bluuebunny/crossref_metadata_2025 huggingface dataset:
UNILATERAL CMV RETINITIS IN HIV/AIDS PATIENT WITH MULTIPLE OPPORTUNISTIC INFECTIONS
Authors: Bening Daya Banyu , Firmansjah Muhammad , Zuhria Ismi
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.
The Comparison of Visual Acuity between Spectacles and Rigid Gas Permeable (RGP) Group in Myopia Patients
Authors: Havilah Zeki Rosa  , Rinda wati
Published: February 2024

Introduction & Objectives : The prevalence of myopia has approximately doubled in the past three decades, with rates of 70–87% among populations of school children and young adults in Asia. Approaches to treating myopia include spectacles and Rigid Gas Permeable (RGP) contact lenses. RGP has become a new "preference" because it is more comfortable and provides a more aesthetic look. This study aims to determine which method is better for correcting visual acuity in myopia patients.

Methods : This cross-sectional study analyzed the outcomes and exposures measured at the same time. The sample included myopia patients (based on spherical equivalent) who underwent RGP contact lens fitting in the refraction outpatient clinic of M Djamil Hospital from January 2021 to December 2022. The samples were selected based on inclusion and exclusion criteria. The collected data included gender, age, and best-corrected visual acuity using spectacles and RGP.

Results : Forty-three patients were eligible as the sample in this study. Most of the subjects were women (62.8%), and the mean age was 23.58 years old. The median LogMAR for the RGP group was lower than the spectacles group (0.00:0.10 on both eyes). Statistical analyses found a significant visual acuity improvement in the RGP group compared to the spectacles group in both the right and left eyes (p = 0.014 and p = 0.005, respectively (p < 0.05)).

Conclusion : The use of RGP provides significantly better visual acuity in correcting myopia than spectacles. Myopia is more frequently found in young women.
Bilateral Hypocalemic Cataract Post Thyroidectomi : A Case Report
Authors: Lestari Andi Ayu , Ismail Muh. Abrar , Poli Adelina T. , Syamsu Noor
Published: February 2024

Introduction : Young adult cataracts are negligible, and their prevalence is rarely reported in Indonesia. We reporta rapidly developing cataract in a 25-year-old woman due to secondary hypoparathyroidism. Cataracts in this case, progress remarkably fast compared to primary cataracts.

Case Illustration : A twenty-five-year-old female patient presented bilateral vision loss and a history of a total thyroidectomy caused by diffused toxic goiter 7 years before admission. Postoperative calcium levels were extremely depleted. The uncorrected visual acuity examination measured 1/300 in the right eye and 20/200 in the left. Slit lamp examination revealed cortical opacities in both eyes. We diagnosedit as bilateral hypocalcemia cataracts. Patient has undergone bilateral phacoemulsification and intraocular lens implantation. The day following surgery visual acuity in the right eye was 20/30 and the left eye was 20/30 without correction. After one year of evaluation the visual acuity in RE become RE was 20/20 with a correction of -0.50 D sphere and the LE was 20/20 with a correction of -1.0 D sphere.

Discussion : Patients with hypoparathyroidism risk developing cataracts due to chronic hypocalcemia, which inhibits the lenticular Na/K pump and induces intracellular sodium flux. This high sodium level triggers the osmosis process, followed by swelling of the lens fibers to form dystrophic calcifications. Thyroid surgery procedures suspectedly involving the parathyroid gland may cause hypocalcemia, thus leading to development of cataract.

Conclusion : Clinicians should always consider hypoparathyroidism as the cause of bilateral cataracts in patients with a previous total thyroidectomy.
Retinal Nerve Fiber Layer as The Preferred Objective Measure in Differentiating Pseudopapilledema with True Papilledema: A Systematic Review
Authors: Lourisa Ruth Eldenia  , Rona Ali Badjrai  , Lazuardiah Anandi  , Fierda Ovita Azhari  , Erika Anggraini  , Brigitta Marcia Bidihardja  , Syntia Nusanti
Published: February 2024

Abstract

Introduction & Objectives : Distinguishing pseudopapilledema from true papilledema may generate confusion for some cases. Regardless of the subjective judgment on clinical examination alone, objective measurement for confirmation of diagnosis might be costly, operator-dependent, invasive, or not readily available. This study aims to evaluate whether retinal nerve fiber layer (RNFL) could be the reliable and efficient objective measure to ascertain the diagnosis.

Methods : Literatures were obtained by comprehensive searching on PubMed, ProQuest, Google Scholar, and Cochrane between 2012 - 2023. Last search was March 26, 2023. Non-english study, animal study, review articles, case studies, and editorial letters were excluded. We included studies with available full-text containing both groups of papilledema and pseudopapilledema. The result was presented according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline.

Results : A total of 615 participants were included from 8 different studies all comprising a group of papilledema and pseudopapilledema with or without optic disc drusen (ODD). Studies resulted in good accuracy on RNFL in differentiating pseudopapilledema with papilledema as the area under curve ranging from 0,78 to 0,91. However, specificity and sensitivity were varied between 65-100% and 33-91% respectively. Lower accuracy was found when pseudopapilledema only includes patients with ODD or papilledema was narrowed to mild papilledema.

