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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research
Ramzi Amin
Department of Ophthalmology, Faculty of Medicine, Universitas Sriwijaya/Dr. Mohammad Hoesin Central General Hospital, Palembang, Indonesia
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Mechanism-Specific Tear Film Instability Across Diabetic Retinopathy Severity: Fluorescein Break-Up Pattern Classification in Type 2 Diabetes Mellitus Ramzi Amin; Siti Shalihah Ramadhani Novizar; Petty Purwanita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1662

Abstract

Background: Diabetic retinopathy and dry eye disease coexist in type 2 diabetes mellitus, yet conventional metrics treat tear film instability as one entity and cannot identify which layer has failed. Objective: This pilot study asked whether the Asia Dry Eye Society fluorescein break-up pattern classification tracks Early Treatment Diabetic Retinopathy Study (ETDRS) severity. Methods: Fifteen patients (30 eyes) with type 2 diabetes and any retinopathy grade were enrolled under a quota framework at RSUP Dr. Mohammad Hoesin Palembang, Indonesia, from November 2024 to July 2025. Break-up patterns were classified into five categories under cobalt-blue slit-lamp biomicroscopy on three consecutive observations; Ocular Surface Disease Index (OSDI) and tear break-up time (TBUT) were recorded. Analysis used rank correlation with exact permutation testing, proportional-odds regression and receiver operating characteristic analysis. Results: Pattern distribution differed across grades (Fisher–Freeman–Halton p = 0.007; Cramér's V = 0.536). Within the aqueous-deficiency pathway, line break progressed to area break (rho = 0.905, 95% CI 0.666–0.975, exact p = 0.002); within the decreased-wettability pathway, dimple break progressed to spot break (rho = 0.824, 95% CI 0.445–0.953, exact p = 0.009). Each one-grade increase multiplied the odds of a more severe pattern 7.442-fold (95% CI 2.555–21.673), and grade discriminated severe-mechanism patterns with an area under the curve of 0.87 (95% CI 0.681–0.955). OSDI and TBUT deteriorated monotonically (both p < 0.001), whereas random break showed no gradient (rho = 0.095, p = 0.618). Conclusion: Mechanism-specific tear film failure scales with retinopathy severity, supporting fluorescein-based tear film oriented diagnosis in Indonesian practice.
Diagnostic Accuracy and Optimal CD4 Threshold for Detecting Cytomegalovirus Retinitis in Advanced HIV Disease: A Prospective Indonesian Study Ramzi Amin; Fadillah Amrina; Petty Purwanita; Nuzulul Aini
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1663

Abstract

Background: Cytomegalovirus retinitis (CMVR) is a leading preventable cause of AIDS-related blindness where systematic screening is absent, and World Health Organization guidance triggers ophthalmic assessment below a CD4 count of 50–100 cells/µL, a range not previously calibrated in an Indonesian population. Objective: To determine the diagnostic accuracy of the CD4 count against adjudicated cytomegalovirus retinitis, and to derive an optimal CD4 threshold for triggering ophthalmic screening, in Indonesian adults with advanced HIV disease. Methods: This prospective single-gate diagnostic accuracy study, reported to STARD 2015, enrolled 51 consecutive adults with HIV-1 infection and a CD4 count below 100 cells/µL at Dr. Mohammad Hoesin Central General Hospital, Palembang, from January 2024 to January 2025. The index test was the CD4 count by flow cytometry; the reference standard was masked adjudication by two retina specialists using dilated ophthalmoscopy, fundus photography and optical coherence tomography (Cohen's κ = 0.91). Because only aggregated summaries were released, estimands the data do not identify are reported as sharp bounds. Results: CMVR was present in 17 of 51 participants (33.3%, 95% CI 22.0–47.0); the median CD4 count was 17.0 cells/µL (IQR 11.0–27.0) versus 48.0 (30.0–72.0). The area under the ROC curve was 0.863 (95% CI 0.741–0.985). At the Youden-derived threshold of 32.5 cells/µL apparent sensitivity was 88.2% (95% CI 65.7–96.7) and specificity 91.2% (77.0–97.0); after correction for in-sample threshold selection these became 80.5% and 93.8%, and across two admissible reconstructions sensitivity ranged from 76.5% to 88.2%. CD4 rose monotonically across fulminant, indolent and frosted-branch phenotypes (bounded Kruskal–Wallis p = 0.001–0.013). Conclusion: A CD4 count of approximately 30–35 cells/µL, with an unconditional visual-symptom over-ride, prioritises dilated retinal examination within the World Health Organization stratum in Indonesian HIV services.
Co-Authors Fadillah Amrina Nuzulul Aini Petty Purwanita Siti Shalihah Ramadhani Novizar