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KEBERHASILAN OPERASI TRABEKULEKTOMI PADA GLAUKOMA SUDUT TERBUKA PRIMER PERIODE 2019-2021 Radilia, Fasya; Rifada, R. Maula; Kartiwa, R. Angga
Oftalmologi : Jurnal Kesehatan Mata Indonesia Vol 5 No 2 (2023): Jurnal Oftalmologi Vol 5 No 2 2023
Publisher : Pusat Mata Nasional Rumah Sakit Mata Cicendo Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/ojkmi.v5i2.50

Introduction: Glaucoma represents a group of diseases defined by a characteristic optic neuropathy that is consistent with remodeling of the connective tissue elements of the optic nerve head and with loss of neural tissue associated with the eventual development of distinctive patterns of visual dysfunction. The most common surgery for glaucoma treatment is trabeculectomy, which in principle is done by creating a new channel that drains the aqueous humor, and return the intraocular pressure to normal levels. Objective: This study aimed to know the success rate of trabeculectomy in primary open-angle glaucoma. Methods: This study used a retrospective descriptive research method and was conducted in the Medical Records Center of the Cicendo National Eye Hospital, Bandung City with a data collection period of 21 July 2022 – 6 September 2022. The data collection process was carried out by looking at secondary data from medical records of patients with primary open-angle glaucoma for the period January 2019 – December 2021. Results: Mean IOP decreased from 32.6±12.9 before surgery, to 19.8±10 one week after surgery, and 18.8±7.3 one month after surgery. The overall success rate reaches 82.1%. Conclusions: The success rate for open-angle glaucoma treated with trabeculectomy at Cicendo National Eye hospital is considered good with a total success rate of 82.1% with or without anti-glaucoma medication to control IOP after surgery.

PENGETAHUAN, SIKAP, DAN PERILAKU PASIEN GLAUKOMA DI PMN RS MATA CICENDO TERHADAP PENYAKIT GLAUKOMA Akbari, Anamika Lingga Anjani; Rifada, R. Maula; Gustianty, Elsa
Oftalmologi : Jurnal Kesehatan Mata Indonesia Vol 5 No 2 (2023): Jurnal Oftalmologi Vol 5 No 2 2023
Publisher : Pusat Mata Nasional Rumah Sakit Mata Cicendo Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/ojkmi.v5i2.52

Pendahuluan: Glaukoma merupakan penyebab kedua kebutaan terbanyak secara global. Sebagian besar kasus glaukoma bersifat asimptomatik, sehingga pasien tidak sadar dengan penyakitnya sampai munculnya gangguan penglihatan hingga kebutaan. Melalui pengetahuan, sikap, dan perilaku (PSP) pasien yang baik dapat mendukung pengendalian keparahan penyakit glaukoma. Akan tetapi, di Indonesia penelitian yang menunjukkan tingkat PSP pasien glaukoma terhadap penyakit glaukoma masih tergolong sedikit. Oleh karena itu, penelitian ini bertujuan untuk menilai tingkat PSP pasien glaukoma di PMN RS Mata Cicendo terhadap penyakit glaukoma. Metode: Studi ini menggunakan metode kuantitatif dengan desain penelitian deskriptif cross-sectional melalui pengisian kuesioner pada 59 pasien glaukoma di PMN RS Mata Cicendo pada bulan Februari 2023. Pada penelitian ini terdapat tiga variabel yang dinilai, yaitu pengetahuan, sikap, dan perilaku. Hasil: Pasien glaukoma menunjukkan pengetahuan baik (35,6%), cukup (59,5%), dan kurang (5,1%) dengan hanya 42,4% pasien yang bersikap positif dan 49,2% pasien berperilaku baik. Secara keseluruhan tingkat PSP pasien adalah 47%. PSP yang baik banyak ditemukan pada pasien dengan durasi pengobatan ≥6 bulan. Simpulan: Tingkat PSP pasien glaukoma terhadap penyakit glaukoma yang sudah cukup baik tetap harus ditingkatkan dengan strategi edukasi agar tingkat sikap dan perilaku pasien jauh lebih baik.

