bluuebunny/crossref_metadata_2025 huggingface dataset:
FAMILY’S VIEW REGARDING THE DECISION TO BE A CORNEA DONOR: A PHENOMENOLOGICAL STUDY
Authors: Baswedan Rizki Hafidzah , Padmawati Retna Siwi , Widyandana Doni
Published: February 2024

Introduction and Objective: Family has an important role in the corneal donor process. Corneal extraction can be done when a potential donor dies, so it requires family involvement and support. The purpose of this study is to explore the family's view on the decision to be a cornea donor so that we can obtain a deep understanding on this issue.

Methods: Phenomenological studies were conducted in Yogyakarta, Indonesia on families of prospective cornea donors (n=6) and registered cornea donor candidates (n=6). Data were collected using in-depth interviews and study documents. Data were analyzed using the Colaizzi’s method.

Results: Family participants' knowledge and understanding of the urgency and procedure of corneal donors is the main point that constructs their view of corneal donors. Most family participants consider being corneal donors a good thing to do. All participants expressed their willingness to carry out the will of prospective donors, but there was no guarantee they would do so. Fifty percent of participants’ families are also interested in becoming corneal donors in consideration of religious organizations, educational background, and experience participating in activities with the Eye Bank and the donors.

Conclusion: Families have an important role in the corneal donor process because they will carry out the will of prospective donors and serve as liaisons for the Eye Bank. Family involvement in the promotion of the cornea donor program is needed.
Visual And Refractive Outcomes of Myopia Astigmatism After Small Incision Lenticule Extraction (ReLEx SMILE) Procedures; Retrospective Study
Authors: ANDI AKHMAD FAISAL  , Nashrul Ihsan  , Ucok P. Pasaribu  , Vidyapati Mangunkusumo
Published: February 2024

Abstract

Introduction & Objectives : Small Incision Lenticule Extraction (ReLEx SMILE) is becoming more popular as a flapless and minimally invasive form of laser vision correction for the treatment of myopia and myopia astigmatism. This study aimed to assess postoperative visual and refractive outcomes of SMILE- based correction of myopia astigmatism, to evaluate the efficacy, predictability, safety, and stabilityof this procedure over a one-month postoperative period

Methods : This retrospective study evaluated 200 eyes of 100 patients who underwent ReLEX SMILE technique, using the Zeiss VisuMax Laser between July 2020 and October 2022. Before surgery, 1 day and 1 month after surgery, the efficacy, predictability, safety, and stability of the procedure were assessed.

Results : The preoperative Mean Uncorrected Distance Visual Acuity (UCVA) was 1.55 ± 0.53. Corrected Distance Visual Acuity (BCVA) was 20/20 or better in 74.50% and 90% of eyes in 1 day and 1 month after surgery, respectively. MRSE reduced from -5.22 ± 2.44 to -0.22 ± 0.54 at 1 day post-operative, and -0.19 ± 0.51 at 1 month. 75% of eyes had an unchanged BCVA between 1 day and 1 month after surgery. 72% of eyes achieved spherical equivalent within ±0.5 D and 94% of eyes were within ±1.0 1 month after surgery. The intraoperative complication was suction loss in two patients.

Conclusion : SMILE can be considered an effective and safe refractive surgery for the treatment of myopia astigmatism.
A Watchful Eye: A Case Report on The Management of Hypotony Maculopathy after Non-Valved Glaucoma Drainage Device Implantation
Authors: Herdian Felicia Sesih , Amanda Lia , Ivanovna Regina , Gunardi Triana Hardianti , Yunard Ardiella , Suryono Astrianda Nadya
Published: February 2024

Introduction : Low intraocular pressure (IOP) and reduced visual acuity following glaucoma surgery have been linked to a serious complication known as hypotony maculopathy. Here, we report a case of hypotony maculopathy following glaucoma drainage implant which was successfully managed by a conservative approach utilizing oral and topical steroids, resulting in favorable outcomes.

Case Illustration : A 25-year-old female with juvenile glaucoma presented with low IOP in the right eye (RE) following glaucoma drainage surgery using non-valved implant four months prior. Ophthalmic examination revealed a decrease of IOP (9mmHg to 4mmHg) and visual acuity (6/6 to 6/24). Fundus examination and optical coherence tomography (OCT) of macula was indicating hypotony maculopathy. All glaucoma medications were discontinued and the patient was given oral methylprednisolone 3x8 mg and topical prednisolone acetate three hourly for two months. Subsequent follow-up revealed an increase in IOP to 37mmHg and visual acuity improvement to 6/6. The patient was then given oral and topical antiglaucoma medications to maintain IOP control.

Discussion : Hypotony and its related sequelae are more common with the non-valved drainage devices. Prompt intervention is crucial for improving visual outcomes. Treatment options include surgical and conservative approach. Closely monitored conservative therapy may also give favorable outcomes similar to surgical approach.

