bluuebunny/crossref_metadata_2025 huggingface dataset:
DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE
Authors: Wardani Sabrina Indri , Rifada R. Maula , Prahasta Andhika , Gustianty Elsa , Umbara Sonie
Published: February 2024

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important.

Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery.

Discussion : Age older than 60 years old, female gender, short axial length (<23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals.

Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.
The effect of topical atropine 0.05% compared to atropine 0.01% for Myopia control in Children : A Meta-analysis
Authors: DEWI INGGRIANA SUKMA , SAVITA SALMA
Published: February 2024

Introduction & Objectives : Myopia is the most common ocular anomaly manifesting during primary school and progresses until a mean age of 16, but rarely beyond age of 25. Atropine, a nonselective muscarinic antagonist, has been studied widely in recent years as an option for myopia control. To analyse the efficacy of Atropine 0,05% compared with Atropine 0,01 % for myopia control in children aged 4-16 years toward the axial length examination through a meta-analysis.

Methods : A systematic search was performed using Medline and Cochrane database up to December 2022. Review was performed according to the PRISMA Statement. The eligible studies were RCTs which comparing Atropine concentration 0.05% with 0.01%.

Results : From 101 retrieved articles, 5 trials involving total 1035 patients were included. The follow-up period of the studies was 1-2 year. The analysis shows Atropine 0,05% significantly decrease axial length (Mean Difference [MD]: -0.11, 95%CI [-0.15-0.07], p<0.00001, I2= 99 %) comparing to Atropine 0,01%.

Conclusion : In myopia control in children, atropine 0,05 % was more effective to reduce myopia progression in controlling axial length elongation over a period of 1-2 year comparing to atropine 0,01%.
EFFECT OF “SENAM PERMATA-KU” COMPARED WITH WARM COMPRESS ON THE AMPLITUDE OF ACCOMMODATION IN COMPUTER VISION SYNDROME PATIENTS
Authors: Setiawan Teguh , Nugroho Trilaksana , Dharma Andhika Guna , Rahmi Fifin L. , Sadasih Wisnu
Published: February 2024

Introduction and Objective: The COVID-19 pandemic has virtually made many work activities, resulting in increased use of Visual Display Terminals (VDT) at work and home. Excessive close-range activities due to the use of VDT causes Computer Vision Syndrome (CVS). Various therapies, such as ocular yoga and warm compress, have been created to reduce CVS-related complaints. Diponegoro University developed “Senam PERMATA-KU” as an alternative therapy to reduce complaints related to CVS. This study compares the effect of “Senam PERMATA-KU” and periocular warm compress on the amplitude of accommodation (AA) value in patients with CVS.

Methods: The study subjects were divided into “Senam PERMATA-KU” group (22 people) and periocular warm compress group (20 people) with each treatment for two weeks. CVS score was measured using CVS-Questionnaire and AA using Prince’s rule. Both variables were assessed before and after treatment. Data were collected and analyzed using a statistical computer program.

Result: “Senam PERMATA-KU” group experienced a significant increase in monocular and binocular AA (p<0.001 and p=0.006), while periocular warm compress did not show a significant difference (p=0.982 and p=0.483). The mean delta of monocular and binocular AA between groups differed significantly (p=0.001 and p=0.034). The mean CVS scores in both groups have significant improvement (p<0.001), while the mean delta CVS scores between groups was not significant (p=0.522).

Conclusion: “Senam PERMATA-KU” for two weeks significantly increased monocular and binocular AA, while periocular warm compress showed no significant difference. “Senam PERMATA-KU” and periocular warm compress can significantly reduce CVS score, whereas the difference between the two is insignificant.
THERMAL IMAGING ACCURACY ON CLINICAL ACTIVITY SCORE (CAS) THYROID EYE DISEASE PATIENTS
Authors: MUHAMMAD REZA ARLAS  , Dr. Devi Azri Wahyuni, Sp.M, Sub.Sp NO, MARS
Published: February 2024

Abstract

Introduction & Objectives : Thyroid Eye Disease (TED) also known as Graves' ophthalmopathy, thyroid-associated orbitopathy, and other terms is an autoimmune inflammatory disorder with the most common extra-thyroid manifestations of Graves' Disease (GD). The disease phase is usually assessed clinically, by assessing the presence or absence of cardinal signs and symptoms of inflammation which are assessed in the form of a clinical activity score (CAS). In addition, the use of Thermal Imaging (IT) as a passive measurement technique that does not require contact with the patient (non-invasive and non- contact) and does not use ionizing radiation or contrast agents is another option. The use of TI in patients with TED still has minimal data and does not have more specific results. This study aims to determine the accuracy of TI and CAS images in TED patients.

Methods : This study design is accuracy test at the Ophthalmology Polyclinic of RSUP Dr. Mohamad Hoesin Palembang in July 2021 until the sample is filled with 24 people. Thermal Imaging (TI) accuracy test was performed to establish active and inactive TED compared to CAS (Clinical Activity Score) in TED patients. Analysis of research results with SPSS version 22.0.

