bluuebunny/crossref_metadata_2025 huggingface dataset:
Silent Progressive Glaucoma in Encephalofacial angiomatosis (Sturge-Weber Syndrome): A Vision-Preserving Trabeculectomy
Authors: Gunardi Triana Hardianti , Iskandar Ferdy , Herdian Felicia Sesi , Amanda Lia , Priscilla Florentina , Oktariana Virna Dwi
Published: February 2024

Introduction : Encephalofacial angiomatosis, also known as Sturge-Weber Syndrome (SWS), is a rare, non- hereditary condition affecting multiple organs. Glaucoma occurs in almost 70% SWS children, more commonly when the port-wine stain involves the upper eyelid skin. Secondary glaucoma was present due to elevated venous pressure.

Case Illustration : An 8-year-old boy with typical port-wine stain involving eyelid, came with recurrent painful right eye (RE) and headache in the past 3 months. He was diagnosed with SWS at 1 year and was on daily doses of carbamazepine and valproic acid for seizure control. His best visual acuity and intraocular pressure were 0.5/60 RE, 6/38 LE, 38 mmHg RE, 28 mmHg LE, respectively. Examination revealed Cup-disc-ratio (CDR) 0.9-1.0 RE and 0.5-0.6 LE. During the first three months, he showed favourable outcome with timolol and latanoprost (controlled IOP with target of <12 mmHg and markedly similar Cup-Disc Ratio). However, at 4th and 5th month visit, his IOP significantly increased despite of additional regiments, thus underwent trabeculectomy on both eyes for preserving his sight. After procedure, his IOP remained stable <12mmHg with maintained bleb, deep anterior chamber, also attached posterior segment.

Discussion : Treatments of secondary glaucoma of SWS typically involved surgery with significantly lower success rate compared to Primary Congenital Glaucoma. Trabeculectomy or tube shunt surgery should be performed with caution due to risks of choroidal effusion and hemorrhages.

Conclusion : Secondary glaucoma in children with SWS is common and challenging. Trabeculectomy should be pursued when the benefit outweighs the risks, even with a slim chance, to preserve the vision.
AI for Little Eyes: A Systematic Review of Deep Learning in Evaluating Pediatric Cataract
Authors: Dr. Eric Tjoeng, MRES  , DEVINS NUR ANNISA
Published: February 2024

Abstract

Introduction & Objectives : Pediatric or congenital cataract (CC) is a leading cause of visual impairment and blindness in children worldwide. Deep learning (DL), a subfield of artificial intelligence, has the potential to enhance diagnosis, treatment, and outcomes in various medical fields. We conducted a systematic literature review to summarise and evaluate the diagnostic and prediction capabilities of DL algorithms for CC.

Methods : From 1st February to 25th March 2023, a literature search was conducted in databases such as PubMed, ScienceDirect, EMBASE, and EBSCO, as well as alternative sources such as Google Scholar. Search terms included “pediatric/congenital cataract”, “artificial intelligence", "deep learning", "convolutional neural network", “diagnosis”, "screening", "prediction" and other relevant synonyms. Quality assessment of studies were assessed based on CONSORT-AI and QUADAS-2. Outcomes extracted included accuracy, sensitivity, specificity, and area under the curve (AUC).

Results : Out of 69 studies screened, five studies with different study designs, dataset sizes, and type of DL algorithms employed were included in the systematic review. Most studies employed DL to analyse slit-lamp images to diagnose CC, while one study utilised DL to predict existence of CC from several risk factors. In silico, most studies demonstrated high accuracy and validity of DL algorithms in detecting and predicting CC; however, DL algorithm is not as accurate in diagnosing CC when compared to human counterparts. These studies had limited generalizability given the homogenous population.

Conclusion : DL shows potential as an adjunct tool for ophthalmologists to improve diagnosis and, therefore, treatment decisions for CC, particularly in remote and underdeveloped regions with limited medical resources.
Ocular Manifestations of Von Hippel-Lindau Disease: a Rare Sight- Threatening Condition
Authors: Elsyanty Firda Muthia , Widyanatha Made Indra , Ihsan Grimaldi , Virgana Rova , Iskandar Erwin , Kartasasmita Arief S.
Published: February 2024

Introduction : Von Hippel-Lindau (VHL) disease is a rare phacomatosis characterized by multi-organ neoplasia which usually manifests in young adulthood. Ocular manifestations of this disease are frequently presented initially before the involvement of other organ systems.

Case Illustration : An 18-year-old girl came with a chief complaint of photopsia in the left eye and complete vision loss in the right eye for five years. The visual acuity of the right eye was no light perception and the left eye was 0.8. The anterior segment of the right eye showed iris neovascularization. The posterior segment of the left eye demonstrated multiple elevated red-yellowish lesions fed by a dilated and tortuous vessel. The head CT scan revealed multiple lesions at the pons and cerebellum. The patient was diagnosed with multiple retinal and brain hemangioblastomas due to VHL disease, neovascular glaucoma, and chronic retinal detachment of the right eye due to sequelae of VHL. The patient was treated with cryotherapy and laser photocoagulation of the left eye. Five-month post-cryotherapy follow-up showed the lesions were still active then she underwent the second cryotherapy. The lesions became whitish in appearance with smaller feeder vessels one month after the second cryotherapy and the visual acuity was preserved.

Discussion : Retinal hemangioblastoma is the most common ocular manifestation of VHL disease. Prolonged ischemia causes sight-threatening complications including neovascular glaucoma and exudative retinal detachment. Prompt treatment of detected lesions is crucial for visual preservation.