Conclusion : In advanced cases of glaucoma, extremely low IOP is just as risky as a high IOP. Conservative therapy, including topical and oral corticosteroids, can be employed to reverse hypotony, at the expense of transient IOP rise, in corticosteroid-responsive patients. Restoring normal IOP in a timely manner may improve retinal function.
Pearls And Pitfalls of Keratoplasty to Achieve and Optimal Visual Function: A Case Report
Authors: Askary Fadel , Solahudin Alie
Published: February 2024

Introduction : Keratoplasty, also known as corneal transplant, is a surgical procedure in which a damaged or diseased cornea is replaced with a healthy donor cornea. One of the common reasons for performing this procedure is to restore vision in people with a leukoma eye. Leukoma, also known as corneal opacification, is a condition in which the cornea becomes cloudy or opaque, leading to impaired vision or even blindness. This case will explain keratoplasty procedures for treating leukoma, the benefits and risks of the surgery, and the postoperative care required for a successful recovery.

Case Illustration : A 49 years old Female diagnosed with Leukoma due to her symptoms, signs, and examination with VOD: 1/60 ph (-) and VOS : 6/7.5. The patient then underwent keratoplasty surgery. 7th day post operation, Corneal Graft had 16 interrupted sutures with minimal edema. VOD 6/60 and Intra ocular pressure on the right eye was 13.1 mmHg. Oral and topical corticosteroids Continued and planned to taper off gradually.

Discussion : The success of the procedure depends on several factors, including the cell count of donor, determining high/low risk patients, Intraoperative, and the postoperative care provided. Topical corticosteroids remain the mainstay to prevent immunological graft reactions. Regular evaluation of the graft is important as the risk of rejection occur up to years.

Conclusion : Keratoplasty has proven to be an effective treatment option for individuals with a leukoma eye. The procedure can significantly improve visual acuity and quality of life for these individuals.
Clinical Outcome in Lens Drop evacuation after a High-Risk Characteristics Proliferative Diabetic Retinopathy Post Pars Plana Vitrectomy Case
Authors: Suryathi Ni Made Ari , Andayani Ari , Anasary Anak Agung Ayu Putri Prematura Sri
Published: February 2024

Introduction : Vitrectomy surgery affects zonular strength, which increases the risk of lens drop and can be sight- threatening if not managed correctly. Pars plana vitrectomy (PPV) and evacuation of dislocated lens fragments have to be done very carefully.

Case Illustration : A 42-year-old female with blurred vision in the right eye for two months and a history of right-eye surgery three months ago due to proliferative diabetic retinopathy (PDR) was tamponed with SF6 gas. On examination was found visual acuity (VA) was 6/120, with cloudy lens and attached retina. The patient was diagnosed with a right-eye complicated cataract with advanced PDR post-PPV and planned to undergo phacoemulsification. While waiting for the surgery, the lens dropped into the posterior chamber, then planned to do the evacuation immediately. Dropped lens evacuation, PPV, retro-pupil IOL implantation, and silicone oil (SO) tamponing were done. Two months after the SO evacuation, the best corrected VA improved to 6/15.

Discussion : Cataract progression after vitrectomy is common. In a vitrectomized eye, there is a lack of vitreous tamponade and a less stable lens. Peripheral zonules are attached to the pars plana, which can be disrupted during the vitrectomy surgery. Improvements in visual acuity and lower rates of complications were found if the lens fragment was evacuated soon.

Conclusion : Cataract surgery is better done soon after PPV to prevent dropped lenses into the posterior chamber, whether the zonulisis sign is seen or not. The interval between the dropped lens incident and evacuation was associated with better final visual outcomes.
Lower Eyelid Laceration in Children: A Case Report
Authors: FRANCISCUS ASSISI TIMMY BUDI YUDHANTARA  , FADIMA FITRI LARASATI
Published: February 2024

Introduction : Eyelid lacerations may be associated with serious ocular injury and are often accompanied by other ocular injuries. Most injuries occur in children. Eyelids have an important role in protecting the globe. Effective management of eyelid lacerations requires an understanding of the basic anatomical features of the eyelids.

Case Illustration : A two-year-old boy was brought to our emergency department after getting scratched in the eyelid by the family dog. The patient has received first aid and a tetanus shot at another hospital. Eye examination shows a lower eyelid laceration on the right eye, extending from the medial downwards around 3 cm. Visual examination was central+, steady+, maintenance+, and eye movement was within normal limits. The patient was admitted to undergo eyelid repair in the operating room.

Discussion : The first step in eyelid repair is wound irrigation and removal of foreign particles to avoid infection and inflammation, and primary repair of eyelids should be performed within 12 to 24 hours of the injury to reduce subsequent complications. The recommended method for best wound closure and healing is gently handling tissue edges, slight eversion, and using the smallest diameter sutures. A proper pre-operative assessment and surgical planning include evaluation of the thickness of the defect, the size, the location, and the involvement of canthus and lacrimal drainage. The goals are to provide adequate eye closure, preservation of tear film, maintenance of visual field, and aesthetics.

