bluuebunny/crossref_metadata_2025 huggingface dataset:
A Continuous Red Eye: Case Report of Indirect Carotid Cavernous Fistula
Authors: Nurul Qalbi Ramadhani  , Dr. Andi Muhammad Ichsan, Ph.D, Sp.M(K)  , Dr. dr. Yunita Mansyur, Sp.M(K), M.Kes  , Dr. Ashari Bahar, M.Kes, Sp.S(K)  , FINS  , FINA
Published: February 2024

Abstract

Introduction : Carotid cavernous fistula (CCF) is a type of arteriovenous shunt in the cavernous sinus. Indirect CCF symptoms are not typical that can outwit us. Ocular manifestations occur because of venous and arterial stasis around the eye and orbit. The aim of this report is to increase awareness of the existence of other causes if there is no improvement after treatment.

Case Illustration : A 59-year-old male presented with prolong conjunctival hyperemia on both eyes for two months that been diagnosed and treated as conjunctivitis. The ophthalmologic examination showed dilated episcleral vessels on both eyes with no evidence of infection and inflammation, this became a suspicion about the existence of a suppression from retro orbital region. The magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) brain examination were performed anda right CCF was diagnosed. The patient was referred to interventional neurology, digital subtraction angiography (DSA) examination showed a fistula in the right cavernous sinus and embolization was conducted.

Discussion : The patient categorized as spontaneous, low flow, indirect CCF Barrow type D. On this type of CCF conjunctival injection is often the most prominent feature, and patients are commonly treated for other conditions, such as conjunctivitis, before a correct diagnosis is made.

Conclusion : Carotid cavernous fistula can be characterized by the insidious onset of symptoms, diagnosis is based on the angiographic examination. When a sign suggestive of orbital or cavernous sinus pathology is present, a more thorough examination is crucial. Early diagnosis and appropriate management are essential to avoid vision and life threatening complications.
POSTOPERATIVE COMPLICATIONS OF ORBITAL TUMOR REMOVAL IN SARDJITO GENERAL HOSPITAL
Authors: Prasthiti Dewi Hasdini
Published: February 2024

Abstract

Introduction & Objectives : Orbital tumor removal surgery represent a small but significant portion of ophthalmologic surgery, and few reports of the associated complications are available. The aim of this study is to report the complications of orbital tumor removal surgery in Sardjito General Hospital, Yogyakarta.

Methods : Descriptive retrospective study was carried out 138 patients who undergone orbital tumor removal surgery during July 2021-March 2023. Surgery approach and postoperative complications were collected from medical record.

Results : Of approximately 138 patients, 12 (8%) patients had postoperative complications. Five (5%) of 75 patients who undergone anterior orbitotomy had postoperative complications. One percent had lagophthalmos, 1% had ptosis, 2% had decreased vision, and 1% had ocular movement disorders. Lateral orbitotomy was done in 21 patients. Three (12%) patients had postoperative complications. Four percent had ptosis, 4% had decreased vision, and 4% had ocular movement disorders. Four (60%) of 6 patients who undergone medial orbitotomy had ptosis (16%) and decreased vision (50%). Posterior orbitotomy was done in 8 patients. One (12,5%) patient had complication of ptosis.

Conclusion : Anterior orbitotomy was the most common surgery approach for orbital tumor removal. The most common postoperative complications were ptosis and decreased vision. Informed consent is an important aspect to improve patient’s knowledge of postoperative complications.
Prosthetic Contact Lens Combined with Strabismus Surgery : Confronting Psychosocial Prejudice in Anomalous and Misaligned Eyes
Authors: PRISCILLA DWIANGGITA  , Ariesanti Tri Handayani  , Ni Made Ayu Surasmiati
Published: February 2024

Introduction : Patients with defects in the cornea such as abnormal size, opacities as well as misalignment of the eyes may feel inferior about their physical appearance. Such patients will benefit from prosthetic contact lenses (CL) and strabismus surgery to restore anatomical appearance. The majority of patients also seek strabismus surgery for both cosmetic and psychosocial reasons along with decreased levels of anxiety and depression. Our goal not merely cosmetic, but also improving psychosocial health and quality of life.

Case Illustration : We reported a 14-year-old male with complaints of white spot on his left eye and squint since birth. On ophthalmology examination, we found 45 degree esotropia with BCVA 6/6 in the right eye and 1/300 in the left eye. Corneal diameter was 10 mm and 9 mm on the right and left eye, respectively. He was diagnosed with right eye posterior embryotoxon, left eye corneal dystrophy, microcornea on both eye, congenital esotropia and deprivative amblyopia. He had developed low self-esteem due to his eyes. To enhance his appearance, left eye lateral rectus resection and medial rectus recession with adjustable suture was done to align the eye. Afterwards, brown-tinted soft contact lens with power -0.50 D, diameter 14,2 mm, and base curve 8,5 mm was given to disguise the corneal opacities and microcornea. Patient felt very satisfied with the result.