Conclusion : Early detection of VHL ocular manifestations plays a critical role in establishing the diagnosis and initiating treatment for a better prognosis.
Diabetes, Diabetic Retinopathy, and Intravitreal Injection as a Risk Factor of Posterior Capsular Rupture in Phacoemulsification Cataract Surgery :A Systematic Review and Meta Analysis
Authors: NI LUH PUTU NURINDAH SUKMAWATI  , I Gusti Putu Eka Suryawan Widnyana
Published: February 2024

Abstract

Introduction & Objectives : The risk of PCR in patients with diabetes and its sequential complication including diabetic retinopathy and Intravitreal Injection (IVI) was still under debate. This study was aimed to summarize the risk of diabetes, diabetic retinopathy, and intravitreal injection towards PCR events during phacoemulsification cataract surgery.

Methods : A systematic literature search was performed up to March 2023 from the last 10 years publications using Medline and Cochrane library databases. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) of diabetes, diabetic retinopathy, and IVI with PCR events were calculated using random-effects models. The quality of included studies was appraised using the Newcastle-Ottawa Scale.

Results : Six studies about diabetes, six studies about diabetic retinopathy and seven studies about IVI were included in this meta-analysis. The pooled odds ratios of PCR in eyes with diabetes was 1.22 (95% CI: 1.16-1.28) I2 =0.0%, with the diabetic retinopathy patients was 1.23 (95% CI: 1.13-1.33) I2 =64.3%, and with prior IVI was 1.05 (95% CI: 1.03-1.08) I2 =51%.

Conclusion : This meta-analysis emphasize that diabetes, diabetic retinopathy, and previous IVI significantly increase the risk of PCR on future phacoemulsification surgery. Further studies are needed to elucidate the underlying mechanism.
INTRAVENOUS CORTICOSTEROID EFFECTS ON SUPERIOR AND INFERIOR RECTUS MUSCLE IN THYROID EYE DISEASE
Authors: Milzan Murtadha
Published: February 2024

Abstract

Introduction & Objectives : Intravenous corticosteroid has been used in management of Thyroid Eye Diseases (TED) which was an autoimmune inflammatory disease of the orbital tissues and the eyes. Previous study has shown benefits of intravenous corticosteroid therapy on TED but there was need of quantitative measure to assess the effect of intravenous corticosteroid therapy on extraocular muscle. This study aimed to report the effect of high-dose intravenous corticosteroid pulse therapy on superior and inferior rectus muscle and providing data distribution of active TED before and after therapy

Methods : Retrospective analyses were used in the data collection of patients with active TED underwent high- dose intravenous methylprednisolone pulse therapy regiment 500mg every week for six consecutive weeks at Sardjito Eye Centre between January and December 2022. Ophthalmological investigation and quantitative computed tomography (CT) scan of the orbit were performed before and after corticosteroid pulse therapy and demographics data were presented in tables and graphs

Results : This study included 62 eyes of 31 patients (61,3% female) with mean age of 37.8±13.47 years old. The mean thickness of Superior Rectus (SR) muscle before therapy were 4.12±2.20 mm and decreased to 3.64±1.50 mm post therapy. The mean thickness of Inferior Rectus (IR) muscle before therapy were 4.45±1.80 mm and decreased to 4.26±1.63 mm post therapy. There was significant difference in mean ΔSR -0.47±1.84 mm (p=0.046) but not in ΔIR -0.18±1.69 (p=0.381)

Conclusion : The treatment of Thyroid Eye Disease (TED) with high dose intravenous corticosteroid is safe and effective in reducing extraocular muscle tissue thickness with minimal side effects.
A Case Report Intravitreal Anti VEGF Bevacizumab on Patient with Hypertension Retinopathy and Exudative Retinal Detachment
Authors: Sulamanda Ivan Chandra , Watania Dyana Theresia
Published: February 2024

Introduction : To present a case of intravitreal anti VEGF bevacizumab function on patient with hypertension retinopathy and exudative retinal detachment.

Case Illustration : A 29 years old man presented with chief complaint blurry vision with visual acuity 1/60 on both eyes. History of hypertension sinced one year ago and already got hemodialisa treatment twice a week sinced 6 months ago. Ophthalmic examination showed decreased vision on both eyes and posterior segment both eyes we can find macular star and papil edema. Patient had diagnosed with hypertension retinopathy scheie 4 and exudative retinal detachment both eyes.

Discussion : Hypertension will cause blood vessels to become damage in the form of sclerosis, thickening of blood vessel walls, and plasma leakage. Hypertension retinopathy acts as predictor of systemic morbidity and mortality due to organ target damage. Regulating systemic disease like blood pressure to become normal will improve clinical signs of hypertension retinopathy. Administration of anti-VEGF intravitreal injection therapy like bevacizumab can improve permeability of blood vessels in retina and decreased volume of exudate in retina. Visual acuity for this patient will improve to become 4/60 for both eyes.

Conclusion : Uncontrolled hypertension can lead to organ target damage, which one of that was eyes. Hypertension retinopathy can make complications like exudative retinal detachment if the blood pressure still uncontrolled. Management of exudative retinal detachment caused by hypertension retinopathy was giving intravitreal anti VEGF injection in eyes to repair breakdown of blood retinal barrier, and the blood pressure must be well controlled to maintain permeability of blood retinal barrier.
Comparative Validity of LEA Contrast Sensitivity Chart to Pelli-Robson Contrast Sensitivity Chart in Neuroophthalmology Patients
Authors: Lovenia Valencia  , Riski Prihatningtias
Published: February 2024

Abstract

Introduction & Objectives : The Pelli-Robson and LEA contrast sensitivity chart are widely used to measure clinical contrast sensitivity. The Pelli-Robson is a gold standard with the limitation of its bulky size. The LEA contrast sensitivity chart offers a reliable test in a way more practical and portable chart. This condition 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 Pelli-Robson and validating the conversion score.

