bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
FAMILY’S VIEW REGARDING THE DECISION TO BE A CORNEA DONOR: A PHENOMENOLOGICAL STUDY
Authors: Baswedan Rizki Hafidzah , Padmawati Retna Siwi , Widyandana Doni 
Published: February 2024

Introduction and Objective: Family has an important role in the corneal donor process. Corneal extraction can be done when a potential donor dies, so it requires family involvement and support. The purpose of this study is to explore the family's view on the decision to be a cornea donor so that we can obtain a deep understanding on this issue.
Methods: Phenomenological studies were conducted in Yogyakarta, Indonesia on families of prospective cornea donors (n=6) and registered cornea donor candidates (n=6). Data were collected using in-depth interviews and study documents. Data were analyzed using the Colaizzi’s method.
Results: Family participants' knowledge and understanding of the urgency and procedure of corneal donors is the main point that constructs their view of corneal donors. Most family participants consider being corneal donors a good thing to do. All participants expressed their willingness to carry out the will of prospective donors, but there was no guarantee they would do so. Fifty percent of participants’ families are also interested in becoming corneal donors in consideration of religious organizations, educational background, and experience participating in activities with the Eye Bank and the donors.
Conclusion: Families have an important role in the corneal donor process because they will carry out the will of prospective donors and serve as liaisons for the Eye Bank. Family involvement in the promotion of the cornea donor program is needed.
Visual And Refractive Outcomes of Myopia Astigmatism After Small Incision Lenticule Extraction (ReLEx SMILE) Procedures; Retrospective Study
Authors: ANDI AKHMAD FAISAL  , Nashrul Ihsan  , Ucok P. Pasaribu  , Vidyapati Mangunkusumo  
Published: February 2024

Abstract
Introduction & Objectives : Small Incision Lenticule Extraction (ReLEx SMILE) is becoming more popular as a flapless and minimally invasive form of laser vision correction for the treatment of myopia and myopia astigmatism. This study aimed to assess postoperative visual and refractive outcomes of SMILE- based correction of myopia astigmatism, to evaluate the efficacy, predictability, safety, and stabilityof this procedure over a one-month postoperative period
Methods : This retrospective study evaluated 200 eyes of 100 patients who underwent ReLEX SMILE technique, using the Zeiss VisuMax Laser between July 2020 and October 2022. Before surgery, 1 day and 1 month after surgery, the efficacy, predictability, safety, and stability of the procedure were assessed.
Results : The preoperative Mean Uncorrected Distance Visual Acuity (UCVA) was 1.55 ± 0.53. Corrected Distance Visual Acuity (BCVA) was 20/20 or better in 74.50% and 90% of eyes in 1 day and 1 month after surgery, respectively. MRSE reduced from -5.22 ± 2.44 to -0.22 ± 0.54 at 1 day post-operative, and -0.19 ± 0.51 at 1 month. 75% of eyes had an unchanged BCVA between 1 day and 1 month after surgery. 72% of eyes achieved spherical equivalent within ±0.5 D and 94% of eyes were within ±1.0 1 month after surgery. The intraoperative complication was suction loss in two patients.
Conclusion : SMILE can be considered an effective and safe refractive surgery for the treatment of myopia astigmatism.
A Watchful Eye: A Case Report on The Management of Hypotony Maculopathy after Non-Valved Glaucoma Drainage Device Implantation
Authors: Herdian Felicia Sesih , Amanda Lia , Ivanovna Regina , Gunardi Triana Hardianti , Yunard Ardiella , Suryono Astrianda Nadya 
Published: February 2024

