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All Journal Medicinus : Jurnal Kedokteran IJRETINA - International Journal of Retina Ophthalmologica Indonesiana
Djatikusumo, Ari
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Health Professions Medicine & Pharmacology Public Health

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Brolucizumab for Neovascular Age-Related Macular Degeneration in Real-World Setting Nadhira, Andi Marsa; Djatikusumo, Ari; Victor, Andi Arus
International Journal of Retina Vol 6 No 2 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss002.247

Abstract

Introduction: The mainstay treatment for neovascular AMD (nAMD) is intravitreal injections of anti-vascular growth factor (anti-VEGF) agents. Based on clinical trials, a newly developed anti-VEGF named brolucizumab showed noninferiority in anatomical and functional outcomes with longer injection interval, when compared to previous anti-VEGF agents; however, severe post-injection inflammation has been observed. This review aims to evaluate the efficacy and safety of brolucizumab in real-world clinical setting. Methods: We conducted systematic searches in Pubmed, Science Direct, Clinicalkey, and Scopus. Observational studies, case series, and individual case studies enrolling naïve-treatment and switch-therapy nAMD patients who received intravitreal injection of brolucizumab were eligible for this review. Result: We included 12 studies, comprising 772 patients and 848 eyes, that reported the outcome of intravitreal injection of brolucizumab in real-world practice. The mean age of patients was 77 years old. Follow-up period ranged from 7,2 weeks to 52 weeks. Improvement in visual acuity was mostly observed in treatment-naïve groups, ranging from +4,5 to +11,9 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Improvement in retinal thickness and reduction in retinal fluids were reported in both groups, with mean central retinal thickness (CRT) change of 94,92 μm. Significant reductions of subretinal fluid (SRF) were observed in 4 studies, intraretinal fluid (IRF) in 2 studies, and pigment epithelial detachment (PED) in 3 studies. Eight studies reported injection interval, the longest of which extended to 12 weeks. Inflammatory events following brolucizumab injection were reported in 8,01% of eyes, ranging from mild to severe inflammation, with 34,2% of the intraocular inflammation occurring in the vitreous (22 eyes). Brolucizumab may help alleviate treatment burden in real-world clinical setting by reducing disease activity, mainly demonstrated as improvement in retinal thickness, reduction in retinal fluid, and prolongation of injection interval. Clinicians must be aware of the possible inflammatory events following brolucizumab injection.
Clinical Characteristics and Management of Wet Age-Related Macular Degeneration at Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia Leonedine, Tengku Viona Zohra; Victor, Andi Arus; Djatikusumo, Ari; Adriono, Gitalisa Andayani; Yudanta, Anggun Rama; Hutapea, Mario Marbungaran; Suryoadji, Kemal Akbar
International Journal of Retina Vol 7 No 2 (2024): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2024.vol007.iss002.291

Abstract

Introduction: Age-related macular degeneration (AMD) is a leading cause of blindness globally, with wet AMD being particularly debilitating. The prevalence of AMD is increasing, necessitating a deeper understanding of its clinical characteristics and management. This study aims to investigate the demographic and clinical features, management, and treatment outcomes of wet AMD at Cipto Mangunkusumo Hospital during January-December 2022. Methods: A retrospective descriptive study was conducted, analyzing medical records of wet AMD patients treated during the specified period. Data analysis included patient demographics, clinical characteristics, treatment modalities, and outcomes. Results: Of 129 eyes from 122 patients, 115 eyes met the inclusion criteria. The majority were female (55.7%) with an average age of 67 years. Most patients presented with blurry vision (93.9%) and received Patizra anti-VEGF injections (60.9%). Hypertension was the most common risk factor (28.7%). Anti-VEGF treatment significantly reduced central macular thickness (p < 0.05) but had no significant impact on visual acuity. Avastin and Patizra injections similarly influenced macular thickness but not visual acuity. There were no significant differences between loading and non-loading dose groups in terms of outcomes. Conclusion: Anti-VEGF treatment effectively reduces central macular thickness in wet AMD patients, regardless of the specific agent used. However, it does not significantly improve visual acuity. Further research is needed to explore differences between loading and non-loading dose protocols, compare treatment strategies, and investigate demographic risk factors. Consistency in visual acuity documentation using the ETDRS format is recommended for future studies.
Randomized Trial Comparing Adjuvant Intravitreal Triamcinolone Acetonide 2mg and Bevacizumab 12,5mg for Diabetic Macular Edema Larasati, maria; Setiawati, Arini; Djatikusumo, Ari
Medicinus Vol. 7 No. 2 (2018): February 2018 - May 2018
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v7i2.1792