Methods : This study retrospectively examined the relationship between LEA and Pelli-Robson Contrast Sensitivity Test. There were 120 eyes included in this study. We produced a conversion table using the equipercentile equating method. Then, we evaluated the reliability and accuracy of this algorithm to convert the LEA to the Pelli-Robson contrast sensitivity score.

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

Conclusion : This study reported a reliable and comparable conversion algorithm for transforming LEA scores into converted estimated Pelli-Robson scores. This method will enhance the utility of existing data in clinical and research settings.
CATARACT SYMPTOMS SCALE AS A SCREENING TOOL FOR VISION DISORDERS DUE TO CATARACT BY NON-MEDICAL CADRES
Authors: Fauzie Radityo Akhmedika
Published: February 2024

Introduction: Cataract is an eye disease with clouding of the lens causing visual interference. Blindness due to cataracts is still the leading cause of blindness in the world. Cataract screening using the questionnaire integrated interview method can be an easy instrument for non-medical cadres to use. Cataract Symptoms Scale (CSS) is a complaint-based questionnaire in cataract patients which is used to screen for visual disturbances due to cataracts.

Objective: To find out whether CSS has good validity as a screening tool for visual impairment due to cataracts by non-medical cadres.

Methods: This study used a diagnostic test to assess the accuracy of CSS. All respondents who met the inclusion and exclusion criteria were included as research subjects.

Results: 151 respondents included in the vision screening activity of the Community Ophthalmology Unit of Cicendo Eye Hospital. Respondents with cataracts in this study amounted to 59 (39.07%) and non-cataracts amounted to 92 (40.93%). The most complaints of respondents were blurry with 145 complaints and the least complaints were changes in the color of objects, namely 36 complaints. The CSS questionnaire sensitivity value of 61.01% indicates a weak value statistically. The specificity value of 78.26% indicates a moderate specificity value statistically. The positive predictive value of 64.28% indicates a statistically weak NDP value. The negative predictive value of 75.78% indicates a statistically moderate value. The value of accuracy is 71.52% statistically moderate.

Conclusions: The Cataract Symptoms Scale has poor validity to be used by non-medical cadres as a screening tool for patients with visual impairment due to cataracts. Further research is needed by adjusting the components of the questionnaire and adding variables such as visual acuity and cataract laterality.
INTO THE DARKNESS AND SILENCE: EVISCERATION IN A DEAF-MUTE- BLIND PATIENT WITH NEGLECTED GLAUCOMA
Authors: Lumita Ferdinand Inno , Laksmita Yulinda Arty , Sieman Andrew John , Iskandar Ferdy , Paramita Carennia , Aziza Yulia
Published: February 2024

Introduction : Glaucoma can have a potentially devastating effect on patient’s vision and quality of life if not treated properly. We described a neglected glaucoma case in a deaf-mute-blind patient that leads to evisceration.

Case Illustration : A 64-year-old deaf-mute female came to our emergency room with chief complaint of bloody discharge from her right eye 12 hours prior to admission with no history of trauma. Patient’s right eye has been blind for the last four years; her left eye has been nonfunctional since she was in her 30s. She went to a primary clinic during this time but did not get any diagnoses. Physical examination revealed uveal prolapse of the right eye with infiltrates around the remaining cornea; and phtisical left eye with IOP of 30 mmHg and opaque cornea. We performed evisceration with dermato-fat graft of the right eye.

Discussion : Glaucoma is a challenging disease, especially in developing countries. It is difficult to diagnose due to its nature to be asymptomatic until late in the disease course. The loss of vision is painless and insidious; resulting in late diagnosis unless patients are screened for glaucoma early on. Patient in this report is particularly difficult for the caretaker since she is a deaf-mute patient; resulting in a suspected undiagnosed glaucoma that leads to evisceration and blindness.

Conclusion : Glaucoma care generally necessitates routine follow-up for monitoring of disease progression and medication adjustments. Good screening system, family support, and integration of eye care into existing healthcare systems is needed for early detection to reduce blindness from glaucoma.
RELATIONSHIP OF PUPIL SIZE WITH REFRACTIVE ERROR IN METABOLIC SYNDROME AND NON METABOLIC SYNDROME: AMONG RURAL POPULATION IN MALANG
Authors: AINI KURROTUL , Sulistyowati Anny , Vierlia Wino Vrieda , Holipah
Published: February 2024

Introduction & ObjectivesNearly one in four Indonesians has metabolic syndrome (MS). One of the microvascular side effectsin Metabolic Syndrome affects the eyes. The aim of this study to evaluate the relationship of pupilsize with refractive error in MS and non-MS groups among rural populations in Malang.

MethodsA descriptive study was carried out in 2019 in three villages in Malang districts. A detailed ocularexamination was conducted on all participants who attended a research facility. We definedpupillary abnormalities and clinically important refractive errors. Blood samples were obtained todetermine the parameter of the metabolic syndrome by IDF 2006 criteria. Subjects were classifiedinto 2 groups: Metabolic Syndrome status and non metabolic syndrome.

Results953 participants completed the examination which consists of 944 right eyes and 942 left eyes. Theresults of visual acuity on the right eye: emmetropia in 434 eyes, myopia with 252 eyes, hyperopiawith 141 eyes, and astigmatism with 17 eyes where if it is not significant if associated with pupillaryabnormalities (P-value 0.893). On the left eye, the emmetropia results were 444 eyes, while formyopia were 244 eyes, hyperopia as many as 138, and astigmatism in 116 eyes and if associatedwith pupillary abnormalities, the result also not significant (P-value 0.864). The result of pupil sizewith metabolic syndrome 499 eye and non syndrome metabolic 454 eye are not significant (p-value0.649).