Conclusion : RNFL is a useful objective measure with favorable accuracy in differentiating pseudopapilledema with papilledema especially in acute settings or whenever operator-dependent examination is not obtainable
Recurrent Candida Parapsilopsis Corneal Ulcer cum Hypopion: A Case Report
Authors: Septian Dwi Prabowo  , Ismi Zuhria
Published: February 2024

Introduction : Candida is common in tropical and subtropical climes estimated for 20-60% of all culture-positive corneal infection. Over the past two-decades, candida parapsilosis has become a common opportunistic fungal pathogen.

Case Illustration : A-60-years-old-man, came with redness and pain in the left eye since one month ago after working at field. In the left eye, visual acuity was hand movement, palpebra was spasm and oedema, conjunctiva was hyperaemia, hazy, feathery edge and fluorescein test were positive in paracentral corneal 6x7 mm and hypopyon in anterior chamber. KOH staining revealed yeast, corneal scrapping revealed candida parapsilopsis, and antifungal sensitive to fluconazole. Fluconazole intravenous 200mg 2-times-a-day, moxifloxacin eyedrop loading dose, fluconazole eyedrop fortified every-one- hour, atropine 1% eyedrop 2-times-a-day, artificial tears eyedrop every-one-hour was administered.In the fifth-day, hypopyon was improved, and patient was discharged. Tenth-days after, patient felt pain and hypopyon raised 4mm. Debridement in the ulcer, and therapy was continued. Two weeks later, hypopyon was less than 1 mm, and pain was relieved.

Discussion : There was clinically improvement using antifungal therapy. Recurrent hypopyon was happen, and mechanical debridement in the ulcer was administered. In four-times within two-weeks, hypopyon was improved. Although, initial treatment was antibiotics until microbiological confirmation, antifungal therapy, combined with mechanical eradication of fungal filaments could be administered for fungal corneal ulcer.

Conclusion : In this case, combination of antifungal therapy with mechanical debridement could be the right choice to treat candida parapsilopsis corneal ulcer. Better outcomes can be achieved and complications can be avoided with appropriate diagnosis and efficient therapy.
Combination Therapy of Amniotic Membrane Transplantation with Conjunctival Peritomy and Autologous Serum for Mooren's Ulcer: A Case Report
Authors: AUFAA SHAFIRA WIDOWATI  , Suhardjo Pawiroranu  , Reny Setyowati
Published: February 2024

Introduction : A case report of a patient with Mooren’s ulcer who received partial amniotic membrane transplantation and autologous serum eye drops.

Case Illustration : A 44-year-old male patient presented with chief complaint of blurred vision, pain in left eye, and history of eye trauma 6 months prior. Empirical topical antibiotics didn’t improve his condition. VA of left eye was hand movement with good colour/light perception. We diagnosed the patient with marginal ulcer. Partial amniotic membrane transplantation with conjunctival peritomy was planned for this patient along with fortified antibiotic eye drops. Autologous serum eye drops were started at 2 weeks post-surgery. 2 months after surgery, his condition has significantly improved with visual acuity of 6/12 (Snellen), healed corneal defect, and subjective relief of symptoms.

Discussion : Mooren’s ulcer is a severe ulcerative inflammation of the cornea with unclear exact pathogenesis. Many therapies of Mooren’s ulcer are recommended in literatures, including surgical and non- surgical treatment. It was reported that amniotic membrane transplantation and conjunctival peritomy may be chosen as alternative surgical procedure for Mooren’s ulcer, as peritomy displaces the source of inflammation away from the cornea and amniotic membrane helps in corneal reepithelialization. Autologous serum is considered as an effective adjuvant therapy for ocular surface diseases such as dry eye disease, cicatricial pemphigoid, Steven-Johnson syndrome, and Mooren’s ulcer—thus the decision to include the therapy in our regiment.

Conclusion : The combination of amniotic membrane transplantation, conjunctival peritomy, and autologous serum may help in the overall improvement of patients with Mooren’s ulcer.
Rigid Gas Permeable (RGP) as Keratoconus Management After Corneal Collagen Cross-Linking (CXL) Procedure: a Case Report
Authors: Miranti Laras Ayu Sanusi  , Karmelita Satari  , Joan Sherlone Hutabarat  , Ine Renata Musa  , Susanti Natalya Sirait
Published: February 2024

Introduction : Rigid Gas Permeable (RGP) contact lenses are the mainstay for keratoconus patients and widely used. This case report presents RGP as a management for keratoconus after Corneal Collagen Cross- Linking (CXL) procedure.

Case Illustration : A 22-year-old woman diagnosed with keratoconus since eight months ago, came for vision correction. She had CXL performed on both eyes. Ophthalmologic examination revealed uncorrected visual acuity of 0.63 in the right eye (RE) and 0.08 in the left eye (LE). Her best-corrected visual acuity (BCVA) was 1.0 in the RE with -0.75 D and 0.125 in the LE with -2.00 D. Anterior segment examination of the RE was unremarkable, but the LE has Vogt’s striae and Munson's sign (Figure 1). Corneal topography for the LE showed K1 64.7D/5.2 mm, K2 68.7D/4.9 mm, and Kmean 66.7D/5.1 mm. She was fitted with trial lens of BC 5.40 and the fit was loose. She then fitted with a BC of 5.50 mm showed a good fit result. RGP contact lenses were prescribed with S -8.50, BC 5.50, and 8.6 mm diameter for her LE and combined with spectacle for her RE. Her over-refraction BCVA of the LE was 0.9.

Discussion : The management goals are to improve the patient’s visual acuity and to decrease the progression. The visual acuity of this patient improved after RGP fitting.