Survival Analysis of Trabeculectomy and Phacotrabeculectomy in Primary Angle Closure Glaucoma Gustianty, Elsa; Shalim, Nikho Melga; Virgana, Rova; Prahasta, Andika; Rifada, R. Maula; Umbara, Sonie
Majalah Kedokteran Bandung Vol 56, No 4 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v56.3594

Glaucoma is the global leading cause of irreversible blindness. Primary angle closure glaucoma occurs most frequently in Asian populations, including in Indonesian population. Surgical management of Primary Angle Closure Glaucoma (PACG) includes cataract extraction, trabeculectomy, or combined phacotrabeculectomy. Many patients presented in the advanced stages of the disease with significant cataracts, requiring combined surgery. This study aimed to determine whether trabeculectomy alone was better in reducing intraocular pressure compared to phacotrabeculectomy in primary angle closure glaucoma. This was an analytic retrospective observational study reviewing medical records of PACG patients underwent trabeculectomy or phacotrabeculectomy from January to December 2015, within a 5-year follow-up period of a tertiary eye hospital. The success rates of the two groups were assessed with Kaplan-Meier survival analysis. Success criteria were defined as > 20% reduction of IOP or IOP <21 mmHg with or without medication. Results showed 104 and 41 eyes underwent trabeculectomy and phacotrabeculectomy, respectively. The cumulative 5-year survival rate in trabeculectomy group was 58.6%, and 85.4% in phaco trabeculectomy. There was no statistical difference in the success rate between the trabeculectomy and phaco trabeculectomy groups (p=0.102). Postoperative complications observed in the phacotrabeculectomy group were one choroidal detachment, one malignant glaucoma, and one vitreous prolapse. Thus, the cumulative success rate of phacotrabeculectomy was better than trabeculectomy after 5 years of follow up, albeit not statistically significant.

COMPARISON OF SITA STANDARD 24-2 WITH SITA FASTER 24-2C PROGRAM ON HUMPHREY FIELD ANALYZER IN ASSESSING VISUAL FIELD DEFECTS OF GLAUCOMA PATIENTS Rianti, Nuzul; Satari, Karmelita; Prahasta, Andika; Rifada, R. Maula; Umbara, Sonie
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/a4syph39

Introduction: Periodical perimetry examination to detect and determine the rate of glaucoma progression continues to be a challenging task, because it depends on many factors. Besides, there is now a paradigm shift which central visual field defects occur earlier. SITA Standard (SS) 24-2 is the clinical standard for glaucoma examination, but there were studies reporting on the prevalence of central visual field defects not detected. SITA Faster (SFR) 24-2C was developed to address current shortcomings, but the performance has yet to be formally and independently assessed. Objective: To compare the global indices (Mean Deviation, Pattern Standard Deviation, Visual Field Index) and test duration between SS 24-2 and SFR 24-2C program. Methods: This is an analytical observational study with a cross-sectional design. Subjects aged >18 years who diagnosed with glaucoma and whose visual fields unaffected by other condition besides glaucoma were included. All subjects underwent testing of both programs. Results: This study was conducted in 94 eyes of 66 patients. Comparison of global indices and test duration between the two programs was carried out by the Wilcoxon test. The mean results of MD and PSD global indices were not significantly different, however there was a difference in the mean VFI of 1.5% between the two programs. The test duration of SFR 24-2C was 55.03% faster. Conclusion: There was no significant difference in the MD and PSD global indices, but there was a significant difference in the VFI, as well as the test duration between the two programs.

COMPARISON OF ANGLE OPENING DISTANCE AND TRABECULAR IRIS SPACE AREA BEFORE AND AFTER LASER PERIPHERAL IRIDOTOMY IN ANGLE CLOSURE DISEASE: Abstract Only Ramdhani, Rizki Fasa; Rifada, R. Maula; Irfani, Irawati; Gustianty, Elsa; Umbara, Sonie
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/p64vmm95

