract surgery is safe in this case.
Ocular Syphilis in an Immunocompetent Young Man
Authors: Vincentius Handy Suria  , Halida Wibawaty
Published: February 2024

Introduction : Syphilis is called the great imitator because its clinical presentations vary widely and overlap with many other etiologies. We present a case of ocular syphilis in an immunocompetent young man with negative HIV test and history of unprotected sexual activities.

Case Illustration : A 27 year-old male initially presented to an outpatient Solo Eye Hospital with complain of blurred vision and sudden visual impairment in the right eye and acute onset left eye redness, pain, clear discharge. His right eye VA was counting finger and 0,2 in his left eye. The patient diagnosed with acute posterior uveitis in the RE and acute iridocyclitis in the LE. A detailed sexual history, he endorsed having unprotected sex with numerous men in the past. Patient was subsequently started on P-Pred ED/2 hourly, atropine ED and testing to evaluate cause of iridocyclitis was sent. Fundus RE : clouded fundus view, vascular occlusion, vitreous opacification. Fundus LE : within normal limit. Rheumatoid factor negative, HIV antigen antibody screen non-reactive, syphilis IgG reactive, RPR screen reactive, RPR quantitative titer 1:128. ANA screen negative. The patient was started on intravenous penicillin G, and both his genital lesion and bilateral visual acuity improved. He was discharged to complete 14 fays of iv penicillin G.

Discussion : HIV-positive patients may often present with ocular syphilis before the HIV status is known. Ocular syphilis is considered to be neurosyphilis for treatment purposes.

Conclusion : Ocular syphilis should be kept in the differential diagnosis in immunocompetent/HIV negative patient, and the importance of obtaining a detailed sexual history should not be forgotten.
SICS as a procedure for cataract with severe corneal scar: a case report
Authors: Yunita Tina , Rahman Sp. M Dr. Faisal , Anggraeni Sp.M M.Kes Dr. Nila
Published: February 2024

Introduction : Cataracts are the most common cause of visual impairment and blindness in Indonesia, according to the Rapid Assessment of Avoidable Blindness (RAAB) survey, which is around 70-80% of patients. Meanwhile, corneal disorders are the second cause of blindness after cataract in the world. Incidence of corneal scar in patients with cataracts can exacerbate visual disturbances to cause blindness and require special treatment.

Case Illustration : A 75 years old woman with blurry eyes since 1 year ago. Acuity of the right eye (OD) was 1/300 and the left eye (OS) was 1/300. Extensive and severe scars were found on the corneas of both eyes. Lens opacities were found in the anterior eye segment. Patient was diagnosed with ODS mature senile cataract and ODS corneal scar. Surgical treatment was carried out using the small-incision cataract surgery (SICS) method, IOL inserted and iridectomy.

Discussion : Mature cataract patients with advanced age tend to have a denser and harder lens. Cataract extraction performed by phacoemulsification procedure in very dense and hard cataracts requires higher ultrasound energy settings thereby increasing the risk of corneal endothelial trauma and burns which will exacerbate corneal scarring in patients. SICS is a better treatment compared to phacoemulsification in patients with complex situations such as corneal scarring in dense and hard cataracts with minimal surgical complications and optimal results. Iridectomy in cataract surgery can be performed if iris prolapse occurs due to high pressure from the posterior segment of the eye.

Conclusion : The SICS procedure shows good results for cataract patients with severe corneal scars
Involutional Entropion of The Upper Eyelid: A Rare Case Report
Authors: Patrick Toar Panelewen  , Yuliana Hartono
Published: February 2024

Introduction : Entropion is a condition in which the eyelid folds inward or the edge of the eyelid folds inward, causing the eyelashes, eyelid margin, and skin to touch the eyeball. The most common entropion is involutional which caused by the aging process, but reports of cases of involutional entropion in the upper eyelid are rare.