Conclusion : The combination of CXL procedure and the use of RGP effective to increase visual acuity, regularity of corneal surface, and patient satisfaction. Keratoconus should be monitored regularly to avoid possible progressivity.
EFFICACY AND SAFETY OF MANUAL SMALL-INCISION CATARACT SURGERY WITH TRABECULECTOMY VERSUS PHACOTRABECULECTOMY IN THE TREATMENT OF GLAUCOMA WITH CATARACT: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Andini El Asha , Avianty Astri , Herman  , Choliq Abdul
Published: February 2024

Introduction & Objectives : The coexistence of two globally leading causes of blindness, glaucoma and cataract, is frequent, while the consideration of surgical management is complex. Therefore, a systematic review and meta-analysis was conducted to compare the efficacy and safety of two surgical procedures, manual small-incision cataract surgery (MSICS) combined with trabeculectomy and phacotrabeculectomy.

Methods : A comprehensive search was performed in PubMed, Science Direct, and Cochrane Library published up to March 2023. Articles not indexed in those databases were also searched. Pooled odds ratios (OR) and mean differences (MD) with corresponding 95% confidence interval (CI) were also retrieved to compare the outcomes estimating efficacy and safety. Biases in selected studies were assessed.

Results : A total of seven studies consisting of 352 eyes for MSICS with trabeculectomy and 348 eyes for phacotrabeculectomy were included. Postoperative intraocular pressure (IOP) was comparable between the two techniques (MD: -0.45; 95%CI: -1.07 to 0.16; p=0.15). Postoperative Best Corrected Visual Acuity (BCVA) <6/12 (OR: 1.26; 95%CI: 0.62 to 2.53; p=0.52), complete success (OR: 0.92; 95%CI: 0.51 to 1.67; p=0.78), and postoperative complications (OR: 1.27, 95%CI: 0.75 to 2.15, p=0.38) did not differ significantly.

Conclusion : This meta-analysis indicated no significant difference between MSICS with trabeculectomy and phacotrabeculectomy regarding the efficacy and safety profile. Further high-quality studies are required to confirm these findings.
Interferon alpha 2b or Mitomycin-C as Adjuvant Therapy of Pigmented Conjunctival Malignancy : A Literature Review
Authors: Dr. meuthia rana amira primaputri
Published: February 2024

Abstract

Introduction & Objectives : To compare the efficacy and safety between Mitomycin C (MMC) and Interferon alpha-2b (IFN-α2b) eye drops as adjuvant therapy for conjunctival melanoma.

Methods : Literature searching was conducted using PubMed, ScienceDirect, and Google Scholar. All studies that met the inclusion and exclusion criteria were categorized based on the level of evidence. The data of patients demographics, staging of disease, type of treatments, and outcomes of this review including local control rate, side effect, and recurrence and/or metastases were also reported.

Results : From twelve articles, topical adjuvant chemotherapy with MMC and IFN α-2b showed favourable complete remission rate. Local control (complete remission) of IFN α-2b group is 46%, while in MMC group is 57%. The most side effect of MMC group were severe corneal-conjunctival irritation and corneal defect, while the IFN α-2b group showed mild side effect. Recurrency rate of IFN α-2b group and MMC group both is 35%. Metastases case of IFN α-2b group is 3.8%, while none of cases from MMC group metastases.

Conclusion : Topical adjuvant chemotherapy with MMC and IFN α-2b showed favourable local control rate even though the recurrency rate also relatively high. Both medications showed promising results to reduce residual tumor size after wide excision surgery, preserving eye so reduce the chance of exenteration in various stages. It is important to consider adjuvant therapy following wide excision surgery as the first line treatment.
SCHWARTZ-MATSUO SYNDROME : AN IMPORTANT CAUSE OF SECONDARY GLAUCOMA : RARE CASE
Authors: Perkasa Teguh Ridho , Fidalia  , Sari Prima Maya
Published: February 2024

Introduction : Schwartz-Matsuo syndrome is a rare ocular condition characterized by rhegmatogenous retinal detachment, elevated intraocular pressure, and open anterior chamber angle with presence of aqueous cells. The prevalence of Schwartz-Matsuo syndrome is quite low and only reported through case studies.

Case Illustration : A 63 years old female complained a visual aquity was no light perception on the left eye (LE) since 2 months ago. The symptoms are gradually getting worse, history of ocular trauma, recent surgery, photopsia, peripheral visual field loss were denied. Patient came to the hospital with IOP elevation on left eye. On Gonioscopy we interpretated as open angle chamber and USG examination we founded retinal detachment, Anti-glaucoma medication were given but no success to lower the IOP.

Discussion : Typically, retinal detachment is associated with low IOP. In Schwartz-Matsuo syndrome the opposite is observed with elevated IOP. Hypothesized that photoreceptor outer segments pass through the retinal break allows for fluid and photoreceptor outer segments to gain access, enter the anterior chamber and block aqueous outflow at the level of the trabecular meshwork. A significant increase in IOP can lead to visual loss and blindness complicated by glaucoma requiring further medical or surgical intervention. Referred to this patient, she came with IOP elevation, open angle anterior chamber and retinal detachment that clinically diagnosed as Schwartz-Matsuo syndrome.

