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ACCURACY OF MEASUREMENT RESULTS ON SCHIOTZ TONOMETER TOWARDS GOLDMANN APPLANATION TONOMETER IN TYPE II DIABETES MELLITUS PATIENTS IN MOHAMMAD HOESIN HOSPITAL, PALEMBANG: Oral Presentation - Experimental Study - Ophthalmologist AN NASHER, DAMAL; Fidalia; Erial
Majalah Oftalmologi Indonesia Vol 49 No S2 (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/zkxbj229

Introduction & ObjectivesThe Goldmann Applanation Tonometer is now the most accurate gold standard compared to othertonometers. IOP measurement errors using the Schiotz Tonometer can be caused by ocular rigidity,where the IOP is read higher in eyes with higher ocular rigidity and vice versa. Type II DiabetesMellitus (DM) patients are at risk for increased ocular rigidity MethodsThis research is a cross-sectional study with a diagnostic test design regarding the accuracy ofintraocular pressure results on the Schiotz Tonometer against the Goldmann Applanation Tonometerin type II Diabetes Mellitus patients with 35 research samples. The research was conducted at theMohammad Hoesin Hospital in Palembang from April 2022 – September 2022 until the sample sizewas met ResultsIntraocular pressure (IOP) as measured by The average Goldmann Applanation Tonometer was 15.5± 2.4 mmHg, with a Schiotz load of 7.5 grams the average was 16.2 ± 2.3 mmHg. Ocular rigidityhad a median of 0.0242 (0.0176 – 0.0341) From the results of this study the IOP examination withthe Schiotz Tonometer had a sensitivity of 92.9%, a specificity of 80.9%, a positive predictive valueof 76.5%, a negative predictive value of 94.4% and an accuracy value of 92.3% indicating astatistically strong level of accuracy ConclusionThe Schiotz tonometer has an accuracy rate of 92.3% in examining intraocular pressure using a loadof 7.5 type II diabetes patients which can replace the Goldmann Applanation Tonometer as the goldstandard if normal ocular rigidity is found

FILTRATION SURGERY OF TRABECTULECTOMIES WITH 5 – FLUOROURACIL IN ADVANCED POAG: Poster Presentation - Case Report - Resident Amrina, Fadillah; Fidalia; Sari, Prima Maya
Majalah Oftalmologi Indonesia Vol 49 No S2 (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: 10.35749/8c2cqp88

Introduction : Advanced Glaucoma (AG) is total cupping of optic nerve with or without severe visual field loss. The prevalence of AG in POAG, shows that 15% have a substantial visual field defect. Initial therapy for AG can use medications, surgical therapy is performed when adecuate medical treatment isn’t effective. Filtration surgery such as trabeculectomy and implantation of tube shunts can be performed. This case reports aims to understand the used of trabeculectomy+5FU in Advanced POAG. Case Illustration : A 55 years old woman came with blurry and tunnel vision accompanied by headache since 2 years ago. She got treatment yet stopped to control. Vision has progressively reduced since 2 months ago. Visual acuity OD 1/300 OS 1/60, IOP OD 25.1 mmHg and OS 29.8 mmHg with 4 drugs, cloudy lens, cupping, c/d ratio 0.9, nasalization, bayonet sign and peripapillary atrophy. The patient was diagnosed with Advanced POAG with immature senile cataract ODS. Patient was treated with trabeculectomy+5-FU due to uncontrolled IOP despite receiving adecuate therapy. Releasing sutures were used to control IOP after surgery. After surgery, the last IOP OS 12.6 mmHg, and bleb formed E1H1V0. Discussion : Conclusion : Patients was treated with trabeculectomy+5-FU, can control IOP stably in advance of POAG without serious complications, cost less than routine drugs and maintain visual function and improve quality of life. Filtration surgery such as trabeculectomy with AF agents is proven to reduce IOP more stably in advance of POAG.

RE-TRABECULECTOMY + 5-FLUOROURACIL IN PRIMARY ANGLE CLOSURE GLAUCOMA PATIENTS AGGRAVATED BY CONSUMPTION OF SCHIZOAFFECTIVE DRUG: Poster Presentation - Case Report - Resident Syafridon, M Fadhil; Fidalia; Sari, Prima Maya
Majalah Oftalmologi Indonesia Vol 49 No S2 (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/nykrk915

