bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPARISON OF SITA STANDARD 24-2 WITH SITA FASTER 24-2C PROGRAM ON HUMPHREY FIELD ANALYZER IN ASSESSING VISUAL FIELD DEFECTS OF GLAUCOMA PATIENTS
Authors: Rianti Nuzul , Satari Karmelita , Gustianty Elsa , Prahasta Andika , Rifada R. Maula , Umbara Sonie
Published: February 2024

Introduction & ObjectivesIntroduction: Periodical perimetry examination to detect and determine the rate of glaucomaprogression continues to be a challenging task, because it depends on many factors. Besides, thereis now a paradigm shift which central visual field defects occur earlier. SITA Standard (SS) 24-2 isthe clinical standard for glaucoma examination, but there were studies reporting on the prevalenceof central visual field defects not detected. SITA Faster (SFR) 24-2C was developed to addresscurrent shortcomings, but the performance has yet to be formally and independently assessed.Objectives: To compare the global indices (Mean Deviation, Pattern Standard Deviation, Visual FieldIndex) and test duration between SS 24-2 and SFR 24-2C program.

MethodsThis is an analytical observational study with a cross-sectional design. Subjects aged >18 years whodiagnosed with glaucoma and whose visual fields unaffected by other condition besides glaucomawere included. All subjects underwent testing of both programs.

ResultsThis study was conducted in 94 eyes of 66 patients. Comparison of global indices and test durationbetween the two programs was carried out by the Wilcoxon test. The mean results of MD and PSDglobal indices were not significantly different, however there was a difference in the mean VFI of1.5% between the two programs. The test duration of SFR 24-2C was 55.03% faster.

ConclusionThere was no significant difference in the MD and PSD global indices, but there was a significantdifference in the VFI, as well as the test duration between the two programs.
Uncovering the Uncommon Nocardia Keratitis: Early Recognition of Its Pathognomonic Characteristic to Save Vision
Authors: Maria Astrid Claudia  , Ismi Zuhria
Published: February 2024

Introduction : Nocardia keratitis is a rare bacterial infection. Global prevalence is below 2%. Mimicking a fungal infection and slow-growth bacteria in culture leads to improper management and an increased risk of permanent vision loss. This case highlights the pathognomonic infiltrate seen in Nocardia keratitis.

Case Illustration : A 41-year-old male presented with a four-week history of redness of the left eye, associated with ocular pain, tearing, photophobic, and decreased vision following an injury caused by a grasshopper while riding a motorcycle two weeks before. Visual acuity was hand movement. Conjunctival and ciliary injection, mid-periphery corneal “wreath-pattern” infiltrate with satellite lesions, corneal thinning, and hypopyon were found. Topical antibiotics and antifungals were given empirically earlier with little to no effect. Progressive hypopyon necessitated paracentesis. After seven days of inoculation, a culture test showed slow-growing Nocardia sensitive to amikacin and tobramycin. Treatment then changed to an amikacin subconjunctival injection and tobramycin eye drops. The epithelial defect was resolved, but leukoma and neovascularization were found; thus, keratoplasty was planned.

Discussion : Corneal involvement of Nocardia may occur in several forms. Slowly progressive symptoms, satellite lesions, and cotton-wool-like infiltrate can mimic fungal infection. However, it has a pathognomonic characteristic, a pinhead-sized infiltrate forming a “wreath-pattern” in the mid-periphery cornea. Familiarity with this classical pattern could prevent neovascularization, endophthalmitis, corneal perforation, and that cause vision loss.

Conclusion : Due to slow-growth inoculation of Nocardia, clinicians should be aware of this pathognomonic presentation to aid in early diagnosis and proper treatment that leads to favorable outcomes and salvage vision in most cases.
A RISK FACTOR STUDY OF VISUAL ACUITY IN PTERYGIUM PATIENTS ON BAWEAN ISLAND, INDONESIA, 2023
Authors: Handayani Rizki Matta , Jelita Erdina Hana , Handayani Rizki Matta , Kaptuti Ujik Unari Dwi , Anandita Faizal Ablansah
Published: February 2024

Introduction & ObjectivesPterygium is associated with excessive exposure to sunlight and UV rays in the eyes. This causesisland countries in Asia which are in the "pterygium belt", including Indonesia, to have a highprevalence of pterygium. Other risk factors, such as gender, age, and medical conditions, such asblood pressure and diabetes, have also been linked to this chronic eye disease. However, of themany studies that have examined pterygium and its risk factors, very few have linked these riskfactors to the severity or grade of the pterygium. This study aimed to study the correlation betweenpterygium severity and its risk factors, within the people of Bawean Island, Indonesia.

MethodsThis research was an analytic cross-sectional, with the research sample selected by total samplingmethod based on the results of a diagnosis performed by ophthalmologists. The research variablewere visual acuity (good-blindness), the severity / grade of pterygium (I-IV), gender, age,occupational group, pterygium location, blood pressure, and fasting blood sugar.

ResultsFrom 62 patients with pterygium, 75,8% categorized as grade IV, and 41,93% has a moderate toblindness visual acuity. More than half of the patients are old female above 50 years old with 40,32%has an occupational risk of sunlight exposure.

