bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing Iris Cysts with Surgical Excision: A Case Series
Authors: Sitorus Tigor Santoso , Afifah Azzahra , Dini Dharmawidiarini  , Farida Moenir  , Napitupulu Sanata PH
Published: February 2024

Introduction : Iris cysts are uncommon iris tumors. Primary iris cysts are congenital and usually not detected until late into the first or second decade of life. Secondary iris cysts have history of trauma or intraocular surgery. Small and asymptomatic iris cysts should be monitored, whereas larger cysts require treatment as they cause complications.

Case Illustration : Case 1 a 17-year-old teenager had blurred vision without prior intraocular trauma or surgery. Anterior segment examination of the left eye revealed an oval, light brown, and semi-translucent cyst. Case 2 a 15-year-old girl had blurred vision and enlarging white spot in right eye with history of penetrating ocular trauma. Patient had undergone immediate penetrating repair followed by combination of pupilloplasty and cataract surgery. Anterior segment examination of the right eye showed corneal scar and cystic lesion. Both cysts extended to corneal endothelium and were managed surgically.

Discussion : Larger cysts, especially with complications, require cyst aspiration, laser therapy, injections of antiproliferative agents, or surgery. We decided to surgically aspirate and excised iris walls to remove both iris cysts which were vital to achieve good result. Post-operative periods were uneventful with no significant inflammatory reactions associated with the procedure.

Conclusion : Different modalities, with varying degrees of success, have been reported for the treatment of iris cysts. Surgical intervention remains the last option which can give a good functional outcome with minimal inflammatory complications, especially when less invasive options do not seem feasible due to the extensive nature of the cyst.
KISSING NEVUS RECONSTRUCTION WITH A SUPRACLAVICULAR GRAFT: A RARE CASE REPORT
Authors: Lissa Novia Permatasari  , Ratna Doemilah
Published: February 2024

Introduction : Kissing nevus is a rare form of congenital nevus that occurs on upper and lower eyelid of one eye, forming a large nevus when the eyelids are closed. This condition causes functional and aesthetic problems thus the reconstruction is essential.

Case Illustration : A 23-years old female presented to our ophthalmology outpatient clinic with complain of having painless, black colored, non-progressive nevus over left upper and lower eyelids since birth that cosmetically unpleasing. The dark brown-black colored was sized 55x30 mm with hypertrichosis covering approximately two third of both left upper and lower eyelid margins and extending to cheek. The entire nevus was excised and reconstructed by supraclavicular full thickness skin graft, lateral canthopexy and canthoplasty. Three weeks after operation showed satisfactory results. Histological examination revealed intradermal nevus pigmentosus.

Discussion : The reconstruction of eyelid after excision remains a challenge because of its specialized function and cosmetic significance. Ideally, the reconstruction should provide a stable eyelid margin, protect the ocular surface, and sustain mobility. Free skin grafts harvested from the control lateral eyelid, postauricular, supraclavicular, and upper arm region have been the most common reconstructive approach. The supraclavicular area is a reliable donor option to cover large head and neck defects due to its similarity in colour, thickness, and flexibility.

Conclusion : Free supraclavicular graft is safe, reliable and cosmetically acceptable choice for reconstruction head and neck defects.
Neglected Coats Disease: Determining the Most Appropriate Treatment
Authors: Anastasia Ruth , Yustiarini Ima , Prakosa Ady Dwi , Widjaja Sauli Ari , Firmansjah Muhammad , Sasono Wimbo
Published: February 2024

Introduction : Coats disease is defined as retinal telangiectasia and aneurysm with retinal exudation that typically found in unilateral eyes of young male. This condition remains a diagnostic challenge because of its varied presentation.

Case Illustration : A 12-years-old boy presented with a chief complaints of vision loss and pain in the right eye in the last 3 months and gradually blurred vision for a year. Visual acuity was positive light perception in the right eye and 5/5 in the left eye. Intraocular pressure of the right eye was 43.4 mmHg and 15mmHg of the left eye. Slit lamp examination of the right eye revealed conjunctival hyperemia, slightly corneal oedema, iris neovascularization, xantocoria, dilated pupil. Bullous total exudative retinal detachment with telangiectasia in all quadrants was found in the ophthalmoscopy examination of the right eye and left eye is within normal limit. The patient was diagnosed with stage IV coats disease and antiglaucoma agents was given as initial treatment.

Discussion : Coats disease is a clinical diagnosis that can be assessed by clinical triad of exudative retinal detachment, irregularly-dilated telangiectatic vessel, and peripheral nonperfusion and can be supported by the diagnostic tools such as Ultrasonography, OCT, CT-Scan and MRI. Treatment of coats disease varies depend on the stage. In stage IV coats disease, external drainage is the most appropriate treatment. The more advanced stages demonstrating poor visual acuity both at presentation and at the time of final visit

Conclusion : Majority of coats disease cases present with advanced stage therefore cause limited treatment option and poorer prognosis.
Quality of Life After Cataract Surgery in Patients with Age-Related Macular Degeneration: A Literature Review
Authors: Rosa Syahruzad  , Syska Widyawati
Published: February 2024

Abstract

Introduction & Objectives : Age-related macular degeneration (AMD) is a common ocular disease that affects millions of people worldwide. Cataract surgery is one of the most performed surgical procedures in the world and is effective to improve visual function and quality of life (QoL) in individuals with cataracts. Both cataract and AMD are conditions that occur in late age. However, the presence of AMD may complicate the postoperative outcomes and QoL of these patients. This review aims to examine the impact of cataract surgery on the QoL of patients with AMD.