Results : The result shown that the proportion of research subjects who were female was 17 people (70.8%) and male research subjects were 7 people (29.2%). At 7 locations the Thermal Imaging examination was found to have varying sensitivity

Conclusion : Thermal Imaging can be used to help diagnose active and inactive TED.
Proptosis in Adult Onset of Unilateral High Myopia Patient : A Case Report
Authors: Marcellina  , Yoseph Siahaan
Published: February 2024

Introduction : Unilateral high myopia is an uncommon refractive condition, because two eyes typically grow bilaterally by the same amount and resulting in symmetric myopia. Proptosis can appeared due to high axial length in myopia.

Case Illustration : A 41-year-old female patient complain protruding eyeball in her left eye, gradually decrease vision, eye discomfort, and headache in her left eye since last year. There was no family history of eye disease, trauma or mass. On examination, her left eye was proptotic 3mm, best corrected visual acquity (BCVA) was 6/21 with -10.00 Sphere, and high intraocular pressure 23 mmhg. Her right eye BCVA 6/6 with -2.75 Sphere, other within normal limits. Her fundus examination showed features of high myopia and B-scan ultrasonographic showed different in axial lengths in both eyes. Orbita computerized tomography non contrast confirmed enlarge globe to posterior and proptotic in left eye.

Discussion : Unilateral high myopia developing in adult onset is a rare case. It appears to be a progressive condition that have a variable age of onset. Amblyopic eye, high intraocular pressure and proptosis demonstrated as the symptoms of unilateral high myopia in this patient. Left eye proptosis confirmed by CT orbita appears secondary due to elongation anteroposterior of the globe / changesin axial components of the eye.

Conclusion : High myopia can be a consideration of proptotic eye beside of mass/ tumor. Several studies to investigate patients with unilateral high myopia should be done to know the etiology and progression of the disease, thus can achieve good treatment and visual outcomes for patient.
UNILATERAL CMV RETINITIS IN HIV/AIDS PATIENT WITH MULTIPLE OPPORTUNISTIC INFECTIONS
Authors: Bening Daya Banyu , Firmansjah Muhammad , Zuhria Ismi , Yustiarini Ima , Widjaja Sauli Ari
Published: February 2024

Introduction : CMV Retinitis is the most common opportunistic infection in HIV/AIDS patient. Ocular manifestations in HIV/AIDS have similar clinical features though the management therapies are different.

Case Illustration : A 47-year-old man was presented with blurred vision on LE since 4 months. Patient was diagnosed with HIV/AIDS since 2 years. Patient only had light perception on LE, and 5/10 on RE. The LE anterior segment showed flare and cell indicating active anterior uveitis. The LE posterior segment revealed extensive hemorrhage and exudate known as ‘pizza pie’ appearance, and cotton wool spot with multiple ischemic areas on RE. Laboratory tests revealed reactive IgG CMV and very low CD4 count (4 cell/?l). Patient was also diagnosed with Tinea Corporis, Scabies, and Pneumocystis carinii pneumonia. Oral Valganciclovir 900 mg was administered twice a day for 3 weeks, along with anti- retroviral therapy.

Discussion : The anterior uveitis and ‘pizza pie’ appearance with positive CMV IgG indicate CMV Retinitis in fulminant form. Cotton wool spot found in the RE leads to retinal microvasculopathy due to HIV invading the vascular endothelium and causing increased plasma viscosity. This patient only had 4 cell/?l CD4 which indicates severe immune deficiency. If not treated immediately, patients with CD4 count <50 are at higher risk of contralateral eye involvement. Oral Valganciclovir was chosen considering the multiple opportunistic infections the patient had.

Conclusion : It is important to distinguish CMV retinitis with other HIV/AIDS ocular manifestations. The choice of therapy needs be considered with the overall condition of patient.
LONG-TERM FOLLOW-UP ON A RARE CASE OF PERIOPERATIVE POSTERIOR ISCHEMIC OPTIC NEUROPATHY: FINDING HOPE IN THE DARKNESS
Authors: Affannul Hakim  , Lukisiari Agustini  , Gatot Suhartono
Published: February 2024

Abstract

Introduction : Perioperative posterior ischemic optic neuropathy (PION) following maxillectomy is a rare and devastating condition that leads to permanent vision loss in most reported cases. This case report offers a different perspective through long-term follow-up, providing valuable insights into the prognosis and potential treatments for PION.

Case Illustration : Following a left maxillectomy for ameloblastoma, a 28-year-old female experienced sudden vision loss in her left eye. The visual acuity was 5/60, and an altitudinal inferior visual field defect with a superior extension was present. Ishihara's color vision examination revealed 15/38. The patient was diagnosed with perioperative PION and treated with neurotropic and folic acid. After 16 months, optic atrophy was observed. However, there are complete recovery in visual acuity to 5/5 and Ishihara score to 38/38, along with a significant improvement in the visual field defect.

Discussion : The current management of perioperative PION is focused on prevention, because once vision loss occurs, it is usually severe and irreversible. In our case, the patient exhibited a favorable outcome after a long follow-up period, suggesting that there is still potential for improvement in PION patients. The finding is consistent with previous study, which reported that a small percentage of patients may still experience improved vision during follow-up. The role of neurotropics in improving patient outcomes is further supported by in vitro studies that demonstrate early neurotropic treatment significantly prevents loss of retinal ganglion cells in PION.