ConclusionThe results of this study indicate that although all the risk factors studied did not have a significantyon the visual acuity, age (p=0,13) and occupational groups (p=0,20) are determinant factors on thevisual acuity of pterygium patients on Bawean Island, Indonesia.
Monovision versus multifocal intraocular lens implantation in cataract patients: a systematic review and meta-analysis
Authors: Fadhli Waznan  , Yosilia Nursakina  , Aydan Jalil Rancakbudi  , Syska Widyawati
Published: February 2024

Abstract

Introduction & Objectives : Modern cataract surgery technique entails replacing the crystalline lens with an artificial intraocular lens (IOL). While the standard monofocal IOL implantation with monovision technique has been cost- effective and provided patients with good visual acuity, multifocal IOLs present the prospect of spectacle-free vision despite various adverse outcomes. It remained contentious whether multifocal IOLs were superior to monovision. Our review provide an up-to-date assessment of monovision vs. multifocal IOL implantation's visual acuity and spectacle independence following cataract surgery.

Methods : A systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacle independence, and visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data.

Results : Ten studies were identified. Pooling analysis for uncorrected binocular distance visual acuity and binocular uncorrected near visual acuity showed no difference between monovision vs. multifocal IOL (SMD 0,31; 95% CI -0,21 to 0,82 and SMD 0,41; 95% CI -0,58 to 1,40, respectively). Spectacle independence showed monovision was inferior to multifocal IOL (OR 0,22; 95% CI 0,08 to 0,61; heterogeneity I2=75%).

Conclusion : Current evidence showed that multifocal IOL had comparable visual acuity to monovision with slightly higher likelihood of being spectacle-free. Despite that, monovision can be an efficacious and affordable option to be implemented in countries with high cataract burden.
Neuromyelitis Optica Spectrum Disorder (NMOSD) or Chronic-Relapsing Inflammatory Optic Neuropathy (CRION)?: A Challenge in Diagnosis and Treatment
Authors: Alia Arianti, MD
Published: February 2024

Abstract

Introduction : Neuromyelitis optica spectrum disorder (NMOSD) is a chronic inflammatory, immune-mediated central nervous system disease targeting the AQP4-water channel membrane protein of the optic nerve and the spinal cord. This case report aims to present a case of seroconverting NMOSD which was initially diagnosed as chronic relapsing inflammatory optic neuropathy (CRION).

Case Illustration : 15-year-old female with recurrent, steroid-dependent optic neuritis of the LE. During the first attack, brain MRI showed optic nerve inflammation with normal brain findings. Initial test for AQP4-IgG, MOG-Ab and ANA profile were negative. The diagnosis of CRION was made. Treatment with corticosteroid and immunosuppressant agent was maintained for one year. After treatment cessation, however, LE optic neuritis recurred with bilateral lower limb weakness. Spinal MRI showed signs of longitudinal extensive transverse myelitis. Re-testing for AQP4-IgG showed positive result. Diagnosis of NMOSD was made, and the patient was treated with high-dose intravenous corticosteroid followed by oral dose, and immunosuppressant. Final visual acuity of the LE was 1.0, with minimal residual visual field defect and good motor function.

Discussion : During the initial attack, the patient did not meet the 2015 NMOSD international consensus diagnostic criteria. The AQP4-IgG was negative and no other corresponding signs and symptoms. The criteria was met one year after: optic neuritis, LETM and positive seroconversion of AQP4-IgG.

Conclusion : Diagnosing NMOSD is at times challenging especially during initial attack. Retesting of the AQP4- IgG is at times necessary in seronegative patients, especially in children showing ADEM-like event with optic neuritis and LETM to achieve diagnosis and proper treatment strategy.
Implementation of Integrated People-Centered Eye Care at Sub-District Level in Barru
Authors: Rakatama Rahmat Priyangga , Amalius Ahmad Ashraf , Faisal Andi Akhmad , Kamaruddin Muhammad Irfan
Published: February 2024

Purpose: Integrated People-Centered Eye Care (IPCEC) was initiated by the World Health Organization as a global strategy in community-centred and integrated health services. In Indonesia, the Rapid Assessment of Avoidable Blindness survey showed the largest number of moderate and severe visual impairment was found in South Sulawesi, particularly uncorrected refractive error (33.8%). The results of this study are expected to initiate and introduce IPCEC-based eye health services and promotion at the sub-district level.

Methods: The program started with advocacy of eye health programs at the sub-district level to policy makers. In schools, education and training for visual acuity examination were given to teachers. All children who failed the screening or have ocular abnormalities are referred to eye care center. Mass counseling and examination were also carried out at the health center simultaneously with screening for mass cataract surgery at the Barru District Hospital.

Results: Implementation of IPCEC was welcomed by Barru District government. School eye health program conducted by the teachers in 5 schools screened 1263 students with 90.74% of the students had normal visual acuity. Mass screening at the Pekkae and Pancana Public Health Centers found that most participants had cataracts (58%) followed by refractive error (38%).

Conclusion: Visual acuity examination among school-age children by the teacher will improve early detection of refractive errors. Screening by eye health worker at public health center needs to be carried out to identify blindness causes often found in the community, and proceed with prescribing drugs, eyeglasses, and mass cataract surgery as definitive step in eradicating blindness.
Initial Outcome of Subconjunctival Bevacizumab for Corneal Neovascularization - a Case Series
Authors: DEZCA NINDITA  , Anang Tribowo  , Petty Purwanita
Published: February 2024

Introduction : Corneal neovascularization (CNV) has a variety of causes and threatens corneal clarity, thus optimal visual acuity. Conventional medical management includes topical steroids and matrix metalloproteinase inhibitors like doxycycline. Anti-vascular endothelial growth factor (anti-VEGF) agents have demonstrated promise but remain off-label for this indication.

