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Clinical Characteristics and Management of Wet Age-Related Macular Degeneration at Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia Leonedine, Tengku Viona Zohra; Victor, Andi Arus; Djatikusumo, Ari; Adriono, Gitalisa Andayani; Yudanta, Anggun Rama; Hutapea, Mario Marbungaran; Suryoadji, Kemal Akbar
International Journal of Retina Vol 7 No 2 (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.iss002.291

Introduction: Age-related macular degeneration (AMD) is a leading cause of blindness globally, with wet AMD being particularly debilitating. The prevalence of AMD is increasing, necessitating a deeper understanding of its clinical characteristics and management. This study aims to investigate the demographic and clinical features, management, and treatment outcomes of wet AMD at Cipto Mangunkusumo Hospital during January-December 2022. Methods: A retrospective descriptive study was conducted, analyzing medical records of wet AMD patients treated during the specified period. Data analysis included patient demographics, clinical characteristics, treatment modalities, and outcomes. Results: Of 129 eyes from 122 patients, 115 eyes met the inclusion criteria. The majority were female (55.7%) with an average age of 67 years. Most patients presented with blurry vision (93.9%) and received Patizra anti-VEGF injections (60.9%). Hypertension was the most common risk factor (28.7%). Anti-VEGF treatment significantly reduced central macular thickness (p < 0.05) but had no significant impact on visual acuity. Avastin and Patizra injections similarly influenced macular thickness but not visual acuity. There were no significant differences between loading and non-loading dose groups in terms of outcomes. Conclusion: Anti-VEGF treatment effectively reduces central macular thickness in wet AMD patients, regardless of the specific agent used. However, it does not significantly improve visual acuity. Further research is needed to explore differences between loading and non-loading dose protocols, compare treatment strategies, and investigate demographic risk factors. Consistency in visual acuity documentation using the ETDRS format is recommended for future studies.

Real-World Evaluation of the Effectiveness of Intravitreal Bevacizumab Injection for Neovascular Age-Related Macular Degeneration at Cipto Mangunkusumo National Referral Hospital Adriono, Gitalisa Andayani; Pambudy, Indra Maharddhika; Victor, Andi Arus; Djatikusumo, Ari; Yudhanta, Anggun Rama; Hutapea, Mario Marbungaran; Triyoga, Ichsan Fauzi
International Journal of Retina Vol 8 No 2 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss002.319

Introduction: Neovascular age-related macular degeneration (nAMD) is a leading cause of visual impairment globally. While intravitreal anti-VEGF therapy is the standard treatment, real-world data on bevacizumab (IVB), the most accessible agent in Indonesian public hospitals despite being off-label, remains limited. This study aims to evaluate the effectiveness of IVB in patients with nAMD at a tertiary referral center in Indonesia. Methods: This retrospective study included patients diagnosed with nAMD who received IVB injections at Cipto Mangunkusumo National Referral Hospital between January and December 2017. Inclusion criteria encompassed patients with confirmed nAMD and available clinical data pre- and post-injection. Data on demographics, best-corrected visual acuity (BCVA), central macular thickness (CMT) measured by OCT, and IVB injection regimen were extracted from electronic medical records. Statistical analysis was performed using Wilcoxon signed-rank and Mann–Whitney U tests, with p < 0.05 considered statistically significant. Result: A total of 138 eyes from 131 patients (mean age: 66.7 years; 51% male) were analyzed. The median number of injections was three (range: 1–6). Mean BCVA showed a non-significant improvement from 1.19 to 1.14 logMAR (mean change: 0.05 logMAR; p = 0.770). Subgroup analysis indicated significant improvement in eyes with baseline VA worse than 1.32 logMAR (mean gain: 0.54 logMAR; p < 0.01) and a significant decline in eyes with baseline VA between 0.48 and 1.00 logMAR (mean loss: 0.21 logMAR; p = 0.02). CMT significantly decreased by an average of 108.33 µm (p < 0.01). Conclusion: IVB treatment for nAMD resulted in significant anatomical improvement and was particularly effective in patients with poor baseline visual acuity. These findings highlight the role of IVB in real-world clinical practice within resource-limited settings.