Introduction and Objective: Laser peripheral iridotomy (LPI) is the standard first-line therapy in angle closure disease to increase anterior chamber angle width. Spectral Domain Anterior Segment Optical Coherence Tomography (SD AS-OCT) is an instrument that has a quantitative parameter to measure anterior chamber angle. Angle opening distance (AOD) and trabecular iris space area (TISA) are quantitative parameters in SD AS-OCT. The purpose of this study is to compare AOD and TISA before and one week after LPI in angle closure disease. Methods: This is an analytical prospective study with a cross-sectional study design. Twenty-two eyes with angle closure disease that met inclusion and exclusion criteria underwent LPI and SD AS-OCT before and one week after LPI. Analysis was performed using SD AS-OCT parameters, such as AOD (AOD500, AOD750) and TISA (TISA500, TISA750) in the temporal, nasal quadrants, and average. Results: Twenty-two eyes with angle closure are divided into nine eyes with primary angle closure suspect, seven eyes with primary angle closure, and six eyes with primary angle closure glaucoma. The mean age of participants was 57.86±7.63 years. There was a significant increase in AOD500, AOD750, TISA500, and TISA750 in the temporal and nasal quadrants, as well as in the average (P=0.0001) based on a paired t test or Wilcoxon as an alternative. Average AOD750 had the highest T-value (T= 6.329) with a mean 0.20±0.096 before LPI and 0.31±0.144 one week after LPI. Conclusion: There was a significant increase in AOD and TISA after one week LPI in angle closure disease.

COMPARISON OF SITA STANDARD 24-2 WITH SITA FASTER 24-2C PROGRAM ON HUMPHREY FIELD ANALYZER IN ASSESSING VISUAL FIELD DEFECTS OF GLAUCOMA PATIENTS: Oral Presentation - Observational Study - Resident Rianti, Nuzul; Satari, Karmelita; Gustianty, Elsa; Prahasta, Andika; Rifada, R. Maula; Umbara, Sonie
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: 10.35749/5a6xfs73

Introduction & ObjectivesIntroduction: Periodical perimetry examination to detect and determine the rate of glaucomaprogression continues to be a challenging task, because it depends on many factors. Besides, thereis now a paradigm shift which central visual field defects occur earlier. SITA Standard (SS) 24-2 isthe clinical standard for glaucoma examination, but there were studies reporting on the prevalenceof central visual field defects not detected. SITA Faster (SFR) 24-2C was developed to addresscurrent shortcomings, but the performance has yet to be formally and independently assessed.Objectives: To compare the global indices (Mean Deviation, Pattern Standard Deviation, Visual FieldIndex) and test duration between SS 24-2 and SFR 24-2C program. MethodsThis is an analytical observational study with a cross-sectional design. Subjects aged >18 years whodiagnosed with glaucoma and whose visual fields unaffected by other condition besides glaucomawere included. All subjects underwent testing of both programs. ResultsThis study was conducted in 94 eyes of 66 patients. Comparison of global indices and test durationbetween the two programs was carried out by the Wilcoxon test. The mean results of MD and PSDglobal indices were not significantly different, however there was a difference in the mean VFI of1.5% between the two programs. The test duration of SFR 24-2C was 55.03% faster. ConclusionThere was no significant difference in the MD and PSD global indices, but there was a significantdifference in the VFI, as well as the test duration between the two programs.

COMPARISON OF ANGLE OPENING DISTANCE AND TRABECULAR IRIS SPACE AREA BEFORE AND AFTER LASER PERIPHERAL IRIDOTOMY IN ANGLE CLOSURE DISEASE: Oral Presentation - Observational Study - Resident Ramdhani, Rizki Fasa; Rifada, R. Maula; Irfani, Irawati; Gustianty, Elsa; Umbara, Sonie
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: 10.35749/05vxs382

Introduction & ObjectivesLaser peripheral iridotomy (LPI) is the standard first-line therapy in angle closure disease toincrease anterior chamber angle width. Spectral Domain Anterior Segment Optical CoherenceTomography (SD AS-OCT) is an instrument that has a quantitative parameter to measure anteriorchamber angle. Angle opening distance (AOD) and trabecular iris space area (TISA) are quantitativeparameters in SD AS-OCT. The purpose of this study is to compare AOD and TISA before and oneweek after LPI in angle closure disease. MethodsThis is an analytical prospective study with a cross-sectional study design. Twenty-two eyes withangle closure disease that met inclusion and exclusion criteria underwent LPI and SD AS-OCT beforeand one week after LPI. Analysis was performed using SD AS-OCT parameters, such as AOD(AOD500, AOD750) and TISA (TISA500, TISA750) in the temporal, nasal quadrants, and average. ResultsTwenty-two eyes with angle closure are divided into nine eyes with primary angle closure suspect,seven eyes with primary angle closure, and six eyes with primary angle closure glaucoma. The meanage of participants was 57.86±7.63 years. There was a significant increase in AOD500, AOD750,TISA500, and TISA750 in the temporal and nasal quadrants, as well as in the average (P=0.0001)based on a paired t test or Wilcoxon as an alternative. Average AOD750 had the highest T-value (T=6.329) with a mean 0.20±0.096 before LPI and 0.31±0.144 one week after LPI. ConclusionThere was a significant increase in AOD and TISA after one week LPI in angle closure disease.