Case Illustration : We present three patients with corneal neovascularization varied in etiology who underwent subconjunctival injection of Bevacizumab . Case 1: a-female-69 years old came with blurred vision after had Stephen Johnson Syndrome which affect her cornea. The examination revealed opacification of cornea accompanied by neovascularization at 5 until 9 o’clock position up to edge of pupil in the left. Case 2: a-male-47 years old presented corneal haze with neovascularization almostin all corneal region on background of fungal keratitis. Case 3: a-male-63 years old who underwent penetrating keratoplasty of indication corneal lekoma following an episode of fungal keratitis. There was opacity in all corneal region and neovascularization in 360 degree of limbus. All of these patients showed regression of neovessel after first injection of bevacizumab.

Discussion : Corneal neovascularization is a condition caused by disruption homeostasis in which proangiogenic balanced by antiangiogenic, thereby maintaining avascularity. Bevacizumab as VEGF-A-binding proteins could prevent VEGF-A from binding cell surface receptors.

Conclusion : Subconjunctival injection of Bevacizumab can be considered as a treatment for corneal neovascularization. It has shown promising effects in recess neovascularization in cornea regardlessthe etiology.
NEUROPROTECTIVE ROLE OF VITAMIN D3 ON GANGLION CELL-INNER PLEXIFORM LAYER THICKNESS IN NMDA-INDUCED RETINAL EXCITOTOXICITY MODEL OF GLAUCOMA
Authors: Margareth Ezra , Nugroho Trilaksana , Dharma Andhika Guna , Rahmi Fifin L , Maharani  , Istiadi Hermawan
Published: February 2024

Introduction & ObjectivesRetinal ganglion cell (RGC) damage can affect the thinning of the GCC layers, which is the nervefiber layer, the ganglion cell layer and the inner plexiform layer. The loss of RGC and inner plexiformlayer (IPL) is strongly correlated with the loss of visual field defect. RGC and inner plexiform layerare potential targets to evaluate the progression of glaucoma. Glaucoma treatment not only focus onreducing IOP. Decreasing IOP according to the target pressure often can’t stop the process of RGCdamage and make it permanently and irreversible. Vitamin D3 is known as neuroprotector which hasthe ability to protect RGC and prevent layer thinning of GC-IPL in retina. The aim of this study is todetermine the effect of oral Vitamin D3 on the GC- IPL layer thickness in retinal of Wistar rats withNMDA-induced glaucoma model.

MethodsGlaucoma Wistar rats were divided into 2 groups. The treatment group was given oral Vitamin D3 ata dose of 500 IU/kgBW/day for 10 weeks. GC-IPL layer thickness in retinal was examined byHematoxylin Eosin staining. Data were collected and processed then used with Independent T Test.(significant p<0.05)

ResultsThe mean GC-IPL layer Thickness in the treatment group was 77,59 ± 15,15 ?m and 35,32 ± 4,04?m in the control group. There was a significant different between two group ( p = <0,001 )

ConclusionVitamin D3 has a neuroprotective effect on ganglion cell-inner plexiform layer Wistar rats in NMDAinducedexcitotoxicity model of glaucoma
Management of Full Thickness Traumatic Macular Hole In An 7-Year-Old Boy : A Case Report
Authors: Amin Ramzi
Published: February 2024

Introduction : Traumatic macular hole (TMH) formation is uncommon, usually occurs in young males, and the incidence varies in the literature from 1 to 9%.The study by Chen et al reported that early vitrectomy resulted in significantly higher rate of TMH closure compared to initial observation (100% vs 66.7%, respectively)

Case Illustration : A 7yo boy presented with diminution of vision in right eye (RE) of 2 months duration.There was history of trauma on the right eye. Visual acuity (BCVA) was 6/60 and 6/6 in RE and LE (Left Eye) respectively.Dilated fundus examination of OD revealed a full thickness macular hole (FTMH). SSOCT of OD confirmed the presence of an FTMH (with minimal hole diameter of 850 microns) with cystoid changes at the edges.The patient underwent vitrectomy followed with ILM peeling and advised facedown position for a week. At postoperative week one, BCVA was improved 6/9. SSOCT showed type 3 hole closure. BCVA improved to 6/7.5 at 1 months.

Discussion : The study by Chen et al. was the first multicenter, prospective, comparative case study that attempted to address the outcomes of patients with TMHs comparing observation to early vitrectomy. Authors reported that early vitrectomy resulted in significantly higher rate of TMH closure compared to initial observation (100% vs 66.7%, respectively). The child in our case was resulted in good outcome.

Conclusion : Early vitrectomy in full thickness traumatic macular hole in a young age resulted the good outcome.
EARLY POSTOPERATIVE COMPLICATION FOLLOWING FILTRATION SURGERY IN DR. KARIADI GENERAL HOSPITAL SEMARANG 2020-2022
Authors: Zulfa Mazidah , Puspasari Denti , Maharani  , Rahmi Fifin L
Published: February 2024

Introduction & ObjectivesFiltration surgery is the most frequent surgery in managing glaucoma. Although trabeculectomy isgenerally a safe and effective procedure, complications can occur. The purpose of the study was todescribe the early postoperative complications in patients who had undergone filtration surgery.

MethodsThis study was a retrospective study that uses secondary data from electronic medical records ofpatients who had filtration surgery between January 1, 2020, and December 31, 2022, in KariadiHospital Semarang. Preoperative data include age, gender, visual acuity, intraocular pressure, andtype of glaucoma. The incidence of early postoperative complications was described up to 3 weeks offollow-up.