Discussion : 

Conclusion : Prosthetic contact lens combined with strabismus surgery provides satisfactory cosmetic and psychosocial benefit with minimal complications. As clinicians, functional, cosmetic and psychosocial indications must be considered for a comprehensive management.
Ocular Syphilis in an Immunocompetent Young Man
Authors: Vincentius Handy Suria, dr  , Halida Wibawaty
Published: February 2024

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

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

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

Conclusion : Ocular syphilis should be kept in the differential diagnosis in immunocompetent/HIV negative patient, and the importance of obtaining a detailed sexual history should not be forgotten.
THE RELATIONSHIP OF INTERLEUKIN-6 LEVELS AND THE DEGREE OF MYOPIA IN YOUNG ADULTS IN NORTH SUMATRA UNIVERSITY HOSPITAL
Authors: Hidayat Salman Saisar , Amra Aryani Atiyatul , Lubis Rodiah Rahmawaty
Published: February 2024

Background.

Myopia is one of the refractive errors where parallel light from infinity is focused in front of the retina without accommodation. Various cytokines have been implicated in the development of myopia, including interleukin-6 (IL6) and matrix metalloproteinase-2 (MMP-2). IL-6 is one of the pro-inflammatory cytokines that play a role in ocular disease pathology. Chronic subclinical inflammation may play a role in elongation of the eyeball, inflammation promotes the breakdown of the scleral extracellular matrix and results in axial elongation.

Objective.

To determine the relationship of interleukin-6 levels and the degree of myopia in young adults in North Sumatra University Hospital.

Methods.

This research is an analytic observational study with a case control design, held from February 2022. Primary and secondary data are collected from interviews and direct observation. Bivariate analysis of differences in interleukin-6 levels in myopia and emmetropia uses T-independent test, if the data are normally distributed. If the data are not normally distributed, then the Mann Whitney test is used. Bivariate analysis to analyze differences in interleukin-6 levels based on the degree of myopia uses the Kruskal Wallis test, followed by a post hoc test using the Mann Whitney test and t-independent.

Results.

A total sample consists of 30 patients who suffer from myopia and 30 control samples. The mean age in the myopia group was 28.87 years with the youngest age being 25 years and oldest age 34 years. Most of them are moderate myopia with 15 people (50%). There was no significant difference in interleukin-6 levels between myopia and control groups (p = 0.147). There was a difference in the mean level of interleukin-6 based on the degree of myopia (p = 0.005).

Conclusions.

There is an association between interleukin-6 levels and the degree of myopia in young adult patients. No differences in interleukin-6 levels were found significant between myopia and control groups.
Conjunctival flap surgery for traumatic corneal ulcers
Authors: Anisa Fitri  , Yetrina
Published: February 2024

Introduction : Trauma was the most common risk factor for corneal ulcers and blindness. Death of corneal tissue due to loss of part of the surface of the cornea is called a corneal ulcer. Conjunctival flap (CF) surgery has an acknowledged role in assuring a stable ocular surface and repressing inflammation in compromised corneas or eyes with reduced visual potential.

Case Illustration : 26-year- old male patient came to the Chasan Boesorie Ternate Hospital polyclinic with pain in the left eye after splash cement 3 days before being admitted to the hospital. The left eye is runny, feels itchy, looks red and like there is a block and glare. On ophthalmology status there was a visual acuity OD 6/6, OS 1/300, OS cloudy cornea, hypopion, prolapse of iris and central corneal ulcer with a size of ± 2 x 1 mm.

Discussion : The remaining flaps were performed for corneal perforation, graft rejection, bullous keratopathy, and secondary corneal edema. Conjunctival flaps have previously proven to be effective in preserving the globe for individuals with severe ocular surface disease. The flaps promote nutrition, metabolism, structure, and vascularity, as well as reduce pain, irritation, inflammation, and infection. After 6 weeks of surgery visual acuity become better, OS 20/200.

Conclusion : Conjunctival flap surgery is an important and useful surgical option of ocular surface disease, especially recalcitrant infectious keratitis and corneal ulcers, particularly in nonresponsive and some perforated cases. CF procedure went well, provides mechanical support for corneal wound healing with good visual outcomes on the patient.
Management of Bilateral Ankyloblepharon with Hay-Wells Syndrome: A Rare Case Report
Authors: Junetta Airene Priskila Taba  , Putu Yuliawati
Published: February 2024

Introduction : Ankyloblepharon is a partial or complete fusion of the eyelid margins. This condition can be found as a common manifestation of Hay-Wells Syndrome along with lip and/or palate cleft and ectodermal dysplasia. This is an extremely rare case report demonstrating management of ankyloblepharon with Hay-Wells Syndrome.

Case Illustration : A 5-day-old baby consulted from the Neonatal Intensive Care Unit (NICU) with multiple congenital abnormalities. The baby was born preterm (32 weeks) by C-section due to fetal malpresentation with low birth weight (1545 gram). There was no family history of congenital anomalies. Ocular examination revealed a partial ankyloblepharon on both eyes. The baby was also found with labiognatopalatoschizis, microtia, hyperkeratotic skin and nail dystrophy. Then, we planned to do an eyelid separation procedure at the NICU using only sterile conjunctival scissors with drops of Pantocaine 2%. Gentamicin eye ointment three times daily was prescribed. After the procedure, we can do a proper evaluation of the eye.

Discussion : Hay-Wells Syndrome is a rare autosomal dominant disorder. This condition characterized by various congenital abnormalities such as ankyloblepharon, lip and/or palate cleft, and also other abnormalities involving the skin, hair, teeth, nails, and sweat glands. The management of ankyloblepharon can be done easily by excised the webs of skin that connecting the eyelid margins with topical anesthesia. The purpose of this management is mainly to prevent the risk of the development of deprivation amblyopia.