Conclusion : Schwartz-Matsuo syndrome is primarily a clinical diagnosis; Early detection of disease and prompt management of increased IOP and retinal detachment is essential for a good outcome.
A CASE REPORT OF WOODEN STICK IMPALEMENT AND PALPEBRAL RUPTURE : ORBITAL PENETRATION TRAUMA
Authors: NOVIAN ADI SAPUTRA  , MARDIJAS EFENDI  , HENDRIANTI
Published: February 2024

Introduction : Orbital penetration trauma is a severe injury caused by the penetration of a foreign object into the orbit of the eye. It is a potentially life threatening condition that can cause significant damage to the surrounding structures, including the eye, the optic nerve, and the brain.

Case Illustration : 49 y.o M came with The left eye was impaled by a wooden stick 12 hours before entering the hospital, causing pain, bleeding, and loss of vision.Visual acuity of the left eye was no light perception, extensive palpebral rupture, and left eye movement was limited in all directions. The CT scan of left orbit was orbital floor fracture, hypodense lesion in the left retrobulbar oculi which appeared to obliterate the left optic nerve, and orbital floor fracture.He underwent surgery for the removal of the wood and underwent a wide palpebral reconstruction. .

Discussion : The severity of orbital penetration trauma can vary depending on several factors, including the size and shape of the penetrating object. In some cases, the injury may be relatively minor and only result in minor bruising and swelling around the eye. However, more severe cases can cause significant damage to the eye itself, including rupture of the eyeball or damage to the optic nerve.

Conclusion : Orbital penetration trauma treatments typically involves immediate medical attention to assess the extent of the injury and determine the best course of action. In some cases, surgery may be required to repair the damage and prevent further complications.
Uncommon bilateral orbital lesion in leukemic patient: is it cutis leukemia, celullitis or both?
Authors: ANINDITA WICITRA  , Widiarti S. Soemarno  , Lady P. Sukmawidowati  , Agassi Suseno Sutardjo  , Resti Mulya Sari  , Primasari Deaningtyas  , Grace Shalmont
Published: February 2024

Introduction : Acute Myeloblastic Leukemia can infiltrate any parts of the body including the orbit and periocular area. This article was aimed to report uncommon sign of cutis leukemia representing as orbital cellulitis.

Case Illustration : Male, 35 yo with chief complained progressive lesion in his bilateral upper and lower eyelid since 4 days before admission. He felt pain and stingy sensation around lesion. There was history of toothache. He was diagnosed with acute myeloblastic leukemia since 2 month before. Ophthalmology examination showed his visual acuity was 6/6 in both eyes with good ocular motility.His bilateral upper and lower eyelid were edematous and spasm with multiple vesicles, papule and pustule. Conjunctival injection was found in both eyes. The reminder of ophthalmology examination was unremarkable. There were other hyperemic nodules in left mandibulae and right mastoid bone. Laboratory examination showed increased leukocyte, procalcitonin and C-Reactive Protein level. Orbital CT scan revealed edema in cutis and subcutis area in both superior and inferior bilateral palpebra. Board spectrum and anaerobe antibiotic along with steroid were administered intravenously. Biopsy was performed. After two weeks medication, lesion around both palpebra was decreased. Unfortunately, because of his poor systemic condition, he was readministered to our hospital and hospitalized in ICU. He was passed away after 8 days of hospitalization.

Discussion : Male patient is more likely to develop orbital infiltration of leukemia, and it necessitates significant morbidity and mortality condition.

Conclusion : Leukemia with orbital invasion should bring more awareness from both ophthalmologist and hematooncologist as it indicates more mortality and morbidity.
When do Ophthalmology Residents Study to Prepare for The National Exam?
Authors: WIDYANA  , FELICIA WIDYAPUTRI  , SUPANJI  , MUHAMMAD BAYU SASONGKO
Published: February 2024

Abstract

Introduction & Objectives : Ophthalmology residents are occupied with clinical services in the hospital. They only have limited time to study. Since 2022, we established a progress test for residents to facilitate their study especially during the national examination preparation that is obligated to be completed once per year. To report the allocated time for completing the progress test by ophthalmology residents to inform educational centres about the recommended study time for residents.

Methods : Data from the online progress test that was available from the Gadjah Mada eLearning (GAMEL) platform was extracted and analysed. The test was consisted of 60 multiple questions and opened for two weeks with a 24-hour access time. In this study, the scores, the time of the test, and time spent to complete the test were descriptively and quantitatively analysed.

Results : Overall, 42 out of 55 (76.4%) and 42 out of 56 (75.0%) residents completed the progress test with a total test attempt of 60 and 51 times in 2022 and 2023, respectively. The mean score achieved was 43.3 (min-max 3.3-70.0). Majority of residents (65.8%) accessed the test at between 16.00 - 23.00 Western Indonesian Time (WIT), while 19.8% and 14.4% at between 09.00 - 16.00 and 03.00 - 9.00 WIT. The mean time spent to complete the test was 55.2  20.9 minutes.