Conclusion : Visual improvement is still possible in perioperative PION and early neurotropic administration may be considered in therapy
Reconstruction Management for Neglected Tripod Fracture with Ophthalmic Injuries: A Case report
Authors: Priscillia Tondolambung  , Vera Sumual  , Victor Pamolango  , Freili Akay
Published: February 2024

Introduction : Tripod fracture or zygomatico-maxillary complex fracture are among the most common injuries to facial structures, which can make reconstruction more difficult. This case highlights the reconstruction of neglected tripod fracture.

Case Illustration : A 17-year-old male was presented with enophthalmos in his right eye. He had an accident three months prior and had received head surgery. After that, the patient came back with a pan-facial fracture. VA on RE was 1/300, limited movement upwards, 4 mm lagophthalmos, negative Bell’s phenomenon, infiltrates and cicatrices on the cornea. CT-scan examination showed tripod fractures. The surgery was performed by the reconstruction division with an oral and maxillofacial surgeon. Nineteen days after surgery, there has been some improvement in the orbital misalignment.

Discussion : Delayed intervention in this case, increased the difficulty of surgical treatment and could lower the success rate of surgery. If the indication is obvious, an immediate intervention will give better results because soft tissue scarring is minimized and fractures are easily reduced. During the procedure, we released the orbital muscle entrapment and repaired the deviated bone and callus with an osteotome to achieve mobility. Therefore, the tripod fracture was fixed with three-point fixation, followed by reconstruction of the maxilla and mandible. The result after surgery showed some improvements in aesthetics but not in vision.

Conclusion : Orbital reconstruction with mini-plate implants in three-point fixation as the management of orbital fractures is effective, but its accuracy is difficult to assess during surgery, especially when coupled with delayed intervention cases. Early reconstruction is recommended for a better cosmetic result.
Cataract Surgery After Keratoplasty: How Should We Prepare?
Authors: Sadikin Irma Suwandi , Widyawati Syska
Published: February 2024

Introduction : Cataract surgery following corneal transplantation demands special attention to corneal graft stability and optimization to allow for excellent IOL selection, as well as corneal graft preservation since lens removal damages the corneal endothelium. This study aimed to determine how we should prepare for cataract surgery after keratoplasty.

Case Illustration : Case 1: A 34-year-old male has phacoemulsification in his right eye (last eye). He had a history of eye surgery, including, keratoplasty for RE in 2019, and vitrectomy for RE because of endophthalmitis. The pre-operative visual acuity is 0.5/60 with PAS and an irregular pupil. Post-operative VA 3/60 with BCVA 6/40. Last follow-up, the grafted cornea was still clear with normal IOP. Case 2: A 50- year-old female underwent phacoemulsification for both eyes (BE). She had histories of keratoplasty in 1986, 1989, and 1997 for BE. She also had extreme myopia for BE (RE S -17.00, LE S-14.00). Pre- operative VA was 1/60 of BE, and BCVA was 6/20 a month after surgery. During the last check-up, both transplant corneas were clear with normal IOP. Last visit, her both grafts remained clear.

Discussion : 

Conclusion : IOL calculations are challenging due to inaccuracy in corneal measurements, astigmatism, or corneal pathology. The best time to perform surgery is at least 2 years after keratoplasty. We suggest using total keratometry in the K-6 formula or Haigis for the IOL formula. Good dispersive viscoelastic, operating away from the corneal endothelium, and employing low phaco-energy/fluids will help to deliver a clear cornea after surgery. Last, steroid treatment will enhance graft survival rate.
Reversible visual recovery in Optic Neuritis patient with No Light Perception VA
Authors: DEVI PUTRI SWADAYANI  , Irwan sanjaya
Published: February 2024

Abstract

Introduction : Optic neuritis is characterized by an inflammation and demyelination of the optic nerve and is traditionally treated with corticosteroids. The findings of the ONTT, reported in more than 50 publications during the past 20 years, have numerous implications

Case Illustration : A 48-year-old woman presented to the ophthalmology outpatient clinic with a 12-day history of blurred vision. The best-corrected visual acuities and Ishihara colour vision was unilaterally reduced with a non light perception on left eye. There were also relative afferent pupillary defect with slow respons of pupillary reflect. Slit-lamp examination was otherwise normal. Funduscopy was Papillary edema on left eye, with all quadrant blurry edge. Optic neuritis (ON) was presumed as she had suffered with this previously. She was hospitalized and undergone (optic neuritis treatment trial) ONTT . Thereafter, a trial of pulsed methylprednisolone was commenced, resulting in near complete resolution of the Visual acuity that become 6/40 UCVA from NLP.

Discussion : The original ONTT, along with three follow-up studies at five-year intervals, generated more than three dozen papers in scientific journals. Collectively they show what happens to an individual over the course of 15 years following about of optic neuritis.

Conclusion : Prior to the ONTT well-established guidelines for treating optic neuritis did not exist, this case were demonstrates the importance of keep starting ONTT with a point valuable to patient with NLP.
Ophthalmologic findings in Cornelia de Lange syndrome
Authors: Nizma Permaisuari  , Dian Estu Yulia
Published: February 2024

Introduction : Cornelia de Lange syndrome (CdLS) is a rare disease characterized by multisystem abnormalities, including various ophthalmologic problems. The purpose is to report this kind of rare case and highlight the role of ophthalmologist in visual development optimalization.