RESTORING VISION IN CENTRAL MACULAR EDEMA (CME) CAUSED BY CENTRAL RETINAL VEIN OCCLUSION (CRVO): SINGLE INTRAVITREAL BEVACIZUMAB INJECTION Iskandar, Ferdy; Pertiwi, Adinda Mulya; Hutapea, Mario Marbungaran
International Journal of Retina Vol 8 No 2 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss002.325

Introduction: Central retinal vein occlusion (CRVO) stands as a prevalent contributor to vision impairment from retinal vascular issues, affecting approximately 0.08% of individuals over 30. Cystoid macular edema (CME) is the most frequent cause of reduced vision among these cases. This study aimed to report the promising outcome of a single intravitreal bevacizumab injection in treating CME secondary to CRVO. Case Report: A 41-year-old male came with a sudden blurry vision of the left eye (LE) 10 hours before admission, particularly in the superior and temporal areas. He denied any history of red eyes, sudden light flashes, curtain-like shadows, double vision, or pain with eye movements. He had a history of hypertension but was not on medication. His blood pressure was 180/120 mmHg, with visual acuity (VA) of 1/60, positive relative afferent pupillary defect (RAPD), edematous optic nerve head (ONH) with tortuous veins, and hemorrhages throughout the retina of the LE. Macular optical coherence tomography (OCT) of the LE showed massive intraretinal fluid (IRF) with a central macular thickness (CMT) of 779 µm. He had unremarkable laboratory results, with normal coagulation factors. Amlodipine 10 mg once daily (qd) and candesartan 16 mg qd was prescribed, and no antiplatelet or anticoagulant therapy was initiated by the internal medicine. A single intravitreal bevacizumab injection (1.25mg) was performed on the LE. During a 1-month follow-up, his best corrected visual acuity (BCVA) improved to 6/18, with a normal optic nerve head, tortuous veins, flame-shaped hemorrhages, with no IRF and a CMT of 240 on macular OCT. The BCVA and CMT remained stable at the 6-month follow-up, with no complications. Discussion: A Treat and extend (T&E) regimen was initially planned, with ≥ 3 consecutive monthly injections until disease inactivity was established, followed by a gradual extension of the treatment interval in increments of 2 to 4 weeks. We initially planned to administer bevacizumab intravitreal injections according to the T&E regimen. However, the patient showed significant clinical improvement, and macular OCT demonstrated resolution of the IRF after the first injection. Therefore, we decided to discontinue the remaining injections and switch to a pro re nata (PRN) approach, administering bevacizumab as needed. In real-life conditions, the number of anti-vascular endothelial growth factor (VEGF) injections was lower than in randomized controlled trials (RCTs), due to many factors, such as declining motivation after improvement, poor access to hospital facilities, and unaffordable travel expenses. The PRN regimen is also a good option to minimize costs and reduce the burden on both patients and healthcare providers. Conclusion: Single intravitreal bevacizumab is an effective treatment for CME secondary to CRVO. However, the decision to use the T&E and PRN regimen should be based on the patient’s improvement and clinical examination. Additionally, any systemic conditions related to the vascular condition must also be addressed and treated.

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.

CLINICAL OUTCOMES OF SURGERY FOR ADVANCED STAGE RETINOPATHY OF PREMATURITY: A CASE REPORT Yulia, Dian Estu; Jayawinata, Marissa; Hutapea, Mario Marbungaran
International Journal of Retina Vol 6 No 1 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss001.210

