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Scleral Buckling for Retinopathy of Prematurity: A Case Report Permanik, Gustiandari Fidhya; Barliana, Julie Dewi; Yudantha, Anggun Rama
Majalah Oftalmologi Indonesia Vol 51 No 1 (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.v51i1.101725

IntroductionThe selection of management for advanced retinopathy of prematurity (ROP) requires careful consideration. The purpose of this study is to report the effectiveness of scleral buckling in patient with retinopathy of prematurity stage 4B of both eyes within 3 months. Case Description A 4-month-old female baby came to the Pediatric Ophthalmology Unit in Cipto Mangunkusumo General Hospital (RSCM) Kirana with chief complain did not make eye contact of both eyes. Her eyes were moving on their own since she was 3.5 months old, and sometimes squint. The patient came to the pediatrician and was referred to pediatric ophthalmology for further treatment. There was a history of premature delivery at 30 weeks with oxygen therapy for 3 weeks. The Pediatric ophthalmology division performed ultrasonography and retcam, and the diagnosis of retinopathy of prematurity stage 4B of both eyes was made. Scleral buckling was performed in the right and left eyes at the postmenstrual age of 49 weeks, and 52 weeks respectively by vitreoretinal division. Conclusion The management of ROP depends on the type ROP. For advanced ROP, surgery is indicated. The scleral buckle is a treatment option for advanced retinopathy of prematurity patients with retinal detachment if it is assumed that intraocular surgery presents a greater risk. In short-term period, for the right eye, the scleral buckling is effective. Further time to follow up is needed to show the long-term period effectiveness of scleral buckling in patients with advanced ROP.

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

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.

PARS PLANA VITRECTOMY FOR VITREOUS HEMORRHAGE IN CIPTOMANGUNKUSUMO HOSPITAL Razief Fitri, Marsha Alyssa; Yudantha, Anggun Rama
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.iss002.146

Introduction: Vitreous hemorrhage is the presence of blood in the vitreous cavity. This condition could impair the visual function and hindered the clinician’s ability to examine the posterior segment of the eye. Pars plana vitrectomy (PPV) not only act as a surgical treatment of choice but also diagnostic procedure. Immediate PPV has the advantage to optimalize visual acuity Methods: Retrospective descriptive study of vitreous hemorrhage patients underwent pars plana vitrectomy in Ciptomangunkusumo Hospital, Indonesia from January to December 2018 Result: There were 160 cases of vitreous hemorrhage cases undergoes pars plana vitrectomy in 2018. Most frequent etiology was proliferative diabetic retinopathy (49.4%). Rebleeding was found only in 8 cases within the period of three months follow up. Final visual acuity was improved in majority of the cases and found to be related to timing of the surgery. Conclusion: Early vitrectomy along with systemic control of underlying factors lead to improvement of visual acuity in vitreous hemorrhage.

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

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.

Anatomical and Functional Outcomes of Management Pediatric Retinal Detachment with High Myopia and History of Retinopathy of Prematurity: A Case Report: Poster Presentation - Case Report - Resident Sadikin, Irma Suwandi; Yudantha, Anggun Rama
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/ak2gz370

Introduction : To report the anatomical and functional outcomes of management of pediatric retinal detachment in children with high myopia and a history of retinopathy of prematurity. Case Illustration : A 9-year-old boy had a sudden visual loss two months ago. The complaint is accompanied by photopsia and floaters. No history of trauma or infection. He had a history of myopia (S-6.00) and ROP in both eyes. The VA of the right eye was no light perception, and the left eye was 1/60. A retinal detachment with the macula off was discovered in the posterior examination. The axial length was 21 mm. He underwent a scleral buckle with vitrectomy and internal limiting membrane (ILM) peeling for his left eye. After surgery, the visual acuity was 3/60 with the retina attached. Re- detachment was found three weeks after surgery. The patient was scheduled for a second phacoemulsification and vitrectomy surgery. One month later, the best visual acuity reaches 6/48 with S -8.00 D on his left eye. The complication of high intraocular pressure (IOP) after surgery was managed successfully. Discussion : Conclusion : Management of retinal detachment cases in children is challenging. Hence, a thorough understanding is crucial in order to achieve anatomical and functional success. Myopia in ROP eyes was mainly lenticular, with an alteration in the anterior chamber that contributed to the patient's refractive status change. We encourage preterm patients to have regular follow-up not only for refractive status but also for structural changes in the anterior segment until adolescence.