Conclusion : A thorough knowledge of the eyelid anatomy and suture technique is important to successfully repair the defect while maintaining eyelid function.
Persistent Fetal Vasculature with Pediatric Cataract, Microcornea, Sensory Exotropia and Mental Retardation: A Case Report
Authors: MADE KUSUMA WARDANI  , Dr. dr. Ni Made Ayu Surasmiati, M.Biomed, Sp.M(K)  , Dr. dr. I Wayan Eka Sutyawan, Sp.M(K)  , Kevin Anggakusuma Hendrawan  , A. A. Dewi Adnya Swari
Published: February 2024

Introduction : Persistent Fetal Vasculature (PFV) is a congenital, nonhereditary ocular malformation that frequently involves the lens. PFV is most frequently unilateral. The classical presentation is leukocoria, microphthalmia, and cataract.

Case Illustration : A 16-year-old boy patient with mental retardation, came with chief complaint blurred vision and white appearance on the RE, noticed for 1 month ago. Visual acuity of the RE was LPBP and the LE was 6/120. There was microcornea on both eyes with diameter 8 mm. Lens opacity and exotropia with XT 30 0 on the RE. IOP on both eyes was normal. Funduscopic on the RE was negative and LE there was tigroid retina. Ultrasonography of the RE was echogenic with minimal after movement and low to moderate spikes. Planning for this patient were RE lens extraction with IOL. After that evaluate for the posterior segment.

Discussion : Progressive cataract formation often occurs, sometimes leading to a complete cataract. Strabismus associated with a unilateral cataract. The most important was differentiating PFV from retinoblastoma. In patients with poor view of the fundus, ultrasonography should be performed. Retinal or optic nerve abnormalities cannot be definitively ruled out, however, until the posterior pole can be visualized directly. The opacity in the affected eye should be cleared to allow visual development and to save the eye from complications of untreated PFV.

Conclusion : It is important to obtain a detailed history of the child’s growth, development, systemic disorders, family history, and need further comprehensive examination and multidiscipline consultation to establish the diagnose.
Low Vision Management in Chronic Glaucoma
Authors: Muhammad Fahmi  , Ani Ismail  , Eva Kumalasari
Published: February 2024

Introduction : Glaucoma is a group of progressive optic neuropathy corresponding to peripheral vision loss, causing severe visual impairment to blindness. Low vision is a person who has the best visual acuity in the best eye of 6/18 to light perception or with a visual field of <10 degrees from the fixation point, after medical, surgical, and/or optical intervention. Low vision will affect every aspect of patient’s life, hence precise management of low vision is important.

Case Illustration : RY, a woman, 64 years old, works as a housewife. Complained of blurred vision slowly since 3 years ago, especially when reading. The patient then went for treatment to get glasses and was said to have glaucoma. Glaucoma surgery was performed on both patient's eyes and cataract surgery on the right eye. Now the patient’s visual acuity is 6/21 with peripheral vision loss on the right eye and NLP on the left eye.

Discussion : The patient was diagnosed with Low Vision et causa Glaucoma. Treatment includes pharmacological treatment, optical and non-optical treatment to carry out daily activities so that the patient remains independent. Education must be explained to patients that there is no therapy to eliminate visual field disturbances but that the use of the remaining visual fields can be maximized.

Conclusion : The goal of low vision management in this patient is to maximize central vision and provide visual aids to maximize the patient’s quality of life.
ADVANCED ADIPOSE PROTEIN EXTRACT PROMOTES LIMBAL STEM CELLS REGENERATION THROUGH STEM CELL NICHE MODULATION
Authors: YUYUN RINDIASTUTI
Published: February 2024

Abstract

Introduction & Objectives : Limbal stem cells (LSCs) play important role in maintaining corneal clarity. Disruption of LSCs or its niche may lead to LSCs deficiency that result in blindness. This study aimed to investigate therapeutic effect of advanced adipose protein extract (AAPE) in LSCs regeneration.

Methods : AAPE was derived from adipose derived mesenchymal stem cell secretome purifed by ultrafiltration technique. 2D culture of LSCs were exposed by 0.25 NaOH, then treated with serum-free media as control group, media supplemented with 20% and 50% AAPE as treatment group I and II, respectively. MTT assay was conducted to measure cell proliferation and in vitro scratch assay to assess cell migration at 48 hours after treatment. EGF, FGF, HGF, and KGF from supernatant were measured by ELISA. Data was analyzed using One way ANOVA and post-hoc Tukey.

Results : A 50% AAPE successfully promoted the highest proliferation and migration rate of LSCs compared to control group (94.38±2.51%, P 0.001; 68.52±3.51%, P 0.001). EGF (1216.67pg/mL), FGF (988.25pg/mL), HGF (119.33pg/mL), and KGF (793.25pg/mL) from 50% AAPE supernatant group were highest among other groups.

Conclusion : A 50% AAPE demonstrated optimal beneficial effect on LSCs regeneration through upregulation of EGF, FGF, HGF, and KGF associated with niche modulation.
BOTULINUM TOXIN A FOR BLEPHAROSPASM WITH DRY EYE: A SYSTEMATIC REVIEW
Authors: Dr. Muthia Despi Utami  , Yulia Aziza  , Lukman Edwar  , Made Susiyanti  , Rina La Distia Nora  , Ratna Sitompul
Published: February 2024

Introduction & Objectives : Essential blepharospasm is a neurological condition that is defined by uncontrolled and abnormal eyelid closure from a central cerebral disorder. Between 40%-85% of blepharospasm occurs in conjunction with dry eye symptoms. Botulinum neurotoxin (BoNT) injections are commonly used treatment for reducing spasms in blepharospasm. Furthermore, it is often suggested for dry eye therapy due to their ability to reduce lacrimal drainage. The purpose of this review is to assess the effectiveness of BoNT treatment for blepharospasm with dry eye symptoms.