Case Illustration : A 2-year-old boy with CdLS showing bilateral microcornea, cataracts with “dot opacities,” and chin lifts induced by ptosis. We also examined brow hypertrichosis, synophrys, and long arcuate eyelashes. High myopia and high astigmatism was found in the patient with spherical equivalent of 9.8 D. He was born with low birth weight, microcephaly, anteverted nostrils, depressed nasal bridge, thin upper lip, micrognathia, low posterior hairline, short neck, and syndactili. He also showed psychological lag and developmental impairment. Glasses was then prescribed to prevent amblyopia.

Discussion : Individuals with CdLS may have multiple treatable ocular conditions. We recommend that patients have an initial ophthalmic examination after diagnosis of CdLS is first made, in order to establish a baseline and to assess for the presence of abnormalities that would benefit from early intervention. Examination under anesthesia may be required in some patients to adequately assess for any abnormalities, and to obtain a good refraction as well as an inspection of the retinal periphery in children with long axial length. Early intervention may greatly improve function and prevent vision loss due to amblyopia.

Conclusion : Initial ophthalmic examination followed by routine annual screening is warranted when a diagnosis of CdLS is made, given that ocular anomalies are present in the majority of patients and may impact vision and daily functioning.
Kissing Nevus of Eyelid: A Rare Case Report
Authors: Dr. Silva Roza  , Dr. dr. Hendriati Sp.M(K)  , Dr. Mardijas Efendi Sp.M  , Dr. dr. Ardizal Rahman Sp.M(K)
Published: February 2024

Introduction : Kissing nevus, also known as kissing mole, is a rare dermatological condition in the world and characterized by the presence of congenital nevi on both the upper and lower eyelids in symmetrical fashion. Additionally, this report highlights the treatment options available for patients with kissing nevus and discusses the importance of regular monitoring.

Case Illustration : An 11-year-old female patient came with a complaint of a mole on the upper and lower eyelids since birth. The mole was felt to be getting bigger and starting to bother her. The patient feels insecure with the presence of this mole. The patient underwent nevus excision followed by retroauricular graft placement on the superior and inferior eyelidss. Then a biopsy showed benign nevus. After follow-up, it was found that the graft had grown and there was no necrotic tissue.

Discussion : Kissing nevus is a rare skin condition that affects babies and young children. It is characterized by two identical birthmarks that appear on either side of the body, such as on the eyelids. Surgery involves removing the birthmarks surgically. Our patient underwent wide excision and palpebral reconstruction.

Conclusion : Kissing nevuse is a unique skin condition marked by the presence of congenital nevi on both the upper and lower eyelids in a symmetrical pattern. It is worth noting that while treatment may be effective, there is a risk of scarring, infection, and other side effects associated with these procedures.
Efficacy of 0.1 % Sodium Hyaluronate versus 0,5 % Carboxymethylcellulose in Dry Eye Disease : A Meta-Analysis
Authors: ALDILA SAVITRI  , FITRIAN HANIF
Published: February 2024

Introduction & Objectives : Dry eye is a disorder that involves either insufficient tear production or excessive tear evaporation. Artificial tears are the main treatment for dry eye disease. Sodium Hyaluronate (AH) and Carboxymethylcellulose (CMC) are the two most frequently prescribed and used. To analyze the efficacy of 0,1% sodium hyaluronate compared with 0,5% carboxymethylcellulose toward the symptom score, tear break up time, corneal stain fluorescein in dry eye through a meta-analysis.

Methods : A systematic search was performed using Medline and Cochrane database up to December 2022. Review was performed according to the PRISMA Statement. The eligible studies were RCTs which comparing Sodium hyaluronate with Carboxymethylcellulose.

Results : From 88 retrieved articles, 6 trials involving total 373 patients were included. The median follow-up period of the studies was 6 weeks. Sodium hyaluronate significantly increases tear break up time compared to Carboxymethylcellulose (Mean Difference (MD): 0.46, 95%CI [0.09-0.84], p=0.01, I2=76%), and significantly decrease corneal stain fluorescein (MD: -0.54, 95%CI [-0.86-(-0.23)], p=0.0008, I2=88%). The analysis shows insignificantly decrease in subjective symptom scores (MD: -0.08, 95%CI [-0.40-0.23], p<0.60, I2= 79 %).

Conclusion : In dry eye disease, 0,1% sodium hyaluronate significantly improves tear break up time and significantly decreasing corneal stain fluorescein, while insignificantly decrease subjective symptom scores.
Trabeculectomy Versus Tube Outcome in Neovascular Glaucoma
Authors: Syahiqoh Daisy Syakhsiatusy , Rahmi Fifin Luthfia , Puspasari Denti , Maharani
Published: February 2024

Introduction & ObjectivesNeovascular glaucoma (NVG) is known to be a refractory form of glaucoma, which frequentlyrequires the integrated use of medical, laser and incisional surgery. Tube-shunt implantation andtrabeculectomy with antifibrotic agent are the two most-popular incisional procedures for managingrefractory glaucoma. This study aims to compare surgical outcome between patients who underwenttrabeculectomy versus tube-shunt implantation for the treatment of NVG.

MethodsA retrospective study was held of NVG patients that underwent trabeculectomy and tube-shuntimplantation between January 2020 - December 2022 at Dr. Kariadi Hospital, Semarang. IOPoutcome and success rate was measured at 3 months post operatively. Statistical analysis was usedto compare the outcome between groups, p<0.05 was considered significant.