Results287 eyes were obtained from 266 patients who underwent filtration surgery. 168 eyes (58.5%) hadphaco-trabeculectomy, 117 eyes (40.77%) had trabeculectomy and 2 eyes (0.7%) had ECCEtrabeculectomy.Primary angle closure glaucoma (126 eyes, 43.9%) was the most common type ofglaucoma treated with filtration surgery. During the 3-week follow-up period, 93 eyes (32.4%)experienced an early complication with trabeculectomy being more common (17.42%) thancombined surgery. The commonest complication found was hypotony in 69 eyes (24%). Othercomplications include hyphema (3.14%), transient intraocular pressure elevation (3.14%), blebleakage (2.09%), suprachoroidal haemorrhage (0.7%), subhyaloid haemorrhage (0.35%) and retinalhaemorrhage (0.35%).

ConclusionThis study found the most common early postoperative complication of filtration surgery washypotony. This complication occurs frequently after trabeculectomy.
Severe Ocular Manifestations in Stevens-Johnson syndrome : a case report
Authors: Eric Jansen  , Dian Wikaningtyas
Published: February 2024

Introduction : Stevens-Johnson syndrome (SJS) is a severe mucocutaneous reactions, characterized by cell death in the epidermis, resulting in blistering and sloughing. Hypersensitivity reaction to drug causes the majority of SJS cases. Ocular involvement occurs in 80% of patients in the acute phase.

Case Illustration m A 38-year-old female was consulted to the ophthalmology department with diagnosis of Stevens- Johnson syndrome (SJS). She complained of bilateral eye redness and blurred vision. She was first admitted to the Emergency Department with complaints of burning sensation, progressive rash, and blistering skin all over her body for the past 2 weeks. Ophthalmology examination revealed a visual acuity of no-light perception (NLP) for both eyes. The anterior segment examination in both eyes showed the palpebra was edema and lagophthalmos, conjunctival hyperemia and corneal ulcer, while the posterior segment could not be identified. The patient was hospitalized in the intensive care unit (ICU) due to her symptoms and clinical findings. She was treated with combination of systemic intravenous antibiotics and steroid, eye drops and eye ointment. After 2 weeks, she was able to blink partially. She was discharged after 20 days of intensive treatment.

Discussion : 

Conclusion : Ocular manifestations in SJS are a significant aspect of the disease that can lead to severe visual impairment or even blindness. A multidisciplinary approach to managing SJS is necessary to prevent and treat the ocular manifestations of the disease effectively.
Efficacy and safety of Orthokeratology in Moderate and High Myopia Patients at Vio Optical Clinic During Januari 2020- December 2022 : A Retrospective Study
Authors: WENI PUSPITASARI  , Ajeng Kartika Ayu Putri
Published: February 2024

Introduction & Objectives : Orthokeratology (OK) lens causes flattening of the cornea to reduce refractive power temporarily. The purpose of the current study was to determine efficacy, defined in terms of refractive correction, and common adverse effects in Indonesian population.

Methods : Objective: To evaluate the efficacy and safety of OK for myopia correction and visual acuity (VA) changes in moderate and high myopia patients at Vio Optical Clinic Grand Galaxy Bekasi during January 2020 – December 2022

Results : Methods: In this retrospective study, 129 eyes with moderate and high myopia met the inclusion criteria of this study. Each subject wore the lens for 8 to 9 hours while asleep. The efficacy and safety were assessed after 1, 4, and 12 weeks follow up. Result: All subjects divided into two groups: 106 eyes (82.2%) had moderate myopia and 23 eyes (17.8%) had high myopia. The median age was 18 years old (ranging from 5 - 45 years). The spherical equivalent of VA of two groups decreased significantly in 1 and 4 weeks compare to pre-lens (p<0.001). LogMar uncorrected visual acuity (UCVA) of two groups showed improvement in 1 and 4 weeks compare to pre-lens (p<0.001). There were no severe complication in moderate myopia patients. There were three subjects of corneal staining were recorded in high myopia

Conclusion : This study indicates orthokeratology is a safe and effective to correct myopia. Using orthokeratology can improve UCVA within one week and one month after OK lens in moderate and high myopia patients. There were mild complication in high myopia patients.
Neuroretinitis et causa Ocular Syphillis Vision Recovery after Multidisciplinary Management: Case Report
Authors: RANDY VINCENT SUHARTONO KINDANGEN  , Dr. dr. Made Susiyanti, SpM(K)
Published: February 2024

Abstract

Introduction : Ocular syphilis is a sight-threatening condition caused by spirochete infection, Treponema pallidum, with varied clinical presentations. Although uncommon, human immunodeficiency virus (HIV) infection increases the risk of ocular syphilis. If left untreated, it may lead to blindness. The disease can be treated effectively with appropriate antibiotic therapy from a multidisciplinary department. Therefore, early investigation and timely management can prevent infection progression and save patients’ eyesight.

Case Illustration : A 29-year-old man complained of blurry vision with visual acuity light perception in both eyes one month before admission. The patient underwent examination and laboratory workup and was later diagnosed with HIV and ocular syphilis. A multidisciplinary approach was carried out with dermato- venerology, neurology, and internal medicine departments to treat the ocular and systemic infection. The patient was medicated with the antibiotic regimens Benzathine Penicillin 7.2 million IU and Ceftriaxone 1 g for 14 days. Visual acuity was later examined three weeks with a significant result for best corrected visual acuity (BCVA) in decimal 0.8 for the right eye and 0.67 for the left eye.

Discussion : The patient was in poor eyesight condition when initially examined. According to reports, syphilis could be cured if it was diagnosed early and completely treated. Therefore, an immediately established diagnosis helped the patient get suitable therapy thus improving visual acuity.

