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Utomo, Purjanto Tepo
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Health Professions Medicine & Pharmacology Public Health

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INTRAVENOUS METHYLPREDNISOLONE EFFECTS ON RECTUS MUSCLES IN THYROID EYE DISEASE Murtadha, Milzan; Supartoto, Agus; Utomo, Purjanto Tepo; Dibyasakti, Banu Aji; Darajati, Irene Titin
Majalah Oftalmologi Indonesia Vol 49 No S1 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/7nrw4309

Abstract

Introduction & Objective: Intravenous methylprednisolone has been used in management of Thyroid Eye Diseases (TED) which was an autoimmune inflammatory disease of the orbital tissues and the eyes. Previous study has shown benefits of intravenous methylprednisolone therapy on TED but there was need of quantitative measure to assess the effect of intravenous methylprednisolone therapy on extraocular rectus muscles. This study aimed to report the effect of high-dose intravenous methylprednisolone pulse therapy on inferior, medial, superior, and lateral rectus muscles and providing data distribution of active TED before and after therapy. Methods: Retrospective analyses were used in the data collection of patients with active Thyroid Eye Disease (TED) underwent high-dose intravenous methylprednisolone pulse therapy regiment 500mg every week for six consecutive weeks at Sardjito Eye Centre between January 2022 and December 2022. Ophthalmological investigation and quantitative computed tomography (CT) scan of the orbit were performed before and after methylprednisolone pulse therapy and demographics data were presented in tables and graphs. Results: This study included 62 eyes of 31 patients (61,3% female) with mean age of 37.8±13.47 years old. The mean thickness of Superior Rectus (SR) muscle before therapy were 4.12±2.20 mm and significantly decreased to 3.70±1.54 mm post therapy. There was no significant difference in delta mean Inferior Rectus (?IR) -0.18±1.69 (p=0.381), Medial Rectus (?MR) -0.34±1.68 (p=0.116), and Lateral Rectus (?LR) -0.33±1.94 (p=0.188) Conclusion: The treatment of Thyroid Eye Disease (TED) with high dose intravenous corticosteroid is safe and effective in reducing extraocular muscle tissue thickness with minimal side effects. Keywords: Thyroid Eye Disease, Extraocular Muscle, Intravenous Methylprednisolone Therapy.
THE EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN CONTRACTED SOCKET Dwiamelia, Theresia; Respatika, Datu; Darajati, Irene Titin; Dibyasakti, Banu Aji; Utomo, Purjanto Tepo; Supartoto, Agus
Majalah Oftalmologi Indonesia Vol 49 No S1 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/k6np2295

Abstract

Purpose: A contracted socket is considered a common complication in anophthalmic patients, with the resulting poor fitting of an ocular prosthesis. In severe cases where patients have had multiple previous reconstructive attempts, further socket contraction may result from fibrosis, leading to eventual surgical failure. Alpha-smooth muscle actin (?-SMA) is often used to identify pathologic fibroblasts. It may serve as a reliable marker for myofibroblast cells. The aim of the study was to find ?-SMA protein expression in myofibroblasts derived from orbital socket contracture. Methods: In this study, we observed five patients with contracted sockets who underwent fornicoplasty and buccal graft surgery from October 2022 to February 2023. Tissue samples were taken from the conjunctival fornix area during the surgery and then examined for ?-SMA expression. Result: In this study, there were 2 out of 5 (40%) positive ?-SMA expressions with history of recurrent contraction, 2 (40%) negative expressions with no history of recurrent contraction, and 1 result that could not be assessed due to the limited number of samples containing fibroblasts. Conclusion: ?-SMA levels can be detected in patients with contracted sockets. Patients with a history of recurrently contracted sockets have a tendency to express positive ?-SMA. This may allow for the need for the administration of antimetabolites in patients with recurrent contracted sockets to avoid recurrence of this contracted socket.
REVEALING ORBITAL TUMORS: 2-YEAR EVALUATION IN CLINICAL PROFILE, HISTOPATHOLOGICAL FEATURES AND SURGICAL TECHNIQUE Lisani, Silmi Lisani; Supartoto, Agus; Utomo, Purjanto Tepo; Dibyasakti, Banu Aji; Respatika, Datu
Majalah Oftalmologi Indonesia Vol 49 No S1 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/vbeczx79

