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Situasi analisis pelayanan kesehatan mata di Provinsi Bali, Indonesia Anak Agung Ayu Githasari Dewi; Ni Made Ari Suryathi; Ni Made Suryanadi; I Made Agus Kusumadjaja; I Wayan Eka Sutyawan; Anak Agung Mas Putrawati Triningrat; I Wayan Gede Jayanegara
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Introduction: The prevalence of blindness in Bali based on Rapid Assessment of Avoidable Blindness (RAAB) survey in 2015 was 2%. This prevalence rate is still high according to WHO guidelines. Bali has challenges in providing eye care services. The aim of this study was to report situational analysis of the eye care in Bali.Method: This is a descriptive study with quantitative and qualitative approach. Data collection was carried out through interviews and questionnaires targeting respective stakeholders involved in the eye care services in Bali.Result: Bali consists of 9 districts with total 4,337 million people. Eye care in Bali consist of 43 hospitals, 120 primary health care (Puskesmas), 73 general ophthalmologist and subspecialists, 18 trained opthalmic nurses, and 12 refractionist. Bali has mobile eye care unit covering remotes area and a Non-Government Organization (NGO) actively contributing in community eye care service. Total number of cataract surgery in 2019 was 8.225 eyes with cataract surgical rate (CSR) was 1.896. Komite Mata Daerah (Komatda) dan health insurance for eye service and eye surgery is a form of support from the government.Conclusion: The implementation of eye care services in Bali is yet under evaluation. Things needed to consider to improve eye care services including providing better distribution of ophthalmologist to districts, and empowering voluntary local manpower as village health workers / cadres through regularly organized training. Education on blindness and preventable visual disturbances also must be carried out regularly.Pendahuluan: Prevalensi kebutaan di Bali berdasarkan survei Rapid Assessment of Avoidable Blindness (RAAB) tahun 2015 sebesar 2%. Angka prevalensi ini masih tinggi menurut pedoman WHO. Bali memiliki tantangan dalam memberikan pelayanan perawatan mata. Tujuan dari penelitian ini adalah untuk melaporkan analisis situasi perawatan mata di Bali.Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan kuantitatif dan kualitatif. Pengumpulan data dilakukan melalui wawancara dan kuesioner dengan sasaran masing-masing pemangku kepentingan yang terlibat dalam layanan perawatan mata di Bali.Hasil: Bali terdiri dari 9 kabupaten dengan jumlah penduduk 4.337 juta jiwa. Perawatan mata di Bali terdiri dari 43 rumah sakit, 120 Puskesmas, 73 dokter spesialis mata umum dan subspesialis, 18 perawat mata terlatih, dan 12 dokter spesialis mata. Bali memiliki unit perawatan mata keliling yang mencakup daerah terpencil dan Lembaga Swadaya Masyarakat (LSM) yang aktif berkontribusi dalam layanan perawatan mata masyarakat. Jumlah operasi katarak pada tahun 2019 sebanyak 8.225 mata dengan angka bedah katarak (CSR) sebanyak 1.896. Komite Mata Daerah (Komatda) dan jaminan kesehatan untuk pelayanan mata dan operasi mata merupakan bentuk dukungan dari pemerintah.Simpulan: Pelaksanaan pelayanan kesehatan mata di Bali masih dalam tahap evaluasi. Hal-hal yang perlu diperhatikan untuk meningkatkan pelayanan kesehatan mata antara lain penyediaan dokter spesialis mata yang lebih merata ke kabupaten, dan pemberdayaan tenaga sukarelawan lokal sebagai kader/petugas kesehatan desa melalui pelatihan yang diselenggarakan secara rutin. Edukasi tentang kebutaan dan gangguan penglihatan yang dapat dicegah juga harus dilakukan secara berkala.