Methods : A search of the literature was conducted using electronic databases. Studies were included if they evaluated QoL outcomes in patients with AMD who underwent cataract surgery.

Results : The results of the review suggest that cataract surgery can improve visual acuity and QoL in patients with AMD. However, the degree of improvement is influenced by the severity of AMD. Patients with mild to moderate AMD tended to have greater improvements in QoL and visual acuity compared to those with advanced AMD. Incidentally, it is still cost effective to perform cataract surgery in patients with advanced AMD.

Conclusion : Overall, patients with AMD who underwent cataract surgery experienced improvements in their QoL. Nevertheless, individual characteristics including severity of AMD must be considered to optimize the procedure outcomes. Further research, particularly with longer follow up times, is needed to determine the long-term effects of cataract surgery on QoL in patients with AMD.
The Effects of Bevacizumab in Augmenting Trabeculectomy for Glaucoma : Systematic Review and Meta-Analysis
Authors: Rusli Richardo , Kasih Franky Richard
Published: February 2024

Introduction & Objectives : Anti-vascular endothelial growth factor (VEGF) agents have been used to slow the healing response and postoperative scar tissue formation. To determine the effectiveness of adding Anti VEGF bevacizumab to the results of trabeculectomy in glaucoma.

Methods : Searches were conducted in a structured way using keywords across several data sources, including Pubmed, Proquest and Cochrane library. The keywords used for searching were “Bevacizumab”, “Trabeculectomy” and “Glaucoma”. The reviewed articles are Randomized Control Trial in english, conducted on humans in the last 15 years. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results : From a total of 353 articles, there were 6 studies with 362 eyes of 352 patients been evaluated for the effectiveness of bevacizumab addition to trabeculectomy. The primary outcome of all articles was the assessment of Intra Ocular Pressure (IOP). No significant difference in IOP was found between the subconjunctival bevacizumab + Mytomycin-c group and mytomycin-c alone group (MD 0.11 ; 95% CI -0.10 to 0.33), as well as subconjunctival comparison with mytomycin-c (MD 0.11 ; 95% CI -0.29 to 0.50). Similar results were also found in the intracameral and placebo groups (MD 0.08 ; -0.22 to 0.38). However, 3 articles reported significant differences in peripheral vascularity of the bleb both by the Moorfields Bleb Grading System and by the Indiana Bleb Appearance System.

Conclusion : The addition of bevacizumab to trabeculectomy did not show any benefit in reducing IOP when compared with MMC. But it gives better peripheral vascularity of the bleb.
EFFECT OF TOPICAL BRIMONIDINE ON NMDA RECEPTOR EXPRESSION AND RETINA GANGLION CELL DENSITY IN TRAUMATIC OPTIC NEUROPATHY RATS MODEL
Authors: RR. WIDYASTUTI PASPARINI  , Riski Prihatningtias  , Arief Wildan  , Hermawan Istiadi
Published: February 2024

Abstract

Introduction & Objectives : Traumatic optic neuropathy is a visual disturbance caused by acute injury to the optic nerve which results in retinal ganglion cell apoptosis through the glutamate excitotoxicity pathway. Brimonidine is an alpha 2-receptor agonist that acts as a neuroprotector in the glutamate excitotoxicity pathway and causes modulation of NMDA receptors associated with glutamate. Objective of this study is to prove the effect of topical brimonidine on NMDA receptor expression and retinal ganglion cell density in a rat model of traumatic optic neuropathy

Methods : Rat models of traumatic optic neuropathy was carried out using the optic nerve crush method. The treatment group was given topical brimonidine 0.15% 1 drop/12 hours for 14 days. NMDA receptor expression was assessed by immunohistochemical staining and retinal ganglion cell density was assessed by Hematoxylin-eosin staining. Statistical analysis was performed to assess the correlation between NMDA receptor expression and retinal ganglion cell density

Results : The Allred score of NMDA receptors expression in the treatment group was lower than control group, with significant difference (p=0.002). The mean density of retinal ganglion cells in the treatment and control group was 20,99  7,76 and 12,51  3,10, respectively with a significant difference (p=0.032). There was a significant correlation between NMDA receptor expression and retinal ganglion cell density in the treatment group (p=0.035) with strong negative correlation (r= -0.611)

Conclusion : Topical administration of brimonidine to the Wistar rat model of traumatic optic neuropathy can suppress NMDA receptor expression and maintain retinal cell ganglion density
Blindness Management for Retinitis Pigmentosa with Cataract senile immature : A Case Report
Authors: Fitria Nuraisa  , Anggraeni Sp. M , M.Kes Dr Nila , Rahman Sp.M Dr Faisal
Published: February 2024

Introduction : Retinitis Pigmentosa (RP), also called pigmentary retinal dystrophy, is the term of hereditary retinal diseases that feature degeneration of rod and cone photoreceptors. The most common complication of RP is cataract. Cataract formation is most likely the result of retinitis pigmentosa-related inflammation response. Cataract is an important secondary cause of visual impairment in RP.

Case Illustration : A 39-year old female came to the Hospital with complaint of having blurred vision in both eyes since four years ago. Ophthalmologic examination revealed that visual acuity for her right and left eye was 1/300. Anterior segment examination was revealed lens opacification in right and left eye. Funduscopy examination was revealed bone spicula in right and left eye. Patient was diagnosed with retinitis pigmentosa with cataract senile immature in both eyes. Phacoemulsification with intraocular lens (IOL) implantation were done as surgical management for the right eye.