Conclusion : Early investigation and proper treatment are critical to managing systemic and ocular infections of HIV and syphilis. A multidisciplinary approach is required to achieve optimal results.
FILTRATION SURGERY OF TRABECTULECTOMIES WITH 5 – FLUOROURACIL IN ADVANCED POAG
Authors: Amrina Fadillah , Fidalia  , Sari Prima Maya
Published: February 2024

Introduction : Advanced Glaucoma (AG) is total cupping of optic nerve with or without severe visual field loss. The prevalence of AG in POAG, shows that 15% have a substantial visual field defect. Initial therapy for AG can use medications, surgical therapy is performed when adecuate medical treatment isn’t effective. Filtration surgery such as trabeculectomy and implantation of tube shunts can be performed. This case reports aims to understand the used of trabeculectomy+5FU in Advanced POAG.

Case Illustration : A 55 years old woman came with blurry and tunnel vision accompanied by headache since 2 years ago. She got treatment yet stopped to control. Vision has progressively reduced since 2 months ago. Visual acuity OD 1/300 OS 1/60, IOP OD 25.1 mmHg and OS 29.8 mmHg with 4 drugs, cloudy lens, cupping, c/d ratio 0.9, nasalization, bayonet sign and peripapillary atrophy. The patient was diagnosed with Advanced POAG with immature senile cataract ODS. Patient was treated with trabeculectomy+5-FU due to uncontrolled IOP despite receiving adecuate therapy. Releasing sutures were used to control IOP after surgery. After surgery, the last IOP OS 12.6 mmHg, and bleb formed E1H1V0.

Discussion : 

Conclusion : Patients was treated with trabeculectomy+5-FU, can control IOP stably in advance of POAG without serious complications, cost less than routine drugs and maintain visual function and improve quality of life. Filtration surgery such as trabeculectomy with AF agents is proven to reduce IOP more stably in advance of POAG.
Management of Recurrent Anterior Uveitis in Spondyloarthritis: A Case Report
Authors: Nadida nurfadhila  , Patriotika Muslima  , Elfa Ali Idrus  , Arief Akhdestira Mustaram  , Angga Fajriansyah
Published: February 2024

Introduction : Non-infectious anterior uveitis is caused by underlying diseases, one of which is spondyloarthritis. Spondyloarthritis is a part of chronic rheumatic disease. The main goals of uveitis therapy are to prevent blindness, permanent organ damage, and recurrence.

Case Illustration : A 19-years old woman came to Cicendo Eye Hospital with blurry vision for one week. The complaint was accompanied by redness, photosensitivity, and pain in her right eye. She had similar complaints in her right eye one month ago and in her left eye one year ago. She also had a history of morning stiffness in her knee joint and lower back pain. For those symptoms, the rheumatologist diagnosed her with spondyloarthritis. The uncorrected visual acuity examination for both eyes were 0,16. Anterior segment examination on right eye were blepharospasm, ciliary injection, corneal oedema, flare and cells while the left eye within normal limit. She was diagnosed with anterior uveitis and was treated with topical corticosteroid, oral corticosteroid, and immunomodulator. Knowing the treatment was not responding, the rheumatologist added biologic agents to the therapy. As a result, the patient’s conditions improved.

Discussion : Topical steroid therapy was used as the first line of treatment, but for the recurrence of anterior uveitis, systemic medication, including biologic agents, is needed.

Conclusion : Multidiscipline and stepwise approach to treat anterior uveitis with underlying disease is necessary.
Herpes Zoster Keratouveitis : Are We Late in Dealing with It?
Authors: Nurul Akla  , Ferdian Ramadhan  , Nazhira Janani
Published: February 2024

Introduction : Herpes zoster ophthalmicus (HZO) is the viral involvement of the ophthalmic division of the trigeminal nerve. The ocular disease affects approximately 50% of HZO cases and is an ophthalmologic emergency due to the risk of vision loss if not quickly treated. This case reports the ocular complication resulting from delayed management of herpes zoster.

Case Illustration : A 25-year-old woman presented with the decreased vision for one week. Physical examination revealed erythema, crusts, and multiple vesicles in the upper quadrant of the left face, with a positive Hutchinson sign. Ophthalmic examination showed a visual acuity of 0.6 on the left, with ciliary injection, a multiple dots pattern, and stromal edema in the left eye. Fine and fibrillar keratic precipitates were also present. The patient had previously received oral acyclovir 5x400 mg/day for five days after the onset of symptoms. The patient was given oral acyclovir 5x800 mg/day, amitriptyline 25 mg PO/day, homatropine ED 1 gtt/day, ofloxacin ED 4 gtt/day, Prednisolone acetate ED 4 gtt/day for the left eye.

Discussion : Early management of HZO within 72 hours of rash onset is optimal. The Hutchinson sign, characterized by herpetic lesions around the nose tip, indicates nasociliary branch involvement and increases the risk of ocular involvement. Delayed or inadequate treatment can lead to various ocular complications. The prognosis is unpredictable and dependent on long-term sequelae.

Conclusion : HZO keratouveitis, can result in stromal scarring or endothelial dysfunction, potentially requiring surgery if therapy is inadequate. Early recognition of ocular involvement is crucial to prevent complications and increase practitioner awareness.
Comparison of Endothelial Cell Loss after Phacoemulsification Surgery between Patients with Diabetes Mellitus and Non-Diabetic Patients at Kariadi Hospital: A Prospective Study
Authors: Nugraha Adiyasa  , Wisnu Sadasih  , A. Rizal Fanany
Published: February 2024

Abstract

Introduction & Objectives : To compare the endothelial cell loss after phacoemulsification surgery in patients with DM and non- DM patients

Methods : This was a prospective study conducted at Kariadi Hospital, Semarang, Indonesia. A total of 20 eyes of 20 patients (10 DM and 10 non-DM) who underwent phacoemulsification surgery were included in this study. The central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) were measured preoperatively and on day-7 postoperatively. The percentage of endothelial cell loss (%ECL) was calculated and compared between the two groups.