Pathological Risk Factors in Retinoblastoma Patients Underwent Enucleation I Wayan Eka Sutyawan
Journal of Global Pharma Technology Volume 11 Issue 01.
Publisher : Journal of Global Pharma Technology

Show Abstract | Download Original | Original Source | Check in Google Scholar

Objective: Retinoblastoma is a malignancy that originates from primitive retinal cells and is usually found in children under 4-5 years of age. Retinoblastoma is the second largest cause of death among other malignancies in developing countries. The purpose of this study was to determine the characteristics and pathological risk factors of enucleated retinoblastoma Patients and Methods: This is a descriptive study with a cross-sectional study design conducted retrospectively by evaluating data from the patient's medical record. A total of 18 subjects were enrolled in this study. Characteristics observed were sex, age, and laterality. Data was compiled and calculated by Microsoft Excel 2017 software. All calculations and presentations were conducted in descriptive manner. Results: Unilateral retinoblastoma cases (77.2%) were found more often in this study. Leucochoria was the most often presenting symptoms (61.1%), followed by propotosis, strabismus, and cellulitis. Out of 18 subjects, 72.2% subjects had intraocular retinoblastoma. The most common PRF finding in this study was optic nerve invasion (44.4%), followed by choroid invasion, and scleral invasion. While 11.1 % of the subjects had no PRF findings. Conclusion: Invasion to the optic nerve was the most common pathological risk factors found in enucleated retinoblastoma. Other PRFs include choroid invasion and sclera invasion. PRFs may become a sign that determines the progressivity of retinoblastoma, and it can also determine further decisions regarding the prevention of recurrence and possible adjuvant therapy in retinoblastoma patients.Keywords: Pathological risk factor, Retinoblastoma, Enucleation.

Strabismus Surgery for Traumatic Ocular Misalignment: Twelve Cases in Five Years: Poster Presentation - Case Series - Ophthalmologist NI MADE AYU SURASMIATI; NI LUH MADE NOVI RATNASARI; KEVIN ANGGAKUSUMA HENDRAWAN; I WAYAN EKA SUTYAWAN
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/pdg34475

Introduction : Trauma can cause an ocular misalignment due to damage of extraocular muscles, nerves and orbital tissue around the eye. Direct trauma causing extraocular muscle rupture needs immediate surgery, meanwhile indirect trauma resulting in traumatic sixth nerve palsy or other reversible ocular misalignment without orbital floor fracture can be observed for six months. This study describe the characteristic of patients undergo single-step strabismus surgery for traumatic ocular misalignment, mechanism of injury, eye alignment, amount of ocular deviation before and after strabismus surgery. Case Illustration : This was a case series based on medical record of patients underwent strabismus surgery secondary to head or eye injury from 2017 until 2022. Discussion : Twelve individuals with post-traumatic strabismus correction participated in this study. All subjects were male age ranging from 18-51 years. Direct trauma was observed in 6 (50%) patients causing medial rectus muscle rupture in 4 patients and inferior rectus muscle rupture in 2 patients. Indirect trauma was observed in 6 (50%) patients caused by sixth nerve palsy on 4 patients The misalignment was exotropia, esotropia, and hypertropia with amount of 5, 4, and 3 respectively. The deviation was between 30-90 prism dioptre (PD) and 7 (58%) patients had deviation less than 65 PD. Strabismus surgery performed was muscle transposition with or without recession of the antagonist muscle. Conclusion : Single step surgery for traumatic ocular misalignment can provide good result in cases of deviation less than 65 PD

DIAGNOSING OCULAR MALINGERING IN CHILDREN WITH SIMPLE TEST: IS IT POSSIBLE? Poster Presentation - Case Report - Resident KEVIN ANGGAKUSUMA HENDRAWAN; NI MADE AYU SURASMIATI; I WAYAN EKA SUTYAWAN; ANAK AGUNG DEWI ADNYA SWARI; MADE KUSUMA WARDANI
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/c3exwd43