SECONDARY GLAUCOMA AFTER VITREORETINAL SURGERY: A RETROSPECTIVE OBSERVASIONAL STUDY: Oral Presentation - Observational Study - Resident Gunawan, Liani Mulasari; Rifada, R. Maula; Gustianty, Elsa; Umbara, Sonie
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: 10.35749/49ss4368

Introduction & ObjectivesSecondary glaucoma is the most common complication after vitreoretinal surgery. Pars PlanaVitrectomy (PPV) is a common surgical procedure aimed at removing vitreous gel and replacing itwith variety of substances denominated tamponades. Vitreous removal and replacement may causeincreased intraocular pressure (IOP). The IOP can be reduced with medical treatment or surgery.The purpose of this study is to describe the characteristics of secondary glaucoma after vitreoretinalsurgery in National Eye Center Cicendo Hospital from January 2019 - December 2020. MethodsThis study was a retrospective descriptive study which data were obtained from medical records.Data such as age, gender, vitrectomy tamponades, IOP, onset of glaucoma, and glaucoma treatmentwere collected. ResultsOne hundred fifty-three eyes were referred to Glaucoma Unit with increasing IOP after vitreoretinalsurgery. PPV with tamponade was done in 141 eyes (92.16%) and silicone oil (SO) 1000 centistokes(cSt) was the most used tamponade in 101 eyes (66.07%). Secondary glaucoma with open angle wasthe most common type in 124 eyes (81.04%). Secondary glaucoma developed in 4-7 weeks aftersurgery, with the highest IOP recorded at 31-40 mmHg. The IOP decreased after SO evacuation withinitial glaucoma treatment in 121 eyes (79.09%), and glaucoma surgery was performed in 32 eyes(20.91%). ConclusionSilicon oil as a tamponade agent after PPV may cause rise IOP in the post-operative period.Evacuation SO needs to be done after retinal adhesion to prevent secondary glaucoma. Therefore,timely detection and anti-glaucoma treatment are important to decreased IOP, or filtration surgerycan be performed.

ND:YAG Laser Vitreolysis as The Management of Occluded Tube After Glaucoma Drainage Device Implantation (GDD): Poster Presentation - Case Report - Resident Iskandar, Raden Fitri Fatimah; Gustianty, Elsa; Umbara, Sonie; Prahasta, Andhika; Rifada, R. Maula
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: 10.35749/1drs8325

Introduction : Glaucoma Drainage Devices (GDD) implantation surgery can be an alternative therapy for patients with uncontrolled IOP after trabeculectomy. However, tube occlusion is a common complication of GDD implantation. Management of tube occlusion can be done using laser or with surgery. This case presents the management of vitreous occlusion of tube implant using ND:YAG laser-vitreolysis. Case Illustration : A 63 year-old male patient came with chief complaint of pain in his right eye. The patient had a history of cataract surgery on the right eye and was diagnosed with glaucoma. An examination showed IOP in the right eye was increased, vitreous in COA and lens was aphakic with posterior capsule rupture. The patient had undergone trabeculectomy, but IOP remained high, so an Aurolab Aqueous Drainage Implant (AADI) GDD implantation was performed. However, six weeks after the procedure, the IOP still increased, and an examination revealed vitreous occlusion of the GDD tube (Figure 1) . The patient underwent Zeiss ND-YAG laser-vitreolysis on his right eye (Figure 2) with laser spot size of 50?m and power of 2.1 MJ. Post laser IOP was decreased. Discussion : GDD implantation is a surgical option for primary or secondary therapy, but tube occlusion can cause implantation failure. Laser-vitreolysis is a non- invasive modality to treat tube occlusion caused by vitreous. Conclusion : GDD occlusion can occur due to various etiologies, but laser-vitreolysis is a non-invasive treatment option aimed at restoring tube patency and aqueous outflow.

DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE: Poster Presentation - Case Series - Resident Wardani, Sabrina Indri; Rifada, R. Maula; Prahasta, Andhika; Gustianty, Elsa; Umbara, Sonie
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: 10.35749/349t6495

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important. Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery. Discussion : Age older than 60 years old, female gender, short axial length (<23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals. Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.

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