Discussion : RP is one of the leading causes of irreversible blindness. The possible explanation of reduced vision in RP can be photoreceptor cell death and treatable complications of RP. Cataract is the most common anterior segment complication described in RP. Visual acuity in RP could be improved for the complications that receive effective treatment, especially with the improvement of the cataract surgery. However, the visual prognosis and surgical risk following cataract surgery is uncertain, the cataract surgery should still be considered in patients with RP. Phacoemulsification with IOL implantation remains the most preferred method to manage cataracts.

Conclusion : Cataract surgery in patients with RP leads to significant improvements in visual acuity
The Challenges of Handling Neovascular Glaucoma at Undaan Eye Hospital Surabaya, Indonesia
Authors: Malika Rosalia Adriani , Nuradianti Lydia
Published: February 2024

Introduction & Objectives : The management of neovascular glaucoma is challenging because frequently it is incurable with poor visual prognosis. Delay in treatment can lead to sight threatening glaucoma. This study aimed to provide an overview of incidence and management of neovascular glaucoma at Undaan Eye Hospital.

Methods : This descriptive epidemiology study comprised 111 eyes of 102 patients. The inclusion criteria were patients diagnosed with NVG who came to Undaan Eye Hospital for 1 year (January 2021 to December 2021). Patients with incomplete medical records were excluded. The patient’s age, gender, risk factors, and treatment were reviewed.

Results : There were 102 patients (111 eyes) diagnosed with NVG. The patients were mostly men (53,2%) and the mean age was 54.98 ± 12,4 years. Diabetes Mellitus (DM) was observed in 70 (63,1%) eyes, hypertension in 60 (54,1%) eyes, central retinal vein occlusion (CRVO) in 11 (9,9%) eyes, cholesterol in 7 (6,3%) eyes, and branch retinal vein occlusion (BRVO) in 1 (0,9%) eyes. Mean IOP at the time of diagnosis was 42,8 ± 11,2 mmHg. Anti-VEGF (25,2%), trabeculectomy (59,5%), glaucoma drainage device (17,1%), micropulse transscleral cyclophotocoagulation (5,4%) were done as an option of the treatment.

Conclusion : NVG is more common in men. Most patients presenting NVG had DM and hypertension with mean IOP of 42,8 mmHg. Trabeculectomy is the most commonly performed procedure.
Revealing Orbital Tumors: A 2-Year Evaluation in Clinical Profile, Histopathological Features and Surgical Technique
Authors: Silmi Lisani Rahmani
Published: February 2024

Abstract

Introduction & Objectives : Incidence of orbital tumors is relatively low, but the delay in diagnosis, even if benign, can lead to vision loss and deformity. This study aims to review clinical and demographic information of orbital tumors in Sardjito General Hospital, Yogyakarta.

Methods : We retrospectively reviewed clinical data of 138 patients who diagnosed with orbital tumors during July 2021 - March 2023. Data extracted included clinical characteristics, operative procedures, and histopathologic characteristics of orbital tumors.

Results : There were 138 orbital tumors managed at hospital during a 2-year period. Among 138 patients, 82 patients (59%) were female and 56 patients (40%) were male. Twenty-one patients (15%) were in childhood age and 117 patients (84.8%) were in adulthood age. The common clinical manifestations were proptosis (83.3%) and decreased vision (10.4%). The main procedure used was anterior orbitotomy (54.34%). Eighty-eight patients (63.7%) have primary tumors and 51.4% of the orbital tumors were malignant. The most common orbital tumor in childhood age was a cyst (15%). On the other hand, in adult patients, the most common orbital tumor was meningioma (18%) and Non- Hodgkin Lymphoma (15.7%). There was an overall 8% complication rate after orbitotomy tumor removal, including decrease in vision (3.3%), ptosis (2.6%), and strabismus (1.3%).

Conclusion : Orbital tumors are challenging group of tumors with proptosis become the most frequent clinical characteristic that found. The orbital tumors in childhood and adulthood differ significantly in their incidence and tumor type with the percentage of malignant tumors increasing with age.
The Outcome of O-shape and Y-shape Nd:YAG Laser Capsulotomy in Patients with Posterior Capsule Opacification
Authors: Daniel Atnil  , Yoseph Siahaan
Published: February 2024

Introduction & Objectives : Neodymium:yttrium-aluminium-garnet (Nd:YAG) laser capsulotomy is the method of choice in secondary cataract. Nd:YAG laser capsulotomy is a safe and effective method in treating decreased visual acuity. This study was conducted to determine the outcomes of Nd:YAG laser capsulotomy with O shape and Y shape in patients with posterior capsule opacification.

Methods : This descriptive study was conducted in Siloam Karawaci General Hospital from February – March 2023. We included all patients with posterior capsule opacification who underwent Nd:YAG laser capsulotomy. The outcome included pre- and post-procedure uncorrected visual acuity (UCVA) after 1 week follow-up.

Results : A total of six eyes from five patients (two men, three women) were included in this study. Three subjects underwent Nd:YAG laser with O-shape and three subjects with Y-shape. All subjects with O- shape had improved UCVA (0.7 to 1.0; 0.2 to 0.5; 0.5 to 0.8). Meanwhile, all subjects with Y-shape also had improved UCVA (0.2 to 0.5; 0.2 to 0.3; 0.5 to 0.7). No subjective symptoms reported following capsulotomy procedure in all patients.