Methods : A literature research was conducted on online databases such as PubMed, Cochrane library and Google scholar. All studies of BoNT and dry eye with full-text journals published in English within the last 10 years were included. We assessed Tear Breakup Time (TBUT), Schirmer Test, and Blepharospasm Disability Index (BSDI).

Results : 204 patients from 6 publications were analyzed. In five trials, the BoNT treatment statistically significant increased TBUT (p<0,5), with mean final TBUT 5,7 ±1.1 s. Furthermore, the Schirmer test also increased with the mean final score 6,29 ± 4,6 mm. The mean BSDI score dropped by 6,05 ± 3,7 in two studies.

Conclusion : It is confirmed that BoNT injection is an effective treatment for essential blepharospasm with dry eye symptoms. Clinicians should be screened for dry eye in all blepharospasm patients prior to BoNT treatment.
CENTRAL CORNEAL THICKNESS IN METABOLIC SYNDROME POPULATION, NON-METABOLIC SYNDROME POPULATION, AND DIFFERENT BODY MASS INDEX POPULATION
Authors: KHULUQI ROFA HUSNUL , Handayani Nina , Anandita Nanda Wahyu
Published: February 2024

Introduction & ObjectivesCentral corneal Thickness (CCT) is associated with many factors including systemic disease. Thisstudy aims to evaluate and compare the CCT values in Metabolic Syndrome (MS) population, Non-Metabolic Syndrome (non-MS) population, and all different Body Mass Index (BMI) population.

MethodsThis population-based & community service-based cross sectional study, conducted on September-November 2019 in 3 rural areas of Malang. Written informed consent was obtained from all subjects.CCT was measured with ultrasound pachymeter. The diagnosis of MS was based on InternationalDiabetes Foundation 2006 criteria. Subjects were classified into 2 groups by MS and non-MS, alsostratifed by BMI, gender, and age. Differences in CCT value between groups based on MS & non-MS, BMI, age, and gender were analyzed.

ResultsA total of 890 subjects aged ? 40 years old were included in this study, whereas 400 subjects werediagnosed as MS (44.9%) and 490 (55.1%) others as non-MS. Mean CCT of MS were significantlygreater than that of non-MS (549.743±43.22 ?m, P<0.05). Mean CCT of obese subjects weresignificantly greatest among other BMI groups (549.036±48.31 ?m, P<0.05). Mean CCT in womenwere significantly greater than that in men (546.268±39, P<0.05). Mean CCT of subjects aged 40–49years were significantly greatest among other age groups (551.278±33,33, P<0.05).

ConclusionMS population had greater CCT value as compare to non-MS population. Obese population hadgreatest CCT value than overweight, normal, and underweight population. These findings may haveimplications for understanding the relationship between CCT changes and metabolic syndrome, aswell as BMI.
MANAGEMENT OF CORNEAL ULCER PRESENTED WITH RARE PATHOGEN : STREPTOCOCCUS MITIS
Authors: Ibnu Gilang Syawali  , Marina Yusnita Albar
Published: February 2024

Introduction : Corneal ulcers can arise from various corneal diseases, including infections, inflammation, and autoimmune disease. Staphylococcus aureus is the most common bacterial pathogen, but lesser- known bacteria like Streptococcus mitis can also cause corneal ulcers. Accurate diagnosis and treatment are essential to prevent vision loss and complications.

Case Illustration : A 19-year-old female patient presented with a chief complaint of white spots on her right eye for three months. Previously, her right eye was hit by a foreign object and subsequently, the patient experienced redness and pain in the affected eye. One week later, white spot appeared in the patient's eye and reported to enlarge in the last month. The patient also complained of pain, blurry vision with visual acuity of 1/300, redness, glare, and a foreign body sensation. Corneal swab culture discovered Streptococcus mitis to be the causative agent. The patients was given hourly drop of topical levofloxacin. One month after initial treatment, patient’s symptoms was improving with visual acuity of 6/60 on her affected eye and the ulcer was healed.

Discussion : Streptococcus mitis is a commensal pathogen in oral cavity and not normally cause infection of ocular tissue. It may cause ulcer due to prolonged use of topical steroid and previous ocular trauma, since Streptococcus mitis had low virulence rate.

Conclusion : Corneal scraping culture should be carried out before treatment of infectious corneal ulcer. Streptococcus mitis is considered rare for corneal ulcer pathogen. Topical quinolones are the first- line drug for bacterial corneal ulcer and worked exceptional for wide range of bacteria.
Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy With and Without Internal Limiting Membrane Peeling: A Case Series
Authors: WISESAPUTRA TJOK AGUNG PURNAMA , Panjawati, Sp.M(K) Dr. Ni Luh Diah
Published: February 2024

Introduction : Proliferative Diabetic Retinopathy (PDR) is a potentially blinding complication of diabetes mellitus, one of them because of tractional retinal detachment. Pars Plana Vitrectomy (PPV) is performed to treat it and in recent years internal limiting membrane (ILM) peeling has been employed as an additional treatment for patient with PDR.