Conclusion : Most ophthalmology residents spent their time for completing the progress test after working hours with an average duration of less than an hour. Any national exam preparation programs can be scheduled in this time for better resident’s engagements.
Ocular Manifestations Of Hiv Patients At Ophthalmology Polyclinic Of Prof.Dr.I.G.N.G.Ngoerah Hospital January 2019 - December 2021
Authors: NI MADE AYU WULANDARI
Published: February 2024

Abstract

Introduction & Objectives : Human Immunodeficiency Virus (HIV) is a disorder that affects many organs including the eyes. It is highly recommended that HIV patients be referred to an ophthalmologist before experiencing symptoms.To determine the ocular manifestations in HIV patients

Methods : This was an observational study with anayltic cross-sectional approach. Data was collected retrospectively from medical records of HIV patients who visited Ophthalmology Polyclinic at Prof.Dr.I.G.N.G. Ngoerah Hospital Denpasar for the period 1 January 2019 – 31 December 2021. Data analysis was performed using chi-square test in SPSS version 22

Results : There were 52 patients included, mostly were male (61.5%), aged 30-39 years (40.4%), WHO stage IV (63.5%) taking 1st Highly Active Antiretroviral Theraphy (HAART) (75%), have been diagnosed with HIV and consume (HAART) for 1-5 years, CD4 100-249 (42.3%), BCVA <3/60 (46.2%), and had not ckecked their HIV RNA (77.2%). There were 71 occurrences of HIV ocular manifestations with dry eye as the most common type (31%), followed by ocular CMV (26.8%). In patients with CD4 < 250, the most ocular manifestations were dry eye, in CD4 250-500 were dry eye and ocular syphilis, whereas in CD4 > 500 were ocular toxoplasmosis and ocular syphilis. There is no relationship between the use of HAART and dry eye syndrome

Conclusion : The most common ocular manifestations of HIV patients at the Ophthalmology Polyclinic of Prof.Dr.I.G.N.G.Ngoerah Hospital was dry eyes. Ocular manifestations in patients with CD4 <500 was dry eye whereas those with CD4>500 was ocular toxoplasmosis and syphilis.
Orbital Apex Syndrome in a diabetic patient, Is It Tolosa Hunt?
Authors: MADE PARAMITA WIJAYATI  , AA Mas Putrawati
Published: February 2024

Abstract

Introduction : The presence of that specific sign in neuro ophthalmology cases can easily determine the differential diagnosis. But the challenge is how do we found the cause. We describe a case of visual loss with ophthalmoplegia in a diabetic patient suspected of having Tolosa Hunt syndrome.

Case Illustration : Woman, 63 years old with acute visual loss and feel a "heavy eyelid" in the left eye for 2 weeks. The Visual Acuity is no light perception on the left and ophthalmoplegia with mild proptosis. We do the laboratory test and MRI. No specific result of infection was found but the patient was diagnosed with diabetes mellitus (DM) type 2. MRI shows a lesion in the left cavernous sinus. Diagnosis of Orbital Apex syndrome was made. We give the patient a high dose of steroid and then continue with prednisone orally. In 24 hours after treatment the "heavy eyelid" decreased. One month after therapy there are improvements in eye movement but still no light perception.

Discussion : In cases of orbital apex syndrome with DM, we need to consider mucormycosis as the cause. In this case, the symptoms and signs as well as the MRI led to a Tolosa Hunt. Steroid administration was able to reduce heavy eyelids and cranial nerve palsy even though visual acuity had not improved after 1 month of therapy.

Conclusion : Laboratory test and Neuroimaging plays an important role to find out the cause. High-dose steroid therapy in a diabetic patient with Tolosa Hunt Syndrome can be given with tight hyperglycemic control.
A Case of Pediatric Eyelid Laceration ec Unusual Foreign Body
Authors: Olivia Mokolensang Gabriella , Umboh Roy , Umboh Anne
Published: February 2024

Introduction : Eyelid lacerations refer to partial or full-thickness defects in the eyelid and constitute a significant subset of facial trauma which is often accompanied by other injuries including foreign bodies.

Case Illustration : A 16-year-old boy was brought to the emergency department with a laceration and penetrating orbital injury in his right upper eyelid. On examination, there was a 4 cm x 0,5 cm upper eyelid laceration caused by tooth penetrating, CT scan revealed a high density foreign body measuring 1,5 cm x 0,5 cm in the right upper eyelid as deep as levator muscle and no globe injury. The patient underwent an emergency operation under general anesthesia, the foreign body was removed completely and the size of the foreign body was 2,6cm x 0,5cm. After the removal of the foreign body, debridement was performed and then sutured layer by layer. After surgery, he was treated with Tetanus prophylaxis, antibiotic, and analgetic.

Discussion : Eyelid laceration is one of the most encountered ocular trauma, but needed to be evaluated and treated carefully. Although the rate of ocular foreign bodies found was low, it can lead to devastating ocular morbidities. After surgery and treatment, there is no other complaint from the patient. Visual acuity and ophthalmology examination are all in normal condition.

ConclusionEyelid trauma with foreign bodies must undergo a complete examination. A good prognosis and outcomes can be achieved when appropriate medical and surgical treatment is performed.
HISTOLOGICAL FEATURES OF ETHAMBUTOL INDUCED MICE EYES: A PRE- EXPERIMENTAL STUDY ON TOXIC OPTIC NEUROPATHY CASE
Authors: BATARI TODJA UMAR  , Itzar Chaidir Islam
Published: February 2024

Abstract

Introduction & Objectives : Toxic Optic Neuropathy (TON) is a visual disease caused by toxic substances damaging the optic nerve. It can be caused by inflammation, infection, or long-term drug use. Over 10% of ethambutol- treated optic neuropathy patients developed major complications. Cellular changes should be observed histologically. This study examines ethambutol-induced mice's eye histology in the fibrous, vasculous, nervous tunica, optical media, and optic nerve tissue.

Methods : This pre-experimental study used 20 eyes of 10 white mice aged 1-2 weeks weighing 50-65 grams. Group 1 consisted of healthy mice without therapy and group 2 received 35 mg/kgBW/day of ethambutol for 60 days. (group 2). Hematoxylin eosin staining was used to observe binocular experimental animal eyes after enucleation. All measurements used Olympus® CX-20 microscope with 40x objective resolution.