Conclusion : Nd:YAG laser posterior capsulotomy with O shape provided better UCVA than Y shape.
Successful Management of Cataract in Patient With Long Anterior Zonules and Small Pupil :A Rare Case
Authors: Pangestika Riskha , Rhendy Rio , Widyawati Syska
Published: February 2024

Introduction : Long anterior zonules (LAZ) are rare disease with prevalence was 1–2%, characterized by zonular fibers that extend centrally leading to a small zonule-free zone (ZFZ), which raises the risk of complications during zonular cutting while continuous curvilinear capsulorhexis (CCC). This leads to two options whether to perform phacoemulsification through a small CCC within the small ZFZ or an adequately sized CCC. The objective of this study was to report challenging management of phacoemulsification surgery with LAZ eyes with small pupil

Case Illustration : A 62 y.o female had visual acuity(VA) 0.7(logMAR) due to corticonuclear cataract in left eye. She had history complicated cataract surgery with secondary sulcus fixated IOL in her fellow eye. The IOP was normal, no phacodenesis and pseudoexfoliative material observed in left eye. The posterior segment was normal. The left eye observed otherwise normal in initial examination. Intraoperatively, after viscomidriasis technique the ZFZ identified in the area of 2.0-2.5 mm from central. Five millimeter CCC can be achieved in the central area and phacoemulsification with the help of CTR (Capsular Tension Ring) safely performed and one piece IOL was implanted in the bag.

Discussion : On the first postoperative day, VA was improves to 0.4(logMAR), IOL central and clear corneal with minimal inflammation. One week after surgery, the VA 0.3(logMAR) and no sign of IOL decenteration.

Conclusion : Phacoemulsification in eyes with LAZs can be safely performed with CTR through an adequately sized CCC without significant complications. A combination of early recognising high-risk eye, proficient skills, and surgical instruments can improve outcome.
Scleral Buckling for Retinopathy of Prematurity: A Case Report
Authors: Permanik Gustiandari Fidhya , Barliana Julie Dewi , Yudantha Anggun Rama
Published: February 2024

Introduction : Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease that affects premature infants. Patients with advanced ROP require surgery to minimize retinal distortion and prevent total retinal detachment. This case reports the efficacy of scleral buckling (SB) in a patient with stage 4B ROP in both eyes within 3 months.

Case Illustration : A 4-month-old female baby presented to the Pediatric Ophthalmology Division in Cipto Mangunkusumo Hospital with the chief complaint of no eye contact in both eyes. Her eyes moved by themselves since the age of 3.5 months and sometimes looked crossed. The patient presented to the pediatrician and was referred to the pediatric ophthalmology division for further management. There was a history of premature delivery at 30 weeks with oxygen therapy for 3 weeks. Pediatric Ophthalmology Division performed ultrasonography and Retcam and diagnosed ROP stage 4B in both eyes. Scleral buckling was performed by vitreoretinal division in the right and left eyes at 49 and 52 weeks postmenstrual age, respectively.

Discussion : Vitrectomy and scleral buckling are the surgical options in advanced ROP. Vitrectomy is ideally performed in stage 4A without macular involvement. We considered performing SB because vitrectomy seems to be ineffective in this patient and the patient is more prone to intraocular complications.

Conclusion : Scleral buckling is effective in preventing further progression of retinal detachment, reducing vitreoretinal traction and preventing ischemia in the retinal detachment. In short-term follow-up, we found no worsening of progression. However, further follow-up is needed to demonstrate the long- term efficacy of SB in advanced ROP.
CORRELATION OF THE DURATION OF DOCETAXEL ADMINISTRATION IN BREAST CANCER PATIENTS WITH EPIPHORA DEGREES
Authors: DITA MINTARDI
Published: February 2024

Abstract

Introduction & Objectives : Epiphora is caused by excessive secretion and/or obstruction of lacrimal drainage system, malposition or weakness of the eyelids, failure of the nasolacrimal duct, and reflex tearing. Obstruction of the lacrimal drainage system can be caused by inflammatory processes in the palpebra, the use of certain medications or congenital abnormalities. Some drugs that are at risk of causing epiphora are chemotherapy drugs, especially 5-FU and docetaxel. Most epiphora were foundin weekly therapy than every 3 weeks therapy. Docetaxel causes epiphora, induces obstruction of the lacrimal drainage system and fibrosis of the stroma in the mucous layer of the lacrimal drainage system. According to Erkan et al, cases of recurrent or persistent and symptomatic epiphora had a Munk score of 2 to 4. This study interested in conducting research on the Correlation of the Duration of Docetaxel Administration in Breast Cancer Patients with Epiphora Degrees at RSUP Dr. Mohammad Hoesin Palembang.

Methods : Cross sectional study with 25 samples suffering from breast cancer and experiencing epiphora at RSUP Dr. Mohammad Hoesin Palembang. The epiphora degree assessment is carried out using the Munk Score.

Results : The sample was predominantly ≤50 years old as many as 21(84%) samples with a median 45 (23-64) years. The most dose of docetaxel was 70 mg in 20(80%) samples. Somer's D test showed that there was a significant correlation (p=0.021) between the duration of docetaxel administration to epiphora degrees and the strength of the strong correlation (r=0.645).

Conclusion : The length of the docetaxel cycle is strongly correlated to having an epiphora
MANAGEMENT APPROACH OF LOW VISION IN RETINITIS PIGMENTOSA: WHAT SHOULD WE DO?
Authors: Novi Auliya Dewi  , Ani Ismail  , Eva Kumalasari
Published: February 2024

Introduction : Retinitis pigmentosa is a chronic and progressive disease throughout patient’s life. Management low vision in retinitis pigmentosa patients are to maximize their remaining vision and provision of visual aids, it can be financial dan social burden.