ResultsThere were no significant differences in characteristics between groups at baseline. Mean IOPmeasured at 3 months post operatively was 18.58 ± 5.53 and 15.94 ± 10.79 in trabeculectomy andtube group respectively (p=0.04), complete success rate was 18.8% in trabeculectomy and 25% intube group, qualified success rate was 37.5% in trabeculectomy and 56.3% in tube group. Greaterfailure rate was observed in trabeculectomy group (43.8%).

ConclusionCompared to trabeculectomy, tube-shunt implantation has lower IOP at 3 months post operatively inNVG. Greater failure rate was observed in trabeculectomy.
Anterior Segment Dysgenesis in A Child, A Rare Case Report: What Should We Do?
Authors: Permatasari Devi Sarah Intan , Hermawan Dicky , Loebis Rozalina
Published: February 2024

Introduction : Anterior segment dysgenesis affects a various range of ocular structure, including: cornea, iris, ciliary body, anterior chamber, and lens associated with approximate 50% of glaucoma

Case Illustration : A 20 month-old boy presented with bilateral corneal opacity. VA was 6/480 on both eye. Examination revealed bilateral central corneal opacity with keratolenticular adhesions, anterior lens dislocation and opacification, aniridia, and posterior segment were difficult to evaluate. The IOP were 17.3 mmHg and 14.6 mmHg in the right and left eye respectively. The aforementioned feature contributed to the diagnosis of Type II Peters Anomaly (PA). Lens aspiration combined with adhesiolysis on the LE was performed. Patient was given topical antibiotic, corticosteroid, and anti- glaucoma medication post-operatively. Postoperative course showed no complication and the corneal opacity diminished

Discussion : Lens aspiration in combination with adhesiolysis was performed because the presence of cataract interfered the visual axis and increased the risk of corneal decompensation due to keratolenticular adhesions. We considered to perform the surgery on the LE first because the corneal opacity was milder than the RE. Glaucoma is an almost ineluctable issue and medical therapy are necessary. Further evaluation was required to determine if a similar procedure is needed for the fellow eye and whether the IOL implantation was going to enhance the visual prognosis in the future

Conclusion : The keratolenticular adhesions and corneal opacity in type II PA make the surgical approach more challenging. Cautious manipulation can prevent further corneal decompensation. In addition, parents should receive extensive counseling regarding the complications and prognosis
Neuroophthalmic Manifestations and Management of Cryptococcal Meningitis in HIV-negative Pregnant Woman : A Rare Case
Authors: FARIMAH SYAKIRAH  , DEVI AZRI WAHYUNI
Published: February 2024

Abstract
Introduction : Cryptococcal meningitis (CM) is Cryptococcus infection affecting mostly immunocompromise patients. However, immunocompetent and pregnant woman can also be affected. This condition can cause neuroophthalmic manifestations which may result in permanent vision loss or even death if not managed properly. However, literatures on neuroophthalmic manifestations and management of HIV-negative pregnant woman with CM are very scarce.
Case Illustration : We present a rare case of 25 y.o. HIV-negative pregnant woman with neuroophthalmic manifestations associated with CM. The patient was consulted from neurology department with complaints of painless vision loss accompanied by diplopia, severe headache, nausea, and frequent vomitus. Ophthalmological examination showed best corrected visual acuity 20/40 in both eyes, ophthalmoplegia, and grade 4 papilledema. Lumbal puncture result was 89 cmH20. Cerebrospinal fluid (CSF) analysis showed mononuclear cells domination, increased protein, and decreased glucose. Indian ink stain showed Cryptococcus organism. Patient was given intravenous fluconazole, topical nonsteroid anti-inflammatory drug, and therapeutic lumbal punctures which result in clinical improvement.
Discussion : CM can cause neuroophthalmic manifestations resulting from increase intracranial pressure (ICP) due to fungal load in arachnoid granulation which obstruct CSF outflow. The manifestations found in this patient were papilledema, ophthalmoplegia, and diplopia due to 6th nerve palsy. The management was multidisciplinary with obstetrics-gynecology and neurology department, focused in pathogen eradication and ICP management to prevent neuroophthalmic sequelae, with considerationof maternal-fetal life saving dilemma.
Conclusion : Various neuroophthalmic manifestations can be involved in CM. Prompt and appropriate therapy in a rare case of HIV-negative pregnant woman with CM can decrease both maternal and fetal morbidity and mortality risk.
Post Stroke, Is Perimetry Necessary? A Case Report
Authors: AULIA PURNAMA EFFENDI  , Bobby Ramses Erguna Sitepu
Published: February 2024

Abstract

Introduction : Stroke are generally associated with peripheral visual field loss. Three out of four stroke patients report some form of disability, one of which is visual impairment. Approximately 16% of these patients have a homonymous visual field defect poststroke. These vision problems can lead to difficulty carrying out a lot of daily tasks and activities, such as driving. This report tries to define the diagnostic flow to determine the exact type and lesion.