Results : The mean pre-operative and post-operative CCT was similar in both groups (DM =546.6±44.26μm, non-DM=516.7±42.2μm, p=0.949 ;DM=562.8±46.1μm, non-DM=533.7±46.6μm, p=0.997). The mean percentage of endothelial cell loss was slightly higher in the DM group compared to the non- DM group but not significant (6.66±2.36% vs. 2.31±1.72%, p=0.566). There were no significant differences between the CV and HEX on pre-operative and day-7 after surgery

Conclusion : Patients with DM have a slightly higher percentage of endothelial cell loss after phacoemulsification surgery compared to non-DM patients. The mean CCT, CV and HEX pre-operation and day-7 were quite similar in both groups. These findings suggest that patients with DM may require more careful monitoring and follow-up after phacoemulsification surgery.
GOOD OUTCOMES OF OCULAR MYASTHENIA GRAVIS IN A YOUNG ADULT MALE: A CASE REPORT
Authors: Muhammad Wahyu Aghdhi Pradipta  , Lukisiari Agustini
Published: February 2024

Abstract

Introduction : Myasthenia gravis (MG) is characterized by fluctuating weakening and fatigability of skeletal muscles. Ocular MG (OMG) occurs when the symptoms of MG are limited to the ocular muscles.

Case Illustration : A 21-year-old male presents with a two-month history of drooping both eyelids. The drooping eyelids improved in the morning or after a nap, and got worse in the evening. Ocular examination revealed limitation towards all gazes with bilateral ptosis. Visual acuity, anterior segment, visual fields, slit lamp, and fundus examinations were unremarkable. The ice pack and rest test resulted in a significant improvement after two minutes of ice pack application and 30-minute rest, raising suspicion for the diagnosis of MG. Acetylcholine receptor antibody (AChR) test was positive for AChR binding antibody. Treatment for OMG is initiated with an oral acetylcholinesterase inhibitor, pyridostigmine, and corticosteroid. The ptosis and ophthalmoplegia improved after one week follow- up and recovered completely after eight weeks of follow-up.

Discussion : The hallmarks of MG are fluctuating fatigable muscle weakness that worsen with activity and improve on rest. Neurological exam and clinical neurological history are essential to establish the diagnosis. Bedsite tests, electrophysiologic test, and the antibody test all support the clinical diagnosis of MG.

Conclusion : OMG progresses to its generalized form 90% of the time during the first two years of the onset of ocular symptoms. Early detection and prompt treatment are the key which may help to prevent or minimize the occurrence of myasthenia crisis.
HOMONYMOUS HEMIANOPIA IN CEREBRAL INFARCTION: CASE REPORT
Authors: Hadwer Wicaksono Pandjaitan
Published: February 2024

Abstract

Introduction : Homonymous hemianopsia is a visual field defect characterized by loss of half of the visual field in each eye. Cerebral infarction in the occipital lobe is the most common cause of homonymous hemianopsia. Sudden visual field loss should be considered as a cerebral infarction for prompt management.

Case Illustration : Male 43 years old, vision in both eyes appears dark on the left side since 3 months ago, complaints occur suddenly. Patients with a history of hypertension (+) hypercholesterolemia (+). Ophthalmological examination revealed visual acuity in both eyes 6/6 with normal pupillary reflexesand normal fundoscopy in both eyes. Humphrey's visual field perimetry test showed left homonymous hemianopsia. A brain CT scan examination showed multiple cerebral infarctions in the right occipital lobe, cerebellum and basal ganglia bilaterally. The patient was referred to the neurology department for further treatment.

Discussion : The visual field defect pattern is used to predict the location of the lesion in the visual pathway. Neurologic symptoms that may be present in occipital lobe lesions are migraine with aura and visual hallucinations. The patient had left homonymous hemianopsia where the results of brain CT scan showed multiple cerebral infarctions in the right occipital lobe.

Conclusion : Manifestations of homonymous hemianopsia can predict the presence of cerebral infarction so that in the presence of visual field defects it can be used as a predictor of intracranial abnormalities for further evaluation and collaboration with the neurology department.
Terson Syndrome: A Rare, Treatable Visual Loss After Subarachnoid and Intraventricular Hemorrhage
Authors: DITA PERMATASARI  , SYNTIA NUSANTI  , MUHAMMAD SIDIK  , SALMAREZKA DEWIPUTRI  , SITA PARAMITA AYUNINGTYAS
Published: February 2024

Abstract

Introduction : Intracranial pathologies commonly affect vision through optic neuropathy. However, visual loss could be due to vitreous hemorrhage as in Terson syndrome. This report warns us rare cases of visual loss after intracranial hemorrhage that requires totally different management than more commonly found optic neuropathies.

Case Illustration : Female, 46 years old, had a severe headache and decreased consciousness two days later. CT angiography revealed wide subarachnoid hemorrhage and intraventricular hemorrhage causing hydrocephalus. She received emergency lumbar drainage followed by digital subtraction angiography and flow diverter device. Postoperative she regained consciousness, CT scan showed reduced ventricular size without residual hemorrhage, yet visual acuity of left eye reduced to hand movement and did not improve until one month later. Ophthalmologic examination showed vitreous hemorrhage of the left eye. Right eye was normal. Vitrectomy was planned to clear the vitreous hemorrhage.