ConclusionRefractive error didn’t relate pupil size in metabolic syndrome and non metabolic syndrome.
FOSTER-KENNEDY SYNDROME: WHAT FUNDUSCOPY WON'T MISS
Authors: Putri Nabillah Mulya  , Cut Putri Samira
Published: February 2024

Abstract

Introduction : Optic nerve is the only visible extension of central nervous system and often represents several intracranial diseases. This case demonstrates the importance of funduscopy in detecting intracranial mass.

Case Illustration : A 45-year-old woman suffered progressive blurry vision in both eyes for a year and severe headaches and seizures. The right eye (RE) had no light perception, and the left eye (LE) had 6/60 visual acuity. The relative afferent pupillary defect (RAPD) was positive on the RE. A funduscopic examination revealed a pallor optic disc on the RE and papilledema on the LE, consistent with type 1 Foster- Kennedy Syndrome (FKS). A Head CT scan showed a 5.3x6x5 cm mass in the right frontotemporal lobe. We referred the patient to the neurology and neurosurgery department for further management and surgical intervention.

Discussion : FKS is a condition associated with tumors in the frontal lobe, characterized by ipsilateral optic disc atrophy due to direct compression, contralateral papilledema due to increased intracranial pressure, and ipsilateral anosmia in advanced stages. RAPD is a sluggish pupillary response to light stimuli due to unilateral retinal or optic nerve disease that occurs anterior to the lateral geniculate body. True FKS is extremely rare nowadays because of advances in neuroimaging to detect intracranial masses earlier.

Conclusion : As a primary care physician, performing a direct funduscopy on patients complaining of decreased vision, headaches, and impaired mental status is essential. Although rare, FKS should be kept in mind while finding a patient with optic disc atrophy and papilledema.
Strabismus Surgery for Traumatic Ocular Misalignment: Twelve Cases in Five Years
Authors: SURASMIATI NI MADE AYU , RATNASARI NI LUH MADE NOVI , HENDRAWAN KEVIN ANGGAKUSUMA , SUTYAWAN I WAYAN EKA
Published: February 2024

Introduction : Trauma can cause an ocular misalignment due to damage of extraocular muscles, nerves and orbital tissue around the eye. Direct trauma causing extraocular muscle rupture needs immediate surgery, meanwhile indirect trauma resulting in traumatic sixth nerve palsy or other reversible ocular misalignment without orbital floor fracture can be observed for six months. This study describe the characteristic of patients undergo single-step strabismus surgery for traumatic ocular misalignment, mechanism of injury, eye alignment, amount of ocular deviation before and after strabismus surgery.

Case Illustration : This was a case series based on medical record of patients underwent strabismus surgery secondary to head or eye injury from 2017 until 2022.

Discussion : Twelve individuals with post-traumatic strabismus correction participated in this study. All subjects were male age ranging from 18-51 years. Direct trauma was observed in 6 (50%) patients causing medial rectus muscle rupture in 4 patients and inferior rectus muscle rupture in 2 patients. Indirect trauma was observed in 6 (50%) patients caused by sixth nerve palsy on 4 patients The misalignment was exotropia, esotropia, and hypertropia with amount of 5, 4, and 3 respectively. The deviation was between 30-90 prism dioptre (PD) and 7 (58%) patients had deviation less than 65 PD. Strabismus surgery performed was muscle transposition with or without recession of the antagonist muscle.

Conclusion : Single step surgery for traumatic ocular misalignment can provide good result in cases of deviation less than 65 PD
Ocular Penetration Trauma due to Bamboo Resulting in Evisceration: A Case Report
Authors: Indah Latifah  , Dr. Lailus Sofatul Layyin, Sp. M
Published: February 2024

Introduction : Penetrating ocular trauma includes open-eye trauma, which leads to the time and a precision of eye- penetrating trauma’s management determine the advanced vision prognosis. In this case a male experience penetration trauma of the right eye due to exposure to the bamboo, delaying and inadequate management resulted in evisceration of the right eye. A 42-year-old male came to ER RSUD Prof. Soekandar mojokerto with bloody right eye and pain from getting a piece of bamboo from two days before entering the hospital. The patient also complained that the right eye is swollen so that it is unable to open the eyes. vision examination revealed LP (-) in the right eye, visual acuity in the left eye was 6/6, soft palpation in the right eye, normal palpation in the left eye, examination of the right anterior segment of the eye revealed that part of the eyeball content had prolapsed and for the left eye within the normal range. During laboratory tests, 15.280 white blood cells were found, which confirmed the infection of the right eye.

Case Illustration : Descriptive Study

Discussion : The observations on these patients include covered the right eye, antibiotic, steroids, and analgesic by intravenous injection. Based on the condition of the patient's right eye, it is advisable to do evisceration of the right eyeball under general anesthesia.

Conclusion : Penetrating ocular trauma resulting in extensive intra ocular tissue damage and poor vision prognosis, considered for evisceration, in order to prevent the development of the sympatetic ophthalmia.
Phacodonesis in Angle-Closure Glaucoma: Phacomorphic or Other Lens- Induced?
Authors: Claudia Alyssa , Caesaria Aquirina , Noerdiyani Niken Indah , Koesoemowardani Dianawati
Published: February 2024

Introduction : Glaucoma is defined as progressive optic neuropathies characterized by optic disk cupping, reduced visual field, and visual loss. As a “silent thief of sight”, glaucoma ranked second worldwide and third in Indonesia as the cause of blindness. The cause of glaucoma varies, one of which is lens-induced which presents as loss of vision and red eye.