Abstract

ObjectivesTo evaluate the efficacy and safety of Intravitreal Triamcinolone Acetonide (IVTA) 2 mg and Bevacizumab (IVB) 12,5 mg for adjuvant therapy of Diabetic Macular Edema (DME)DesignThis was a prospective, randomized clinical trial. Each participants with DME was randomized to received single intravitreal injection of IVTA or IVB  and then being followed until fourth week after injection. The efficacy parameters were the improvement in Best Corrected Visual Acuity (BCVA) in logMAR and Standardized Central Macular Thickness (SCMT) by Optical Coherence Tomography. The safety parameters were the Intra Ocular Pressure (IOP) and Posterior Capsular cataract progression using LOCSIII criteria.ResultsTwenty five eyes of 20 participants were randomly assigned to receive IVTA 2 mg (n=12) and IVB (n=13). At 4 weeks, mean BCVA was better in IVTA group than in IVB group -0,39 logMAR (p<0,05). CMT reduction were significant in all visits of both groups. The SCMT showed 78,37%  at final follow-up for IVTA group. There were no statistic significant difference in the mean IOP and posterior capsular cataract changes among two groups. (p>0,05)ConclusionAdjuvant IVTA injections were more effective than IVB injections in patients with DME. However, it was associated with higher increment in IOP, despite not reaching statistical significance.
Real-World Evaluation of the Effectiveness of Intravitreal Bevacizumab Injection for Neovascular Age-Related Macular Degeneration at Cipto Mangunkusumo National Referral Hospital Adriono, Gitalisa Andayani; Pambudy, Indra Maharddhika; Victor, Andi Arus; Djatikusumo, Ari; Yudhanta, Anggun Rama; Hutapea, Mario Marbungaran; Triyoga, Ichsan Fauzi
International Journal of Retina Vol 8 No 2 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss002.319

Abstract

Introduction: Neovascular age-related macular degeneration (nAMD) is a leading cause of visual impairment globally. While intravitreal anti-VEGF therapy is the standard treatment, real-world data on bevacizumab (IVB), the most accessible agent in Indonesian public hospitals despite being off-label, remains limited. This study aims to evaluate the effectiveness of IVB in patients with nAMD at a tertiary referral center in Indonesia. Methods: This retrospective study included patients diagnosed with nAMD who received IVB injections at Cipto Mangunkusumo National Referral Hospital between January and December 2017. Inclusion criteria encompassed patients with confirmed nAMD and available clinical data pre- and post-injection. Data on demographics, best-corrected visual acuity (BCVA), central macular thickness (CMT) measured by OCT, and IVB injection regimen were extracted from electronic medical records. Statistical analysis was performed using Wilcoxon signed-rank and Mann–Whitney U tests, with p < 0.05 considered statistically significant. Result: A total of 138 eyes from 131 patients (mean age: 66.7 years; 51% male) were analyzed. The median number of injections was three (range: 1–6). Mean BCVA showed a non-significant improvement from 1.19 to 1.14 logMAR (mean change: 0.05 logMAR; p = 0.770). Subgroup analysis indicated significant improvement in eyes with baseline VA worse than 1.32 logMAR (mean gain: 0.54 logMAR; p < 0.01) and a significant decline in eyes with baseline VA between 0.48 and 1.00 logMAR (mean loss: 0.21 logMAR; p = 0.02). CMT significantly decreased by an average of 108.33 µm (p < 0.01). Conclusion: IVB treatment for nAMD resulted in significant anatomical improvement and was particularly effective in patients with poor baseline visual acuity. These findings highlight the role of IVB in real-world clinical practice within resource-limited settings.
Clinical Characteristics of Patients with Retinal Vein Occlusion and Macular Edema at Cipto Mangunkusumo Hospital Kirana in Indonesia Isfyanto, Isfyanto; Djatikusumo, Ari; Andayani, Gitalisa; Yudantha, Anggun Rama; Hutapea, Mario Marbungaran; Suryoadji, Kemal Akbar; Victor, Andi Arus
International Journal of Retina Vol 7 No 1 (2024): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2024.vol007.iss001.271