Case Illustration : Male, 61 years old, came to Universitas Sumatera Utara Hospital with visual field loss in both eyes. Two months ago, he was diagnosed with ischemic stroke and treated with Aspirin 80 mg, with no limbs disability right now. He also had hypertension and treated with Amlodipine 10 mg. VOD: 6/60 with BCVA S-2.00 6/7,5, VOS: 6/60 with BCVA S-2.00 6/7.5. With confrontation test and perimetry, defect was found in medial visual field OD and lateral visual field OS. Hess screen and Amsler Grid was normal. Head CT-Scan was performed with multiple infarcts, mainly in right occipital lobe. The patient was diagnosed with Incomplete Hemianopia, Left Congruous Homonymous Hemianopia with Macular Sparing, and treated with Citicholine 1000 mg once daily.

Discussion

Conclusion : In stroke patients with homonymous visual field loss, visual field testing with detailed evaluation of visual field defect can determine the lesion location, and neuro-radiological imaging was necessary to assess visual pathway. It’s important for educate the patients, diagnostic and prevent the stroke recurrent.
A peculiar case of idiopathic orbital myositis in adolescence
Authors: NABILA ALJUFRI  , Agung Nugroho  , Sita Paramita  , Salmarezka Dewiputri  , M. Sidik  , Syntia Nusanti
Published: February 2024

Abstract

Introduction : Idiopathic orbital myositis, an inflammation localized at the extraocular muscles, is rarely reported in pediatrics. Until now, the prevalence and incidence of orbital myositis remain unknown. This paper aims to report a case of idiopathic orbital myositis in a young girl with headache.

Case Illustration : A-16-year-old presented with a droopy eyelid of the left eye (LE) and double vision since 1 week before admission. She also experienced swollen eyelid and cluster headache for 5 months with no neurological abnormalities. Ophthalmic examinations showed exotropia with limited eye movement of LE. Ptosis of LE was noted with margin reflex distance 1 (MRD-1) +2 mm, while MRD-1 +6 mm for the right eye. Other examinations were unremarkable with normal funduscopy and negative RAPD. Non-contrast orbital sinus CT-Scan revealed an enlargement of the superior rectus and lateral rectus muscle. The laboratory result showed slight leucocytosis and normal ESR. High-dose intravenous corticosteroid was administered and tapered with oral steroid. The orbital clinical findings showed improvements, better ocular movements, and diminished headache complaints.

Discussion : As a rare case, the diagnosis of orbital myositis in adolescence can be challenging and requires detailed examination, and proper imaging to exclude other diagnosis such as ophthalmoplegic migraine, infections, malignancies, or congenital lesions (hemangioma). The first-line therapy is a systemic corticosteroid, which well responded in this patient.

Conclusion : In this patient, intravenous corticosteroid represent an effective treatment. Close monitoring of the disease progression is required after switching to oral therapy to prevent relapse.
Exploring the Intricacies of Carotid Cavernous Fistula: A Case Series
Authors: SAPHIRA EVANI  , PUTU YULIAWATI  , NI MADE LAKSMI UTARI
Published: February 2024

Introduction : Carotid cavernous fistula (CCF) is caused by an abnormal connection between the carotid artery and the cavernous sinus, which can lead to eye-related problems. It is crucial to recognize its signs, as they can resemble other conditions.

Case Illustration : First patient is a male 3-month-old baby, with unilateral right eye proptosis that was observed soon after birth and history of hypothyroid. Proptosis is more prominent while the baby is crying. Orbital ultrasonography revealed ophthalmica vein dilatation with S configuration, complex flow, and velocity of 10 cm/s. Second case is a 50-year-old male also with unilateral proptosis and orbital bruit with history of head trauma 2 months prior to admission. Patient came with complain of sudden blurry vision for 1 week. The results of the magnetic resonance venogram revealed tortuos dilated superior ophthalmica (SOV), cavernous sinus bulging, and dilated superior petrosal, sigmoid, transverse sinus, and internal jugular vein.

Discussion : CCFs can occur at any age, but are more common between 40-60. Risk factors like head trauma, hypertension, connective tissue disorders increase the likelihood of developing CCF. They are often misdiagnosed as other conditions such as thyroid ophthalmopathy or conjunctivitis. Ocular doppler ultrasound can detect SOV dilation and arterial flow, while magnetic resonance imaging can show superior ophthalmic vein engorgement, muscle hypertrophy, and cavernous sinus dilatation. Treatment for symptomatic CCFs involves endovascular obliteration using balloons, embolic agents, or metallic coils, while asymptomatic and mildly symptomatic patients can be treated conservatively.

Conclusion : Awareness of CCF symptoms, varied workup, prompt treatment is important to prevent severe complications.
Clinical Correlation of CD4 Count and Dry Eye Disease (DED) Severity Among HIV Patients: A Case Study in Voluntary Counseling and Testing Clinic Prof Ngoerah General Hospital, Bali
Authors: PUTU AYU WULANSARI
Published: February 2024

Abstract

Introduction & Objectives : Dry Eye Disease is a multi-factorial ocular surface and tear film instability disease. It has been reported as one of the most frequent anterior segment ocular manifestations in HIV patients, occurring late in the disease. The study aimed to investigate clinical correlation of CD4 count and severity of the disease.

Methods : This study was a hospital based cross-sectional study where 75 HIV patients (150 eyes) aged 18-50 years old were referred to ophthalmology clinic in VCT for ocular surface related complaints and were included in the study.