Conclusion : Congenital ankyloblepharon has the potential to cause deprivation amblyopia. An immediate management is needed to provide a good prognosis regarding the visual development
Successful probing of Congenital Nasolacrimal Duct Obstruction on 11 years old child: A case report
Authors: SUTJIPTO  , Mohammad Haikal Bakry
Published: February 2024

Introduction : Congenital nasolacrimal duct obstruction (CNLDO) is a common cause of epiphora in infants; its prevalence rate of 5% to 20%, although only 2–6% will need intervention. The pathogenesis involves an imperforate membrane of the nasolacrimal duct but it may involve bony abnormalities and narrowing of the lacrimal drainage system.

Case Illustration : An 11-year-old boy came to the hospital with complaints of a watery and excreted eye since he was born. On the dye disappearance test the result is +4. The patient was decided to have probing procedures. There was positive dye flow in the nasolacrimal duct after probing and irrigation with saline and dye. One week after the probing procedure, dye disappearance test was performed and the result is negative. Patients also no longer complain of watery and sticky eyes.

Discussion : The management of CNLDO remains controversial. Probing can be used as a primary treatment for children <36 months of age, where success rate of 78–93% can be achieved. For older children success rate is even less. Studies on older children between 25 and 60 months have shown failure rates as high as 28%. The prevalence of complex obstruction in children between 49 and 60 months was 43% with a success rate of only 33% on probing.

Conclusion : Appropriate time for probing the CNLDO is still under debate. The high success rate of probing in patients older than 2 years old confirm that the first intervention could be probing before considering complex intervention.
Management of Open Globe Injury Followed by Cataract Traumatic and Corneal Laceration in a 37-year-old Man. A Case Report
Authors: Martyana Dr Diana Eka , Kusumastuti Diana Haryati
Published: February 2024

Introduction : Ocular trauma is the most common cause of visual impairment and unilateral vision loss. According to the Birmingham Eye Trauma Terminology, ocular trauma consists of Open Globe Injury and Closed Globe Injury. Open globe injury is a full-thickness eyewall wound due to a laceration or occult rupture. Damage to the cornea and lens are among the most common types of ocular trauma.

Case Illustration : This case report involves a 37 year-old-man who presented with complaints of pain and visual impairment in the left eye for the past month. The symptoms appeared after accidentally getting hit by a bamboo branch. Upon examination, the patient had a visual acuity of 1/300 in the left eye, ciliary injection (+), non-spherical pupil, and normal intraocular pressure on palpation. On slit lamp examination, a 7mm corneal laceration with a scar formation and a lens mass in the eye's anterior chamber.

Discussion : In this case, the open globe injury resulted in visual impairment due to corneal laceration and traumatic cataracts. The trauma occurred one month before the examination, and the corneal laceration had already formed a leukoma. The patient underwent corneal repair and vitrectomy, extracapsular cataract extraction using the ECCE technique, and intraocular lens implantation.

Conclusion : The prognosis of ocular trauma depends on the severity of the injury to the eye structures, the time between the injury and surgery, the preoperative visual acuity, the mode of injury, and the patient's age. The OTS scoring system can predict the final visual acuity outcome in such cases.
Combination of Superficial Keratectomy, Ethylenediaminetetraacetic (EDTA), and Amniotic Membrane Transplantation as A Treatment of Band keratopathy: A Case Report
Authors: Ilmah  , Patriotika Muslima  , Elfa Ali Idrus  , Arief Akhdestira Mustaram  , Angga Fajriansyah
Published: February 2024

Introduction : Band keratopathy is a degeneration of the cornea characterized by the presence of opacity, which isa deposit of calcium hydroxyapatite. These calcium deposits can be removed in several ways, including using ethylenediaminetetraacetic (EDTA), superficial keratectomy, or phototherapy keratectomy.

Case Illustration : A 29-year-old male patient came with complaints of blurry vision in the right eye since 2-3 years ago, accompanied by the middle part of both eyes looking white, especially the right eye, since 17 years ago. The examination revealed a band keratopathy in the nasal to temporal region with neovascularization in the right eye, and keratopathy bands in the nasal and temporal parts, as wellas a cloudy lens in the right eye (Figure 1). Patients received treatment that included a combination of superficial keratectomy, administration of EDTA, and amniotic membrane transplantation (Figure 2). After the procedure, the clarity of the cornea improves (Figure 3). The patient was scheduled to undergo cataract surgery on his right eye.

Discussion : Band keratopathy is a degenerative condition of the cornea characterized by grayish-white hazy deposits in the superficial layers of the cornea, primarily affecting Bowman's layer. In the treatment of individuals with symptomatic band keratopathy, chelation with EDTA, superficial keratectomy, laser keratectomy for phototherapy, or combining current procedures are the most often utilized therapeutic approaches.