Introduction : Malingering is a condition in children which need a thorough and meticulous examination to diagnose the condition. According to several publication, simple test can be done to diagnose this condition without necessarily performing imaging and electrophysiologic tests. Case Illustration : An 8-year-old male patient, came to eye clinic with sudden visual loss on both eyes for the last 3 days, following pain on both eyes and headache which fluctuating over the last 3 weeks. Patient insisted on wearing black glasses during examinations. Preliminary examination revealed visual acuity no light perception on both eyes. Slit lamp examination and pupillary reflex were normal, fundus examination revealed normal fundus. We tried to do surprise test by suddenly swaying hand towards patient’s eyes and record a visual response. Afterwards we asked patient’s parent to wait outside while performing LEA test which revealed visual acuity 6/6 on both eyes. Further history taking revealed that patient got bullied on school that makes him try to avoid attending school. Discussion : Patient with malingering usually come with decreased vision but seldomly come with blindness. Though it was quite challenging, doing some simple test available in daily practice such as surprise test can help us to diagnose the suspicion. Handling such patient needs a cautious analysis towards patient’s condition and gentle approach towards the patient. It is crucial to rule out organic condition before diagnosing patient with malingering. Conclusion : Simple test such as surprise test can be done in assisting malingering diagnosis when carefully done with the support of thorough history taking and physical

Different Retinopathy of Prematurity Severity, Onset Therapy and Outcomes in Triplet Babies: A Case Report: Poster Presentation - Case Report - Resident PUTU ANINDYA AGRASIDI; I WAYAN EKA SUTYAWAN; NI MADE AYU SURASMIATI
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: 10.35749/1de12078

Introduction : Retinopathy of prematurity (ROP) is a vasoproliferative disease of the premature infants, characterized by abnormal vascularization at the junction of vascular and avascular retina. Intravitreal anti-VEGF injection is one of promising management of ROP. The aim is to present the therapy outcomes of triplet babies with different severity and onset therapy. Case Illustration : This case shows ROP in triplets born at 25-26 weeks gestational age. First baby, weighed 630 g with Bilateral Stage 2 Zone II Posterior with Plus Disease treated with intravitreal ranibizumab injection at 11 weeks (PMA 36-37 weeks). Second baby, weighed 620 g and get bilateral intravitreal ranibizumab injection a week after first baby, left eye got worse on first week, but getting better on the last follow up. Third Baby, weighed 750 g with bilateral Stage 3 Zone I with Plus Disease (worst eye condition), but because he had worst general condition, so the latest got screening, got no intervention. Two babies were treated with anti-VEGF therapy – bevacizumab. All babies has outcome regression, no recurrence of ROP in those short term end point, and no adverse reactions were observed until the last follow up at 27 weeks old (PMA 52-53 weeks) recorded for all babies. Discussion : Conclusion : Primary prevention through well-managed screening programme for premature infants was the more effective way to manage the ROP. Intravitreal anti-VEGF treatment could be promising for management of ROP if it was given on the right time and early stadium.

Systemic Metastase in Late Management of Group D Retinoblastoma: A Case Report Suryawijaya, Ernes Erlyana; I Wayan Eka Sutyawan; Ni Made Ayu Surasmiati; I Made Agus Kusumadjaja
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 10 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i10.1085

Background: Retinoblastoma (RB) is a common malignancy that affects children and is fatal if left untreated. This case report aims to raise awareness the importance of starting therapy immediately in RB patients. Case presentation: A girl aged 1 year 9 months, came with complaints that her left eye (LE) appeared white for 2 weeks. Anterior segment examination was normal. On funduscopic examination, optic nerve was difficult to evaluate, covered by a mass, multiple mass scars on the retina, a size of > 6 mm at the posterior pole, and vitreous seeding. Ultrasound examination and CT scan showed an intraocular mass with calcification. The patient was diagnosed with group D intraocular LE RB and was planned for enucleation but was postponed due to cost constraints. The patient came back after 1 year and was diagnosed with extraocular LE RB stage IVB. Conclusion: Early diagnosis without adequate therapy leads to tumor spread and reduces patient survival.