Results : The study showed significant moderate positive correlation between CD4 count with Tear Break Up Time (TBUT) (r-value=0.509;p-value=0.05) and negatively correlated with Ocular Surface Disease Index (OSDI) score (r-value=-0.252, p-value=0.035). There were a significant difference in CD4 count between mild and moderate dry eyes (p-value=0.005) and between mild and severe dry eyes (p-value=0.005), however no significant difference was observed between moderate and severe dry eyes (p value=0.435). The severity of dry eye in HIV patients also tends to differ in-between clinical stage of the disease (p value=0.513) and with the presence of co-infection (p value=0.228), although the result was not statistically significant.

Conclusion : There is a correlation between CD4 Count and Dry Eye Disease severity among HIV patients. The lower the CD4, the higher the risk for HIV patients to get severe dry eye disease. This shows the importance of CD4 control and monitoring to prevent various ocular disease and manifestations related to HIV.
Retroauricular Graft as a Management of Simple Kissing Nevus in a Young Woman : a Case Report
Authors: NI MADE LIENDERI WATI
Published: February 2024

Introduction : Kissing nevus is a rare case. The existence of this kissing nevus often causes disturbances not onlyof function but also cosmetic for the patient. This case report aims to report the surgical management of a simple kissing nevus that occurred in a young woman.

Case Illustration : A 27 years old woman came to the ophthalmology department of Karangasem Hospital with complaint of visual disturbances and blackish mass growth on lateral aspect of upper and lower eyelids of left eye since birth. She underwent surgery to excise the mass. Eyelid reconstruction was carried out using a retroauricular graft.

Discussion : Most cases of kissing nevus are usually present at birth. Eyelid reconstruction after kissing nevus excision can be a challenge for the surgeon to achieve functionally and cosmetically satisfactory results. In this case, eyelid reconstruction was chosen using retroauricular graft with the consideration that this technique is quite easy to do, the skin color is relatively similar, and the scar tissue behind the ears can also be hidden. Two months after surgery , the color of the graft is getting similar to the color of the surrounding skin, and the patient was quite satisfied with the results.

Conclusion : Retroauricular graft can be an alternative graft for eyelid reconstruction after kissing nevus excision. It can provide quite satisfactory results functionally and cosmetically, especially for simple kissing nevus.
MULTIPLE GIANT CHALAZIA IN HYPERIMMUNOGLOBULINEMIA E SYNDROME: A CASE REPORT
Authors: Lily Raudah Putri  , Florentina Priscilia  , Dany Petra Pranata Barus  , Annisa Windyani  , Muhammad Shafiq Advani  , Lukman Edwar
Published: February 2024

Introduction : Hyperimmunoglobulinemia E syndrome (HIES) is a rare primary immunodeficiency disorder that manifests as elevated level of serum immunoglobulin E (IgE) higher than 1.000 IU/mL and multisystem disorder characterized by recurrent skin and pulmonary abscesses caused by autosomal dominant or recessive disorder with gene mutation. We present a case of multiple giant chalazion ina patient with HIES.

Case Illustration : A 15-year-old boy was referred to Ophthalmology Department with multiple giant lumps on the left eyelid for the last 2 weeks. He had a history of recurrent multiple lumps on the left lower eyelid in the last 1 year. He was diagnosed with HIES since 8 years ago. He had normal visual acuity of both eyes. Multiple giant chalazion were observed on the left upper and lower eyelid. The patient also presented with scalp and neck infection. Laboratory studies showed elevated total serum IgE level of 53,032 IU/mL and eosinophilia.

Discussion : Ocular manifestations in HIES patients are not common. Some cases reported chalazia, keratoconus, and blepharitis. Surgical incision drainage was performed in our patient. Medications and surgical intervention had produced only transient improvement. The patient was treated conservatively. Riskof chalazia recurrence remains unknown as reported cases presented with diverse clinical presentation and follow-up serum IgE evaluation is not routinely performed.

Conclusion : Recurrent multiple giant chalazia may occur as an ophthalmic feature of HIES. HIES should be considered and investigated in patients presenting with recurrent giant chalazia.
SITUATIONAL ANALYSIS OF EYE CARE SERVICES IN SOUTH SULAWESI
Authors: AULIA NABITA , Amalius Ahmad Ashraf , Faisal Andi Akhmad , Kamaruddin Muhammad Irfan
Published: February 2024

Introduction & ObjectivesGlobal initiative, also known as “VISION 2020: the Right to Sight”, suggested that determining thenational target of human resources in eye health substantially reduces avoidable blindness andvisual impairment. Shortage of human resources is currently recognized as one of the mainproblems in achieving progress in eye health services to attain the global initiative. The purpose ofthis study is to analyze the situation of eye services in South Sulawesi.

MethodsA descriptive study with a qualitative and quantitative approach was performed through aquestionnaire to ophthalmologists in South Sulawesi Districts and also secondary data fromophthalmologists, ophthalmic nurses, the Indonesian Ophthalmologists Association committee,provincial and district health office staffs Hospital in 2022.