Case Illustration : Two patient, patient 1 (male, 64 years old) was diagnosed with right eye vitreous hemorrhage due to high-risk PDR and left eye vitreous hemorrhage due to early PDR + DME, and patient 2 (female, 58 years old) was diagnosed with right and left eye PDR + ERM + senile immature cataract. Both patients underwent PPV + membrane peeling + endolaser for both eyes, and additional ILM peeling on their left eye. The visual acuity 1 month after surgery without ILM peeling on right eye was improved to 6/30 and 6/18, and with ILM peeling on left eye was improved to 6/30 for both patients.

Discussion : Removal of the ERM either with or without ILM peeling can significantly improve vision. However, many other comparison studies found no functional difference between both groups. In addition, one study found ILM removal was correlated with worse visual outcome. In this study, visual acuity 1 month after surgery in both with and without ILM peeling was improved compared with pre- operative.

Conclusion : Although there are still pros and cons, PPV with additional ILM peeling gives results as good as PPV without ILM peeling for patient with PDR.
Oral Vitamins for Lowering the Risk of Cataracts: Is It Needed?
Authors: Badruddin Gabriella Hafidha , Nathania Stella , Safira Nadya , Jutamulia Jovita , Utami Muthia Despi
Published: February 2024

Introduction & Objectives : Cataracts are a common age-related ocular disorder leading to blindness. As the role of oral vitamins in the prevention of cataracts remains controversial, various studies have investigated the potential association between oral vitamin supplementation and risk of cataracts. This review aims to find association between oral vitamins and the risk of cataracts.

Methods : A thorough literature research was conducted on online databases (PubMed, ProQuest, and Cochrane) and hand-searching. This review incorporates human studies in the past decade (2013-2023), conducted concerning the correlation between various kinds of oral vitamins and cataracts. All studies shall be published in English and be available in full-text journals.

Results : The majority of studies indicated that vitamin C, vitamin E, and multivitamin supplementations were associated with lower risks of cataract incidence. Two articles had similar relative risks (RR) for vitamin C (RR = 0.80-0.81), one article had RR of 0.90 for vitamin E, while two others had RR of 0.66 and hazard risk (HR) of 0.91 for multivitamin. However, one cohort stated otherwise as both vitamin C and vitamin E increased the risk of developing cataracts (HR = 1.21 and 1.59, respectively), while multivitamin had no association (HR = 0.96).

Conclusion : Oral multivitamin, vitamin C, and E have a significant association with cataracts. Further research is needed to specify the efficacy of each vitamin.
Kearns–Sayre Syndrome with Bilateral Ptosis and External Ophthalmoplegia: A Rare Case Report
Authors: Philipus Putra Raharjo  , Yunia Mansyur  , Batari Todja Umar
Published: February 2024

Abstract

Introduction : Kearns-Sayre syndrome (KSS) is a rare genetic disorder caused by a deletion of mitochondrial DNA (mtDNA) segment, typically characterized by a triad of symptoms includes external ophthalmoplegia, pigmentary retinopathy and appeared before the age of 20. The prevalence rate is about 1–3 per 100.000 individuals. It was diagnosed based on clinical features and supported by biochemical, radiological, histologic, and molecular genetic tests.

Case Illustration : 26-year-old male with bilateral ptosis, chronic progressive external ophthalmoplegia, pigmentary retinopathy was shown from ophthalmology examination and associated with hearing loss. Physical examination showed short stature, wasting, and weakness of limb muscles. MRI examination revealed focal brain atrophy on bilateral parietal regions.

Discussion : Mitochondrial DNA defect led to dysfunction of the central nervous system, endocrine system, extraocular muscle, myocardium, skeletal muscle, and other multiple systems. The clinical findings in this patient are appropriate for classical signs and symptoms of KSS. Central nervous involvementis shown by the neuroimaging result. There is no cardiac involvement suggested by normal cardiology examination. Although muscle pathology and molecular genetic analysis can play a great role to diagnose KSS, the classical triad of clinical signs plus one of the other symptoms could establish KSS diagnosis.

Conclusion : KSS is a rare genetic disorder and challenging to diagnose. However, if a patient presents with the classic triad of symptoms, clinicians should have a high level of suspicion for the disorder. Additionally, It is important to perform a thorough evaluation to rule out other conditions that can cause similar symptoms.
Amnion Membrane Transplantation: A Therapy for Persistent Epithelial Defect as A Result of Neurotrophic Keratitis
Authors: Nathasya Maharani Susilo  , Nathasya Maharani Susilo  , Patriotika Muslima  , Elfa Ali Idrus  , Arief Akhdestira Mustaram  , Angga Fajriansyah
Published: February 2024

Introduction : A persistent epithelial defect (PED) is a failure of re-epithelialization and complete healing of the cornea. The primary goal of PED treatment is to create a favorable environment for corneal wound healing. Amniotic membrane transplants (AMT) become one of the refractory cases treated for PED. This study aims to report AMT as therapy for a PED.