Discussion : Terson syndrome is intraocular hemorrhage associated with subarachnoid hemorrhage, cerebral hemorrhage, or traumatic brain injury. The proposed mechanisms were transmission of subarachnoid blood to the optic nerve sheath and rapid effusion of cerebrospinal fluid into the optic nerve sheath due to sudden increase of intracranial pressure. It compresses central retinal vein, causing vascular rupture. The manifestations could be vitreous, subhyaloid, subretinal, or intraretinal hemorrhage. Visual prognosis is good in those resolved spontaneously or receiving vitrectomy in nonresolving cases.

Conclusion : Visual loss from intracranial hemorrhage or trauma could be caused by intraocular hemorrhage. It deserved different management than optic neuropathies. Prompt recognition should improve the management and the prognosis of rare cases such as Terson syndrome.
A Challenging Case of Simple Limbal Epithelial Transplantation (SLET) in Limbal Stem Cell Deficiency Following Chemical Injury: A Case Report
Authors: Amanda Lia , Widyawati Syska , Martha Faraby , Zarwan Jessica
Published: February 2024

Introduction : Limbal stem cell deficiency (LSCD) often arises following trauma or inflammation that hinders corneal epithelium healing, commonly caused by chemical or thermal injuries. Despite significant advancements, treating LSCD remains challenging. This case highlights a challenging case of simple limbal epithelial transplantation (SLET) in LSCD following chemical injury.

Case Illustration : A 20-year-old male presented with reduced vision in left eye following an alkaline chemical injury (grade III) was diagnosed with unilateral LSCD. Upon examination, conjunctivalization of the peripheral cornea, a central corneal cicatrix, and stromal neovascularization present after previous necrotomy, tenoplasty, and amniotic membrane transplantation (AMT). The patient then underwent SLET, with limbal biopsies from the collateral eye. Four months after surgery the visual acuity improved from 3/60 to 6/15 with spectacles. However, the cornea conjunctivalization still developed despite improved visual acuity.

Discussion : To effectively manage the recurrence of stem cell deficiency, other stem cell transplantation techniques are needed to manage the problem. Combining different limbal stem cell transplantation approaches can be customised to address the problem and achieve lasting results.

Conclusion : Prompt diagnosis and treatment of LSCD is crucial to prevent complications and blindness. SLET is a surgical option for LSCD after chemical injury, but this report highlights a challenging case and the need for the alternatives approaches.
Anatomical and Functional Outcomes of Management Pediatric Retinal Detachment with High Myopia and History of Retinopathy of Prematurity: A Case Report
Authors: Sadikin Irma Suwandi , Yudantha Anggun Rama
Published: February 2024

Introduction : To report the anatomical and functional outcomes of management of pediatric retinal detachment in children with high myopia and a history of retinopathy of prematurity.

Case Illustration : A 9-year-old boy had a sudden visual loss two months ago. The complaint is accompanied by photopsia and floaters. No history of trauma or infection. He had a history of myopia (S-6.00) and ROP in both eyes. The VA of the right eye was no light perception, and the left eye was 1/60. A retinal detachment with the macula off was discovered in the posterior examination. The axial length was 21 mm. He underwent a scleral buckle with vitrectomy and internal limiting membrane (ILM) peeling for his left eye. After surgery, the visual acuity was 3/60 with the retina attached. Re- detachment was found three weeks after surgery. The patient was scheduled for a second phacoemulsification and vitrectomy surgery. One month later, the best visual acuity reaches 6/48 with S -8.00 D on his left eye. The complication of high intraocular pressure (IOP) after surgery was managed successfully.

Discussion :

Conclusion : Management of retinal detachment cases in children is challenging. Hence, a thorough understanding is crucial in order to achieve anatomical and functional success. Myopia in ROP eyes was mainly lenticular, with an alteration in the anterior chamber that contributed to the patient's refractive status change. We encourage preterm patients to have regular follow-up not only for refractive status but also for structural changes in the anterior segment until adolescence.
Terson Syndrome: what an ophthalmologist should know?
Authors: ANINDITA WICITRA  , Muhammad Firdaus
Published: February 2024

Abstract

Introduction : Terson syndrome is the occurrence of any intraocular hemorrhage in patients with intracranial hemorrhage or traumatic brain injury. In this article we present a case of patient with Terson Syndrome after craniotomy.

Case Illustration : Forty-six yo female patient consulted from neurosurgery department with chief complain of blurry vision in both eyes since 1 day before. Pain or red eyes were denied. There was no history of visual field defect. She had history of breast cancer and she underwent craniotomy four days before because of her brain metastases. Her Glasgow Coma Scale was 15. In ophthalmology examination, her visual acuity is 6/6 with correction in both eyes with good ocular motility. RAPD was positive in her left eye, and posterior segment showed bilateral optic disc edema with intrapapillary and peripapillary hemorrhage. Humphrey examination revealed enlargement of blind spot in the right eye. Brain CT Scan demonstrated hemorrhagic lesion with pneumoencephal within post operative defect area in right parietal lobe. Laboratory examination showed normal fibrinogen and thrombocyte aggregation with elevation of d-dimer. After two weeks observation, visual acuity still 6/6 in both eyes with decreasing intrapapillary and peripapillary hemorrhage.

Discussion : The exact pathophysiology of Terson Syndrome is still unknown. Even though, it has association with high intracranial pressure. Patient with Terson Syndrome will develop 5 times higher mortality rate compare to subarachnoid hemorrhage without Terson Syndrome.