Results : The average thickness of the cornea was 72.238 ± 10.542 and 60.572 ± 10.25, while the sclera was 336.533±40.851 μm and 331.339±34.219 μm. In groups 1 and 2, no significant changes were foundin the cell layer morphology of both tissues (p > 0.05). Iris, ciliary body, and choroid were observedin the tunica vasculosa. Groups 1 and 2 had eye and ciliary body lengths of 595.148±137.805 μm and 497.705±213.866 μm, respectively, and choroid thicknesses of 161.369±37.925 and 162.605±25.160 (p>0.05). Group 1 had 402.268±55.666 μm retinal thickness in the tunica nervosa, while group 2 had 399.854±27.585 (p>0.05).

Conclusion : Ethambutol-induced and normal experimental animals had substantial histological differences in optic nerve thickness, but no significant difference in the other ocular structures.
How Childhood Obesity May Be Harming Your Child’s Vision: A Systematic Review of High Myopia in Obese Children and Adolescents
Authors: Ajeng Kartika  , Seruni Hanna Ardhia  , Marcelius Patria Prabaniswara  , Sarah Shabrina  , Rona Ali Badjrai
Published: February 2024

Abstract

Introduction & Objectives : High myopia is a severe and progressive form of myopia that can result in blindness. The prevalenceof high myopia is rising globally, and obesity has been identified as a potential risk factor, particularly in children and adolescents. This review aims to evaluate complex interplay between obesity and myopia in the young population.

Methods : A systematic literature review was conducted through PubMed, Embase, and Cochrane databases using relevant keywords. Abstract-only papers, case reports/series, and review studies were excluded, and only studies published in English between 2019 - 2023 were considered. The study selection process will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Results : This review analyzed four studies that involved 1.326.898 participants aged between 5 to 19 years. The majority of the studies found a significant association between obesity and high myopia (p<0.05). One of the studies reported that individuals with a normal BMI have a 40% lower risk of developing high myopia compared to those who are obese. Additionally, one study found that even a slightly higher BMI value, which is not yet categorized as obesity, was significantly linked to high myopia (OR 1.19; p=0.009).

Conclusion : Most of the studies showed a significant association between high myopia and higher BMI, especially in cases of obesity. However, to establish a deeper understanding of the potential link between high myopia and obesity, further studies are necessary to consolidate data from a larger population and investigate the underlying pathological pathway.
An Uneventful Case of Unresolved Suprachoroidal Hemorrhage After Cataract Surgery: When to Operate?
Authors: Dearaini  , Ivanovna Regina , Lumintang Agnesstacia Vania , Augiani Amani Sakinah , Mawarasti Burhana , Djatikusumo Ari
Published: February 2024

Introduction : Suprachoroidal hemorrhage (SCH) is a rare, but potentially vision-threatening condition. The management options for SCH varied and still debatable.

Case Illustration : Female 54 years old with chief complaint blurry vision of right eye (RE) since four days after she underwent cataract surgery. She also experienced radiating pain from RE with nausea and vomiting. No history of elevated intraocular pressure (IOP) before the surgery. Her left eye was blind for 20 years prior due to an unknown cause. Visual acuity (VA) on presentation was light perception good projection and IOP was 34mmHg. There was 2.5mm hyphema and fibrin on the anterior chamber. Lens appeared to be aphakic and there was lens material at pupillary margin. Ultrasonography (USG) of RE showed choroidal elevation with medium to high spike and positive after movement indicating SCH. She was hospitalised for IOP monitoring and serial USG was performed to monitor the hemorrhage. Six days after admission, IOP remain elevated despite medications and SCH didn’t resolve, then vitrectomy and scleral drainage was performed. Postoperative exam showed improved VA to 0.5/60, IOP to 16mmHg without medication, and reduced suprachoroidal hemorrhage on USG.

Discussion : It’s imperative to perform complete evaluation of ocular and systemic conditions in preoperative period to prevent SCH. Ultrasonography is crucial during the close follow-up after developing SCH, it also aids in the timing of surgical intervention.

Conclusion : Vitrectomy with scleral drainage is a valuable approach in managing extensive SCH, a condition generally associated with poor prognosis.
Validation of Indonesian Graves’ Ophthalmopathy Quality of Life Questionnaire and Its Association with Clinical Activity and Severity of Graves’ Ophthalmopathy
Authors: CECILIA ANGGRAINI  , Syntia Nusanti  , Muhammad Sidik  , Dicky L Tahapary  , Levina Chandra Khoe
Published: February 2024

Abstract

Introduction & Objectives : Graves' ophthalmopathy (GO) ocular abnormalities persisted even after treatment, negatively impacting the patient's psychological and social health. The Indonesian Graves' Ophthalmopathy Quality of Life (GO-QoL) Questionnaire has not been validated; hence it cannot measure patient quality of life in Indonesia, which is crucial to GO treatment. This objective of this study is providinga reliable Indonesian GO-QoL questionnaire and identifying an association between patient quality of life and clinical activity and severity of GO.

Methods : The cross-sectional study ran from May through October 2022. Graves' ophthalmopathy and thyroid disease management were the inclusion criteria. Those who could not be reached by video call or controlled for two weeks for test-retest data collection were excluded. The process of questionnaire validation involves transcultural adaptation and cross-sectional design. The content validity index (CVI) and Cronbach's alpha assessed validity and reliability, respectively.