Scleral Buckling for Retinopathy of Prematurity: A Case Report: Presentation - Case Report - Resident Permanik, Gustiandari Fidhya; Barliana, Julie Dewi; Yudantha, Anggun Rama
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/esqh6d30

Introduction : Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease that affects premature infants. Patients with advanced ROP require surgery to minimize retinal distortion and prevent total retinal detachment. This case reports the efficacy of scleral buckling (SB) in a patient with stage 4B ROP in both eyes within 3 months. Case Illustration : A 4-month-old female baby presented to the Pediatric Ophthalmology Division in Cipto Mangunkusumo Hospital with the chief complaint of no eye contact in both eyes. Her eyes moved by themselves since the age of 3.5 months and sometimes looked crossed. The patient presented to the pediatrician and was referred to the pediatric ophthalmology division for further management. There was a history of premature delivery at 30 weeks with oxygen therapy for 3 weeks. Pediatric Ophthalmology Division performed ultrasonography and Retcam and diagnosed ROP stage 4B in both eyes. Scleral buckling was performed by vitreoretinal division in the right and left eyes at 49 and 52 weeks postmenstrual age, respectively. Discussion : Vitrectomy and scleral buckling are the surgical options in advanced ROP. Vitrectomy is ideally performed in stage 4A without macular involvement. We considered performing SB because vitrectomy seems to be ineffective in this patient and the patient is more prone to intraocular complications. Conclusion : Scleral buckling is effective in preventing further progression of retinal detachment, reducing vitreoretinal traction and preventing ischemia in the retinal detachment. In short-term follow-up, we found no worsening of progression. However, further follow-up is needed to demonstrate the long- term efficacy of SB in advanced ROP.

FACTORS INFLUENCING THE OUTCOMES OF RECURRENT RETINAL DETACHMENT AFTER PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT AT CIPTO MANGUNKUSUMO NATIONAL GENERAL HOSPITAL IN INDONESIA Ziaulhak, Samsul Rizal; Adriono, Gitalisa Andayani; Victor, Andi Arus; Djatikusumo, Ari; Yudantha, Anggun Rama; Hutapea, Mario Marbungaran; Ayuningtyas, Sita Paramita; Harlena, Filza Amara Kamila
International Journal of Retina Vol 9 No 1 (2026): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2026.vol009.iss001.345

Introduction: Recurrent retinal detachment (re-RD) after primary pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) remains a major surgical challenge with often unsatisfactory visual outcomes. This study aims to determine the incidence and identify factors influencing the anatomical and functional outcomes after surgical repair of re-RD. Methods: This retrospective, descriptive analytical study was conducted between October 2024 and December 2024 at RSUPN Cipto Mangunkusumo Hospital, Indonesia. We reviewed 368 RRD cases that underwent primary PPV between January 2022 and December 2023. Of these, 110 developed re-RD, and 72 cases that underwent at least one repair surgery were included. Detailed data on demographics, clinical status (BCVA, high myopia and lens status), and intraoperative details (number and location of tears, extent of RD, macula and proliferative vitreoretinopathy status, tamponade type, presence of choroidal detachment) were analyzed. BCVA was converted to LogMAR. Outcomes were assessed using paired t-test, Chi-square test, and multivariate logistic regression. Result: From this study, the incidence of re-RD was 29.9% (110/368). Following repair, the anatomical success rate (retina attached) was 75% (54/72). Multivariate analysis found that undergoing only one repair surgery (OR, 4.90; CI95%, 1.28–18.79; p=0.020) was the only factor significantly associated with better anatomical success. Functional outcomes improved statistically (median LogMAR 1.7 [0.5−2.3] to 1.7 [0.4−3.0]; p<0.001), but only 11.1% (8/72) of patients achieved BCVA of ≥6/60. Multivariate analysis showed macula-on status at the time of re-RD (OR 9.67; p=0.006) was the only significant predictor for better final functional outcomes. Conclusion: The anatomical and functional outcomes of re-RD management are comparable to reports from other countries. Prognosis is associated with macula status at the time of recurrence and the number of repair surgeries performed.