Case Illustration : A 66-years-old woman presented with redness, foreign body sensation and teary on both eyes. No history of trauma or foreign body exposure. She had a history with similar complaint 2 years ago. Upper eyelid turn inward, dermatochalasis, and corneal abrasion of both eyes were found in ophtalmic examination. Patient was diagnosed with involutional entropion of the left upper eyelid and treated with anterior lamellar repositioning (ALR). A week after the ALR procedure, on examination it was found that the position of the left eye's upper eyelid was good, there was still minimal swelling, with intact sutures.

Discussion : Involutional entropion generally occurs in elderly patients over 60 years old and is more common in women. Progressive senile changes in the structure of the eyelid cause the occurrence of involusional entropion. Involutional entropion in the upper eyelid is associated with dermatochalasis. One management option for involutional entropion is ALR, which aims to pull the folded-in eyelid margin outward.

Conclusion : This case shows that involutional entropion on the upper eyelid can still occur, albeit very rarely. ALR can be a simple and safe surgical option for patients with involutional entropion on the upper eyelid.
Topical Immunosuppressant Agent Cyclosporine (CsA) as Therapy for Ocular Alkali Chemical Injury: Is It Really Beneficial?
Authors: Rijena Karina Abigael F .K. Bangun  , Balgis Desy Sulistyowati
Published: February 2024

Introduction : Alkali chemicals can cause more severe ocular injury than acidic chemicals, because the alkali can rapidly penetrate the cornea into the anterior chamber of the eye and damage the iris, ciliary body, lens and trabecular meshwork, which can cause significant visual impairment. A topical immunosuppressant Cyclosporine (which also known as Cyclosporin A or CsA) was used in the treatments.

Case Illustration : A 3-year-old male patient presented painful eyes 3 days after an accidental ocular injury with Calcium Hydroxide. The ophthalmic examination revealed based on Roper-Hall grading, the injuries indicated grade III-IV ODS. The patient's BCVA OD 2/60, and OS 20/200. The patient was hospitalized and underwent intensive conservative pharmacological therapy, including topical CsA. Corneal healing was examined by serial corneal Optical coherence tomography (OCT) and showed improvement of the corneal haze throughout the follow-ups. From the last follow-up, the BCVA OD 20/70, OS 20/40.

Discussion : Topical CsA reduces the number of CD3-positive cells (T lymphocytes) and the production of pro- inflammatory cytokines, which was associated with the decreased expression of matrix metalloproteinase-9, inducible nitric oxide synthase, VEGF and active caspase-3. Corneal neovascularization is a clinical condition caused by alkali burn that, when left untreated, leads to significant visual impairment. VEGF-A is one of the most important mediators of angiogenesis, leading to neovascularization. Hence, topical CsA 0.1% eye drops may play a role in the treatment of alkali corneal injury.

Conclusion : This case report showed that topical CsA gave a significant corneal wound healing, combined with the mainstay of alkali chemical injury.
Exploring the Distinct Characteristic of Two Procedures for Sulcus Implementation following Posterior Capsular Rupture during Phacoemulsification: Single-piece Foldable IOLs and Polymethylmethacrylate IOLs
Authors: Pramono Barii Hafidh , Sophian Darmawan M.
Published: February 2024

Introduction : Posterior capsular rupture (PCR) is one of the most feared complications of phacoemulsification. In? the?bag implantation of the lens becomes difficult if the PCR was large. Implantation of rigid polymethylmethacrylate (PMMA) or single?piece foldable IOL is implanted in the sulcus

Case Illustration : After noting the PCR on both patients, single?piece foldable IOL of the same power was implanted in the ciliary sulcus. Same action was implemented to PMMA IOLs by enlarging the main port twice. Intracameral pilocarpine was injected and vitrectomy anterior was performed. The wound was closed with hydration on single-piece foldable IOL, meanwhile on PMMA IOLs, one hecting is required in the middle of mainport wound. The postoperative VA on day 1 from 0.12 on single-piece foldable IOLs and 0.25 on PMMA IOLs. Corneal edema, increased anterior chamber reaction was seen on single-piece foldable IOLs. Raised IOP was not found on both patients

Discussion : Complications implantation single?piece foldable IOLs such as pigment dispersion syndrome, increased IOP. A surgical peripheral iridectomy can be created as a solution. Complication less likely occurred on the patient with longer axial length. The AL on this patient is AL 23.33 mm (single?piece foldable IOLs) and 24.08 mm (PMMA IOLs). The weakness of single piece foldable acrylic lenses are poor choice for ciliary sulcus placement and PMMA IOLs can induce astigmatism.