Abstract

Introduction: Incidence of orbital tumors is relatively low, but the delay in diagnosis, even if benign, can lead to vision loss and deformity. Purposes: This study aims to review clinical and demographic information of orbital tumors in Sardjito General Hospital, Yogyakarta.  Method: We retrospectively reviewed clinical data of 138 patients who diagnosed with orbital tumors during July 2021 - March 2023. Data extracted included clinical characteristics, operative procedures, and histopathologic characteristics of orbital tumor.  Result: There were 138 orbital tumors managed at hospital during 2-year period. Among 138 patients, 82 patients (59%) were female and 56 patients (40%) were male. Twenty-one patients (15%) were in childhood age and 117 patients (84.8%) were in adulthood age. The common clinical manifestations were proptosis (83.3%) and decreased vision (10.4%). The main procedure used was anterior orbitotomy (54.34%). Eighty-eight patients (63.7%) have primary tumors and 51.4% of the orbital tumors were malignant. The most cases in children were benign tumors (61.9%) meanwhile in adults were malignant (54.7%). The main orbital tumor in childhood age was a Non-Hodgkin Lymphoma (NHL) (19%) and cyst (14.3%). On the other hand, in adult patient, the most common orbital tumor was meningioma (18%) and NHL (15.7%).  Conclusion: Orbital tumors are challenging group of tumors with proptosis become the most frequent clinical characteristic that found. The orbital tumors in childhood and adulthood differ significantly in their incidence and tumor type with the percentage of malignant tumors increasing with age.
INVESTIGATING THE INTERPLAY: UNRAVELLING THE IL-6 CONNECTION AND INTRAVENOUS METHYLPREDNISOLONE’S IMPACT ON RECTUS MUSCLE IN THYROID EYE DISEASE Fajar, Rangga Athallah; Supartoto, Agus; Utomo, Purjanto Tepo; Dibyasakti, Banu Aji; Darajati, Irene Titin
Majalah Oftalmologi Indonesia Vol 49 No S1 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/67prp434

Abstract

Introduction & Objective: Intravenous corticosteroid has been used in management of Thyroid Eye Diseases (TED). Many previous studies have shown the therapeutic benefits of corticosteroid therapy. Recently, the efficacy of high-dose intravenous corticosteroid pulse therapy has been reported. Recent studies have highlighted the potential role of interleukin-6 (IL-6) in the pathogenesis of TED. However, the correlation between IL-6 levels and the effects of IVMP on rectus muscles in patients with TED remains unclear. This study aims to investigate the correlation between IL-6 levels and the effects of IVMP on rectus muscles in patients with TED Methods : Retrospective analysis were used in the data collection of patients with active Thyroid Eye Disease who undergone high-dose intravenous methylprednisolone pulse therapy (500mg per week for 6 successive weeks) at Sardjito General Hospital between January 2022 and December 2022. Data on the Level of IL-6 were obtained at the start of treatment, and quantitative computed tomography (CT) of the orbit and were performed before and after treatments. Demographics data were presented in tables and graphs. Results : This study included 62 eyes of 31 patients (61,3% female) with mean age of 37.8±13.47 years old. There was significant inverse correlation in levels of IL-6 and ?SR (P=0.037) which implies a reduced effect of IVMP on SR. However, other statistical analyses on different rectus muscle groups bare no statistical significance. Conclusion : The use of IL-6 as a single predictor of responsiveness of the treatment of high dose intravenous methylprednisolone is not endorsed by the result of this study.  However, further studies with better established level of IL-6 both pre and post treatment, and more inclusive parameters are needed to better provide better understanding on the role of IL-6.
Co-Authors Darajati, Irene Titin Datu Respatika Dibyasakti, Banu Aji Dwiamelia, Theresia Fajar, Rangga Athallah Lisani, Silmi Lisani Murtadha, Milzan Supartoto, Agus