Pars Plana Vitrectomy Management of Dropped Nucleus or Dropped IOL After Cataract Surgery at Cipto Mangunkusumo National General Hospital in Indonesia Putri, Karniela Ayuni; Djatikusumo, Ari; Victor, Andi Arus; Andayani, Gitalisa; Yudantha, Anggun Rama; Hutapea, Mario Marbungaran; Harlena, Filza Amara Kamila
International Journal of Retina Vol 9 No 1 (2026): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2026.vol009.iss001.339

Introduction: Dropped nucleus or dropped intraocular lens (IOL) are two potential complications of cataract surgery that threaten visual acuity and require further intervention. The standard procedure for both conditions is pars plana vitrectomy (PPV). This retrospective study aimed to describe the demographic, clinical characteristics, and treatment outcomes of dropped nucleus or dropped IOL cases after PPV at Cipto Mangunkusumo National General Hospital between January 2023 and December 2024. Methods: This retrospective descriptive study analyzed the medical records of 120 patients diagnosed with dropped nucleus or dropped IOL who underwent PPV. Data collected included demographics, visual acuity (logMAR), procedure characteristics, and postoperative complications. They were then analyzed using SPSS. Result: Out of 120 total cases (63 dropped nucleus, 57 dropped IOL), the patients were predominantly male with a mean age of ≈60 years old. Mean preoperative visual acuity was poor (1.84 logMAR for dropped nucleus, 1.81 logMAR for dropped IOL). The primary surgical management for dropped nucleus was vitrectomy with endofragmentation (≈53% of total cases) and for dropped IOL, the main procedure was vitrectomy with IOL explantation (≈41% of total cases). The management of most dropped nucleus cases (65.07%) was done within ≤1 month, while dropped IOL cases were often delayed. Postoperative complications were infrequent (≈92% complication-free), with increased IOP (4.76–5.26%) and retinal detachment (1.58–1.75%) being the most common. Mean postoperative visual acuity showed improvement for both groups (1.81 logMAR for dropped nucleus and 1.77 logMAR for dropped IOL). Conclusion: PPV with appropriate adjunct procedures, such as endofragmentation or IOL explantation, is an effective and necessary treatment for dropped nucleus or dropped IOL, leading to an improvement in postoperative visual acuity outcomes with minimal to no postoperative complications.

RETINAL REATTACHMENT OF SCLERAL BUCKLING WITH OR WITHOUT SUTURES FOR RHEGMATOGENOUS RETINAL DETACHMENT AT CIPTO MANGUNKUSUMO NATIONAL GENERAL HOSPITAL IN INDONESIA Adikusuma, Wirawan; Adriono, Gitalisa Andayani; Victor, Andi Arus; Djatikusumo, Ari; Yudantha, Anggun Rama; Hutapea, Mario Marbungaran; Ayuningtyas, Sita Paramita; Harlena, Filza Amara Kamila
International Journal of Retina Vol 9 No 1 (2026): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2026.vol009.iss001.346

Introduction: Rhegmatogenous Retinal Detachment (RRD) is a common, vision-threatening condition traditionally managed by Scleral Buckling (SB), Pars Plana Vitrectomy (PPV), or Pneumatic Retinopexy. SB is effective, however, it carries risks such as strabismus and buckle extrusion, often linked to the use of sutures. This study aimed to determine the outcomes and compare complications of SB with and without sutures for primary RRD cases. Methods: This was a retrospective, analytical cross-sectional study of 65 patients who underwent primary SB (alone or combined with PPV) at Cipto Mangunkusumo National General Hospital (RSCM) from January 2023 to December 2024. Data on demographics, clinical factors, anatomical success (retinal reattachment), functional success (BCVA), and complications were collected and analyzed using descriptive statistics and comparative tests (Chi-square, t-test/Mann-Whitney). Result: During the period, 65 RRD patients underwent the SB procedure. Subjects included 28 cases with sutures and 37 cases without. The mean age was 32.88 years, with a majority of male patients (73.8%) with a mean RRD duration of 17.82 weeks. Preoperative clinical findings showed a high rate of myopia, phakic status, RRD extent in 1 and 4 quadrants, single tear, macula-on, and PVR grade A, with preoperative visual acuity of 1.49 logMAR. The overall anatomical success rate was 76.9%. Statistically, there was no significant difference in retinal reattachment success between SB without sutures (75.7%) and SB with sutures (78.6%) (p=0.784). No demographic or clinical factors was found to significantly predict reattachment success. Postoperative complications included cataract (24.6%) and glaucoma (21.5%). Strabismus (4.61%) was only found in the SB with sutures group. No buckle extrusion occurred in either group. Conclusion: Scleral buckling provides a high enough anatomical success rate for RRD. The SB without sutures technique is equally effective in achieving retinal reattachment and shows a lower incidence of strabismus compared to SB with sutures, making it a viable option for RRD management.

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