Abstract

Introduction: Retinal vein occlusion (RVO) is a significant retinal vascular disease, often resulting in macular edema and vision impairment. This study aims to investigate the clinical characteristics, management, and outcomes of RVO patients with macular edema at Cipto Mangunkusumo Hospital Kirana from January 2020 to December 2021. Methods: This retrospective descriptive study analyzed medical records of 85 RVO patients with macular edema. Demographic data, clinical characteristics, management approaches, and treatment outcomes were examined. Data were analyzed using SPSS. Results: Most patients were over 50 years old, predominantly male, and affected in one eye. Hypertension and diabetes mellitus were common comorbidities. Central RVO cases had worse initial visual acuity and macular thickness than branch RVO cases. Anti-VEGF injections were the primary therapy, and patients received an average of two injections in the first year. Macular thickness reduced after anti-VEGF injections, but visual acuity improvement was minimal. Conclusion: Patients with RVO and macular edema are often older males with systemic risk factors. Anti-VEGF injections are the primary treatment, with improvements in macular thickness but limited visual acuity gain. Patient education, comprehensive management, and public awareness are recommended to enhance RVO care. Further research to analyze parameter relationships is needed.
GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF DIABETIC RETINOPATHY AND DIABETIC MACULAR EDEMA IN INDONESIA Harley, Ohisa; Hertanto, Martin; Sembiring, Sindy Boru; Yustiarini, Ima; Susilo, Teguh; Dharma, Andhika Guna; Sjahreza, Emil; Firmansyah, M; Iskandar, Erwin; Agustiawan, Referano; Andayani, Ari; Dewi, Nadia Artha; Andayani, Gitalisa; Djatikusumo, Ari; Elvioza, Elvioza; Ichsan, Andi M; Kartasasmita, Arief S
International Journal of Retina Vol 7 No 2 (2024): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2024.vol007.iss002.300

Abstract

Diabetic retinopathy (DR) and diabetic macular edema (DME) are among the microvascular complications in individuals with diabetes mellitus (DM) that can lead to blindness if not diagnosed early and managed appropriately. Both disorders can be diagnosed and treated using a variety of techniques. Treatment modalities include laser photocoagulation therapy, vitrectomy surgery, intraocular steroid injections, and anti-vascular endothelial growth factor (anti-VEGF) injections. These methods can help avoid blindness when used in conjunction with metabolic control. These recommendations were created with the use of evidence-based medicine principles to help medical professionals—particularly ophthalmologists—identify and treat cases of DR and DME.The primary objective is to provide consensus recommendations and hopefully reduce the incidence of blindness caused by DR and DME in Indonesia.
DAPSONE-INDUCED TOXIC MACULOPATHY IN LEPROSY PATIENT Ayuningtyas, Sita Paramita; Djatikusumo, Ari; Nusanti, Syntia; Dewiputri, Salmarezka; Sidik, Mohamad
International Journal of Retina Vol 6 No 1 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss001.226

Abstract

Introduction: Dapsone has been widely used as a part of multidrug therapy for leprosy patients. Ocular side effects are rare. Ocular toxicity manifestations include retinal necrosis, optic atrophy, macular infarction, bilateral exudative retinal detachment, and choroidal detachment. We reported a rare case of dapsone-induced toxic maculopathy in a leprosy patient. Case Report: A 32-year-old male complained of blurred vision and a gray spot in central vision in the left eye (LE) for one month prior to admission. He had been treated with multidrug therapy (MDT) for leprosy for seven months. The MDT consists of dapsone, clofazimine, and rifampicin. The best-corrected visual acuity (BCVA) of the right eye (RE) and the LE were 6/6 and 6/12, respectively. A funduscopy of the LE showed decreased macular reflex. A color vision defect following the tritan axis was found in the LE. The Humphrey visual field (HVF) test of the LE revealed a central scotoma. Macular optical coherence tomography (OCT) showed intraretinal hyperreflectivity and subretinal fluid. Dapsone was then stopped in collaboration with a dermatologist. Two months after the discontinuation of Dapsone, the BCVA of the LE improved to 6/7.5, then 6/6 three months later. Color vision, macular OCT, and HVF tests revealed improvements. Multifocal ERG of both eyes (BE) also showed improvement in N1 and P1 wave amplitude in both eyes on 9-month follow-up after dapsone discontinuation. Discussion: Instead of direct drug toxicity, the mechanism of ocular side effects is thought to be ischemia caused by two distinct mechanisms. Macular ischemia is caused by acute, severe peripheral hypoxia and the physical effect of red cell fragmentation due to the hemolytic process. After discontinuation of dapsone, this case showed improvement in visual function and macular structure. Conclusion: Toxic maculopathy may be present in leprosy patients receiving dapsone treatment, although it is uncommon. Regular follow-up and evaluation of visual function and macular involvement are essential. Early detection of dapsone-induced toxic maculopathy and prompt discontinuation of dapsone may result in an improvement of visual functions.
CLINICAL CHARACTERISTICS OF PROLIFERATIVE DIABETIC RETINOPATHY (PDR) PATIENTS WITH VITREOUS HEMORRHAGE AT CIPTO MANGUNKUSUMO HOSPITAL Ali, Reyno Satria; Victor, Andi Arus; Djatikusumo, Ari; Andayani, Gitalisa; Yudanta, Anggun Rama; Hutapea, Mario Marbungaran
International Journal of Retina Vol 6 No 1 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss001.227