Conclusion : Single-piece foldable IOLs are not designed for sulcus implantation. PMMA IOLs implantation can induce astigmatism.
An Alternative in Managing Duane Retraction Syndrome Type I Using Modified Nishida Procedure: A Case Report
Authors: Dearaini  , Anna Puspitasari Bani
Published: February 2024

Introduction : Various surgical approaches have been proposed to address the challenge in managing abduction deficit in Duane Retraction Syndrome (DRS) Type I, with no clear guidelines to achieve optimal result. This report aims to describe the outcome of combining medial rectus (MR) recession and modified Nishida procedure to improve abduction in DRS Type I.

Case Illustration : Twenty six year-old female came with inability to abduct her left eye (LE) since early childhood and an abnormal left head turn. No complaints of double vision nor visual impairment. There was -5 abduction on LE with a noticeable narrowing of vertical palpebral fissure during adduction. Prism alternate prism cover test shared a 30 PD esotropia with normal anterior and posterior segment. Patient was assessed with DRS Type I of LE and managed with 5mm MR recession combined with modified Nishida procedure (vertical rectus transposition without tenotomy and muscle splitting). On postoperative day 1 and last follow-up (1 year), the alignment was ortophoric, abduction improvement of -2, and diminished anomalous head posture.

Discussion : Although studies have only reported successful cases of modified Nishida procedure in CN VI palsy, it can be assumed that the procedure can also be implemented to treat lateral rectus muscle innervation abnormality such as in DRS type I. Surgical intervention may not normalize abduction deficit. However, the procedure successfully corrects ocular alignment, eliminates anomalous head posture, and able to improve abduction with no complications.

Conclusion : Modified Nishida procedure can be implemented as an alternative in managing DRS type I with relatively satisfactory result.
Glabellar rotation flap technique in patient with squamous cell carcinoma in right upper eyelid: case reports
Authors: SENYUM INDRAKILA
Published: February 2024

Introduction : Squamous cell carcinoma (SCC) is the second most common skin malignancy after basal cell carcinoma, with an increasing incidence worldwide. Found in various parts of the body, in the eye and periocular area, it may affect the skin of the conjunctiva, cornea, and eyelid. Surgical excision is the preferred mode of SCC treatment. After excision, reconstructive surgery is often required for the best functional and cosmetic results. Early diagnosis and treatment of tumors and follow up care for at least 5 years have a significant impact on patient survival.

Case Illustration: Description of two cases squamous cell carcinoma that had undergone reconstructive biopsy and blepharoplasty procedure with glabellar rotation flap technique alone in one case and together with a cheek advancement flap in the second one. In both cases, conjunctival replacement by using lower labial mucosa.

Discussion : In both cases tumor affects the margin of the upper eyelid, therefore flap reconstruction is necessary to maintain eyelid function and esthetics. The glabellar flap has the advantages of being a fast surgery, having a good vascular supply, and being able to fill deep abnormalities because it is a thick flap. A cheek lateral rotation flap was designed to avoid unnecessary facial distortion in second case.

Conclusion : Glabellar rotation flap alone or together with cheek advancement flap was done to maintain function and physical aesthetic of eyelid. Additional cheek lateral rotation flap could reduce skin tension.
Ocular Manifestation of Monkeypox: A Systematic Reviews
Authors: Dr. Wilson Christianto Khudrati  , Dr. Titiek Ernawati, dr., SpM  , Dr. Kevin Anggakusuma Hendrawan
Published: February 2024

Introduction & Objectives : On July 23, 2022, the World Health Organization declared the monkeypox epidemic a global public health emergency. The majority of clinical studies on monkeypox have concentrated on its dermatological symptoms, but mounting data raises questions regarding its ocular side effects.