Conclusion : Terson Syndrome needs to be recognized early since it will bring significant prognostic effect and cause permanent vision loss if left untreated
CHALLENGES IN THE SURGICAL MANAGEMENT OF BILATERAL POSTERIOR LENTIGLOBUS
Authors: RAHMANI SYIFA , Memed Feti Karfiati , Caesarya Sesy , Amiruddin Primawita Oktarima , Irfani Irawati , Kuntorini Mayasari Wahyu
Published: February 2024

Introduction : Lentiglobus is a lens deformation characterized by spherical bulging of the lens surface. The weakness of the posterior capsule in the lentiglobus makes the surgery challenging. We present a case of bilateral posterior lentiglobus and its management.

Case Illustration : A 5-year-old boy was presented with the chief complaint of gradually blurred vision since 1 year ago. Visual acuity were 0.1 and closed face finger counting in the right and left eyes, respectively. An ophthalmology examination revealed lens opacities with partially reabsorbed lens material and protrusion of the lens surface posteriorly in both eyes (figure 1). The patient was diagnosed with developmental cataracts of the membranous type and posterior lentiglobus in both eyes. The patient underwent a surgical intervention for cataract extraction with aspiration technique. A spontaneous posterior capsule rupture was found with a shape like a lentiglobus. An anterior vitrectomy was performed. An intraocular lens was implanted. At one month after surgery, the best corrected visual acuities were 0.5 in both eyes (figure 2).

Discussion : Several difficulties can be encountered during pediatric cataract surgery with the posterior lentiglobus morphology because of the thin or ruptured capsule. Previous studies have found preoperative and intraoperative posterior capsule rupture in 25% and 3.13% of lentiglobus cases, respectively. Hydrodissection should be avoided due to the weakness of the posterior capsule.

ConclusionAppropriate surgical techniques to anticipate posterior capsule defects in the lentiglobus are required to produce a favorable outcome.
RETINOPATHY OF PREMATURITY IN TERTIARY REFERRAL EYE HOSPITAL IN INDONESIA: CHARACTERISTICS AND MANAGEMENT
Authors: RAISHA PRATIWI INDRAWATI  , Mayasari Wahyu Kuntorini  , Sesy Caesarya  , Primawita O. Amiruddin  , Irawati Irfani  , Feti Karfiati Memed
Published: February 2024

Abstract

Introduction & Objectives : Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina that occurs in premature infants. Incidence of ROP is higher in middle- and lower-income countries, including Indonesia; hence information about the characteristics of the patients is essential to make strategies regarding its management. The aim of this study is to describe the characteristics and managementof patients with retinopathy of prematurity at the National Eye Center, Cicendo Eye Hospital.

Methods : Data were obtained retrospectively from medical records from January 2018 until December 2020 using ICD-10 coding for retinopathy of prematurity. Variables include demographic data, clinical characteristics, and management.

Results : In total, 177 patients (340 eyes) were included in this study. Demographically, 53.7% of the patients were boys; 67.8% came from West Java; 93.2% were referred; and 85.9% were health coverage users. The mean gestational age was 29.9±2.6 weeks and the mean birth weight was 1415.6±393.1 grams. Most of the patients have bilateral conditions and already have stage 5 ROP, regardless of their gestational age and birth weight. Conservative management was given to 95.5% of stage 5 ROP patients. As many as 50% of stage 4 patients underwent pars plana vitrectomy, and 85.4% stage 3 patients were managed by laser photocoagulation. Those in earlier stages were mainly observed first.

Conclusion : Patients with ROP at Cicendo Eye Hospital mostly came in the advanced stage of the disease with conservative management. Early screening, timely referral, and prompt treatment are recommended in order to prevent blindness in premature infants.
Recurrent Orbital Subperiosteal Abscess in Patient with Nasopharyngeal Carcinoma
Authors: Mefina Aulia Mufidah  , Lukman Edwar  , Mutmainah  , Rwtno Sulistyo Wardani
Published: February 2024

Introduction : Subperiosteal abscess (SPA) is a rare finding in cancer patients with orbital cellulitis. Severe complications associated with this condition are permanent visual loss, intracranial extension, and death.

Case Illustration : A 38-year-old male with history of nasopharyngeal carcinoma (NPC) came with progressive right eyelid swelling, non-axial proptosis, and visual acuity was NLP. CT scan revealed right SPA associated with frontal sinusitis. NPC staging was T3N2M0. Despite the treatment of intravenous antibiotics and drainage incision of SPA, there was recurrence of right SPA two weeks after procedure and re-staging revealed T4N3M0. A joint operation with otolaryngology department to do debulking of the mass, frontal sinus surgery, and drainage incision was held. Culture resulted in Talaromyces marneffei. Patient was assessed with talaromycosis and given itraconazole for ten weeks. Moreover, patient came again with proptosis seven weeks postoperatively. Re-drainage incision was performed and clinical presentation was improved.

Discussion : This case describes rare biological nature of NPC where extensive blockage of paranasal sinuses allows microorganism overgrowth and infection. The anatomical changes and cancer-related immunosuppression contribute to recurrent SPA. Chemotherapy and radiotherapy are ideal treatments for our patient, however, infection must be treated adequately first. Surgical interventionis needed to manage the infection by SPA drainage where antimicrobial has poor penetration into the abscess and debulking of tumor to clear the blockage of drainage pathway.

Conclusion : Recurrent orbital SPA could happen in patients with NPC, therefore appropriate medical treatment and timely surgical intervention are essential in managing orbital SPA. Multidisciplinary management is required to optimize patient outcomes.