Case Illustration : A 56-year-old man came with blurred vision in his both eyes for 12 years. The patient had cataract surgeries and IOLs implantation in 2022. Ophthalmologic examination revealed the right eye was 4/40 and the left eye was 3/60. Funduscopic examination revealed the bone spicule appearance, blood vessel attenuation, and waxy disc pallor in both eyes. Contrast sensitivity test decreased and Farnsworth hue test showed mild to severe. Humphrey visual field examination showed peripheral visual field defect, therefore patient diagnosed with low vision caused by retinitis pigmentosa with bilateral pseudophakia and his Low Vision Quality of Life was intermediate.

Discussion : Treatment includes pharmacological treatment with supplementation, optical or non-optical treatment, and rehabilitation. Spectacles clarified distant and near vision with Best Corrected Visual Acuity 6/30 with photochromic lenses, for adapting the light and gave addition lens +5.00 in both eyes. Rehabilitation enhances his head tracking, scanning, and habitual spotting skills. Lighting and typoscope would help his daily reading activities as well.

Conclusion : Low vision requires several management approach, patient with visual impairment can get low vision aids to optimize his visual function based on his needs. Managing low vision in patient with visual impairment has to be considered from multiple aspects.
Homonymous Quadrantanopia as the First Manifestation of Cerebral Infarction: A Case Report
Authors: Dr. Rizki Dwayana Putra  , Muhammad Hidayat
Published: February 2024

Abstract

Introduction : Homonymous quadrantanopia, a visual impairment caused by lesions in the occipital lobe is typically due to vascular or traumatic injuries with tumors, abscesses, demyelination, or toxic substances in the white matter in rarer cases. Cerebral infarction in the occipital lobe is often diagnosed by ophthalmologists since initial symptoms involve visual disturbances without neurological symptoms.

Case Illustration : A 52-year-old woman complained visual disturbance in the upper left visual field. Ophthalmologic examination showed normal visual acuity (6/6), pupillary response, and fundus appearance. The patient had history of hypertension for the past three years. Laboratory findings revealed hypercholesterolemia (240 mg/dl) and increased fasting blood sugar levels (102 mg/dl). A Brain CT scan identified infarction in the right occipital lobe and perimetry revealed left superior homonymous quadrantanopia.

Discussion : The left superior homonymous quadrantanopia is caused by an infarction in the inferior calcarine of the occipital lobe due to the occlusion of a branch of the posterior cerebral artery. Atherosclerotic factors, such as hypertension, dyslipidemia, and hyperglycemia, are identified as the main causes of this condition. Normal pupillary responses and optic nerve appearance distinguish visual impairment caused by anterior lesions of the lateral geniculate body. Larger infarcts of the occipital lobe may result in neurological symptoms such as migraine with aura and visual hallucinations.

Conclusion : The clinical manifestation of homonymous quadrantanopia should emphasizes the importance of ophthalmologic examinations, laboratory tests, perimetry, and imaging to estimate the location and etiology of the lesion.
CORRELATIONSHIP BETWEEN THE LEVEL OF THYROTROPIN RECEPTOR ANTIBODY WITH ACTIVITY AND SEVERITY OF GRAVES’ OPHTHALMOPATHY AT WAHIDIN SUDIROHUSODO HOSPITAL MAKASSAR
Authors: ARDY GISNAWAN
Published: February 2024

Abstract

Introduction & Objectives : Graves’ Ophthalmopathy (GO) is an autoimmune orbital disease with mostly occurs along with hyperthyroidism. The underlying cause of GO is theoretically connected with thyrotropin receptor that activated antigen-presenting cells from thyrotropin-receptor peptides, then attached with T- helper and B cell that produce the level of thyrotropin receptor antibody (TRAb) and cause an enlargement of orbital tissue and increase the level of triiodothyronine (T3) and thyroxine (T4). To determine the active manifestation status from those clinical findings, the Clinical Activity Score (CAS) is utilised. Meanwhile, European Group on Graves' Orbitopathy (EUGOGO) is used to classify the severity of the disease. This research aims to assess the correlation of TRAb levels toward its activity and severity in patients with Graves’ Ophthalmopathy.

Methods : Thirty-four patients with Graves’ Ophthalmopathy underwent clinical and laboratory examinations. The result of clinical finding was plotted into CAS to determine its activity status and EUGOGO to classify its severity. TRAb concentration was measured with ELISA or TBII Assays.

Results : All patients have high level TRAb. We analysed the level of TRAb with activity and severity. We found a significant result of cofounding variables related to gender and smoking history, with P value 0.011 and 0.017 respectively. There is no statistically significant result TRAb with activity (CAS) P=0.465, and TRAb with Severity (EUGOGO) P=0.812.

Conclusion : The level of TRAb is primarily used as diagnostic marker for Graves’ Ophthalmopathy, but they haveno correlation from the level of TRAb with activity and severity patient with Graves’ Ophthalmopathy.
One-Step Surgical Approach for Treating Lens-Induced Glaucoma with Iridodialysis Following Blunt Trauma
Authors: Haryono Aditia Apriyanto , Gustianty Elsa , Rifada R Maula , Umbara Sonie
Published: February 2024

Introduction : Traumatic glaucoma is one of secondary glaucoma that can be challenging to treat. Blunt trauma to the eye may result in iritis, hyphema, lens subluxation, or dislocation leading to increased intraocular pressure (IOP). Every complication needs to be addressed promptly. Here we present about one-step surgical approach to treat lens indued glaucoma with iridodialysis following blunt trauma.

