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All Journal Majalah Kedokteran Bandung Jurnal Medika Malahayati Ophthalmologica Indonesiana
Umbara, Sonie
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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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

Abstract

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

Abstract

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.
ACETAZOLAMIDE INDUCED SECONDARY ANGLE CLOSURE GLAUCOMA: A RARE CASE REPORT: Poster Presentation - Case Report - Resident Atisundara, Siti Mutia; Rifada, R Maula; Umbara, Sonie; Gustianty, Elsa; Prahasta, Andhika
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: 10.35749/5mw96e77

Abstract

Introduction : Drugs such as topiramate, acetazolamide, methazolamide, buproprion, and trimethoprim- sulfamethoxazole potentially cause an elevation of IOP. Drug-induced glaucoma may be an ophthalmic emergency if not treated promptly and can results in permanent visual loss. Case Illustration : A 36-years-old female came to Glaucoma Unit at Cicendo National Eye Hospital with progressive blurred vision since 1 year ago, worsening in the past six months. Accompanying symptoms included pain, headache, halo, and conjunctival hyperemia. She had been diagnosed with glaucoma and received timolol maleate, acetazolamide, and glycerin. Seven days later, her visual acuity worsened to 3/60 ph 0.15 RE and 2/60 ph 0.15 LE, with high IOP in both eyes, with the higher IOP being >30 mmHg. The cup-to-disc ratio was 0.3 RE and 0,8 LE. The anterior segment showed shallow anterior chamber, mid-dilated pupil, and conjunctival injection (Figure 1.). Gonioscopy examination showed Schwalbe line of both eyes (Figure 2.). Acetazolamide was stopped, and one week later the condition resolved (Figure 3.). Discussion : Secondary angle closure glaucoma caused by acetazolamide is important to consider because most people tolerate acetazolamide well. The mechanism of closed-angle glaucoma can be pupillary block and non-pupillary block. Non-pupillary block is caused by thickening, forward movement the iris-lens diaphragm, rotation of the ciliary body, and choroidal effusion. This process is an idiosyncratic reaction to certain systemic drugs. Conclusion : Few cases were reported about secondary bilateral angle closure glaucoma due to acetazolamide. Treatment of angle closure glaucoma involves stopping acetazolamide
One-Step Surgical Approach for Treating Lens-Induced Glaucoma with Iridodialysis Following Blunt Trauma: Poster Presentation - Case Report - Resident Haryono, Aditia Apriyanto; Gustianty, Elsa; 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/g56hfd75

Abstract

Introduction : Traumatic glaucoma is one of secondary glaucoma that can be challenging to treat. Blunt trauma to the eye may result in iritis, hyphema, lens subluxation, or dislocation leading to increased intraocular pressure (IOP). Every complication needs to be addressed promptly. Here we present about one-step surgical approach to treat lens indued glaucoma with iridodialysis following blunt trauma. Case Illustration : A 65-year-old man presented with a chief complaint of blurred vision and pain in his right eye for a month following blunt ocular trauma where he was hit with piece of wood while operating a chainsaw. Ophthalmologic examination revealed RE VA of 2/60 with IOP 32 mmHg. Anterior examination revealed a shallow anterior chamber, iridodialysis 90 degrees, cloudy lens with phacodonesis (Fig 1). Patient was diagnosed with lens-induced glaucoma, lens subluxation, iridodialysis and traumatic cataract. Patient was treated with antiglaucoma agents prior to surgery. One-step surgical approach: trabeculectomy, phacoemulsification with capsular tension ring, and iridodialysis repair become the treatment of choice (Fig 2). After one month of surgery, IOP decreased to 16 mmHg without anti-glaucoma medication, final VA RE achieved 0.2 (Fig 3).DiscussionManagement of traumatic glaucoma depends on the underlying cause of increased IOP. Trabeculectomy combined with lens extraction should be considered with degree of subluxation that may cause pupillary block. Repair iridodialysis can be done using various techniques. Conclusion : Management of traumatic glaucoma can be done with trabeculectomy, lens extraction and repair iridodialysis in one-step surgery. Surgical technique should be considered depending on the patient’s eye condition.
Management of Secondary Angle Closure Glaucoma in Nanophthalmic Eye : A Challenging Case: Poster Presentation - Case Report - Resident Almira, Dwirianti; 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/b5xt0p78

Abstract

Introduction : Nanophthalmos is a condition characterized by short eyeball length (AXL <20.0mm), short and dense anterior segment, high eye volume or lens ratio, hypermetropia (+8.00 to +20.00) and scleral thickening (>1.7mm) Case Illustration : A 63-year-old man came to the Glaucoma outpatient clinic at Cicendo Hospital with complaints of blurry eyes since 3 years ago. The visual acuity in the right eye was light perception, and in the left eye was hand movement. The anterior chamber was shallow, with seclusio pupil in both eyes (Figure1). Biometry showed axial length 17.06 mm in the right eye and 16.82 mm in the left eye. The patient underwent phacoemulsification surgery + IOL + iris retractor + pupiloplasty + synechiolysis + sclerectomy for the right eye with satisfactory result (Figure3). Discussion : This surgical procedure for nanophthalmos has its own challenges for the operator due to the shallow anterior segment and small corneal diameter. In this case, surgery was performed first in the right eye, with consideration of a greater anterior chamber depth than the left eye. The sclerectomy procedure performed on this patient was 4 mm from the limbus and was performed full thickness only in one quadrant (Figure2). Conclusion : Multiple anatomic abnormalities in nanophthalmic eyes make surgery extremely challenging and are associated with a high incidence of significant intraoperative and postoperative complications. Phocoemulsification with sclerectomy can be alternative option to manage secondary glaucoma in nanophthalmic eye.
Co-Authors Almira, Dwirianti Andika Prahasta Atisundara, Siti Mutia Elsa Gustianty Gunawan, Liani Mulasari Haryono, Aditia Apriyanto Irawati Irfani Iskandar, Raden Fitri Fatimah Knoch, Andrew M.H Maula Rifada Prahasta, Andhika Rahayu, Annisa Rianti, Nuzul Rifada, R Maula Rifada, R. Maula Rifada, R. Maulana Rizki Fasa Ramdhani, Rizki Fasa Rova Virgana Satari, Karmelita Setiawan, Grace Shalim, Nikho Melga TRIANGGADEWI, DYAH PURWITA Wardani, Sabrina Indri