Conclusion : The combination of surgical management in cases of band keratopathy is expected to remove deposits on the cornea, improve the ocular surface, and reduce recurrences.
RELATIONSHIP OF GESTATION AGE AND WEIGHT IN PREMATURE BIRTH WITH RETINOPATHY OF PREMATURITY IN A TERTIER HOSPITAL
Authors: ABDI ROY NABABAN  , Rozalina Loebis MD  , Reni Prastyani MD
Published: February 2024

Abstract

Introduction & Objectives : Retinopathy of Prematurity (ROP) is the leading cause of preventable blindness in these children and significantly impacts vision. It is estimated that from about 15 million infants born prematurely worldwide, around 53,000 infants are found to have vision-threatening ROP, and 20,000 infants experience severe visual impairment. This study is to determine the relationship between gestational age and body weight in preterm birth with retinopathy of prematurity.

Methods : Medical records data with a diagnosis of retinopathy of prematurity were found in 385 infants treated at Dr. Soetomo Hospital from January 2016-December 2020. From 385 premature infants, 45 premature infants were found with ROP. The relevant data is then entered into the recording sheet and Microsoft Excel software and processed using SPSS 22.0 software.

Results : Premature infants with ROP who were found 385 infants with 45 infants were found with ROP. Premature infants with ROP in the gestational age group >32 weeks were 10 infants (22.2%). Of 45 premature infants, 23 premature infants with birth weights less than 1500 grams. AP ROP there is also 1 infant in the weight category

Conclusion : There is a relationship between gestational age at premature birth and retinopathy of prematurity. Meanwhile, birth weight was not associated with retinopathy of prematurity. In infants with a gestational age of more than 32 weeks, it is still necessary for ROP because there is still a possibility of ROP.
CAN RIGID GAS PERMEABLE (RGP) CONTACT LENS BE THE BEST OPTION FOR A KERATOCONUS PATIENT?
Authors: DINA FATMA DWIMARTA  , ANI ISMAIL  , EVA KUMALASARI
Published: February 2024

Introduction : Keratoconus is a condition of cone-shaped cornea caused by stromal thinning. This disorder leads to visual disturbance due to irregular astigmatism, myopia, and corneal protrusion. A severe irregular astigmatism must be corrected by rigid gas permeable (RGP) contact lenses.

Case Illustration : A 29 y.o female visited Ophthalmologist Clinic Subdivision of Refraction, Contact Lens, and Low Vision in RSKMM Provinsi Sumsel, complaining of discomfort while using her current glasses. Anamnesis, physical examination, and ophthalmologic examination were carried out. The patient then was maximally corrected of her refractive status, followed by contact lenses fitting and post- fitting evaluation.

Discussion : Early ophthalmologic examination showed visual acuity of 6/60 ph 6/9 on both eyes. Corneal topography evaluation confirmed pattern of bilateral keratoconus, each 78% on right eye and 87% of left eye. Best-corrected visual acuity was 6/6 using S-3.50 C-7.00 180? (right eye) and S-4.00 C-6.00 170? (left eye). RGP fitting test was carried with trial lenses of S-4.00 D for both eyes with both base curve of 7.2 mm and diameter of 9.2 mm. Over-refraction showed result of S-3.50 D (right eye) and S-3.75 D (left eye) for both eyes to reach visual acuity of 6/6 and for patient to feel comfortable.

Conclusion : While some period of adaptation was needed, severe keratoconus should be treated using RGP contact lenses to achieve a better prognosis. Accurate fitting test of RGP resulting in comfortable and satisfied outcome of patient.
Improving Low Vision through Bioptic Telescope: A Case Series
Authors: ADISTI LUKMAN
Published: February 2024

Introduction : Low vision (LV) is a condition when a person have binocular visual acuity of less than 6/18 to light perception, or a visual field of less than 10 degrees from the point of fixation, even after treatment and/or standard refractive correction. In Indonesia, it is known that the number of LV patients is around 4.8% of all blindness. Bioptics telescope is handsfree magnifying lenses, attached to the spectacles, used to enhance moderate to distant vision for patients with severely damaged eyesight. However, the use of this device is still uncommon in Indonesia.

Case Illustration : Bioptic Telescope prescribed to 3 patients, adaptation time were less than 48 hours. The 1st patient, 11 years old male with chorioretinitis toxoplasmosis, initial visual acuity (VA) 6/60 both eyes improved to 6/18 both eyes, and able to write/type 30 words per minutes. The 2nd patient, 18 years old male with Familial Exudative Vitreoretinopathy, initial VA 1/60 Right Eye (RE) & 1/300 Left Eye (LE) improved to 6/18 RE, and able to write/type 10 words per 2 minutes. The 3rd patient, 25 years old female with congenital visual impairment, initial VA NLP RE & 6/60 LE improved to 6/24 LE, and able to write/type 20 words per minute.

Discussion : 

Conclusion : This study reports the initial experience with bioptic telescope in low vision patients. This device proven to significantly increase visual acuity with short adaptation time and learning curve to watch, read, write, and type. The ability to escalate patient's quality of life makes bioptic telescope superior from other (hand-held) telescope
PEDIATRIC BLEPHAROKERATOCONJUNCTIVITIS WITH DESCEMETOCELE AND CORNEAL NEOVASCULARIZATION : A CASE REPORT
Authors: Fadia Ghaisani  , Ismi Zuhria
Published: February 2024

Introduction : Blepharokeratoconjunctivitis is a chronic and recurrent inflammatory eyelid disorder that is commonly associated with secondary conjunctival and corneal involvement that is frequently underdiagnosed in children. The objective is to report a descemetocele and corneal neovascularization as severe complications of blepharokeratoconjunctivitis in children.

