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Augiani, Amani Sakinah
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Health Professions Medicine & Pharmacology Public Health

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Combined Virna Glaucoma Implant (VGI) Implantation and Pars Plana Vitrectomy for Refractory Aphakic Glaucoma: Poster Presentation - Case Report - Resident Herdian, Felicia Sesih; Augiani, Amani Sakinah; Lumintang, Agnesstacia Vania; Iskandar, Ferdy; Oktariana, Virna Dwi; Djatikusumo, Ari
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: 10.35749/7e24y445

Abstract

Introduction : Glaucoma drainage devices (GDDs) implantation are frequently indicated for refractory glaucoma. The preferable anterior chamber may be inaccessible for patients with anterior chamber abnormalities. Case Illustration : A 6-year-old boy presented with high intraocular pressure (IOP) on the right eye (RE) four months before admission. Cataract surgery on both eye was done four years prior, due to congenital cataract. On examination, the visual acuity of the RE was hand movement with IOP 61mmHg with medications. Anterior chamber was shallow, posterior synechiae was found and posterior segment was hard to be evaluated. The fellow eye was nonfunctional with IOP 31mmHg. Pars plana vitrectomy (PPV) was performed followed by implantation of GDD (Virna Glaucoma Implant) with posterior chamber sulcus tube placement without adding a new incision. Post-operatively, IOP was 3mmHg and choroidal detachment was found. With steroid medication, satisfactory IOP control was achieved within three weeks of follow-up. Visual acuity of RE was improved to 0.5/60. Discussion : In eyes with shallow anterior segments, tube placed in the anterior chamber may increase the risk of corneal endothelial injury. Placement of the silicone tube in the posterior chamber sulcus is an effective alternative technique. Although it is relatively safe in experienced hands, vitrectomy and insertion of the tube into the posterior segment carries significant risks, including choroidal detachment. Careful monitoring and management is needed to control IOP and maintain vision. Conclusion : Combined GDD implantation and PPV may be considered for refractory aphakic glaucoma, showing favorable outcomes with a relatively safe procedure.
Classic Choroidal Neovascularization in Young Man: Poster Presentation - Case Report - Resident Mawarasti, Burhana; Augiani, Amani Sakinah; Pratiwi, Rianti Wulandari; Djatikusumo, Ari
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/kw1xdq52

Abstract

Introduction : Classic choroidal neovascularization (CNV 2) represent a pathological growth of blood vessels and can result in loss of visual function. The most common cause of CNV 2 in elderly patients is age- related macular degeneration, meanwhile in young age it is frequently due to inflammation, high myopia, angioid disks and hereditary disorders. Hence, the presented case reports the characteristic findings as well the management of the disease. Case Illustration : A 37-year-old man had two weeks history of metamorphopsia on both eyes. The left eye (LE) had a worse visual acuity, macular fibrosis with pigment epithelial detachment in funduscopy and Optical Coherence Tomography (OCT). A submacular hemorrhage and exudative lesion were recognized on the right eye (RE) with type 2 choroidal neovascularization. Fundus Fluorescence Angiography (FFA) was also performed. Systemic conditions were unremarkable. Intravitreal anti-VEGF injections on RE were given for three consecutive months and showed significant improvement. Discussion : The etiology of CNV 2 includes high myopia, and inflammation. However, none was found in this patient. Nonetheless, CNV type 2 is still uncommon in young age without predisposing conditions. As most common lesions involve the macula, symptoms shown include metamorphopsia, central scotoma and floaters. FFA is still considered to be the gold standard to differentiate the types of choroidal vascularization. Neovascularization and submacular hemorrhage can be treated with intravitreal injection of anti-VEGF, as previous studies reported significant improvement. Conclusion : This was a case of bilateral CNV type 2 in a young man without any previous predisposing conditions. Three monthly injections of anti-VEGF showed significant improvement.
An Uneventful Case of Unresolved Suprachoroidal Hemorrhage After Cataract Surgery: When to Operate? Poster Presentation - Case Report - Resident Dearaini; Ivanovna, Regina; Lumintang, Agnesstacia Vania; Augiani, Amani Sakinah; Mawarasti, Burhana; Djatikusumo, Ari
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/tvhx6r93

Abstract

Introduction : Suprachoroidal hemorrhage (SCH) is a rare, but potentially vision-threatening condition. The management options for SCH varied and still debatable. Case Illustration : Female 54 years old with chief complaint blurry vision of right eye (RE) since four days after she underwent cataract surgery. She also experienced radiating pain from RE with nausea and vomiting. No history of elevated intraocular pressure (IOP) before the surgery. Her left eye was blind for 20 years prior due to an unknown cause. Visual acuity (VA) on presentation was light perception good projection and IOP was 34mmHg. There was 2.5mm hyphema and fibrin on the anterior chamber. Lens appeared to be aphakic and there was lens material at pupillary margin. Ultrasonography (USG) of RE showed choroidal elevation with medium to high spike and positive after movement indicating SCH. She was hospitalised for IOP monitoring and serial USG was performed to monitor the hemorrhage. Six days after admission, IOP remain elevated despite medications and SCH didn’t resolve, then vitrectomy and scleral drainage was performed. Postoperative exam showed improved VA to 0.5/60, IOP to 16mmHg without medication, and reduced suprachoroidal hemorrhage on USG. Discussion : It’s imperative to perform complete evaluation of ocular and systemic conditions in preoperative period to prevent SCH. Ultrasonography is crucial during the close follow-up after developing SCH, it also aids in the timing of surgical intervention. Conclusion : Vitrectomy with scleral drainage is a valuable approach in managing extensive SCH, a condition generally associated with poor prognosis.
Co-Authors Dearaini Djatikusumo, Ari Herdian, Felicia Sesih Iskandar, Ferdy Lumintang, Agnesstacia Vania Mawarasti, Burhana Oktariana, Virna Dwi Pratiwi, Rianti Wulandari Regina Ivanovna