Case Illustration : A 53-year-old female complained about blurred and pained red eyes. Examination of the right eye revealed VOD 1/300, cloudy-milky lens, phacodonesis, and IOP 26.3 mmHg. She was diagnosed with angle-closure glaucoma suspected as phacomorphic or other lens-induced and was treated by topical hypotensive agents and phacoemulsification with IOL implantation procedure. Right eye examination on day one post operation showed VA 2/60 and IOP 13.6 mmHg. Improvement on two weeks follow- up revealed VA 6/15 with best VA of 6/6, IOP 15.7 mmHg, CD ratio 0.5, and negative glaucoma optic neuropathy (GON) finding.

Discussion : When accompanied by phacodonesis, angle-closure glaucoma is mainly caused by a secondary process. It involves zonule of Zinn fragility, which usually occurs in subluxation but also appear in hypermature cataract. Dilated eye examination showed no sign of subluxation, therefore the final diagnosis was phacomorphic glaucoma and hypermature cataract. Cataract surgery as the definitive treatment must be done at an appropriate time as was done for this patient with a favorable outcome.

Conclusion : The presence of phacodonesis in angle-closure glaucoma should be thoroughly evaluated. Meticulous decisions on definitive treatment can be planned afterward.
ANALYSING THE SIDE EFFECT OF AMIODARONE N CONSUMPTION ON OPTIC NERVE HEAD, CONTRAST SENSITIVITY AND COLOR VISION IN ARRYTHMIA PATIENT
Authors: Callina Floriana Y. Br. Bangun  , Bobby Ramses Erguna Sitepu  , Delfi
Published: February 2024

Abstract

Introduction & Objectives : To analyze the side effect of duration consumption of amiodarone on ONH, contrast sensitivity and color vision in arrythmia patient

Methods : This study was an analytical observational study with cross sectional design. A total of 23 subjects with arrhythmias taking amiodarone were included in the study. Sampling was carried out from April 2022-August 2022 at the Eye Polyclinic and Cardiology Polyclinic.

Results : Most of the subjects were female, 12 people (52.2%) with a mean age of 59 years. The results of the examination showed that two subjects had decreased vision, ONH edema and decreased contrast sensitivity in the right eye where the mean duration of amiodarone consumption was 4.5 months. The results of binocular color vision examination were normal in all study subjects. There was a significant effect of the consumption duration of amiodarone on ONH (p=0.024) and on contrast sensitivity (p=0.022)

Conclusion : There was a significant effect of the duration consumption of amiodarone on ONH and contrast sensitivity in arrythmia patient
Ocular Penetration Trauma due to Bamboo Resulting in Evisceration: A Case Report
Authors: Indah Latifah  , Dr. Lailus Sofatul Layyin, Sp.M
Published: February 2024

Introduction : Penetrating ocular trauma includes open-eye trauma, which leads to the time and a precision of eye- penetrating trauma’s management determine the advanced vision prognosis. In this case a male experience penetration trauma of the right eye due to exposure to the bamboo, delaying and inadequate management resulted in evisceration of the right eye. A 42-year-old male came to ER RSUD Prof. Soekandar mojokerto with bloody right eye and pain from getting a piece of bamboo from two days before entering the hospital. The patient also complained that the right eye is swollen so that it is unable to open the eyes. vision examination revealed LP (-) in the right eye, visual acuity in the left eye was 6/6, soft palpation in the right eye, normal palpation in the left eye, examination of the right anterior segment of the eye revealed that part of the eyeball content had prolapsed and for the left eye within the normal range. During laboratory tests, 15.280 white blood cells were found, which confirmed the infection of the right eye.

Case Illustration : Descriptive Study

Discussion : The observations on these patients include covered the right eye, antibiotic, steroids, and analgesic by intravenous injection. Based on the condition of the patient's right eye, it is advisable to do evisceration of the right eyeball under general anesthesia.

Conclusion : Penetrating ocular trauma resulting in extensive intra ocular tissue damage and poor vision prognosis, considered for evisceration, in order to prevent the development of the sympatetic ophthalmia.
THE EFFECTIVENESS OF LEVOFLOXACIN 0.5% WITH POVIDONE IODINE 2.5% IN REDUCING CONJUNCTIVA BACTERIAL FLORA IN PRE INTRA OCULAR OPERATIVE
Authors: OKTA KURNIAWAN SAPUTRA
Published: February 2024

Abstract

Introduction & Objectives : This study aims to compare the effectiveness of Levofloxacin ED 0.5% with Povidone iodine 2.5% in reducing normal bacterial flora of the conjunctiva in preoperative procedures.

Methods : Clinical trials will be conducted in the inpatient ward on patients who will undergo intravitreal surgery at Mohammad Hoesin Hospital Palembang from May 2022-July 2022. Subjects were divided into two groups, which is Levofloxacin ED 0.5% and Povidone iodine 2.5% group. Before and after the fornices preparation, the number of bacterial colonies that grow will be counted and evaluated using bivariate analysis.

Results : There were 32 samples that fulfilled the inclusion criteria. A significant decrease of conjunctival flora was observed in both groups (p value = 0.000). Comparison of the two groups’ decrease in conjunctival flora was not significant. There was a reduction of up to 100% in 11 samples (68.75%) of both intervention groups.