Case Illustration : A 65-year-old man presented with a chief complaint of blurred vision and pain in his right eye for a month following blunt ocular trauma where he was hit with piece of wood while operating a chainsaw. Ophthalmologic examination revealed RE VA of 2/60 with IOP 32 mmHg. Anterior examination revealed a shallow anterior chamber, iridodialysis 90 degrees, cloudy lens with phacodonesis (Fig 1). Patient was diagnosed with lens-induced glaucoma, lens subluxation, iridodialysis and traumatic cataract. Patient was treated with antiglaucoma agents prior to surgery. One-step surgical approach: trabeculectomy, phacoemulsification with capsular tension ring, and iridodialysis repair become the treatment of choice (Fig 2). After one month of surgery, IOP decreased to 16 mmHg without anti-glaucoma medication, final VA RE achieved 0.2 (Fig 3).DiscussionManagement of traumatic glaucoma depends on the underlying cause of increased IOP. Trabeculectomy combined with lens extraction should be considered with degree of subluxation that may cause pupillary block. Repair iridodialysis can be done using various techniques.

Conclusion : Management of traumatic glaucoma can be done with trabeculectomy, lens extraction and repair iridodialysis in one-step surgery. Surgical technique should be considered depending on the patient’s eye condition.
ANGLE RECESSION, THE SEQUELA OF EIGHT-BALL HYPHEMA AFTER SPRAYED BY FIRE HYDRANT: A CASE REPORT
Authors: Asti Annisa Kinanti , Komaratih Evelyn , Nurwasis  , Primitasari Yulia
Published: February 2024

Introduction : Hyphema results from damage to the blood vessels of the iris or anterior ciliary body after blunt trauma, and in 56–100% of cases can occur angle recession.

Case Illustration : A 40-year-old man complaints of pain and blurred left eye after being sprayed by a high-pressure fire hydrant five hours before coming to the emergency room. Visual acuity was 20/20 and hand movement in right and left eye, IOP is 13 mmHg and 18 mmHg in both eyes. Subconjunctival bleeding, conjunctival and pericorneal injections were found with punctate fluorescein test in the left eye. The cornea was edema and the anterior chamber was full of hyphema. Five days after being hospitalized and treated with topical atropine, antibiotics, and steroid in combination with oral tranexamic acid, the visual acuity was 5/6.5 and the hyphema was resolved. The IOP elevated after 1-6 weeks of follow-up in the outpatient clinic then timolol eyedrops were given. Gonioscopy showed widening of CBB, torn iris processus 2 clock hours in the inferior quadrant. The antiglaucoma medication was stopped due to the controlled IOP in the end episode of the treatment.

Discussion : Angle recession involves a tear between the longitudinal and circular muscle fibres of the ciliary body. Medication is needed to control the IOP, while surgical management only indicated in cases where medical treatment fails to control the IOP and risk of progressive visual loss.

Conclusion : Angle recession can occur after blunt eye trauma with hyphema and IOP control is needed to prevent the development of secondary glaucoma.
THE TREATMENT OF ACUTE ANGLE CLOSURE WITH HISTORY OF PSYCHOTROPIC AGENTS : A CASE REPORT
Authors: Rafika  , Subsp GL Dr. dr. Fidalia Sp.M (K) , Sari Sp.M (K) Subsp GL Dr. dr. Prima Maya
Published: February 2024

Introduction : Psychotropic agents may precipitate Acute Angle Closure (AAC) either by inducing pupil block via adrenergic or anticholinergic mechanisms, or via an idiosyncratic non-pupillary block mechanism. This is a serious condition that can diminished aquous humor (AH) outflow and increased intraocular pressure

Case Illustration : A 60-year-old female complained of a sudden onset of a severe painful red eye on the right eye (RE)2 weeks ago and there was an IOP elevation. Anti-glaucoma medications were given with no succcess. The patient regularly consumed psychotropic drugs Trihexyphenidyl, Risperidone, and Chlopromazine since 2005 and Escitalopram since 2 years ago

Discussion : Several classes of centrally acting drugs, including antidepressants such as selective serotonin receptor inhibitors (SSRIs) and antipsychotics have been implicated in precipitate AAC in individuals with pre-existing narrow angels. Rapid lowering of the IOP including medical treatment and relieved relative pupillary block with laser peripheral iridotomy (LPI) is an important initial step in treating AAC. Because the media is not clear due to corneal edema, trabeculectomy + 5 Fluorouracil can be considered for IOP control to prevent further damage.

Conclusion : Trabeculectomy + 5 FU procedures may be a valuable and effective option in cases where LPI is too risky due to unclear visualization because of corneal edema. Trabeculectomy has been shown to effectively reduce IOP. Closed monitoring is necessary to assess ocular side effects due to the use of psychotropic agents
OVERVIEW OF PATIENTS SCREENED FOR AND DIAGNOSED WITH ROP IN PEDIATRIC OPHTHALMOLOGY OUTPATIENT CLINIC BEFORE, DURING, AND AFTER THE COVID-19 PANDEMIC
Authors: BARLIANA JULIE DEWI , Sitorus Rita Rita , Yulia Dian Estu , Casey Anthea , Zahra Raihanny Andrea
Published: February 2024

Introduction & Objectives : The COVID-19 pandemic has profoundly impacted healthcare systems worldwide, leading to significant changes in the delivery of medical services. Non-urgent ophthalmology visits were canceled. However, premature infants at risk of retinopathy of prematurity (ROP) require timely and in-person care to prevent vision loss. This study aims to report on the high-risk babies screened and diagnosed with ROP before, during, and after the COVID-19 pandemic

Methods : This is a descriptive study conducted on premature infants who visited the pediatric ophthalmology outpatient clinic at Cipto Mangunkusumo Hospital Jakarta between January 2019 and December 2022. Data was collected using medical records and presented using tables and charts