Methods : Thirteen studies were found among the 541 distinct articles that were evaluated. Overall, ten studies were case reports, two studies of case series, and one observational cohort study. Ocular manifestations of monkeypox were vesicopapular lesions on the eyelid and conjunctiva, conjunctivitis, epiphora, photophobia, foreign body sensation, eye edema, vision changes, eye pain, itchy eyes, eye discharge, bilateral eye involvement, corneal involvement, keratitis, and subconjunctival nodules.

Results : The most prevalent ocular symptoms of monkeypox were conjunctivitis, followed by eye pain and photophobia. It is still unknown whether the ocular involvement is due to self-inoculation or the systemic transmission of the virus during the early viral phase of the illness. Despite some theories involving the transit of monkeypox into the conjunctival secretions via the plasma compartment, this study also showed that conjunctival swab PCR is 100% positive, equal to skin lesion swabs.

Conclusion : In conclusion, to the best of our knowledge, this is the first review with a larger sample and the newest study to report the ocular manifestations of monkeypox disease. The primary ocular symptoms were conjunctivitis, eye pain, and photophobia. In addition, it is advised that healthcare professionals, especially ophthalmologists, use eye protection goggles when close to patients.
Disaster of Retrobulbar Hemorrhage
Authors: AMELIA DEVY INDRIASARI  , Purjanto Tepo Utomo  , Agus Supartoto  , Banu Aji Dibyasakti  , Irene Titin Darajati  , Datu Respatika
Published: February 2024

Introduction : Retrobulbar hemorrhage is a rare case, 3.6% of which are caused by ocular trauma. However, this case is an ophthalmic emergency and must be treated quickly and accurately. We present a case of neglected traumatic retrobulbar hemorrhage with compartment-syndrome and opportunistic bacterial infection which underwent dilemmatic exenteration and orbitectomy.

Case Illustration : A 39-year-old man was referred with a history of being beaten, 11 days before admission. He felt a dark vision, pain and swelling in his left eye. The visual acuity was no light perception. Eyelid necrosis with proptosis and periorbital edema. We found severe chemosis and cloudy cornea. Negative-light reflex with increase intraocular pressure and limited eye movement in all directions. We did three surgeries due to serious complication. First, evacuation of retrobulbar bleeding. The second was total exenteration. The last was left orbitectomy, necrotomy and reconstruction performed together with plastic-surgeon and neuro-surgeon. Patient was hospitalized for 1.5 months.

Discussion : Accumulation of blood in retrobulbar space leads to increased orbital pressure, which can stretch the optic nerve and impair blood flow in the eye which can lead to orbital compartment-syndrome. Unwanted complications can be prevented with prompt treatment within the first-two hours. Orbital decompression with lateral canthotomy and inferior cantholysis is considered as an emergency procedure. In this case, our patient had chronic compartment-syndrome and had no previous orbital decompression.

Conclusion : Retrobulbar hemorrhage is an ophthalmic emergency. Early diagnosis and treatment are critical to ensure the best clinical outcome. Delayed treatment causes blindness and opportunistic infections can destroy the surrounding structure, a disaster.
Challenging Management in Work-Related Eye Injuries: A Case Report of Steam Boiler Explosion-Induced Open Globe Injury
Authors: Rifhani Atthaya Putri  , Rodiah Rahmawaty Lubis
Published: February 2024

Introduction : Work-related eye injuries (WREIs) are major health problems leading to vision loss worldwide. In this study, we reported a case of WREIs from blast injury caused by a steam boiler explosion

Case Illustration : A 55-year-old male, laundry worker presented to the emergency unit with pain, bleeding, and sudden vision loss in the left eye, 8-hours after a blast injury from steam boiler. He was conscious with normal vital signs. He had lacerations to his left eyelid, frontal, and temporoparietal. Ocular examination revealed a visual acuity of no light perception, full-thickness laceration of the lower eyelid and inferior canalicular, diffuse subconjunctival hemorrhage, corneoscleral laceration with choroidal expulsion, and active bleeding. On investigation, B-scan ultrasonography revealed vitreous hemorrhage and CT scan showed no orbital fracture. He underwent evisceration, eyelid reconstruction, and lacrimal canaliculi repair surgery under general anesthesia and planned to custom-made ocular prosthesis.