Conclusion : The use of Levofloxacin 0.5% and Povidone iodine 2.5% was equally good in reducing the number of bacterial colonies in the conjunctiva.
Quality of Life Comparisons in Strabismic Children Managed Surgically or Conservatively
Authors: ESTER GRACESILLYA APRINONA G  , Maya Sari Wahyu Kuntorini, MD  , Elsa Gustianty, MD  , Feti Karfiati Memed, MD  , Irawati Irfani, MD  , Primawati Oktarima Amiruddin, MD  , Sesy Caesarya, MD
Published: February 2024

Abstract

Introduction & Objectives : Strabismus causes visual impairment due to ocular misalignment, interferes cosmetic appearance, results in negative self-image and impacts quality of life. Studies in adults have shown that successful strabismus surgery improves quality of life, but awareness of strabismus surgery and its benefits are still lacking. Studies regarding the impact of conservative treatment on quality of life are limited, so further study is required.

Methods : This was an observational study comparing 2 unpaired groups. The method used in this study was cross-sectional and samples were obtained purposefully according to medical records and consecutively based on outpatient visits.

Results : Thirty-six subjects in group A, who had undergone strabismus surgery and 33 subjects in group B who were still managed conservatively were included in this study. Both groups had similar demographic characteristics, except parental education background (p=0.048). Comparative test of2 unpaired groups in this study showed higher quality of life scores in group A (p=0.0001).

Conclusion : The quality of life in subjects who had undergone strabismus surgery was better than that in those who were still managed conservatively.
Complete Resolution of Central Serous Chorioretinopathy Cases Treated with Low Power Mode Laser Technology : A Novel Approach
Authors: Setiawan Grace , Virgana Rova , Widyanatha Made Indra , Ihsan Grimaldi , Kartasasmita Arief Sjamsulaksan , Iskandar Erwin
Published: February 2024

Introduction : Central serous chorioretinopathy (CSC) is an idiopathic condition mostly affecting men in their 20s to 50s. It is characterized by serous fluid accumulation behind the neurosensory retina resulting in a localized macular detachment. Aldosterone-receptor antagonist and photodynamic laser therapy are the current mainstay of treatments, although most CSC cases can resolves spontaneously within 2 to 3 months. Low power mode (LPM) laser has emerged as a new effective technology to treat CSC.

Case Illustration : Case 1: A 50-year-old male was diagnosed with recurrent chronic CSC since 2 months ago. His visual acuity declined even after given oral aldosterone receptor antagonist for two weeks, so he was scheduled to undergo LPM. After three weeks of laser treatment, CSC resolved and the visual acuity improved (Figure1). Case 2 : A 47-year-old male complained of decreased vision and metamorphopsia on his right eye since two weeks ago. He was diagnosed with CSC and underwent LPM. Three weeks after LPM, his vision improved and the metamorphopsia resolved (Figure2). LPM helps the migration of retinal pigment epithelium (RPE) cells to restore the outer blood-retinal barrier through expression of heat shock proteins. We used MC-500ViXi laser system (Nidek Co., Gamagori, Japan) and the laser parameters used in this study were 100?m spot size, 0.01s exposure time, 0.25-0.5 spacing, and 30% LPM ratio.

Discussion : 

Conclusion : LPM is a new yet promising treatment modalities to treat acute and chronic CSC. Its low power nature makes LPM a safe choice of treatment with less damage to the surrounding retina.
Comparison of Changes in Quality of Life Based on Changes in Disease Severity in Graves Ophthalmopathy Patients Following Intraorbital Triamcinolone Acetonide Injection
Authors: LADY PRANODIA SUKMAWIDOWATI
Published: February 2024

Abstract

Introduction & Objectives : Graves ophthalmopathy (GO) is associated with visual impairment and appearance changes, affecting the quality of life. Intraorbital injection of triamcinolone acetonide (TCA) in GO resulted in clinical improvement, but its effect on the quality of life is unknown. The objective of this study was to compare the changes in quality of life after intraorbital injection of TCA between different groups based on changes in disease severity.

Methods : Intraorbital injection of TCA was performed on 30 subjects with GO. Disease severity was assessed according to the European Group of Graves Ophthalmopathy (EUGOGO) criteria. Quality of life was measured using the Indonesian version of Graves Ophthalmopathy Quality of Life (GO-QOL) questionnaire. Changes in disease severity and GO-QOL scores were recorded before intraorbital injection of TCA and 1 month after. Subjects were divided into groups based on changes in disease severity: decreased, remained constant, and increased. Changes in quality of life between the groups were compared statistically.

Results : Changes in GO-QOL appearance scores in patients with decreased disease severity were significantly higher (p= 0.016) than those in patients whose disease severity remained constant. Changes in GO-QOL visual function scores in patients with decreased disease severity were higher but not statistically significant (p> 0.05) compared to those in patients whose disease severity remained constant.

Conclusion : Changes in the appearance aspect of quality of life after intraorbital injection of TCA in patients with decreased disease severity are better than that in patients whose disease severity remained constant, whereas changes in the visual function aspect are not significantly different.
ORBITAL TRAUMA IN A CHILD WITH RETROBULBAR HEMORRHAGE
Authors: Rachmawati Dr. Anita Dwi
Published: February 2024

Introduction : Retrobulbar hemorrhage vision threatening condition associated with cranio- facial trauma. Rapidly fill the orbit and cause an “orbital compartment syndrome” that subsequently cuts off perfusion to vital ocular structures. Treatment must be initiated immidietly to prevent permanent visual loss.