Relationship between Hyperglycemia and Retinopathy of Prematurity in Very Low Birth Weight Infants: A Systematic Review Dharmi Lestari, Ni Putu; I Wayan Eka Sutyawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 10 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i10.1102

Background: Retinopathy of prematurity (ROP) is the major cause of neonatal blindness and may account for up to 10% of juvenile blindness. This systematic review evaluates the relationship between hyperglycemia and ROP in VLBW infants. Methods: PRISMA guidelines were used to conduct a systematic review using an online database: Google Scholar, PubMed, and the Wiley Online Library. Original research studies examining the association between hyperglycemia and ROP were the inclusion criteria. Animal studies, a letter to the editor, a commentary report, a review, a meta-analysis not available in full text in English or Bahasa Indonesia, and data in the study insufficient for analysis were all excluded. Results: This systematic review includes nine studies, six cohorts and three case-control studies, involving a total of 1,566 infants. Six studies indicated that newborns in the ROP group had lower mean gestational age and birthweight than those in the non-ROP group. Five investigations found that the mean glucose level in the ROP group was greater than in the non-ROP group. Six studies found that the prevalence of glycemia was much higher than in the non-ROP group. Eight of the nine studies found a significant relationship between hyperglycemia in VLBW infants, and only one found no significant relationship between them. The highest odds ratio and relative risk of hyperglycemia causing ROP were 14.27 (5.16–39.50); p-value <0.001 and 28.062 (7.881–99.924); p-value <0.001, respectively. The overall range of values found across the studies was also considered. Conclusion: Hyperglycemia has a significant relationship with ROP and is also a risk factor for ROP in VLBW infants.

The Temporal Windows of Glycemic Injury: Association of Early and Late First-Week Hyperglycemia with Retinopathy of Prematurity in Low-Birth-Weight Infants Dharmi Lestari, Ni Putu; I Wayan Eka Sutyawan; Putu Junara Putra; I Gde Raka Widiana; Siska; Putu Yuliawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1379

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness, driven by aberrant retinal vascular development in preterm infants. While hyperglycemia is a recognized risk factor, its impact may vary depending on its timing relative to the biphasic pathogenesis of ROP. This study aimed to generate a hypothesis regarding the differential association of hyperglycemia on postnatal day 1 versus day 7 with the incidence of ROP in a high-risk neonatal population. Methods: We conducted a retrospective, cross-sectional, hypothesis-generating study at Prof. Dr. I.G.N.G. Ngoerah General Hospital. Medical records of 68 preterm (<37 weeks gestation) and low-birth-weight (<2500 grams) infants who underwent ROP screening were reviewed. The exposures of interest were hyperglycemia (blood glucose >125 mg/dL) on postnatal day 1 (D1) and day 7 (D7). The primary outcome was the diagnosis of any stage of ROP. Statistical analysis involved Chi-square tests and exploratory multivariate logistic regression to adjust for select confounders. Results: Of the 68 infants included (mean gestational age 30.5 ± 2.2 weeks, mean birth weight 1447.5 ± 373.0 grams), 11 (16.2%) were diagnosed with ROP. Hyperglycemia was present in 29.4% of infants on D1 and 13.2% on D7. In logistic regression analysis, a strong statistical association was observed between hyperglycemia and ROP for both D1 (Adjusted Odds Ratio [AOR] = 55.7; 95% Confidence Interval [CI]: 5.1–611.0; p=0.001) and D7 (AOR = 74.5; 95% CI: 9.0–613.4; p<0.001). However, the profoundly wide confidence intervals indicate significant statistical instability and imprecision. Conclusion: This study found a strong, albeit statistically imprecise, association between hyperglycemia on both the first and seventh day of life and the incidence of ROP. These findings support the hypothesis that the timing of glycemic dysregulation may be critical, potentially impacting different phases of ROP pathogenesis. The results, while preliminary, underscore the need for larger, prospective studies to confirm these associations and elucidate the role of glycemic control in ROP prevention.