Introduction : Low intraocular pressure (IOP) and reduced visual acuity following glaucoma surgery have been linked to a serious complication known as hypotony maculopathy. Here, we report a case of hypotony maculopathy following glaucoma drainage implant which was successfully managed by a conservative approach utilizing oral and topical steroids, resulting in favorable outcomes.
Case Illustration : A 25-year-old female with juvenile glaucoma presented with low IOP in the right eye (RE) following glaucoma drainage surgery using non-valved implant four months prior. Ophthalmic examination revealed a decrease of IOP (9mmHg to 4mmHg) and visual acuity (6/6 to 6/24). Fundus examination and optical coherence tomography (OCT) of macula was indicating hypotony maculopathy. All glaucoma medications were discontinued and the patient was given oral methylprednisolone 3x8 mg and topical prednisolone acetate three hourly for two months. Subsequent follow-up revealed an increase in IOP to 37mmHg and visual acuity improvement to 6/6. The patient was then given oral and topical antiglaucoma medications to maintain IOP control.
Discussion : Hypotony and its related sequelae are more common with the non-valved drainage devices. Prompt intervention is crucial for improving visual outcomes. Treatment options include surgical and conservative approach. Closely monitored conservative therapy may also give favorable outcomes similar to surgical approach.
Conclusion : In advanced cases of glaucoma, extremely low IOP is just as risky as a high IOP. Conservative therapy, including topical and oral corticosteroids, can be employed to reverse hypotony, at the expense of transient IOP rise, in corticosteroid-responsive patients. Restoring normal IOP in a timely manner may improve retinal function.
Pearls And Pitfalls of Keratoplasty to Achieve and Optimal Visual Function: A Case Report
Authors: Askary Fadel , Solahudin Alie 
Published: February 2024

Introduction : Keratoplasty, also known as corneal transplant, is a surgical procedure in which a damaged or diseased cornea is replaced with a healthy donor cornea. One of the common reasons for performing this procedure is to restore vision in people with a leukoma eye. Leukoma, also known as corneal opacification, is a condition in which the cornea becomes cloudy or opaque, leading to impaired vision or even blindness. This case will explain keratoplasty procedures for treating leukoma, the benefits and risks of the surgery, and the postoperative care required for a successful recovery.
Case Illustration : A 49 years old Female diagnosed with Leukoma due to her symptoms, signs, and examination with VOD: 1/60 ph (-) and VOS : 6/7.5. The patient then underwent keratoplasty surgery. 7th day post operation, Corneal Graft had 16 interrupted sutures with minimal edema. VOD 6/60 and Intra ocular pressure on the right eye was 13.1 mmHg. Oral and topical corticosteroids Continued and planned to taper off gradually.
Discussion : The success of the procedure depends on several factors, including the cell count of donor, determining high/low risk patients, Intraoperative, and the postoperative care provided. Topical corticosteroids remain the mainstay to prevent immunological graft reactions. Regular evaluation of the graft is important as the risk of rejection occur up to years.
Conclusion : Keratoplasty has proven to be an effective treatment option for individuals with a leukoma eye. The procedure can significantly improve visual acuity and quality of life for these individuals.
Clinical Outcome in Lens Drop evacuation after a High-Risk Characteristics Proliferative Diabetic Retinopathy Post Pars Plana Vitrectomy Case
Authors: Suryathi Ni Made Ari , Andayani Ari , Anasary Anak Agung Ayu Putri Prematura Sri 
Published: February 2024

Introduction : Vitrectomy surgery affects zonular strength, which increases the risk of lens drop and can be sight- threatening if not managed correctly. Pars plana vitrectomy (PPV) and evacuation of dislocated lens fragments have to be done very carefully.
Case Illustration : A 42-year-old female with blurred vision in the right eye for two months and a history of right-eye surgery three months ago due to proliferative diabetic retinopathy (PDR) was tamponed with SF6 gas. On examination was found visual acuity (VA) was 6/120, with cloudy lens and attached retina. The patient was diagnosed with a right-eye complicated cataract with advanced PDR post-PPV and planned to undergo phacoemulsification. While waiting for the surgery, the lens dropped into the posterior chamber, then planned to do the evacuation immediately. Dropped lens evacuation, PPV, retro-pupil IOL implantation, and silicone oil (SO) tamponing were done. Two months after the SO evacuation, the best corrected VA improved to 6/15.
Discussion : Cataract progression after vitrectomy is common. In a vitrectomized eye, there is a lack of vitreous tamponade and a less stable lens. Peripheral zonules are attached to the pars plana, which can be disrupted during the vitrectomy surgery. Improvements in visual acuity and lower rates of complications were found if the lens fragment was evacuated soon.
Conclusion : Cataract surgery is better done soon after PPV to prevent dropped lenses into the posterior chamber, whether the zonulisis sign is seen or not. The interval between the dropped lens incident and evacuation was associated with better final visual outcomes.