Case Illustration : 10-year-old boy, with left eye blurring of vision, swelling and multiple facial injury post motor accident. Visual acuity was perception of light on left eye, 6/5 and right eye with upper and lower lid laceration wounds. He had a dense afferent pupillary defect and the ocular movements of the left eye were limited in all directions of gaze. The orbit was tense with significant resistance to retropulsion. Diagnosed with acute retrobulbar haemorrhage following blunt trauma with medial wall fracture. Intravenous acetazolamide and timolol was commenced continued with emergency lateral canthotomy. His vision immediately improved to 6/60 and 3 hours later was 6/18. He was treated for left traumatic optic neuropathy with IV Mehtylprednisolone for 3 days followed two weeks oral prednisolone

Discussion :

Conclusion : Retrobulbar haemorrhage is a vision-threatening emergency often necessitating immediate lateral canthotomy for preservation of vision. In children, as the optic nerve canal is smaller, a lesser volume is available for the nerve to expand, thus early visual impairment could occur following trauma. Prompt recognition and appropriate treatment of this ocular emergency is imperative, for timely management determines the ultimate outcome.
Outcomes of Treating a late case of Herpes Zoster Ophthalmicus masquerading as Orbital Cellulitis: A Case Report
Authors: JOSIAH IRMA  , Saraswati Anindita Rizki  , Jennifer Angelina  , Jovita  , Jennifer Handiokho
Published: February 2024

Abstract

Introduction : Herpes zoster ophthalmicus (HZO) refers to a reactivated varicella-zoster virus involving the V1 nerve division. Although rare, previous reports have mentioned HZO cases masquerading as orbital cellulitis (HZO-OC). This report depicts the use of acyclovir, corticosteroids and citicoline in our HZO-OC patient with treatment delay.

Case Illustration : A healthy 66 year old man presented to our clinic 4 weeks after signs of orbital cellulitis followed by vesicular rash following the CN V(1) dermatome were felt which was untreated. The right palpebra was edematous and erythematous. Hazy cornea, mixed injection, grade IV reverse RAPD, diminished direct and consensual reflex and external ophthalmoplegia of the right eye were noted. The diagnosis of HZO-OC with multiple cranial neuropathies OD was established. Topical and symptomatic treatment were given resulting no improvement. Ptosis of the right palpebra became present. The patient was then given systemic acyclovir, methylprednisolone and citicoline. Ophthalmoplegia improved after 2 months and ptosis improved after 4 months.

Discussion : The use of systemic acyclovir and corticosteroids in HZO-OC patients were given promptly in previous literature. Multiple cranial nerve in our patient was thought to occur due to treatment delay. As improvement was not noted after topical treatment, these systemic treatments along with citicoline were added. Citicoline was added due to its ability to promote neural regeneration.

Conclusion : Systemic acyclovir, corticosteroids and citicoline may still be beneficial for HZO-OC patients with delayed treatment.
THE COMPARISON BEST CORRECTION VISUAL ACQUITY (BCVA) BETWEEN SPECTACLES AND SPHERICAL RIGID GAS PERMEABLE (RGP) IN HIGH ASTIGMATISM PATIENTS
Authors: Rino Agustian Praja  , Rinda Wati
Published: February 2024

Introduction & Objective : Rigid Gas Permeable (RGP) toric contact lenses are generally considered in patients with high astigmatism, while spherical RGP contact lenses are present as an alternative option that can be used and still provide optimal results in patients with high astigmatism.

Methods : A cross-sectional study was conducted at DR M Djamil Hospital Padang in January 2021 to December 2022 period. Inclusion criteria were patients who went to the eye clinic at DR M. Djamil Hospital in January 2021 to December 2022 period, patients with high astigmatism ? -2.00 D underwent correction vision with spectacles and RGP spherical contact lenses. Results best correction visual acquity (BCVA) compared between spectacles and spherical RGP contact lenses. Samples must meet the inclusion and exclusion criteria. Data is collected and analyzed using statistical applications.

Results : 49 patients with high astigmatism corrected with spectacles and contact lenses showed data distribution was 15 men (30.6%) and 34 women (69.4%). Most age in the age group 20-29 years 24 people (49%). BCVA with spectacles obtained a median of 0.18 and an RGP of 0.00 based on LogMar. Mann whitney test showed significant difference between BCVA wearing glasses and RGP spherical contact lenses with a value of p = 0.006 right eye p = 0.009 left eye (p <0.005)

Conclusion : Spherical RGP contact lenses can still be used in patients with high astigmatism if we don’t have toric RGP trial. Spherical RGP contact lenses show better BCVA results than spectacles in high astigmatism patients.
DERAJAT APOPTOSIS SEL GANGLION RETINA PASCA PEMBERIAN TAMBAHAN EKSTRAK MORINGA OLEIFERA ORAL DIBANDINGKAN DENGAN TERAPI STANDAR Studi Eksperimental pada Tikus Wistar Model Methanol Toxic Optic Neuropathy
Authors: ADELIA BAYU ISFANDIARI  , RISKI PRIHATNUNGTIAS  , FIFIN LUTHFIA RAHMI
Published: February 2024

Abstract

Introduction & Objectives : Methanol toxic optic neuropathy can lead to retinal ganglion cell apoptosis which causes visual disturbance. Moringa oleifera has been reported to have an anti-inflamatorry effect that can prevent inflammatory mediators from being relased in methanol toxic optic neuropathy

Methods : Twenty-one Wistar methanol toxic optic neuropathy were divided into 3 groups, namely base line group, control group that given intravenous methylprednisolone 4.5mg/6 hours for 3 days, and given standard theraphy and additional administration of oral Moringa oleifera 300mg/kgbodyweight/day for 4 weeks. Assessment of the degree of apoptosis by Anatomical Pathology with histopatolocigal scaoring. The study used Mann Whitney comparative hypothesis test (Significant p<0.05)

Results : The degree of retinal ganglion cell apoptosis was significantly lower in the treatment and standard therapy groups compared to the base line group. The treatment group compared to the standard therapy group was not significantly different (p = 1,000)