Results : Content validity index (CVI) was 1.00 for the Indonesian GO-QoL questionnaire. Cronbach's alpha visual function subscale value was 0.971, while the appearance subscale value was 0.993, and the total score was 0.986. The appearance subscale and total score of GO patients' quality of life had a significant association with the clinical activity score (p<0.05) and disease severity (p<0.001).

Conclusion : The Indonesian version of the GO-QoL questionnaire has high validity and reliability values. Patients' appearance and overall quality of life decreases with active Graves' ophthalmopathy. Graves' ophthalmopathy severity decreases quality of life on the appearance and overall subscales.
Comparison of Pain and Anxiety Scales in The First and Second Cataract Surgeries in Patient with Bilateral Cataract
Authors: SARAH EISYA PUTRI  , Ahmad Ashraf Amalius  , Andi Akhmad Faisal  , M. Irfan Kamaruddin
Published: February 2024

Abstract : Introduction & ObjectivesPain and anxiety in cataract surgery can be investigated as subjective experiences and satisfaction. This study was to evaluate and compare pain and anxiety scale reported by patients with bilateral cataract in the first and second surgery.

Methods : This prospective study was based on patients in Jakarta Eye Centre Orbita Makassar between August-October 2022. Consecutive patients undergoing bilateral cataract surgery with the first and second surgery separated by minimum of two weeks with phacoemulsification method and used topical anaesthesia, by three surgeons. Patients with traumatic cataract, secondary cataract, and other ocular abnormality, also patients with intraoperative complications were excluded. Patients completed questionnaires of Numerical Rating Scale to evaluate pain and Amsterdam Preoperative Anxiety and Information Scale (APAIS) to evaluate anxiety divided into no, mild, moderate, severe, and very severe anxiety.

Results : A total of 42 patients with an average of 64,5 years old were included. There were 2 (4.7%) patients reported more pain in the first surgery, 30 (71%) patients reported more pain in the second surgery, and 10 (23%) patients reported same pain between the first and second surgeries (p=0,000). Most patients reported mild anxiety in the first surgery and no anxiety in second surgery.

Conclusion : Patients with bilateral cataracts reported more pain on the second surgery than the first surgery. The anxiety was reported more severe before and during the first surgery than the second surgery. This report can be used in giving informed concern and in the management of bilateral cataract surgeries consecutively.
Perforating Ocular Sickle Knife Trauma: a Case report
Authors: DEWI KANIA MAEMUNAH
Published: February 2024

Introduction : Perforating ocular injury can lead to disability or even mortality. Most individuals sustaining eye injuries are male in young age. This is a report of an extreme case when a sickle knife stabbed in the right eye of a young male cause perforating of the eyeball.

Case Illustration : Seventeen years old young male presented to Emergency Room of Sukabumi Regional Public Hospital with pain and bleeding in his right eye an hour before. He had been hacked during a brawls. There was a wound in the right supraorbita area and a big sickle knife stuck in the head and tear the eye ball. Visual acuity was no light perception in his right eye. Anterior segment examination of the right eye revealed perforated sclera and cornea. X-ray examination showed fracture of the roof of the right orbit and a metal object had stuck into the Orbits. The sickle knife extraction, enucleation and superior orbit reconstruction of the right eye was done.

Discussion : Identification of wounds caused by sharp metal foreign body is very important for the subsequent treatment of injuries. If the eyeball cannot be preserved, then enucleation can't be avoided. In this case, hard impact of sharp object around of the eye are also cause fracture of superior orbital rim. Reconstruction of the orbital roof using titanium and micro screws given the most stable and effective results.

Conclusion : Removing a metal foreign body and anatomical defect management is important for a good outcome.
A snake venom ophthalmia: A case – report
Authors: Aljufri Nabila , Sadikin Irma Suwandi , Petra Dany , Susantono Diannisa , Oktariani Virna Dwi , Widyawati Syska
Published: February 2024

Introduction : Snake venom ophthalmia is caused by venoms of spitting snakes. Delayed treatment may result in corneal ulcer, corneal perforation and blindness. We aim to report a fortunate snake venom ophthalmia case.

Case Illustration : A-54-year-old male complained of burning eye pain, watery, and redness of the right eye (RE) after being spat by a snake 3 hours before admission. The snake was identified as a cobra-snake, spitted at a distance of 1 meter without body bite. He rinsed his eyes with tap water and irrigated at a nearby hospital before referred. During the admission, the pH of both eyes (BE) was 8. The patient was irrigated with normal-saline. The visual acuity (VA) of the right eye was 6/12 and left eye 6/6. There was RE conjunctival and ciliary injection. Other examinations were unremarkable. The patient was discharged and treated with levofloxacin eye-drop, sulfas-atropine 1%, EDTA 1%, artificial tears, and vitamin C. He did self-eye irrigation. Two days later, he presented with VA of 6/6 for BE with normal ocular examinations and pH of 7 for BE.

Discussion : The general principle is prompt and copious irrigation of the eyes in chemical contact. The snake venom mixture of chemicals was washed out, which local necrosis can be prevented. Managing snake venom as a chemical splash injury with considerable irrigation, lubricants, and topical antibiotics, resulted a good outcome and prevented sequelae in this patient.