Results : A total of 368 babies were screened for ROP in 2019, and 75% were diagnosed with ROP. During the lockdown in 2020, the number of babies screened for ROP decreased to 286, and the incidence of ROP was 38.5%. In 2021 and 2022, ROP screening increased to 458 and 515 babies per year, respectively. After the COVID-19 pandemic subsided, ROP screenings increased significantly from 2020 to 2021. The number of babies screened in 2021 and 2022 was similar, but the incidence of ROP decreased from 45.4% in 2021 to 20.3% in 2022

Conclusion : This study highlights the impact of the COVID-19 pandemic on ROP screening and diagnosis in a pediatric ophthalmology outpatient clinic. After the COVID-19 pandemic, the number of babies screened for ROP increased due to the end of the lockdown
Soft Contact Lenses as a Good Option for Adolescent with Anisometropia
Authors: Widya Wira Putri  , Dr. Ani Ismail, SpM(K)  , Dr. Eva Kumalasari, SpM
Published: February 2024

Introduction : Anisometropia is a condition of asymmetric refraction between the two eyes. Adequate anisometropia treatment, such as SCL (Soft Contact Lens) is required to provide binocular vision, patient comfort and also adolescent’s appearance.

Case Illustration : A 16 years old woman came to the RS Khusus Mata Sumatera Selatan. She complained of blurred vision since 6 years ago, and not feeling comfortable using spectacle. The ophthalmologic examination revealed that uncorrected visual acuity was 2/60 ph 6/12 for right eye and on left eye is 6/30 ph 6/7.5. Best corrected visual acuity was 6/6 using S-7.00 on the right eye and left eye was 6/6 using correction S-3.00 but she was not comfortable. The base-curve measurement of the SCL was 8.60 mm for the both eyes and the diameter was 14.2 mm. After the contact lenses attached , obtained that S-7.00 D for the right eye and S-3.00 for the left eye could reach 6/6 in both eyes, she was more comfortable wearing SCL than spectacle.

Discussion : Anisometropia can cause aniseikonia which is characterized by differences in the size of the image in the two eyes. One way to reduce aniseikonia by reducing the vertex distance, soft contact lenses canbe a choices to maintain binocular vision and minimalized the aniseikonia. Contact lenses significantly improved Adolescent’s appearance and activities, which lead to an overall improvementin satisfaction with vision correction, compared using spectacle.

Conclusion : SCL is one of a good option for Adolescent with anisometropia that can provide good visual acuity, and also adolescent’s appearance.
Steroid Induced Glaucoma and Primary Angle Closure Glaucoma: A Case Report of Mixed Mechanism Glaucoma
Authors: Masloman Anugrah Handini , Kasih Franky
Published: February 2024

Introduction : Steroid induced glaucoma is a form of secondary open angle glaucoma (OAG) caused by adverse effects of steroid usage. Primary angle closure glaucoma (PACG) is characterized by shallow anterior chamber accompanied by peripheral anterior synechiae (PAS), elevated IOP and glaucomatous optic neuropathy (GON).

Case Illustration : A 58 year-old woman presented with red eye, blurry vision, pain in her right eye radiating to the head, watery eye and halo. History of experiencing recurrent red eye, improving after taking steroid topical drug for about 3 months. Visual acuity 6/20 ph 6/20, IOP 39 mmHg, mixed conjunctival injection, shallow anterior chamber Van Herick 1-2, dilated pupil and iris pigment on anterior capsule of lens. Posterior segment showed glaucomatous optic neuropathy with cup disc ratio 0.8-0.9, anterior chamber depth 2.58, and thinning of optic nerve head layer. Patient was diagnosed with steroid induced glaucoma and mixed mechanism PACG. The patient underwent trabeculectomy procedure after mannitol injection was given to reduce IOP.

Discussion : We diagnosed the patient with steroid induced glaucoma and mixed mechanism PACG based on history, clinical findings, and diagnostics. Steroid raised IOP by accumulating polymerized glycosaminoglycans (GAGs) in the trabecular meshwork, producing "biologic edema" thus increased outflow resistance. PACG was determined based on Van Herick and anterior chamber depth. Trabeculectomy remains an effective treatment in this case where medications were failed to control IOP.

Conclusion : Steroid induced glaucoma commonly found in OAG, definitive treatment includes halting steroid drugs and trabeculectomy. Further follow-up is needed to evaluate angle closure mechanism.
OPTICAL COHERENCE TOMOGRAPHY PREDICTS VISUAL RECOVERY OF PATIENTS WITH PITUITARY ADENOMA FOLLOWING SURGERY IN DR KARIADI HOSPITAL SEMARANG
Authors: GALUH YULIETA NITIHAPSARI  , Riski Prihatningtias
Published: February 2024

Abstract

Introduction & Objectives : The characteristics, symptoms, and clinical manifestations of pituitary adenoma in Indonesia have not been widely studied. In 26 patients undergoing pituitary surgery at Dr. Kariadi Hospital, we compared visual acuity pre-surgery and post-surgery from normal and thin optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell layer-internal plexiform layer (GCL-IPL).

Methods : A retrospective study from medical record from Januari 2020 to December 2022 was done. 21 of the 26 patients had surgery by the transsphenoidal route and the rest by craniotomy. All patients had macroadenoma (tumor size >1cm) and histologically confirmed. Visual acuity before and after surgery was evaluated along with patient’s OCT value.

Results : The thinner pre-surgery RNFL thickness was associated with worse visual acuity (VA). Patients with normal RNFL had a median VA of 20/200 while those with thin RNFL had to count their fingers (CF). The patients with normal pre-surgery RNFL had a significant improvement in median VA after surgery, from 20/200 to 20/32 (p=0.022), whereas the patients with thin RNFL did not improve (CF to CF, p=0.026). The patients with normal pre-surgery GCL-IPL had non-significant improvement in median VA after surgery from CF to 20/20 (p=0.505), also the patients with thin GCL-IPL from CF to 20/200 (p=0.151).