Conclusion : The degree of retinal ganglion cell apoptosis in rat model methanol toxic optic neuropathy was not significantly different between the group that was given additional oral Moringa oleifera extract compared to the standard theraphy group
RECURRENT CONGENITAL PTOSIS MANAGEMENT BY SUPRAMAXIMAL LEVATOR RESECTION TECHNIQUE
Authors: Desi Kristina Utami  , Shanti F. Boesoirie  , Raden Angga Kartiwa  , Niluh Putu Ayu Dewi Wardhani  , Mohamad Rinaldi Dahlan
Published: February 2024

Introduction : Congenital ptosis is an abnormal low position of the eyelid since birth. Levator resection technique is one of the surgery technique for ptosis corection. Recurrence could be occured even after ptosis correction

Case Illustration : A 22 year old male presented with a chief complaint of droopy left eyelid since birth. Visual aquity were 0,08 pinhole 0,2 and 0,25 pinhole 0,63 respectively. Opthalmology examination revealed interpalpebral fissure (IPF) 4 mm, margin reflex distance (MRD)1 0 mm, MRD2 4 mm and levator function test (LFT) 6 mm on the left eye (Figure 1). Levator resection technique was conducted on his left eye with a good result, MRD1 2 mm, MRD2 5 mm, IPF 7 mm. But the lid dropped again after3 months (Figure 2). Opthalmology examination of the left eye showed IPF 5 mm, MRD1 0 mm, MRD2 5 mm, LFT 2 mm and lagophtalmos 1 mm. Second surgery was done with supramaximal levator resection technique. Good result was achieved after second surgery, MRD1 3 mm, MRD2 5 mm, IPF 8 mm (Figure 3).

Discussion : Recurrent ptosis could occured after ptosis surgery and had challenges due to scar from previous surgery. Frontal suspension technique was recommended for congenital ptosis levator function less than 4 mm. Supramaximal levator resection was done for this patient, with resection of 30 mm levator muscle, which had result as good as of frontal suspension technique.

Conclusion : Levator resection technique could be repeated to repair recurrent congenital ptosis. Supramaximal levator resection technique is one of the option.
TEAR FILM CHANGES FOLLOWING PHACOEMULSIFICATION SURGERY IN PRIMARY EYE CARE CENTER
Authors: TRI WAHYU
Published: February 2024

Abstract

Introduction & Objectives : Dry eye disease (DED) is one of the most commonly encountered problem in daily ophthalmology practice. One of many risk factors for DED is cataract surgery. Cataract surgery is known to modify tear film and ocular surface through corneal incision and ocular toxicity of peri- and postoperative medications. The aim of this study is to analyze tear film before and after phacoemulsification in primary eye care facility by measuring tear break-up time (TBUT), fluorescein staining, Schirmer I test (ST-I), and ocular surface disease index (OSDI) score.

Methods : This was a longitudinal observational study with prospective cohort design, which included patients diagnosed with senile cataract and underwent uncomplicated phacoemulsification surgery at primary eye care center Sawangan Eye Clinic within period of June to December 2022. Friedman, Wilcoxon, and Cochran tests were used to analyze the data.

Results : Thirty nine eyes from 39 patients met the inclusion criteria and were followed up to 3-month postoperatively. Mean age of the patients was 61.1±10.54 years, which consited of 53.8% males and 46.2% females. Mean preoperative OSDI score, corneal staining, TBUT, and ST-I were 24.94±10.24, 1.38±1.99, 2.94±2.17, and 15.46±8.80 respectively; while 3-month postoperative, these parameters’ means were 11.22±13.15 (p=0.0001), 1.38±2.56 (p=0.118), 3.13±1.79 (p=0.192), and 13.31±9.45 (p=0.006) respectively. OSDI was the only parameter which showed statistically significant changes from preoperative to postoperative follow ups (p<0.05).

Conclusion : Phacoemulsification did not alter corneal staining and TBUT significantly after 3 months postoperatively, even though both of these parameters' preoperative value were already lower; yet OSDI score improved over time after surgery.
What do we miss in this Orbital Retinoblastoma?
Authors: Caroline Christella , Fedora Ghina , Soraya Siti Halida Zoraida , Yulia Dian Estu
Published: February 2024

Introduction : Orbital retinoblastoma (RB) is a dire event with a bleak prognosis. This report highlights the severe complications of retinoblastoma resulting from insufficient diagnostic and treatment efforts due to inadequate medical resources and socio-economic challenges.

Case Illustration : A 4-year-old boy was brought in with swelling on his left eye socket and jaw, present for two months.He had exhibited leukocoria followed by proptosis 12 months prior and underwent enucleation without dermato-fat graft (DFG) five months ago. Histopathology revealed retinoblastoma without optic nerve invasion. Despite referral to a regional hospital for chemotherapy, he did not receive treatment due to socio-economic constraints. Two months post-operation, the left eye prosthesis spontaneously dislodged, accompanied by an enlarging eye and a left jaw mass. An ophthalmologic assessment disclosed a mass in the left orbital socket, while the right eye appeared normal. A CT scan identified masses in the left orbit, parotid, and masticator spaces, as well as bilateral colli lymphadenopathy. The patient was diagnosed with residual retinoblastoma and received chemotherapy.

Discussion : Imaging is crucial in proptosis patients to determine tumor extent and management strategies. The standard approach involves initial chemotherapy, surgery, radiotherapy, and additional chemotherapy. High-risk histological features (HHRF) also warrant chemotherapy, although the presence of such features remains undetermined in this case. Employing multiple treatment modalities may enhance prognosis.

Conclusion : Thorough examination and management are essential in retinoblastoma cases. Patient family education and diligent care play a crucial role in preventing the progression and spread of retinoblastoma.