ResultsThe total population of South Sulawesi Province in 2022 was 9.07 million people. Human resourcedata showed 116 ophthalmologists (ratio 1:250,000 population), 108 trained ophthalmic nurses(ratio of 10 nurses per 1 million population), 1536 trained instructors, 10.918 posyandu cadres, 5trained eye cadres, and 71 refractionists/optometrists (ratio is 20 persons per 1 million people).There were 7 of 24 regencies/cities that have complete mandatory diagnostic examinationequipment.

ConclusionThe ophthalmologist ratio in South Sulawesi is normal, however, their distribution is uneven,necessitating a rise in the number of nurses and optometrists with a balanced distribution.
Challanges Prepupillary Iris Claw Implantation In Irregular-Shaped Pupil
Authors: Rusli Richardo , Umboh Roy
Published: February 2024

Introduction : For decades secondary implants carry a greater risk of high complications. The iris claw technique is popular because of the safe and fast IOL implantation. But, in this case there is a difficulty where the pupil shape is irregular so that it is a challenge for enclavation the haptic on the prepupillary iris.

Case Illustration : A man, 39 YO, came with complaints of blurred right eye after surgery on the right eye 6 months ago. Vision 1/60 with pinhole reaching 20/70, , deep anterior chamber with VH 4, positive iris tremulans, with irregular shape in temporal regio where is the main port where the first operation was performed, not centrally located pupil. There was no intraocular lens found in the lens. The patient was planned for the installation of a Secondary IOL in the right eye with a prepupillary iris claw and endodiathermal pupilloplasty to returns the pupil to the central position. One day after surgery, visual acuity was 1/300, IOP was 30 mmHg and the descment fold. The anterior chamber is difficult to evaluate. 4 weeks after surgery, Vision was 20/70, cornea was clear and IOP was 17mmHg without the need for return surgery.

Discussion : Until now, there is still no consensus regarding the best management options to correct aphakia without adequate lens capsule support. Endothermal diathermy pupilloplasty itself aims to create and maintain an appropriate pupil size.

Conclusion : Even though there are complications, the installation of the iris claw on the prepupillary is still a safe technique for aphakic correction.
When Retinal Vasculitis Wears a Mask: Unveiling Retinal Vasculitis Presented as Branch Retinal Vein Occlusion in a Young Male Patient
Authors: Lia Amanda  , Andi Marsa Nadhira  , Yulia Aziza  , Rina La Distia Nora
Published: February 2024

Introduction : Retinal vasculitis can present with a range of clinical features. Correct diagnosis and prompt treatment are essential to prevent permanent visual loss. We describe a case of retinal vasculitis with branch retinal vein occlusion (BRVO) as initial diagnosis, which is a rare manifestation in a young individual without any vascular risk factors.

Case Illustration : A 24-year-old male was referred to our center with a sudden onset of blurry vision of his left eye. He was previously diagnosed with BRVO. The patient denied having any chronic diseases, fever, or sore throat. Visual acuity was 6/18 on the left eye and 6/6 on the right eye, respectively. The anterior segment showed no abnormalities. However, fundus examination revealed prominent retinal sheathing, retinal whitening at the inferior quadrant, and macular star. Systemic diseases, such as Bechet disease, sarcoidosis, and systemic lupus erythematosus were excluded by ancillary tests. One month after the initial examination, the patient reported worsening of vision. Funduscopic examination revealed preretinal hemorrhages and macular star. The patient then received intravitreal injection of anti-vascular endothelial growth factor (VEGF), which helped to resolve the hemorrhage and improve vision.

Discussion : Further investigations, such as fundus fluorescein angiogram, may aid in the diagnosis and management of this condition. Anti-VEGF therapy may be a useful treatment option for retinal vasculitis-associated hemorrhages.

Conclusion : Our case highlights the importance of considering retinal vasculitis as a differential diagnosis in young patients presenting with BRVO, even in the absence of traditional risk factors.
SURGICAL OUTCOME OF THREE MUSCLES SURGERY IN ONE SINGLE PROCEDURE OF LARGE-ANGLE EXOTROPIA: A CASE REPORT
Authors: Jatikusuma Anas , Prastyani Reni
Published: February 2024

Introduction : The management of large-angle horizontal strabismus poses special difficulties. Literature has outlined large-angle strabismus in a variety of ways. A threshold of 40 to 60 PD has been employed to determine large-angle strabismus.

Case Illustration : A 19-year-old male with complaint of right eye that had been crossed outward since he was 12 years old. There was 90 prism diopter exotropia in near, distance, upgaze, and downgaze. The patient underwent bilateral lateral rectus recession of 10 mm and unilateral medial rectus resection of 6.5 mm in the right eye. Post-operative outcome revealed orthophoria without any misalignment of prism diopter examination in 1 day, one week, and two weeks follow-up.

Discussion : When the deviation exceeds 50 prism diopter, there is no established consensus regarding the number and quantity of extraocular rectus muscles for surgery. The lack of uniform criteria and suggested surgical dosage is the greatest obstacle in using three muscles surgery. In this case, we used surgical dose according to Kenneth Wright exotropia binocular surgery table. We performed bilateral rectus lateral recession of 10 mm and a right rectus medial resection of 6.5 mm. This surgical dose gives good outcome. Moreover, this option can leave one horizontal rectus muscle unharmed.

Conclusion : Determination of the surgical dose is essential in the management of large-angle exotropia. Appropriate surgical dose results in excellent outcomes with low risk of residual deviation.