Case Illustration : A five years old girl complained blackish lump in the right eye since a month ago. She also had a whitish spot in her eye since a year ago with redness, glare and watery. Three years ago she had a lump in the right eyelid and eye redness intermittently that was getting better with eye drop and history of allergy of house dust mites. Visual acuity (VA) in right eye was hand movement. Anterior segment of the right eye showed telangiectasis of palpebra, hyperemic conjunctiva, with neovascularization of entire surface of the cornea, descemetocele, leucoma and corneal thinning around descemetocele. We injected subconjunctival anti-vascular endothelial growth factor (VEGF) injection then we performed amniotic membrane transplantation. Follow-up 2 months post surgery we found VA was 2 m counting finger and the corneal neovascularization was reduced.

Discussion : This case represents severe blepharokeratoconjunctivitis can cause some complications, from this patient we found corneal neovascularization and descemetocele. Anti-VEGF injection was to inhibit new blood formation in the patient’s cornea and the amniotic membrane transplantation was to manage the descemetocele.

Conclusion : Pediatric blepharokeratoconjunctivitis and the complications associated with its treatment can be sight threatening. Early recognition of this disease entity and adequate management may arrest the disease process and may minimize visual morbidity.
Incidence Of Photokeratitis In Factory Workers After Ultraviolet C Exposure and Its Management : A Case Series
Authors: Dr. ANDREAS SURYA ANUGRAH, Sp.M  , Dr. Rima Melati, M.KK, SpAk(K), Sp.Ok(K)
Published: February 2024

Introduction : Ultraviolet C lamps have been used in industry and healthcare to disinfect rooms, air, water, and surfaces. However, exposure to UV-C may cause serious damage to human eyes.

Case Illustration : This were photokeratitis case series of 4 factory workers that occurred simultaneously after 4 hours exposure to UV-C lamp about one meter away without any protective eyewear. Several hours after exposure, they complained swollen, red and watery eyes, photophobia, sandy sensation, and blurry vision. One day after, they were taken to the Emergency Unit. Diagnosis of photokeratitis was established by using biomicroscopic examination. All subjects were treated with antibiotic eye drops, lubricants, oral anti-inflammatory drugs, and cold compress. Evaluation after 1 week showed clinical improvement and all subjects were able to return to work normally.

Discussion : Photokeratitis or ultraviolet keratitis is an inflammatory condition of the cornea after ultraviolet exposure for 30 minutes to 12 hours. The corneal epithelial layer functions as protector for corneal stroma and endothelium. However, the longer corneal epithelium is exposed to ultraviolet light, the more damaged it is. This caused subepithelial nerve plexus exposed, resulting in severe pain, photophobia, and bilateral epiphora. Injection and chemosis of bulbar conjunctiva, epiphora, and punctate keratopathy of cornea were found in examination. The management given is supportive therapy, and should be immediately given until corneal epithelium healed.

Conclusion : Photokeratitis may occurred in daily work. Regulation, warning, training and appropriate protective eyewear for workers in workplaces using UV-C lamps are mandatory. Immediate and adequate treatment can save the sight of workers exposed to UV-C.
PANOPHTHALMITIS SECONDARY TO RETAINED INTRAOCULAR FOREIGN BODY , SETTING IN RURAL AREA
Authors: WAHYU ENDAH PRABAWATI
Published: February 2024

Introduction : IOFB can be serious and result in vison threatening complication. We report IOFB presenting with panophtalmitis secondary to delay in seeking medical attention and misdiagnosed in emergency ward by general practitioner.

Case Illustration : A 40-years-old male presented with pain and outward bulging of his right eye with no light perception after trauma to his right eye by a small metallic object while working as electric grasscutter. He presented to our department 3 days following the incident. Systemically, he had a fever, headache and nausea. 2 days after incident, he visited to emergency ward but he was given eye drop only. On Slit lamp examination, corneal melting with keratinization and lacerated wound in cornea at 12 o'clock about 3 mm. Non-contrast CT showing a linear hyperdense foreign body in the right globe likely metal, measuring 3 mm x 4 mm was found. The patient was admitted ceftriaxone intravenous, twice daily. No light perception of visual acuity, ocular penetrating, persistence of the active inflammation, and risk of spread, a decision was made to eviscerate the eye. A metallic foreign body was found in eviscerated tissue.

Discussion : 

Conclusion : Important to suspect foreign body in all cases ocular trauma. Detailed examination and imaging should be performed. Delay treatment from the time of injury, result in poor prognosis. Surgical treatment such as evisceration, should be informed to patient about the visual prognosis.
Challenges in Diagnosing and Initial Treatment of Advanced Eyelid Basal Cell Carcinoma in Rural Area: A Case Report
Authors: Willy Yahya  , Eunike Cahyaningsih
Published: February 2024

Introduction : Basal cell carcinoma (BCC) is the most common non-melanoma eyelid cancer with a high risk of recurrence. This case report discusses the management of extensive BCC in a rural setting with limited resources.