The Temporal Windows of Glycemic Injury: Association of Early and Late First-Week Hyperglycemia with Retinopathy of Prematurity in Low-Birth-Weight Infants Dharmi Lestari, Ni Putu; I Wayan Eka Sutyawan; Putu Junara Putra; I Gde Raka Widiana; Siska; Putu Yuliawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1379

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness, driven by aberrant retinal vascular development in preterm infants. While hyperglycemia is a recognized risk factor, its impact may vary depending on its timing relative to the biphasic pathogenesis of ROP. This study aimed to generate a hypothesis regarding the differential association of hyperglycemia on postnatal day 1 versus day 7 with the incidence of ROP in a high-risk neonatal population. Methods: We conducted a retrospective, cross-sectional, hypothesis-generating study at Prof. Dr. I.G.N.G. Ngoerah General Hospital. Medical records of 68 preterm (<37 weeks gestation) and low-birth-weight (<2500 grams) infants who underwent ROP screening were reviewed. The exposures of interest were hyperglycemia (blood glucose >125 mg/dL) on postnatal day 1 (D1) and day 7 (D7). The primary outcome was the diagnosis of any stage of ROP. Statistical analysis involved Chi-square tests and exploratory multivariate logistic regression to adjust for select confounders. Results: Of the 68 infants included (mean gestational age 30.5 ± 2.2 weeks, mean birth weight 1447.5 ± 373.0 grams), 11 (16.2%) were diagnosed with ROP. Hyperglycemia was present in 29.4% of infants on D1 and 13.2% on D7. In logistic regression analysis, a strong statistical association was observed between hyperglycemia and ROP for both D1 (Adjusted Odds Ratio [AOR] = 55.7; 95% Confidence Interval [CI]: 5.1–611.0; p=0.001) and D7 (AOR = 74.5; 95% CI: 9.0–613.4; p<0.001). However, the profoundly wide confidence intervals indicate significant statistical instability and imprecision. Conclusion: This study found a strong, albeit statistically imprecise, association between hyperglycemia on both the first and seventh day of life and the incidence of ROP. These findings support the hypothesis that the timing of glycemic dysregulation may be critical, potentially impacting different phases of ROP pathogenesis. The results, while preliminary, underscore the need for larger, prospective studies to confirm these associations and elucidate the role of glycemic control in ROP prevention.

Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Retinopathy of Prematurity: A Systematic Review Ayu Diah Permatasari; I Wayan Eka Sutyawan; Ni Made Ayu Surasmiati
Sriwijaya Journal of Ophthalmology Vol. 8 No. 1 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i1.130

Introduction: Retinopathy of prematurity (ROP) remains a leading cause of childhood blindness, with its pathogenesis linked to aberrant vascular development and systemic inflammation. There is a critical need for accessible biomarkers to improve risk stratification beyond current screening standards. This systematic review critically appraises the evidence for the neutrophil-to-lymphocyte ratio (NLR), a widely available inflammatory marker, as a predictor of ROP. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, ScienceDirect, ProQuest, and SpringerLink for observational studies published between January 1st, 2015, and December 31st, 2024. Studies assessing the association between NLR and ROP in preterm infants were included. Two reviewers independently performed study selection, data extraction, and a formal risk-of-bias assessment using the Newcastle-Ottawa Scale (NOS). A narrative synthesis was performed due to significant heterogeneity. Results: The search identified 32 records, with 6 retrospective studies ultimately meeting the inclusion criteria, encompassing a total reported sample of 1,065 infants. The methodological quality of the included studies was low to moderate, with NOS scores ranging from 5 to 7 out of a possible 9. The evidence base was defined by profound methodological heterogeneity, particularly in the timing of blood sample collection, which was unspecified in half of the studies, and inconsistent reporting of core population data. A narrative synthesis of the findings showed that several studies reported a statistical association between an elevated NLR or related inflammatory markers and ROP. However, one study reported no significant association, and the interpretation of others was complicated by a focus on different biomarkers or a lack of statistical significance. Conclusion: The available evidence, derived exclusively from retrospective studies of varying quality, suggests a possible association between elevated NLR and ROP, a link supported by strong biological plausibility. However, the current evidence base is severely limited by methodological flaws and profound heterogeneity, making it insufficient to support the adoption of NLR into clinical practice. NLR is not a standalone diagnostic or predictive tool for ROP. Its potential utility can only be realized through large-scale, methodologically rigorous prospective studies designed to overcome the limitations identified in this review.

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