Conclusion : Urgent irrigation of the affected eyes and other mucous membranes is the key in treating snake venom ophthalmia
Non-Surgery Management of Globe Rupture in Rural Area
Authors: Diajeng Rindang Galih Annisa  , Dr Dedeh Kurniasih SpM
Published: February 2024

Introduction : Globe rupture is a vision-threatening emergency. The management of globe rupture must arrange immediate.

Case Illustration : A 59-year-old woman presented with painful and sudden vision loss on her left eye after hit by wood an hour prior. From the examination, the palpebra was oedema, and spasm, the conjunctiva was chemosis and bleeding, the sclera was laceration. Visual acuity of the left eye was 1/~. We diagnosed as globe rupture of the left eye. We gave levofloxacin injection, methylprednisolone injection, tranexamic acid injection, prednisolone eyedrop every 3 hours, levofloxacin topical every hour, and oxytetracycline eye ointment once a day in night. After 10 days, clinical manifestation was improved, but the visual acuity. From the examination, we found retinal detachment on her left eye. Patient was referred to the primary health care.

Discussion : In globe rupture, infection risk is high and requires immediate systemic empiric antibiotics and surgical management. The conservative treatment was administered since the patient rejected for the globe exploration and scleral suture surgery. The aim treatment for this case is to prevent the infection. We used combination systemic and topical levofloxacin antibiotics and corticosteroid. Systemic tranexamic acid was to control the bleeding. No improvement of visual acuity after 10 days, we suspected because of retinal detachment and need surgery management.

Conclusion : Surgical exploration and infection prevention are needed for globe injury. The sooner management, the better prognosis it could be.
Periocular Capillary Hemangioma Treated With Low Dose Oral Propranolol - Presentation and Outcome of 2 patients
Authors: TEGUH ANAMANI  , PRIMA SUGESTY NURLAILA
Published: February 2024

Introduction : Infantile hemangioma (IH) is the most common benign vascular tumor of infancy. IH arises in the first few weeks of life, then displays a period of active growth followed by spontaneous involution.[1,2] Most IHs are uncomplicated, do not require intervention, and regress spontaneously.[3] Infantile hemangioma (IH) having an incidence of 4%–5%.[4-6]

Case Illustration : First patient is 6 -month-old girl weighing 6.2 kg, with Periocular lesions on the superior palpebra since 2 weeks after birth. Second patient is 6-month-old girl weighing 6.3 kg, with Periocular lesions on the superior palpebra since 1 weeks after birth. The lesions rapidly increased in size within 1 months. The lesions made it difficult to open superior palpebra. Both patient was diagnosed with periocular infantile hemangioma. The diagnosis was established by clinical examination, and was given oral propranolol therapy. Initially, a dose of propranolol was 1 mg/kg body weight in divided doses for 2 weeks then increased to 2 mg/kg body weight. Patients have followed up at 4-week intervals until the final follow-up was reached according to the response of treatment. The lesions were significantly decreased and bith pastients could open their right eye normally after 3 months of propranolol therapy

Discussion : Some cases of IH require early treatment. Early treatment is indicated for IH causing functional impairment. The use of propranolol in the management of IH is very effective in the reduction of the lesions and Has minimal side effects.

Conclusion : Early diagnosis and intervention with propranolol for IH play an important role in determining the optimal outcomes
EFFECT OF MEMANTINE AS N-METHYL D-ASPARTATE RECEPTOR ANTAGONIST ON CASPASE-9 LEVEL OF RETINAL GANGLION CELL IN METHANOL TOXIC OPTIC NEUROPATHY RAT MODEL
Authors: ANTONIA KARTIKA  , Rusti Hanindyasari  , Dianita Veulina Ginting  , Pretyllayolamada
Published: February 2024

Abstract

Introduction & Objectives : Methanol toxic optic neuropathy (MTON) remains as a health issue in developing countries and there are no current definitive treatments. Accumulation of formic acid as metabolite of methanol causes mitochondrial dysfunction that can reduce ATP synthesis rate, disrupt axoplasmic transport, and elevate the reactive oxygen species (ROS). All of these mechanisms lead to the death of retinal ganglion cell (RGC) and optic nerve. RGC destruction in MTON has similar patterns with those that have been observed in glaucoma, ischemia, and trauma cases, that is through excessive activation of glutamate neurotransmitter via N-Methyl D-Aspartate receptors (NMDAR). Memantine is a NMDAR antagonist that inhibit the ion channel of NMDAR. This inhibitory effect of NMDAR by memantine is expected to reduce intracellular calcium level, prevent apoptosis of RGC, and prevent further mitochondrial dysfunction. Caspase-9 is essential to eliminate cells by executing apoptotic Objective: To observe the effect of Memantine on Caspase-9 level of RGC in Methanol-Intoxicated Rats.

Methods : This experimental study was performed on 28 Methanol-Intoxicated Rats that are assigned into four treatment groups: K1 (MTON;enucleated day-3), K2 (MTON+Memantine; enucleated day-3), K3 (MTON; enucleated day-7), and K4 (MTON+Memantine; enucleated day-7). During the experiment, all groups were exposed to N2O:O2 gas and were given methanol orally. Caspase-9 level of RGC were measured immediately after enucleation.

Results : The average of Caspase-9 level (ng/ml): K1=197,88±33,98; K2=205,64±63,66; K3=243,15±40,13; K4=150,08±119,60. The Caspase-9 level was significantly lower in K4 compared to K3 (p value =0.038).

Conclusion : Memantine decrease the level of Caspase-9 of RGC in Methanol Toxic Optic Neuropathy rat model.