Case Illustration : A fifty-six-year-old male presents with a chief complaint of redness and pain in the left eye in the last2 weeks. The patient complained of blurred vision, tearing, and foreign body sensations. An ophthalmology examination of the left eye revealed that it was close to face finger counting in visual acuity and had a persistent epithelial defect, corneal edema, descemet fold, and a decrease in corneal sensation. The patient was diagnosed with PED and received autologous serum eye drops, levofloxacin eye drops, vitamin A palmitate eye gel, and acyclovir 400mg twice a day, but did not respond adequately. AMT was planned for the patient. The patient's pain level improved one week after surgery.

Discussion : The most common symptom of PED is pain. There are various etiological factors for PED. Neurotropic keratitis has emerged as one of the causes of PED. Management for PED is carried out sequentially according to the protocol.

Conclusion : Amniotic membrane transplantation has become an alternative therapy for PED. The amniotic membrane provides re-epithelialization of the cornea and anti-inflammatory properties. The prognosis for AMT as a therapy for PED is quite good.
Appropriateness of Antibiotics Prescription for Conjunctivitis in Primary Health Care: A Literature Review
Authors: Belinda Liliana  , Atrika Fitri Nur Cahyani  , Azura Nabila Putri  , Oriana  , Mohammad Eko Prayogo
Published: February 2024

Abstract

Introduction & Objectives : Conjunctivitis is one of the most common diseases present in primary health care (PHC) settings. The most common causes of conjunctivitis are viral infections and allergies. Despite this, patients diagnosed with conjunctivitis are often given antibiotics as therapy. Therefore, this literature review will assess the appropriateness of antibiotics prescription for patients with conjunctivitis in PHC settings.

Methods : The authors performed an electronic literature search on databases PubMed and Scopus for eligible articles, which showed antibiotic prescription for patients with conjunctivitis in PHC settings and published between 2012 and 2022, then further sorted based on the inclusion and exclusion criteria.

Results : A total of 8 studies met the inclusion criteria. Five studies showed high rates of inappropriate antibiotic prescriptions for patients with conjunctivitis in PHC. Several factors that might cause inappropriate prescription include the difficulty in determining the exact etiology, the need to fulfill patients’ satisfaction, the amount of experience and training doctors have received, consultation’s duration, stigma, the socio-demographic factors of the patient, the availability of treatment guidelines, and the availability of drugs. Some of the consequences that are concerned include the rise of antimicrobial resistance, stigma revolving around the usage of antibiotics for every infectious disease, and economic burden. Delays in prescribing antibiotics and proper training for general practitioners can be a solution to reduce inappropriate prescribing of antibiotics.

Conclusion : Prescribing antibiotics for patients with conjunctivitis in PHC settings is mostly inappropriate
Nocturnal Lagophthalmos in Pediatric Patient with Hydrocephalus
Authors: IZZA ZUKHRUFIA  , Yunia Irawati  , Julie Dewi Barliana
Published: February 2024

Introduction : Nocturnal lagophthalmos is a physiologic and asymptomatic condition observed in 1.4-5% of the population. In unconscious patients, using mechanical ventilation and neuromuscular blocker medication can worsen the lagophthalmos, causing the patient to have exposure keratopathy. This report aims to emphasize the importance of eye care in unconscious patients.

Case Illustration : A 5-year-old girl came with a chief complaint of a whitish lesion on the right eye. She got the lesion when hospitalized in Pediatric Intensive Care Unit for two weeks due to seizure attacks. A red and watery eye accompanied the whitish lesion. The patient had history of nocturnal lagophthalmos and Dandy-Walker syndrome, a complex malformation characterized by agenesis or hypoplasia of the vermis and cystic enlargement of the fourth ventricle. The corneal ulcer was treated with antibiotic treatment. After several visits, her infection had subsided but left a corneal cicatrix on her right eye.

Discussion : In unconscious patients, it’s important to pay attention to the eyelid. Lagophthalmos can be divided into three groups; where grade 1 has complete eyelid closure; grade 2 has conjunctival exposure; and grade 3 has corneal exposure. It’s important to lubricate the eye in each grade and keep it closed using eyelid tape or cover in grades 2 and 3 to prevent exposure keratopathy. Surgical intervention can be considered when there is a risk of corneal ulcer.

Conclusion : Prevention is always better than cure. Establishing standardized eye care in the intensive care unit is crucial to prevent ocular complications and preserve visual acuity.
Diagnosis of Ocular Toxocariasis: a case report
Authors: Irene Carolin Mulyadi  , Ivonne Ramenusa  , Josef Sem Berth Tuda  , Melissa Ratag
Published: February 2024

Introduction : Ocular toxocariasis (OT) is an eye parasitosis due to incidental ingestion of Toxocara cati or canis larvae. Although mostly affects young children, it can also occur in older individuals. It is usually uniocular with various presentations.