Introduction : PACG occurs when the anterior chamber angle is occluded by the iris thus reducing aqueous humor outflow. Most schizoaffective patients use anticholinergic drugs which may result in iridocorneal angle closure through deposition. This article reported a Re-Trabeculectomy + 5 FU surgery in PACG which was aggravated by the use of schizoaffective drugs Case Illustration : A 43 year old woman, underwent Re-Trabeculectomy + 5 FU on LE after increasing IOP and regularly took schizoaffective drugs. Tapering of schizoaffective therapy was done 1 month preoperatively. Patient presented with LE UCVA of 3/60 and LE IOP is 30.9 mmHg with three anti- glaucoma medications. LE examinations revealed VH1 AC, bayonet sign and cupping on funduscope, closed angle on gonioscope, nasal step defect on humphrey and diffuse RNFL thinning on OCT. On the first postoperative day LE IOP is 18.5 mmHg. The schizoaffective therapy was re-initiated from psychiatric and evaluation was done weekly Discussion : Re-trabeculectomy surgery have been done considering the failure of the first trabeculectomy and administration of 5-Fluorouracil as an anti-fibrosis. The benefits of reducing preoperative dose of schizoaffective drugs for a month due to having an anticholinergic effect and reduces IOP by 5 mmHg. Psychiatrists and ophthalmologists work together to try to administer basic schizoaffective drug doses and evaluate IOP to keep it under control. Conclusion : The re-operative action was carried out by adding anti-fibrosis and cooperating with psychiatry for postoperative tapering of schizoaffective drugs. Long-term use of antidepressant drugs and benzodiazepines increases PACG.

SCHWARTZ-MATSUO SYNDROME : AN IMPORTANT CAUSE OF SECONDARY GLAUCOMA : RARE CASE: Poster Presentation - Case Report - Resident Perkasa, Teguh Ridho; Fidalia; Sari, Prima Maya
Majalah Oftalmologi Indonesia Vol 49 No S2 (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/rkkb3g69

Introduction : Schwartz-Matsuo syndrome is a rare ocular condition characterized by rhegmatogenous retinal detachment, elevated intraocular pressure, and open anterior chamber angle with presence of aqueous cells. The prevalence of Schwartz-Matsuo syndrome is quite low and only reported through case studies. Case Illustration : A 63 years old female complained a visual aquity was no light perception on the left eye (LE) since 2 months ago. The symptoms are gradually getting worse, history of ocular trauma, recent surgery, photopsia, peripheral visual field loss were denied. Patient came to the hospital with IOP elevation on left eye. On Gonioscopy we interpretated as open angle chamber and USG examination we founded retinal detachment, Anti-glaucoma medication were given but no success to lower the IOP. Discussion : Typically, retinal detachment is associated with low IOP. In Schwartz-Matsuo syndrome the opposite is observed with elevated IOP. Hypothesized that photoreceptor outer segments pass through the retinal break allows for fluid and photoreceptor outer segments to gain access, enter the anterior chamber and block aqueous outflow at the level of the trabecular meshwork. A significant increase in IOP can lead to visual loss and blindness complicated by glaucoma requiring further medical or surgical intervention. Referred to this patient, she came with IOP elevation, open angle anterior chamber and retinal detachment that clinically diagnosed as Schwartz-Matsuo syndrome. Conclusion : Schwartz-Matsuo syndrome is primarily a clinical diagnosis; Early detection of disease and prompt management of increased IOP and retinal detachment is essential for a good outcome.

Virna Glaucoma Drainage Device Implantation On Pediatric Patient With Steroid Induced Glaucoma: Poster Presentation - Case Report - Resident CHRISTIAN ANDREW DARIAN SIANIPAR; Fidalia; Sari, Prima Maya
Majalah Oftalmologi Indonesia Vol 49 No S2 (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/y1dyxh57

Introduction : Steroid-induced Glaucoma (SIG) in pediatric patient is reported to have a more progressive and severe manifestations often unresponsive to glaucoma filtration surgery. We aim to report a successful management of SIG using Virna implant on pediatric patient. Case Illustration : A 10 years old boy underwent bilateral Virna GDD implantation following uncontrollable IOP after multiple trabeculectomies. The patient presented with a UCVA of 4/60 on both eyes. IOP of RE and LE is 31.8 mmHg and 29.7 mmHg respectively with four anti-glaucoma medications. Both eyes revealed conjunctival hyperemia with no bleb formation, VH3 AC, 12 o’clock iridectomy, C/D ratio of 0.9 with bayonet sign and nasalization on indirect funduscope, open angle on gonioscope, annular scotoma on Humphrey, and diffuse thinning of RNFL on OCT. Six months postoperatively, BCVA of RE and LE is 6/60 and 6/30 respectively with minimal progression on both ocular visual field defects. As for IOP, RE IOP is 18.7 mmHg with two anti-glaucoma medications and LE IOP is 14.3 mmHg without anti-glaucoma medications. Discussion : Multiple failed trabeculectomies is an indication for GDD. Virna implants are meant for adult subsequently making plate and tube placement crucial in pediatric patient because the globe is still growing and relatively thin. It is necessary to evaluate IOP periodically after implantation as IOP will enter hypertensive phase and stabilize in 3-6 months. Conclusion : GDD implantation, including Virna Implant, is a viable alternative to children with refractory SIG to prevent further glaucomatous damage.

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