Discussion : WREIs include eyeball injuries, eye adnexa injuries, eyelid lacerations, and orbital wall fractures that occur during work-related activities. The incidence of WREIs is higher in men aged 20-40 years. In this case, the patient presented with an open globe injury resulting in sudden vision loss, requiring urgent surgical intervention to prevent further complications. Ocular prostheses can provide acceptable aesthetics and improve the patient's quality of life by helping them to integrate into society.

Conclusion : WREIs can lead to permanent vision loss and require urgent surgical intervention. Employers must prioritize workplace safety by providing adequate training and appropriate eye protection such as safety goggles to minimize the risk of eye injuries.
Management of Lateral Canthal Coloboma in Goldenhar Syndrome: A Rare Case Report
Authors: KETUT PRAMANA ADIPUTRA  , PUTU YULIAWATI  , NI MADE LAKSMI UTARI
Published: February 2024

Introduction : Goldenhar syndrome is a rare congenital disorder characterized by a wide range of physical anomalies affecting the face, ears, eyes, and spine.

Case Illustration : Patient, female 19-year-old, complained of growing mass and blurry vision on right eye since childhood. The patient also has an asymetric face with the right side being smaller then left. She also has hearing disorder on her right ear. Ophthalmology examination revealed right eye's visual acuity is 6/120, lateral canthus coloboma , trichiasis and mass on the inferior palpebral, and conjunctiva attached to the cornea. Left eye is within normal limit. The right ear appears deformed, with no ear canal and preauricular skin tags. Patient underwent conjungtiva tumor excision and given labia mucosa graft with canthoplasty. Histology examination revealed benign lipomatous tumor. Patient feels more confident after oculoplasty surgery.

Discussion : Goldenhar syndrome is a rare condition caused by abnormal development of the first and second branchial arches. It is characterized by a wide range of ocular features, including eyelid and iris coloboma, conjungtiva dermoid or dermolipoma, and more. Beside ocular features, other features are ear malformations, facial asymmetry, cleft lip or palate, and vertebral anomalies. It was unique case because an unformed canthus was found due to a large of conjunctival fornix mass. Appropriate management is necessary for a fulfilling life, though the disorder can have significant psychosocial effects.

Conclusion : Goldenhar syndrome is a rare disease with numerous symptoms and its management is crucial for individuals to have a fulfilling life despite its potentially significant psychosocial impacts.
Spontaneous Ocular Haemorrhage
Authors: Klarissa Chrishalim  , Cisca Kuswidyati
Published: February 2024

Introduction : Hemorrhagic complications are one of the major complications encountered with reperfusion therapies but rarely involve the ocular, especially hyphema.

Case Illustration : a 61-year-old woman presented with blurred vision, discomfort, and red eye in her right eye. She had been treated for hypertension, diabetes mellitus, and coronary artery disease with antiplatelet and other oral medication for 5 years. There was no history of eye trauma or Valsalva-like maneuver effort. The best corrected visual acuity was 20/40 in both eyes and there was no relative afferent pupillary defect. Both eyes had normal IOP. A slit lamp examination revealed pool blood in the anterior chamber as hyphema grade 1. Fundus examination showed dot and blot hemorrhage with cupping discs 0.6 and 0.7. USG examination showed no mass and clear vitreous. The antiplatelet was stopped and evaluated by the internal department. The patient was observed and treated with topical medication, and the hyphema resolved within less than 7 days.

Discussion : Although it is still not clear if there is any increase in intraocular bleeding has been recognized with antiplatelet agents, the concern would be greatest amongst those at high baseline risk due to predisposing conditions, such as elderly with diabetes, hypertension, and usage of antiplatelet agents to maintain cardiovascular disease.

