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All Journal Berita Kedokteran Masyarakat Ophthalmologica Indonesiana
Darajati, Irene Titin
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Health Professions Medicine & Pharmacology Nursing Public Health

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The midwife said “It’s okay” – a qualitative study on the causes of delayed retinoblastoma treatment Darajati, Irene Titin; Sulistyoningrum, Evy; Wardhani, Yulia; Supriyati, Endah; Maharani, Erika; Kurniawati, Herlin Fitriana; Panggabean, Andre Stefanus; Aulia, Afkar; Muttaqqin, Habib Zahar Zaki; Puspitawati, Ira; Supriyati, Supriyati
BKM Public Health and Community Medicine Vol 41 No 08 (2025)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v41i08.18401

Abstract

Purpose: Retinoblastoma is the most common primary intraocular tumour in children. Its prognosis varies depending on the stage of diagnosis. However, in developing countries such as Indonesia, retinoblastoma still has a poor prognosis as most patients present at advanced stages. This research aims to explore the factors influencing the delay in patients with retinoblastoma reaching referral health facilities from the perspective of their families. Methods: A qualitative study using a phenomenological approach was conducted to gather family perspectives through in-depth interviews via WhatsApp calls. Each interview lasted 20-25 minutes and included families of retinoblastoma patients who had visited the eye clinic at Sardjito General Hospital at a late hour. “Late” was defined as tumour spread beyond the eyeball (intraorbital, spread to the optic nerve, or intracranial spread) or involvement of more than one eye. Audio was transcribed verbatim using a mobile phone voice recorder, and open coding was performed using Open Code 4.02 software to identify meaning units, codes, and categories. Triangulation and peer debriefing were used to ensure validity and trustworthiness. Results: Several categories emerged, including reasons for seeking help, trust in medical professionals, family compassion, and challenges in health facilities. Challenges in health facilities, particularly diagnostic capabilities, communication, and education about eye tumours, along with negative emotions like denial from families, contributed to delays in seeking treatment for retinoblastoma patients. Conclusion: Family compassion plays a positive role in encouraging families to seek medical help. However, challenges in health facilities, particularly in diagnosis, communication, and education about eye tumors, as well as family denial, contribute to the delays in retinoblastoma patients reaching referral health facilities.
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.
POSTOPERATIVE COMPLICATIONS OF ORBITAL TUMOR REMOVAL SURGERY IN SARDJITO GENERAL HOSPITAL Hasdini, Prasthiti Dewi; 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/sj5qg752

Abstract

Introduction: Orbital tumor removal surgery represent a small but significant portion of ophthalmologic surgery, and few reports of the associated complications are available. Methods: Descriptive retrospective study was carried out 138 patients who undergone orbital tumor removal surgery during July 2021-March 2023. Surgery approach and postoperative complications were collected from medical record. Results: Of approximately 138 patients, 12 (6%) patients had postoperative complications. Five (5%) of 75 patients who undergone anterior orbitotomy had postoperative complications. One percent had lagophthalmos, 1% had ptosis, 2% had decreased vision, and 1% had ocular movement disorders. Lateral orbitotomy was done in 21 patients. Three (12%) patients had postoperative complications. Four percent had ptosis, 4% had decreased vision, and 4% had ocular movement disorders. Four (60%) of 6 patients who undergone medial orbitotomy had ptosis (16%) and decreased vision (50%). Posterior orbitotomy was done in 8 patients. One (12,5%) patient had complication of ptosis.   Conclusion: Anterior orbitotomy was the most common surgery approach for orbital tumor removal. The most common postoperative complications were ptosis and decreased vision. Informed consent is an important aspect to improve patient’s knowledge of postoperative complications.
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 Aulia, Afkar Datu Respatika Dibyasakti, Banu Aji Dwiamelia, Theresia Erika Maharani Evy Sulistyoningrum Fajar, Rangga Athallah Hasdini, Prasthiti Dewi Herlin Fitriana Kurniawati Ira Puspitawati Murtadha, Milzan Muttaqqin, Habib Zahar Zaki Panggabean, Andre Stefanus Supartoto, Agus Supriyati . Supriyati, Endah Utomo, Purjanto Tepo Yulia Wardhani, Yulia