Introduction: Advanced stages of Retinopathy of Prematurity (ROP) could lead to childhood blindness and retinal surgery is needed as the main treatment. This case aims to report the clinical outcomes after surgery for advanced-stage ROP Case Report: A female infant was admitted to the pediatric ophthalmology clinic in Cipto Mangunkusumo National Central Hospital Jakarta with a lack of visual contact in both eyes at 53 weeks of Post Menstrual Age (PMA). The infant was delivered at 28 weeks of gestational age with a birth weight of 1100 g. The baby was treated in NICU for 24 days and received oxygen therapy in the previous hospital. Retinal examination revealed that the patient had stage 5 ROP in the right eye and stage 4B ROP in the left eye. Furthermore, blinking reflect was absent in both eyes. Vitrectomy and endolaser were performed for the baby’s left eye. Surgery was not conducted for the infant’s right eye due to poor prognosis. Six weeks after surgery, the infant underwent examination under anesthesia (EUA) which showed that the retina was reattached with no vitreous hemorrhage, and intraocular pressure measurement was 7 mmHg. The result of the visual acuity test by Cardiff Acuity Cards was 6/60 on both eyes. Followed up EUA reported that the refraction test result on the left eye was S-3.75 C-5.75 x 85o and an undetermined result on the right eye due to opacity in the visual axis. Discussion: Several surgeries have been described as the treatment of choice for advanced-stage ROP, including scleral buckling and vitrectomy with or without the addition of endolaser. Previous studies illustrated that stage 5 ROP has a low success rate on lens-sparing vitrectomy compared to stage 4A and 4B. The outcome success rate was the best in stage 4A ROP. Moreover, stage 4B ROP had a moderate success rate with sufficient visual outcomes. Conclusion: The functional outcome of vitrectomy surgery may not equate to anatomic success. Retinal reattachment and moderate visual outcome were achieved by performing vitrectomy and endolaser in this case. Followed-up periodically is necessary for advanced stage ROP postoperatively.

CLINICAL CHARACTERISTICS OF PROLIFERATIVE DIABETIC RETINOPATHY (PDR) PATIENTS WITH VITREOUS HEMORRHAGE AT CIPTO MANGUNKUSUMO HOSPITAL Ali, Reyno Satria; Victor, Andi Arus; Djatikusumo, Ari; Andayani, Gitalisa; Yudanta, Anggun Rama; Hutapea, Mario Marbungaran
International Journal of Retina Vol 6 No 1 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss001.227

Introduction: Proliferative Diabetic retinopathy is the most common cause of blindness in adults. In the management of vitreous hemorrhage, vitrectomy is the main choice and also laser photocoagulation with or without anti-VEGF administration as additional therapy. This study aims to determine the number of patients, demographic characteristics, clinics, risk factors, distribution of treatment, and treatment outcomes for PDR patients with vitreous hemorrhage at Cipto Mangunkusumo Hospital. Methods: This study was retrospective descriptive study conducted from January 2020 to October 2022 who met the inclusion criteria. Population in this study were patients at Cipto Mangunkusumo Hospital with PDR accompanied by vitreous hemorrhage. Data shown in the table were mean (standard deviation) and number (percentage) based on the type of the data. Result: A total of 146 patients with the diagnosis of Proliferative Diabetic Retinopathy (PDR) with vitreous hemorrhage. Majority of subjects were men (60,9%), diagnosed with DM more than 10 years (63,0%) with another systemic risk factor. The most common clinical characteristics found visual acuity at the initial visit <3/60 (80,8%), diagnosed phakia (78,9%), retinal detachment (85,3%), grade 2 vitreous hemorrhage (80,8%). The majority of eyes underwent vitrectomy (90,44%), Anti-VEGF injections (22,92%), Laser PRP (11,46 %), Phacoemulsification pre and post- vitrectomy as adjuvant treatment. The condition of the vitreous was clear after vitrectomy (99,1%). Mean visual acuity before vitrectomy is 2.10 (1.80 – 2.50), while mean visual acuity after vitctomy was 1.00 (1.30 – 2.40), with a difference in initial and final visual acuity of -0.10 (-0.50 – 0.60). Conclusion: Majority of study subjects were men with an age range of 25-77 years. Vitrectomy as the main treatment combined with intravitreal injection of anti-VEGF, laser PRP as adjuvant treatment. In nearly all cases, vitreous hemorrhage was clear after vitrectomy treatment. Visual acuity after vitrectomy shows progress even though in some cases there was no improvement.

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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