Abstract

Introduction: Proliferative Diabetic retinopathy is the most common cause of blindness in adults. In the management of vitreous hemorrhage, vitrectomy is the main choice and also laser photocoagulation with or without anti-VEGF administration as additional therapy. This study aims to determine the number of patients, demographic characteristics, clinics, risk factors, distribution of treatment, and treatment outcomes for PDR patients with vitreous hemorrhage at Cipto Mangunkusumo Hospital. Methods: This study was retrospective descriptive study conducted from January 2020 to October 2022 who met the inclusion criteria. Population in this study were patients at Cipto Mangunkusumo Hospital with PDR accompanied by vitreous hemorrhage. Data shown in the table were mean (standard deviation) and number (percentage) based on the type of the data. Result: A total of 146 patients with the diagnosis of Proliferative Diabetic Retinopathy (PDR) with vitreous hemorrhage. Majority of subjects were men (60,9%), diagnosed with DM more than 10 years (63,0%) with another systemic risk factor. The most common clinical characteristics found visual acuity at the initial visit <3/60 (80,8%), diagnosed phakia (78,9%), retinal detachment (85,3%), grade 2 vitreous hemorrhage (80,8%). The majority of eyes underwent vitrectomy (90,44%), Anti-VEGF injections (22,92%), Laser PRP (11,46 %), Phacoemulsification pre and post- vitrectomy as adjuvant treatment. The condition of the vitreous was clear after vitrectomy (99,1%). Mean visual acuity before vitrectomy is 2.10 (1.80 – 2.50), while mean visual acuity after vitctomy was 1.00 (1.30 – 2.40), with a difference in initial and final visual acuity of -0.10 (-0.50 – 0.60). Conclusion: Majority of study subjects were men with an age range of 25-77 years. Vitrectomy as the main treatment combined with intravitreal injection of anti-VEGF, laser PRP as adjuvant treatment. In nearly all cases, vitreous hemorrhage was clear after vitrectomy treatment. Visual acuity after vitrectomy shows progress even though in some cases there was no improvement.
Simple Encircling Scleral Band for Uncomplicated Retinal Detachment Djatikusumo, Ari; Sjahreza, Emil Fahrinandi; Triwijayanti, Triwijayanti; Taim, Abisyifa Rahma; Ardhia, Seruni Hanna
International Journal of Retina Vol 7 No 1 (2024): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2024.vol007.iss001.258

Abstract

Introduction: Report the surgical and visual outcome of using a narrow band in encircling scleral buckling for selected rhegmatogenous retinal detachment (RRD). Methods: A retrospective case series review of 16 patients with primary RRD treated with encircling scleral buckling using a narrow band 240 (2.5 mm) in KMN Eye Care from June 2018 to June 2020. Results: A total of 16 eyes in 16 patients with RRD underwent encircling scleral buckling with a narrow silicone band 240 (2.5 mm) without any additional tire or sponge. All patients have myopic eyes, with the mean pre-operative best-corrected visual acuity (BCVA) is less than 0.50. The primary success rate of retinal reattachment was 81.25%. Three patients had retinal re-detachment within one month post-surgery, and 2 patients had persistent sub-macular fluid, despite retinal reattachment. In patients with retinal reattachment, the BCVA showed improvement better than 0.5 at 1-month follow-up (9 patients, 69.2%). Spherical equivalent changes before and after scleral buckling were -1.90 D. Conclusion: Narrow encircling scleral buckle surgery can be considered an effective and safe technique in selected RRDs, including anteriorly located, multiple, or invisible retinal breaks. A further, large-size randomized controlled study is needed to confirm its efficacy.
Multifocal Electroretinogram, Central Macula Thickness and Visual Acuity in Diabetic Macular Edema Following Intravitreal Injection of anti-VEGF Nusanti, Syntia; Sampurna, Kirana; Djatikusumo, Ari; Yudantha, Anggun Rama; Prihartono, Joedo
International Journal of Retina Vol 4 No 2 (2021): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2021.vol004.iss002.156