Conclusion : This case emphasizes that though the most common cause of hyphema is a traumatic injury, it can be a rare complication of antiplatelet therapy. Patients on antiplatelet therapy should be carefully monitored for ocular bleeding, especially if they have associated systemic or ocular comorbidity.
A SUCCESSFUL TREATMENT OF INTRAVITREAL MOXIFLOXACIN INJECTION IN ACUTE POST-CATARACT SURGERY ENDOPHTHALMITIS: A CASE REPORT
Authors: Ardityastiti Khairani Azizah , Wibawaty Halida
Published: February 2024

Introduction : Endophthalmitis is a severe form of ocular inflammation and one of the most dreaded cataract surgery complications which may lead to loss of vision. Post-cataract surgery endophthalmitis is a serious complication that occurs when infecting organisms invade the posterior segment of the eye during the time of surgery. Currently, intravitreal injection of vancomycin along with ceftazidime is the first-line treatment, but another study showed a good result of intravitreal moxifloxacin injection in patients with Postoperative endophthalmitis.

Case Illustration : We reported a 59-year-old woman presented with blurred vision, redness, and pain in the left eye 4 days after phacoemulsification. Visual acuity of LE was hand movement and anterior segment examination found that there was a conjunctival and pericorneal injection, corneal edema, cells, and anterior chamber fibrin formation. Ultrasonography examination showed severe levels of debris in the vitreous humor. Patient was diagnosed with acute post-cataract surgery endophthalmitis and received an intravitreal moxifloxacin injection. Fortunately, one week after that injection, there wasa good result in the patient’s eye condition. Visual acuity of LE improved to 0,1 and the patient planned to receive the second moxifloxacin injection to get the best possible results.

Discussion : Moxifloxacin expresses broad-spectrum microbial coverage with a very good diffusion and low adverse effects. Moxifloxacin also has a better penetration ability into inflamed ocular tissue than all other antibiotics. Based on that, other studies said that intravitreal moxifloxacin can replace vancomycin and ceftazidime combinations for the treatment of ocular infections.

Conclusion : Intravitreal moxifloxacin injections have a good result in acute post-cataract surgery endophthalmitis.
COMBINED PAPILLECTOMY AND AUTOLOGOUS CONJUNCTIVAL MEMBRANE GRAFT AS MANAGEMENT FOR SEVERE, REFRACTORY PALPEBRAL VERNAL KERATOCONJUNCTIVITIS: A CASE REPORT
Authors: ANNISA DEVINA NUR , SUHARKO HERNAWITA , GAOL HASIANA LUMBAN
Published: February 2024

Introduction : Vernal keratoconjunctivitis (VKC) is a type of allergic conjunctivitis which often occurs repeatedly and chronically. It is unusual compared to other types of conjunctivitis due to its giant papillae (GP) manifestation that may cause serious complication on cornea and eventually lead to permanent vision loss. We present a surgical treatment—resection of GP—in conjunction with autologous conjunctival membrane graft to manage a severe case of VKC.

Case Illustration : An 18-year-old male came with a prior history of recurrent acute allergic keratoconjunctivitis since seven years before. His GP had caused shield-like ulcer, which leads to corneal scar and interferes with his visual acuity. He also had mechanical ptosis due to the giant cobblestones. His symptoms were then managed by performing combined papillectomy and autologous conjunctival membrane graft.

Discussion : During surgery, the GP on both of his eyes were excised until tarsus was visible. Autologous conjunctival membrane was grafted from superior quadrant of each eye, and sutured tightly onto the excised tarsus. Six month postoperatively, his superior tarsal conjunctiva remain relatively smooth, with well-controlled symptoms of keratoconjunctivitis.

Conclusion : Combined papillectomy and autologous conjunctival membrane graft can be considered as an adjunctive intervention to medications, in patients with severe, refractory cases of palpebral vernal conjunctivitis. It can alleviate symptoms and reduce the possibility of permanent damage on corneal tissue.