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All Journal PREPOTIF : Jurnal Kesehatan Masyarakat Ophthalmologica Indonesiana
Eka, Hasnah
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Health Professions Medicine & Pharmacology Public Health

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METHOTREXATE FOR REBOUND PHENOMENON OF VOGT-KOYANAGI-HARADA IN JUVENILE: A RARE CASE REPORT Bachmid, Humairah; Eka, Hasnah; Anoez, Azizah; Fikri, Bahrul
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/x2ytbm20

Abstract

Introduction: Vogt-Koyanagi-Harada (VKH), an auto-immune disorder driven by melanocyte antigen, is rare in children. The mainstay treatments are corticosteroid and immunomodulators. Methotrexate is one of immunomodulator that widely used due to its effectiveness with minimal side effects. Case Report: A 9-years-old boy get diagnosed Vogt-Koyanagi-Harada. His best corrected visual acuities (BCVA) were 20/400 in both eyes. Anterior segment examination showed granulomatous uveitis. Posterior segment examination revealed optic disk swelling, Dallen Fuch’s nodule and exudative retinal detachment. We also found poliosis and vitiligo in his lips. He had been previously treated with topical corticosteroids, oral corticosteroids and topical cycloplegics. The dose was tapered every month. After taking medication for 5 months with the last dose oral corticosteroid 16 mg/day and topical corticosteroid every 8 hours, his BCVA recovered to 20/25 RE and 20/40 LE. During the treatment time, the patient discontinued the medication due to parental disobedience and then came with decrease of vision. Based on the consideration of rebound phenomenon and the use of maximum dose of corticosteroids, we consulted the patient to the pediatrician, and decided to give methotrexate as an immunosuppressant. After receiving 15 mg/week of methotrexate for 3 months, inflammation calmed down but unfortunately the vision did not improve. Discussion: In children, the main treatment for VKH disease is high-dose corticosteroids. Considering the side effects of prolonged systemic corticosteroid therapy, methotrexate become the first line of corticosteroid sparing agent, especially in chronic stage. Conclusion: Methotrexate can be an effective treatment option for rebound VKH.  Keywords: Juvenile Vogt-Koyanagi-Harada, Steroid Sparing Agents, Rebound Phenomenon, Methotrexate.
Diffuse Granulomatous Conjunctivitis as an Ocular Manifestation of ANCA-Negative Limited Wegener’s Granulomatosis: A Case-Based Literature Review Hartono, Cindy; Pratiwi, Andi; Sungowati, Ni Ketut; Fikri, Bahrul; Eka, Hasnah
Majalah Oftalmologi Indonesia Vol 51 No 2 (2025): Ophthalmologica Indonesiana
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/journal.v51i2.101588

Abstract

Introduction: Necrotizing granulomatous vasculitis, which is commonly known as Wegener's Granulomatosis (WG), frequently affects small to medium-sized blood vessels and is associated with anti-neutrophil cytoplasmic antibodies (ANCA). Despite ocular manifestations being prevalent in the disease, initial symptoms involving the eyelid and conjunctiva are infrequent. This study reports a case of an 11-year-old girl diagnosed with localized WG in the conjunctiva, with negative ANCA-test, and biopsy strongly suggested WG.   Case Report: An 11-year-old girl presented a red membrane covering the entire ocular surface and diminished vision in the left eye seven months before admission. At presentation, hand motion in the left eye was the best corrected visual acuity. There were granuloma formations in the palpebral and bulbar conjunctival, covering the entire ocular surface in the left eye. An incisional biopsy was performed in the conjunctiva, which revealed an ulcerative mucous membrane, prominent vasculitis, and necrotizing granulomas with giant cells and massive leukocyte infiltrate consistent with WG diagnosis.   Discussion: There is a need to consider the clinical manifestations suggesting the presence of vasculitis, ANCA determination, and histopathological evidence of the compromised organ to confirm the diagnosis. Overall, 82-94% of patients with WG were ANCA positive, leaving approximately 10% who tested negative, particularly those with limited WG. Moreover, a biopsy can confirm the diagnosis, specifically in ANCA-negative cases.   Conclusion: This case illustrated the consideration for WG diagnosis in limited form and negative ANCA-test. The clinical suspicion of WG and alternative diagnostic criteria using tissue biopsy might be helpful in such cases.
LAPORAN KASUS : PENATALAKSANAAN TRAUMA BENDA ASING BUBUK MESIU PADA OKULAR AKIBAT LEDAKAN KOMPRESSOR KAPAL Zahra Shafanisa Oddang, Andi; Novriansyah, Zulfikri Khalil; Arsal, Muhammad Yasin; Eka, Hasnah; Namirah, Hanna Aulia
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 8 No. 2 (2024): AGUSTUS 2024
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v8i2.28014

Abstract

Trauma mata adalah kerusakan jaringan mata, akibat adanya benda tajam, benturan benda tumpul, atau zat kimia yang mengenai mata. Trauma pada mata dapat diakibatkan oleh benda asing yang masuk yang dapat mengakibatkan kerusakan pada struktur mata akibat reaksi peradangan dan infeksi serta dapat menganggu fungsi penglihatan. Sehingga, perlu segera dikenali dan dikeluarkan. Kami melaporkan seorang pria berusia 39 tahun yang menderita trauma benda asing berupa bubuk mesiu akibat ledakan kompresor kapal. Pasien dilakukan tindakan berupa ekstraksi benda asing dalam jaringan konjungtiva melalui reseksi konjungtiva seluruhnya dan ekstraksi benda asing pada kornea serta dilakukan pemasangan membran amnion. Setelah operasi, pasien diberikan obat tetes mata kombinasi Dexamethasone, Polimiksin B, serta Neomisin sulfat dan analgetik oral berupa Natrium Diklofenak 50 mg. Benda asing di mata adalah sesuatu yang masuk ke mata dari luar tubuh, seperti debu atau pecahan logam. Gejalanya termasuk sensasi tidak nyaman, perih, atau berpasir pada mata, mata merah dan gatal, serta ada riwayat sesuatu yang masuk ke mata. Pemeriksaan fisik dapat menunjukkan injeksi konjungtival, tampaknya benda asing, dan edema kornea. Benda asing ini harus segera dikeluarkan, terutama jika disebabkan oleh bahan kimia. Penggunaan antibiotik topikal dan obat anti nyeri dapat diperlukan setelah pengangkatan benda asing. Kesimpulan dari laporan kasus ini adalah penatalaksanaan pada kasus benda asing pada mata sebaiknya sesegera mungkin dilakukan pengangkatan benda asing untuk mencegah terjadinya resiko infeksi dan kerusakan intraokuler, sehingga penting untuk melakukan penegakan diagnosa awal dalam hal ini anamnesa terpimpin dan pemeriksaan fisik.
Co-Authors Anoez, Azizah Arsal, Muhammad Yasin Bachmid, Humairah Fikri, Bahrul Hartono, Cindy Namirah, Hanna Aulia Ni Ketut Sungowati, Ni Ketut Novriansyah, Zulfikri Khalil Pratiwi, Andi Zahra Shafanisa Oddang, Andi