Case Illustration : A 62-year-old Timorese female, presented to the hospital with a mass on the left periocular region. It appeared as a mole in the lower left eyelid and extended to the surrounding tissues over nine years. As a farmer, she was frequently sun-exposed. A blackish mass was found at the left orbit, buccal, and entire nose (8 x 7.5 cm) with an ulcerated surface and attached firmly. The right eye had bedside visual acuity >6/60, with palpebral edema, free eye movement, hyperemia nasal conjunctiva, and transparent cornea. The left eye is difficult to examine. Two submandibular lymphadenopathies were palpated. A Head CT scan showed a suspected malignant soft tissue mass with irregular thickening of soft tissue with ill-defined borders. Histopathology examination revealed a nodulocystic type of basal cell carcinoma.

Discussion : Locally advanced BCC cases need a multidisciplinary approach. In a limited resources setting, the treatment highlights are histological diagnosis, complete surgical excision, and exenteration with margin control. From a broader perspective, the role of primary health care in educating and revering for early treatment is paramount.

Conclusion : Prevention and early treatment are the most important factors in managing locally advanced BCC.
CORRELATION BETWEEN DEGREE OF PROPTOSIS WITH EYE BALL DIMENSION IN GRAVES OPHTHALMOPATHY PATIENT AT WAHIDIN SUDIROHUSODO HOSPITAL MAKASSAR
Authors: Stephanie Tanjung
Published: February 2024

Abstract

Introduction & Objectives : Introduction Hyperthyroidism is one of the cause of Graves’ Ophthalmopathy (GO), which is an autoimmune orbital disease. Clinical manifestations of GO are orbital and periorbital edema, eyelid retraction, eyelid lag in down gaze, restrictive strabismus, compressive optic neuropathy, and keratopathy exposure. We can also find proptosis in GO patient. this happened because the expansion of adipose tissue and muscle at the edge of the orbital bones resulting in increased intraorbital pressure. Protrusion of eyeball can cause changes in the dimensions of the eyeball such as axial length, anterior chamber depth, and cornea curvature. Objective To assess the correlation of degree of proptosis with eyeball dimension in Patients Graves’ Ophthalmopathy.

Methods : This research was a cross sectional study. A total of seventeen eyes were proptotic from patient with Graves' ophthalmopathy. They underwent measurement with a Hertel exophthalmometer and optical biometry to record the degree of proptosis, axial length, anterior chamber depth, and cornea curvature.

Results : Patient with proptosis in Graves' Ophthalmopathy. This study analysed the degree of proptosis with axial length, anterior chamber depth, and cornea curvature. There is no statistically significant result.

Conclusion : There was no correlation between degree of proptosis with axial length, anerior chamber depth, and cornea curvature in patient with Graves’ Ophthalmopathy.
RELATIONSHIP BETWEEN DEGREE OF OPTICAL NERVE DAMAGE ON LEVEL OF DEPRESSION AND ANXIETY PATIENT WITH PRIMARY GLAUCOMA
Authors: SETIAWAN I KADEK AGUS , Rahayu Ni Kompyang , Ariani Ni Ketut Putri , Widiana I Gde Raka , Kusumadjaja I Made Agus , Juliari I Gusti Ayu Made
Published: February 2024

Introduction & ObjectivesGlaucoma is one of the leading causes of irreversible global blindness and the second most commoncause of blindness in the world after cataracts. Depression and anxiety often occur in glaucomapatients when glaucoma is first diagnosed, the effect of decreased vision function in glaucoma, sideeffects of glaucoma therapy both medically and surgically and financial effects due to length oftreatment and loss of job due to limited vision. This study aims to determine the relationship of thedegree of optic nerve damage to the level of depression and anxiety in patients with primaryglaucoma.

MethodsThis research is an analytic, prospective observational research with a cross-sectional studyapproach. The relationship between independent variables and dependent variables was analyzed.

ResultsThe Man Whitney test found a significant difference in anxiety scores between the severe and mildto moderate groups with a p value of 0.020 . The ANCOVA test found that there was a relationshipbetween the degree of optic nerve damage in primary glaucoma and the level of anxiety aftercontrolling for control variables.

ConclusionThis study can be concluded that there is a difference in the level of anxiety between the degree ofsevere and mild to moderate optic nerve damage. The level of anxiety itself corresponds to thedegree of damage to the optic nerve. The more severe the damage to the optic nerve, increased ofthe patient's anxiety score.
A RARE CASE OF STERILE ENDOPHTHALMITIS FOLLOWING INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION IN VITRECTOMIZED EYE
Authors: Pitanatri Nyoman Brahmani , Panjawati Ni Luh Diah
Published: February 2024

Introduction : Intravitreal Triamcinolone Acetonide (IVTA) has been widely used to treat Diabetic Macular Edema (DME). Sterile endophthalmitis is one of the major related complications after IVTA which occurs between 0.20% and 6.73% of the injections. We present a case of sterile endophthalmitis following IVTA injection in a patient with a vitrectomized eye and DME.

Case Illustration : A 53?year?old female patient with a history of vitrectomy due to high-risk characteristic proliferative diabetic retinopathy on her right eye underwent IVTA for DME. One day after the injection, the visual acuity (VA) improved from 6/45 to 6/12 without any complication. Three days later, she complained of ocular discomfort and sudden diminution of vision. The VA had dropped to hand movement, with conjunctival injection, hypopyon, anterior chamber reaction, and an inaccessible fundus. The patient was treated with topical antibiotics, corticosteroids, and cycloplegic, followed by intravitreal antibiotics injection. Furthermore, vitrectomy and vitreous tap were performed. On one- week follow-up, the VA was improved to 6/60 with normal IOP. The anterior chamber and the vitreous cavity remained clear.