Abstract

Introduction : Diabetic Retinopathy (DR) is one of the major cause of visual acuity deterioration in diabetic patients. The loss of central visual acuity in diabetic patients are mainly due to macula edema, which is found in 29% diabetic patients with the over 20 years duration of disease. The aim of this study is to evaluate and investigate the possible correlation among changes of visual acuity (VA), central macular thickness (CMT) using Spectral Domain Optical Coherence Tomography (SD-OCT). Electrophysiological responses using multifocal electroretinography (MfERG) in diabetic macular edema (DME) following intravitreal injection of bevacizumab. Methods: Single arm clinical trial. Thirty-three eyes of 33 DME patients (16 non-proliferative diabetic retinopathy and 17 non-high-risk proliferative diabetic retinopathy), receives intravitreal bevacizumab 1,25mg. All patients underwent complete ophthalmic examination including ETDRS VA testing, Sixty-one scaled hexagon MfERG and SD-OCT scan at baseline, 1-week and 1-month post-injection. Components of the first order kernel (N1, N2 and P1) in central 2o were measured. Result : MfERG showed reduced P1 amplitude (P<0.05) at 1-week after injection followed by increased P1 amplitude (P>0.05) at 1-month after treatment as compared to the baseline in all subjects. There was 19% improvement CMT and 0.2Logmar VA improvement in 1-month post-injection compared to the baseline (P<005). This study showed no serious ocular adverse effects. There was no significant correlation between changes in visual acuity with changes in CMT or other MfERG parameters. Conclusion: Intravitreal injection bevacizumab resulting in improved VA, reduction in CMT and mild improvement in the MfERG responses. Although VA changes did not correlate with reduced CMT nor with improved responses of MfERG, the combined use of SD-OCT and MfERG may be used to evaluate macular function in DME patient with worsened visual acuity post anti-VEGF injection.
Co-Authors Agustiawan, Referano Ali, Reyno Satria Andayani, Gitalisa Anna Rozaliyani Ardhia, Seruni Hanna Ari Andayani Arief S. Kartasasmita Arini Setiawati Augiani, Amani Sakinah Ayuningtyas, Sita Paramita Dearaini Dewiputri, Salmarezka Dharma, Andhika Guna Elvioza Elvioza, Elvioza Firmansyah, M Harley, Ohisa Herdian, Felicia Sesih Hutapea, Mario Marbungaran Ichsan, Andi M Ikhwan Rinaldi Isfyanto, Isfyanto Iskandar, Erwin Iskandar, Ferdy Joedo Prihartono Khoe, Levina Chandra Kusumowidagdo, Gladys Leonedine, Tengku Viona Zohra Lisnawati Rachmadi Lukman Edwar Lumintang, Agnesstacia Vania Mardianto, Umar Maria Marietta Bali Larasati Martin Hertanto Mawarasti, Burhana Nadhira, Andi Marsa Nadia Artha Dewi Oktariana, Virna Dwi Pambudy, Indra Maharddhika Pratiwi, Rianti Wulandari Regina Ivanovna Sampurna, Kirana Sembiring, Sindy Boru Sidik, Mohamad Sjahreza, Emil Sjahreza, Emil Fahrinandi Suryoadji, Kemal Akbar Susilo, Teguh Syntia Nusanti Taim, Abisyifa Rahma Triwijayanti, Triwijayanti Triyoga, Ichsan Fauzi UTAMI, ALIA NESSA Victor, Andi Arus Wiyogo, Widya Artini Yudanta, Anggun Rama Yudantha, Anggun R. Yudantha, Anggun Rama Yudhanta, Anggun Rama Yustiarini, Ima