Case Illustration : A 69-year-old woman came with a chief complaint of deteriorating vision and pain in her left eye (LE)2 weeks prior to the visit, accompanied by floaters, redness, itchiness, and glare. She had a contact history with neighborhood dogs. Her best corrected visual acuity (VA) was 6/12 in the right eye (RE) and 3/60 in the LE. The intraocular pressure of LE was 27mmHg. Examinations of the LE found corneal edema, keratic precipitates, worm-like foreign bodies that moved in the anterior chamber, lens and vitreous opacity, and obscured fundus. The ultrasound showed a membrane-like lesion and no vitreomacular traction. The examination of the RE was unremarkable. We performed prompt foreign body extraction with local anesthesia and prescribed oral albendazole, topical and oral antibiotics, and steroids afterward. The investigation of the specimen revealed Toxocara larvae. There was no VA improvement after 1 month of close observation.

Discussion : The OT diagnosis is based on clinical findings and a history of exposure to dogs or cats, soil, and consuming raw or undercooked meat. The gold standard for diagnosis is specimen biopsy. While no acceptable treatment regimen exists, the combination of anthelmintics and corticosteroids appears useful in some cases.

Conclusion : Clinical presentation, parasitologic confirmation, and close contact with pets may be key elements to making the diagnosis.
Evaluation of Pharmacological Activities of Piper Betle L. Extract on Bacterial Conjunctivitis Model of Wistar Rat caused by Streptococcus Pneumoniae
Authors: Yudhi Pratama  , Taufik Ashar
Published: February 2024

Abstract

Introduction & Objectives : Conjunctivitis is an eye infection accounted as the third leading ophthalmology cases after cataract and glaucoma globally, with Streptococcus pneumoniae as the main causes in children. Several studies had indicated that Piper betle L. extract inhibited Streptococcus pneumoniae growth. To determine and evaluation of pharmacological activities of Piper Betle L. extract on bacterial conjunctivitis model of wistar rat caused by Streptococcus Pneumoniae

Methods : This study was an analytical study with true experimental design and pre-test-post-test control group. Streptococcus pneumoniae colony growth media was analyzed using Mueller Hinton agar. Streptococcus pneumoniae colony was calculated using Total Plate Count methods.

Results : Sample of this study involved 30 male wistar rat aged 4 – 9 minggu. Kruskal Wallis test reveald a significant differences of Streptococcus pneumoniae colony based on the treatment group (p=0,023). Subsequent test using Posthoc revealed that there was a significant differences in Streptococcus pneumoniae colony between placebo group and group using 25% (p = 0,039) and 30% (p=0,006) piper betle. Test results also revealed that no significant difference was found between placebo group and groups using 20% piper betle (p=0,159) and ofloxacin (p=1,000).

Conclusion : There was a significant difference in Streptococcus pneumoniae colony among placebo group and piper betle eyedrops 25 % and 30 % group. However, significant result among placebo group and piper betle L. 20 % and ofloxacin group were absent.
Modified Hughes Tarsoconjunctival Flap Procedure for Lower Eyelid Defect
Authors: Aulia  , Hendriati  , Mardijas efendi
Published: February 2024

Introduction : Hughes procedure of tarsoconjunctival flap is a method of choice in reconstructing full thickness inferior eyelid defect that involves >50% of eyelid margin to restore anatomical integrity, function, and cosmetic of the eyelid. The modified Hughes procedure includes sparing of the marginal upper lid tarsus and removal of the levator muscle aponeurosis from the tarsoconjunctival flap.This article reports 2 patients who underwent modified Hughes procedure after basal cell carsinoma excision.

Case Illustration : Two patients underwent inferior eyelid reconstruction using modified Hughes procedure. After wide excision of the tumor, tarsoconjunctival flap was made to reconstruct posterior lamella of the eyelid. Subsequently, anterior lamella of the eyelid were reconstructed using full thickness skin graft and advancement flap, respectively. Both patient then underwent second surgery, tarsus flap release, 6-8 week after the first surgery.

Discussion : A tarsoconjunctival flap from the upper eyelid replaces the posterior lamella, whereas a skin graft, a skin flap, or a skin-muscle flap restores the anterior lamella. After surgery, tarsal flap apposition, skin flap/graft, and stitches were intact. After tarsus flap release, wound healing was good. Tumor biopsy showed basal cell carcinoma.

Conclusion : Modified Hughes procedure is a treatment of choice in reconstructing full thickness inferior eyelid defect involving >50% of eyelid margin. Full thickness skin graft and advancement flap to reconstruct anterior lamella of the eyelid is choosen after considering skin color and texture similarity and laxity of eyelid and cheek.
AN UNILATERAL SCLEROMALACIA PERFORANS IN YOUNG PATIENT MANAGED BY MYOCONJUNCTIVAL ENUCLEATION AND DERMIS FAT GRAFT
Authors: ANNISA KARIMA  , DELEFITRI LUTFI
Published: February 2024

Introduction : Scleromalacia perforans is a disease that might compromise vision and globe integrity. The possible associations of systemic disease are autoimmune diseases such as rheumatoid arthritis, lupus, and Wegener's granulomatosis. Determining the underlying etiology in such cases also possess a great challenge to treat disease, especially in this case.