Discussion : The etiology of sterile endophthalmitis following IVTA injection remains unclear. Compared to infectious endophthalmitis, the patient is usually in less pain, and the eye is less injected. Although it generally has a benign course, some studies have shown serious complications such as vitreous hemorrhage and retinal detachment. Therefore, caution should be taken to prevent such complications from developing.

Conclusion : In presumed sterile endophthalmitis, a careful diagnosis and intervention must be reconsidered to avoid potential long-term visual loss due to its related complications.
Chiari I Malformation Presenting Vertical Gaze-Evoked Nystagmus : A Case Report
Authors: Mischka Scalvinni Suvero Suyar  , Nazhira Janani  , Ferdian Ramadhan  , Balgis Desy Sulistyowati
Published: February 2024

Abstract

Introduction : Chiari malformation is characterized by herniation of posterior cerebellar vermis in which type 1 malformation has coexisting syringomyelia of cervicothoracic spinal cord. This malformation can be congenital or acquired, in which gaze-evoked nystagmus is the typical movement deficit. This case aimed to report a case of vertical gaze-evoked nystagmus as a primary symptom to detect Type I Chiari Malformation.

Case Illustration : A 44-year-old woman presented with involuntary movements of both eyes in the last 5 months with vision problems in which objects appear to jump or vibrate. Visual acuity was 20/50 in both eyes with 12 prism diopters BI exotropia. We recognized vertical and torsional nystagmus in upgaze without any movement in primary gaze. While performing supraduction, the oscillation was detected and increased. Brain MRI revealed Type I Chiari Malformation.

Discussion : Nystagmus was seen in many diseases of the central nervous system, in particular those affecting the brainstem and cerebellum. Vertical gaze evoked nystagmus was a disorder of the gaze holding function, purely vertical gaze-evoked nystagmus is observed in midbrain lesions involving the interstitial nucleus of Cajal (INC) as the neural integrator for vertical gaze-holding function. Based on this pathophysiology, the Brain MRI of this patient revealed some degrees of compression in midbrain, and cervico medullary junction due to her brain malformation.

Conclusion : A sustained gaze-evoked nystagmus is an important ocular finding that may indicate serious neurologic pathology. It is important for an eye care provider to thoroughly examine additional tests to determine the underlying cause of the nystagmus.
HUMAN RESOURCES DEVELOPMENT IN CHILDREN EYE HEALTH SERVICES IN SOUTH SULAWESI
Authors: Amalius Ahmad Ashraf , Muhiddin Habibah Setyawati , Ichsan Andi Muhammad , Faisal Andi Akhmad , Kamaruddin Muhammad Irfan , Akib Marlyanti N. , Kotha Satya Prabha
Published: February 2024

Introduction: Children eye health are one of the most common problems in ophthalmology that are getting attention globally and nationally especially in South Sulawesi. To optimize its services quality and quantity of human resources are required. This study aims to report the human resources development in children eye health services in South Sulawesi.

Methods: Surveys were carried out in several districts to assess the availability of human resources in children eye health services. Creating collaborations with several institutes such as Faculty of Medicine, Hasanuddin University and related professional organizations. Conducting several trainings in provinces, districts, subdistricts, village, and urban village.

Results: Preparation and dissemination of materials and media on prevention of blindness in children, improvement of human resources in the form of District Trainer training in 24 districts that recruited 98 people who were ready to become trainers. For 2 years conducting tiered training at 24 districts, they produced human resources of 1,395 officers at the Puskesmas, 11,145 posyandu cadres, and 3,826 teachers. The results of this built system revealed that 3,248 paediatric patients were screened with vision problems, 3,528 toddlers in Integrated Health Centre were screened and referred to Health Centre as many as 426 toddlers, and at the School Health Unit it was recorded that 173,778 children were screened and there were 28,845 (17%) children who had visual disturbances.

Conclusion: Development of human resources in children eye health in Indonesia was not only the responsibility of the government and the health sector but also need cross-sectoral roles.
Full Thickness Skin Graft Procedure for Basal Cell Carcinoma : A Case Report
Authors: PETER SALMON  , Yuliana Hartono
Published: February 2024

Introduction : To present a case of basal cell carcinoma (BCC) of the right upper eyelid using a full thickness skin graft (FTSG) procedure

Case Illustration : 69 year old woman with the main complaint of a lump on the upper right eye that has been getting bigger and bleeding more and more since 4 years ago. Examination revealed a tumor measuring 22mm x 12mm x 5mm, smooth surface of pearl-like nodules, talengectiasis, madarosis, palpebral retraction towards the medial canthus. The patient works as a farmer. Wide excision of the tumor and FTSG procedure was performed from the right infraclavicular area, histopathological results of basal cell carcinoma tumor.

Discussion : BCC accounts for 90% of malignant eyelid tumors. The biggest risk factor for BCC is UV exposure. BCC rarely metastasizes but orbital invasion occurs in approximately 2%. This patient underwent an FTSG procedure. The graft was taken from the infraclavicular area. One of the key factors for graft success is revascularization of the graft area.

