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All Journal Open Access Indonesian Journal of Medical Reviews Bioscientia Medicina : Journal of Biomedicine and Translational Research
Daniel Johosua Siegers
Ophthalmologist, Ambon-Vlissingen Eye Clinic, Ambon, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Neglected Total Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy Coexisting with Bilateral Grade IV Hypertensive Retinopathy in Severe Pre-eclampsia: A Case Report from an Indonesian Archipelagic Province Willy Yahya; Daniel Johosua Siegers; Ari Andayani; I Wayan Ardy Paribrajaka
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 9 (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.v10i9.1657

Abstract

Background: Pre-eclampsia injures the eye through the same endothelial mechanism that injures the kidney and brain, and its retinal signs track systemic severity. Rhegmatogenous retinal detachment arises by an entirely different mechanism, yet where vitreoretinal care is distant the two may present together in one patient, a coexistence not previously described. Objective: To describe a previously unreported coexistence of chronic rhegmatogenous retinal detachment and grade IV hypertensive retinopathy of severe pre-eclampsia in one patient, and to set out the structural features that distinguish the two mechanisms at the bedside — the distinction that determines whether treatment is medical or surgical. Case presentation: A 36-year-old woman was examined three weeks after a term vaginal delivery, four months after sudden visual loss in the left eye that began in the fifth month of a pregnancy complicated by pre-eclampsia. She also reported 19 years of unassessed visual loss in the right eye. Blood pressure was 154/114 mmHg. Acuity was hand movement right and 0.1 decimal left. The right eye showed total retinal detachment with a break at 9 o'clock, fixed folds, pigment clumping, grade C posterior proliferative vitreoretinopathy, posterior subcapsular cataract and a 7-degree sensory exotropia; the left eye showed optic disc swelling, peripapillary haemorrhage and a macular star. Both eyes met Scheie grade IV. Left macular tomography gave a central subfield of 182 micrometres and a minimum foveal thickness of 98, with five of nine sectors below the first percentile. No relative afferent pupillary defect was detectable. Conclusion: Chronic rhegmatogenous and hypertensive retinal disease can coexist in one patient and must be separated structurally, because only one responds to blood pressure control. Sub-percentile macular thinning tempers the expectation of full recovery, and bilateral disease can abolish the relative afferent pupillary defect that would otherwise flag a blind eye.
Multimodal Imaging and Longitudinal Trajectory Analysis of Recurrent Ocular Toxoplasmosis and Contralateral Early-Onset Cataract: An Observational Analytic Case Study Iska Novi Udayani; Daniel Johosua Siegers; I Gusti Ayu Made Juliari; I Wayan Ardy Paribrajaka
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 5 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher in collaboration with CMHC Research Center

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i5.943

Abstract

Background: Ocular toxoplasmosis is the leading cause of infectious posterior uveitis. A dense cataract in an otherwise quiet fellow eye creates a clinical dilemma between bilateral parasitic dissemination and an independent coexisting disorder. Objective: To characterize the longitudinal structural and functional trajectories of recurrent ocular toxoplasmosis with contralateral early-onset cataract and to assess whether the two conditions were causally related. Methods: This ethically approved longitudinal observational analytic case study followed a 37-year-old woman from baseline to week 6. Assessments included visual acuity, tonometry, B-scan ultrasonography, fundus photography, spectral-domain optical coherence tomography, and serological assays. Result: At baseline, right-eye vision was light perception because of an isolated mature grade 4 cataract without signs of uveitis, whereas the left eye had 6/18 vision with active juxtafoveal retinochoroiditis and a peripapillary scar. Anti-Toxoplasma gondii IgG was reactive (393.4 IU/mL) and IgM was nonreactive. After phacoemulsification and intraocular lens implantation, right-eye visual acuity reached 6/6 by postoperative day 3, and imaging revealed a pristine neuroretina with a central macular thickness of 219 μm. Oral trimethoprim-sulfamethoxazole followed by tapered methylprednisolone consolidated the left retinochoroidal lesion and restored 6/6 vision by week 6. Conclusion: Marked interocular asymmetry in ocular toxoplasmosis requires multimodal structural verification. In this patient, the contralateral early-onset cataract represented independent coexistence rather than bilateral parasitic causality.
Co-Authors Ari Andayani I Gusti Ayu Made Juliari I Wayan Ardy Paribrajaka Iska Novi Udayani Willy Yahya