Case Illustration : A 19-year-old female with a progressed protrusion of the left eye since she was 1 year old. Six years ago, she had redness, worsen protrusion, photophobia, tearing, and pain, but resolved without treatment. Her cousin had the same condition but refused to continue the examination. Visual acuityof the left eye was no light perception with 4x4 mm of corneal leukoma, and 360 degrees of anterior scleral ectasia covered with conjunctival neovascularization. USG showed posterior vitreous detachment and 28,9 mm axial length. Systemic examination found ANA test and HLA B27 were normal, positive hypermobility joint, and Rheumatologists ruled out the possibility of autoimmune disease. Myoconjuctival enucleation was performed with a dermis fat graft for cosmesis, and pathological examination showed nonspecific chronic inflammation.

Discussion : A childhood-onset scleromalacia perforans with positive family history and hypermobility joints might be a sign of connective tissue disorder. Possible autoimmune diseases were ruled out by a rheumatologist. The genetic examinations may be necessary to establish the diagnosis.

Conclusion : Scleromalacia perforans is rare yet it is strongly believed to have an association with systemic disease. Collaboration between ophthalmologists, rheumatologists, and geneticist is essential to manage this kind of case.
Comparative Validity of LEA Contrast Sensitivity Chart to Pelli-Robson Contrast Sensitivity Chart in Neuroophthalmology Patients
Authors: Lovenia Valencia
Published: February 2024

Abstract

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

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

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

Conclusion : This study reported a reliable and comparable conversion algorithm for transforming LEA scores into converted estimated Pelli-Robson scores. This method will enhance the utility of existing data in clinical and research settings.
The use of Visual Function Index-14 (VF-14) questionnaire in determining cataract patients’ quality of life in Jonggol subdistrict, Indonesia
Authors: Nadya Safira  , Muhammad Keyvan Fermitaliansyah  , Syska Widyawati  , Mutmainah Mahyuddin
Published: February 2024

Abstract

Introduction & Objectives : Unresolved cataract primarily has caused patients to have disturbance in carrying out daily activities, thus lowering their quality of life (QoL). We aim to use the Visual Function Index-14 (VF-14) questionnaire, one of the most frequently used tools, to discover the extent of daily activities disturbance in patients with cataract.

Methods : In this observational study, we conducted eye screening to 47 subjects in Jonggol subdistrict, Bogor, Indonesia. Patients were asked several questions based on the translated VF-14 questionnaire into Bahasa and also tested to find out their best-corrected visual acuities. Lens examination was carried on using handheld slit lamp.

Results : Out of all 47 subjects, 34 (72,3%) patients had cataract that was marked by lens opacities in either one or both eyes. According to distant vision impairment categories by International Classification of Diseases 11, 8,8% of cataract patients had normal vision from the better eye, 20,6% had mild, 64,7% had moderate, 0% had severe impairment, and 5,9% had blindness. From the assessment using VF-14 translated questionnaire, 14,7% subjects had no disruption in doing daily activities, 82,3% had disruption, and 2,9% could not do the mentioned activities at all. From the Spearman correlation test, there was a significant association with moderate correlation between the degree of vision impairment and QoL (p = 0.006, rs = 0.459).

Conclusion : The majority of cataract patients in Jonggol subdistrict had moderate vision impairment and had disruption in doing daily activities, therefore lowering their QoL.
REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY
Authors: Herdyanto Alexander , Sagara Frisma , Widatama I Made Satya , Wulandari Rina
Published: February 2024

Introduction & ObjectivesIntroduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.

Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power >1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.

Results : Day-1 follow-up keratometry shown that corneal astigmatism was still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism was better in 600um incision depth.

Conclusion : When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.
Levator Resection in Neurogenic Ptosis Oculi Sinistra et causa Third Nerve Paresis + Type II Diabetes: A Case Report
Authors: Retno Tharra Handayani  , Riani Erna
Published: February 2024

Introduction : Neurogenic ptosis is abnormal position of the upper eyelid caused by dysfunction or damage to the oculomotor or sympathetic nerves supplying the eyelids. Third nerve palsy (35.7%) is the most common cause among others. We report a case of neurogenic ptosis managed surgically by levator resection.

Case Illustration : A 67-year-old male complained of drooping left upper eyelid, getting worse in 7 months. He had history of falling off motorcycle 6 months ago. Clinical histories of hypertension and diabetes mellitus were found. Right and left eyelids measurements in millimeter showed horizontal palpebral fissure (HPF) 28/26, vertical palpebral fissure (VPF) 6/3, margin reflex distance 1 (MRD1) 2/-2, margin reflex distance 2 (MRD2) 6/5, margin limbal distance (MLD) 8/4, and levator function (LF) 8/3. Bell’s phenomenon was negative in both eyes. Ice pack test was negative. There were ocular movement restriction in his left eye. Patient underwent a maximum levator resection and had better levator function after 3 weeks follow up.

Discussion : Neurogenic ptosis caused by third nerve injury is associated with microvascular ischemia such as diabetes mellitus and hypertension. Operative management is carried out after 3 to 6 months observation. Evaluation of levator function allows the clinician to correctly classify the degree and type of ptosis. Maximal levator resection is the treatment of choice for ptosis with poor levator function.

Conclusion : Although various surgical techniques have been developed, ptosis correction should be performed according to the indications and clinical condition of the patient.