Conclusion : FTSG procedure for BCC can give good results. The risk after the procedure is sometimes difficult to predict so that it can become difficult in graft attachment and even failure in attachment to the excision area can occur. This patient was under close observation due to a hematoma under the graft skin.
Penetrating Fishhook Ocular Injury: Challenging management in low- resource country
Authors: Nafisa Naaz Nisha  , Andronico Ly
Published: February 2024

Introduction : Fishing is a common income source in rural areas, but fishhook eye injuries are rare. This report describes a case of a rare penetrating fishhook ocular injury, which resulted in endophthalmitis and eye evisceration, and highlights the challenges caused by delayed referral and limited options for intravitreal antibiotics due to inadequate consumable availability.

Case Illustration : A 13-year-old boy from Vanuatu had a fishhook in his right eye and was referred to an Ophthalmologist one day later due to unavailability of flights. Upon arrival, endophthalmitis signs were noted, with the left eye having a visual acuity of 6/7.5 and the right eye showing only hand movement. The right eye showed corneal edema and a blood stain around the fishhook, fresh keratic precipitates, discharge and conjunctival edema. The fishhook was removed, and the cornea repaired under local anesthesia. On Day 1 post-operation, Intravitreal vancomycin and moxifloxacin were administered after procuring privately from pharmacies outside the hospital. However, the patient's condition worsened, requiring evisceration of the right eye.

Discussion : Prompt management of penetrating eye injuries is crucial, with patients requiring broad spectrum antibiotics, tetanus shots, and an eye shield during referral. However, challenges such as lack of an eye shield and transportation delays worsened the patient's condition before arrival. This case also highlights the challenges faced in treating the patient effectively by the ophthalmologist due to limited options intravitreal antibiotics.

Conclusion Timely management and urgent referral are crucial in low-resource areas to prevent complications. Essential consumables are necessary for effective treatment by an ophthalmologist.
Changes in Ocular Surface Parameter After Intense Pulsed Light Therapy in Ocular Demodicosis: A Case Report
Authors: Rizki Adi Santosa  , Angga Fajriansyah  , Elfa Ali Idrus  , Patriotika Muslima  , Arief Akhdestira Mustaram
Published: February 2024

Introduction : Demodex infestation may manifest as blepharitis and dry eye syndrome. Intense Pulsed Light (IPL) therapy is an emerging option for managing ocular demodicosis.

Case Illustration : A 77-years-old woman complained of itch and watery eyes since four years ago. Meibomian pouting, telangiectasias, foamy secretions, and sleeves were identified in both eyelids. Right eye examination showed 52% and 42% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer test 6 mm, lipid layer thickness (LLT) 43 nm, tear meniscus height (TMH) 0.36 mm, and non-invasive tear break-up time (NIBUT) 9.6 seconds. Left eye examination showed 65% and 56% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer test 5 mm, LLT 66 nm, TMH 0.16 mm, and NIBUT 5.8 seconds. Demodex mites were identified during eyelash wet mount examination. She underwent four sessions of IPL. At the two-month follow-up, complaints were alleviated. Signs of blepharitis were subsided. Right eye examination showed 36% and 34% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer's test 9 mm, LLT 68 nm, TMH 0.49 mm, and NIBUT 10.7 seconds. Left eye examination showed 25% and 35% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer's test 9 mm, LLT >100 nm, TMH 0.9 mm, and NIBUT 6.2 seconds.

Discussion : IPL has a role in managing ocular demodicosis by local inflammation control, meibum liquefaction, and meibomian glands photomodulation. IPL is also thought to directly eradicate Demodex mites.

Conclusion : Improvement of ocular surface parameters was observed after IPL therapy in ocular demodicosis.
LOW VISION IN RETINITIS PIGMENTOSA: HOW TO ENHANCE FUNCTIONAL VISION IN PSEUDOPHAKIC PATIENT
Authors: Siti Shalihah Ramadhani Novizar  , Ani Ismail  , Eva Kumalasari
Published: February 2024

Introduction : Retinitis Pigmentosa (RP) could lead to various visual impairments, including decreased visual acuity, poor dark adaptation, decreased contrast sensitivity, poor color vision, visual field constriction, leading to low vision (LV). LV in RP decreases patient’s quality of life (QoL) and Independence. We aim to report a successful case of LV management in a bilateral pseudophakic patient with RP.

Case Illustration : A 33-year-old man came with progressively blurred vision in both eyes (BE) that worsen 6 months ago. Ophthalmologic examination revealed his uncorrected visual acuity for right eye (RE) and left Eye (LE) was 6/60 and 4/60. The patient had cataract surgeries and IOLs implantation on BE in 2021. Funduscopic examination revealed the bone spicule appearance, blood vessel attenuation, and waxy disc pallor on BE. Humphrey's examination showed a peripheral visual field defect. Decreased contrast sensitivity and poor color vision were also found.

Discussion : The patient was managed by LV aids and rehabilitation. Spectacle clarified distant and near vision with best corrected visual acuity (BCVA) 6/21 and 0.8 M on BE, photochromic lenses aided in adapting to various lighting levels and as a UV protection, and the addition of illumination and color contrast enhancement improved vision in dim light. A convex mirror to be used as a field- enhancement spotting tool. Rehabilitation enhances his head tracking, scanning, and habitual spotting skills. Improvement of QoL has been recorded using LVQoL questionnaires.

Conclusion : LV management are vary based on an individual’s level of functional vision and personal preferences. Optimal LV management could enhance patient QoL and Independence.