Conclusion : Based on this study, the visual recovery after pituitary adenoma surgery is likely to be predicted by pre-surgery OCT RNFL. Patients with normal RNFL thickness show an increase propensity in visual recovery after surgery.
Recurrence in Toxoplasma Chorioretinitis: A Case Report
Authors: Satyanegara Pratistha , Helvinda Weni
Published: February 2024

Introduction : Toxoplasma is the most common cause of chorioretinitis and recurrency of toxoplasma chorioretinitis often occur. Recurrences risk factors are patients above 40 years, patients with de novo toxoplasmosis lesions or with less than one year after the first episode, macular area involvement, lesions greater than one disc diameter, congenital toxoplasmosis, and bilateral compromise.

Case Illustration : Female, twenty years old, complained blurred vision on the RE for two years. The patient had a history of cat contact and no systemic manifestation. Anterior segment examination in both eyes is normal with right eye visual acuity 1/60 and left eye visual acuity VA 6/6. Posterior segment examination on the left eye showed normal limit while the right eye showed hyperpigmentation in inferotemporal optic disc and nasal macula. Retina showed hard exudate. Macula showed yellow- white exudate with subretinal bleeding and macular star appearance. Foveal reflex under normal limit. Toxoplasma serology was IgG (+) and IgM (-). The patient has been treated with cotrimoxazole 2x960mg and methylprednisolone 1x32mg.

Discussion : Visual acuity is severely damaged in recurrence toxoplasma chorioretinitis. There are several factors that affect the recurrences of toxoplasma chorioretinitis. In this patient, the risk factors found are de novo lesion, lesions greater than 1 disc diameter, and macular involvement. Cotrimoxazole can reduce recurrence in toxoplasma chorioretinitis but still recurrency can occur.

Conclusion : Recurrences in toxoplasma chorioretinitis affect visual acuity, and even with adequate therapy, recurrence is possible.
Classic Choroidal Neovascularization in Young Man
Authors: Mawarasti Burhana , Augiani Amani Sakinah , Pratiwi Rianti Wulandari , Djatikusumo Ari
Published: February 2024

Introduction : Classic choroidal neovascularization (CNV 2) represent a pathological growth of blood vessels and can result in loss of visual function. The most common cause of CNV 2 in elderly patients is age- related macular degeneration, meanwhile in young age it is frequently due to inflammation, high myopia, angioid disks and hereditary disorders. Hence, the presented case reports the characteristic findings as well the management of the disease.

Case Illustration : A 37-year-old man had two weeks history of metamorphopsia on both eyes. The left eye (LE) had a worse visual acuity, macular fibrosis with pigment epithelial detachment in funduscopy and Optical Coherence Tomography (OCT). A submacular hemorrhage and exudative lesion were recognized on the right eye (RE) with type 2 choroidal neovascularization. Fundus Fluorescence Angiography (FFA) was also performed. Systemic conditions were unremarkable. Intravitreal anti-VEGF injections on RE were given for three consecutive months and showed significant improvement.

Discussion : The etiology of CNV 2 includes high myopia, and inflammation. However, none was found in this patient. Nonetheless, CNV type 2 is still uncommon in young age without predisposing conditions. As most common lesions involve the macula, symptoms shown include metamorphopsia, central scotoma and floaters. FFA is still considered to be the gold standard to differentiate the types of choroidal vascularization. Neovascularization and submacular hemorrhage can be treated with intravitreal injection of anti-VEGF, as previous studies reported significant improvement.

Conclusion : This was a case of bilateral CNV type 2 in a young man without any previous predisposing conditions. Three monthly injections of anti-VEGF showed significant improvement.
Combined Pars Plana Vitrectomy with Core Vitrectomy with 3600 Barrage Laser and Iris Claw IOL Implantation in Nuclear Drop Case: Video Presentation
Authors: Adityo Hasiholan Tigor , Tanong Nicholas Dwiki
Published: February 2024

Introduction : Nuclear drop is one of the numerous complications of phacoemulsification surgery. Today, the incidence of nuclear drop has been declining significantly compared to years before. Eyes with nuclear drop tend to have poorer visual and refractive outcome compared to eyes with existing risk factors but no such complication. This video presentation reports a case of nuclear drop with desirable outcome

Case Illustration : A 46 years old male patient came with blurry vision on his right eye. Patient was undergone eventful phacoemulsification with nuclear drop complication 2 hours ago. Prior to the admission, visual acuity was 1/300, IOP (Intraocular pressure) 24 mmHg, and retinal evaluation showed there is lens nucleus on the retina. Before admission, the patient was given Methylprednisolone 1x 48mg, Ranitidine 2x150 mg, Ciprofloxacin 2x500mg , Asam mefenamat 3x500mg, Cendo LFX ED 6x1 gtt, Cendo Xytrol ed 6x1 gtt. The patient was planned to do the Pars Plana Vitrectomy followed with 360° barrage laser and Retropupil Iris Claw implantation. One day after the surgery, the visual acuity was 0.2, IOL was well implanted, and no sign of retinal detachment. Four weeks after the surgery, the visual acuity was 0.8 with well implanted IOL

Discussion : 

Conclusion : The outcome of nuclear drop cases is affected by several factors. Preparations before PPV are important to attain a better visual outcome. Until now the optimum time to perform PPV in nuclear drop cases remains undetermined. Meanwhile, rise in IOP indicating no luxury of waiting for PPV