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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
I Gusti Ayu Ratna Suryaningrum
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Pediatric Steroid High-Responder: Irreversible Visual Loss and Secondary Glaucoma Following Chronic Cutaneous-Ocular Dexamethasone Misuse I Ketut Anom Widyantara Eka Dana Weka Mona; Ni Made Ayu Surasmiati; I Gusti Ayu Ratna Suryaningrum
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1539

Abstract

Background: Chronic misuse of potent topical corticosteroids can lead to irreversible visual loss, particularly in the pediatric population which exhibits a more aggressive trabecular meshwork remodeling response than adults. This case aims to delineate the silent progression of steroid-induced ocular hypertension in the absence of red-eye symptoms and emphasizes the critical pharmacokinetic risks of cutaneous-ocular absorption in children. Case presentation: We report a catastrophic case of a 7-year-old male presenting with irreversible vision loss following six years of unsupervised, intermittent use of a combined Neomycin-Polymyxin B-Dexamethasone ointment for recurrent hordeolum. The cumulative exposure exceeded 125 mg of Dexamethasone. Examination revealed bilateral dense posterior subcapsular cataracts (PSC) and advanced glaucomatous optic neuropathy in left eye. Following sequential phacoaspiration, the left eye showed persistently elevated IOP (IOP elevated up to 59 mmHg) attributed to decompensated outflow facility. Management required Trabeculectomy with intraoperative 5-Fluorouracil (5 mg/0.1 mL). The high- responder phenotype in children involves rapid formation of Cross-Linked Actin Networks (CLANs) and MYOC gene upregulation. We discuss the double-hit mechanism where cataract extraction washes out hyposecretory factors, unmasking total trabecular blockage. The choice of 5-Fluorouracil over Mitomycin C is defended based on the safety profile regarding hypotony maculopathy in pediatric myopic eyes. Conclusion: Dexamethasone carries a high risk of transcutaneous-ocular absorption in pediatric eye and eyelids. Regulatory reform reclassifying antibiotic-steroid combinations as non-repeatable prescriptions is imperative to prevent such preventable blindness.
Pediatric Steroid High-Responder: Irreversible Visual Loss and Secondary Glaucoma Following Chronic Cutaneous-Ocular Dexamethasone Misuse I Ketut Anom Widyantara Eka Dana Weka Mona; Ni Made Ayu Surasmiati; I Gusti Ayu Ratna Suryaningrum
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1539

Abstract

Background: Chronic misuse of potent topical corticosteroids can lead to irreversible visual loss, particularly in the pediatric population which exhibits a more aggressive trabecular meshwork remodeling response than adults. This case aims to delineate the silent progression of steroid-induced ocular hypertension in the absence of red-eye symptoms and emphasizes the critical pharmacokinetic risks of cutaneous-ocular absorption in children. Case presentation: We report a catastrophic case of a 7-year-old male presenting with irreversible vision loss following six years of unsupervised, intermittent use of a combined Neomycin-Polymyxin B-Dexamethasone ointment for recurrent hordeolum. The cumulative exposure exceeded 125 mg of Dexamethasone. Examination revealed bilateral dense posterior subcapsular cataracts (PSC) and advanced glaucomatous optic neuropathy in left eye. Following sequential phacoaspiration, the left eye showed persistently elevated IOP (IOP elevated up to 59 mmHg) attributed to decompensated outflow facility. Management required Trabeculectomy with intraoperative 5-Fluorouracil (5 mg/0.1 mL). The high- responder phenotype in children involves rapid formation of Cross-Linked Actin Networks (CLANs) and MYOC gene upregulation. We discuss the double-hit mechanism where cataract extraction washes out hyposecretory factors, unmasking total trabecular blockage. The choice of 5-Fluorouracil over Mitomycin C is defended based on the safety profile regarding hypotony maculopathy in pediatric myopic eyes. Conclusion: Dexamethasone carries a high risk of transcutaneous-ocular absorption in pediatric eye and eyelids. Regulatory reform reclassifying antibiotic-steroid combinations as non-repeatable prescriptions is imperative to prevent such preventable blindness.
Comparative Long-Term Durability and Repeatability of Selective versus Argon Laser Trabeculoplasty in Open-Angle Glaucoma: A Systematic Review and Meta-Analysis Ida Ayu Prama Yanthi; I Made Agus Kusumadjaja; I Gusti Ayu Ratna Suryaningrum; Cokorda Istri Winny Prabasari
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1561

Abstract

Background: Primary open-angle glaucoma (POAG) represents a chronic, progressive optic neuropathy necessitating sustained intraocular pressure (IOP) reduction to prevent irreversible visual field loss. For decades, argon laser trabeculoplasty (ALT) served as the standard laser intervention, yet its utility was circumscribed by thermal coagulative damage to the trabecular meshwork, rendering repeat treatments ineffective. Selective laser trabeculoplasty (SLT), utilizing selective photothermolysis, offers a theoretical advantage in tissue preservation. This study performed a systematic review and meta-analysis to evaluate the comparative long-term durability and repeatability of SLT versus ALT to determine the superior modality for chronic glaucoma management. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines using data from nine essential manuscripts encompassing randomized controlled trials and comparative cohort studies published between 1999 and 2025. The primary outcome was the standardized mean difference (SMD) in IOP reduction at 12 months and beyond. Secondary outcomes included medication burden reduction and success rates of repeat treatments. Statistical analysis utilized a random-effects model to calculate pooled SMD and 95% confidence intervals (CI). Results: The analysis comprised data from over 800 eyes across diverse demographic cohorts. In the direct comparison of long-term efficacy, SLT demonstrated a non-inferior IOP reduction profile compared to ALT (Pooled SMD: -0.12; 95% CI: -0.28 to 0.05). However, SLT demonstrated statistically superior outcomes in medication reduction, with patients requiring significantly fewer adjuvant hypotensive drops post-laser (SMD: -0.45; 95% CI: -0.68 to -0.22). Repeatability analysis indicated that repeat SLT achieved a 67% success rate in maintaining drop-free status for 18 months, whereas repeat ALT efficacy was negligible due to trabecular scarring. Conclusion: While both modalities effectively lowered IOP initially, SLT demonstrated superior long-term utility driven by significant medication reduction and a favorable safety profile for repeatability. The absence of coagulative damage in SLT supports its positioning as the primary laser intervention, offering a sustainable paradigm that ALT cannot match.
Comparative Long-Term Durability and Repeatability of Selective versus Argon Laser Trabeculoplasty in Open-Angle Glaucoma: A Systematic Review and Meta-Analysis Ida Ayu Prama Yanthi; I Made Agus Kusumadjaja; I Gusti Ayu Ratna Suryaningrum; Cokorda Istri Winny Prabasari
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1561

Abstract

Background: Primary open-angle glaucoma (POAG) represents a chronic, progressive optic neuropathy necessitating sustained intraocular pressure (IOP) reduction to prevent irreversible visual field loss. For decades, argon laser trabeculoplasty (ALT) served as the standard laser intervention, yet its utility was circumscribed by thermal coagulative damage to the trabecular meshwork, rendering repeat treatments ineffective. Selective laser trabeculoplasty (SLT), utilizing selective photothermolysis, offers a theoretical advantage in tissue preservation. This study performed a systematic review and meta-analysis to evaluate the comparative long-term durability and repeatability of SLT versus ALT to determine the superior modality for chronic glaucoma management. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines using data from nine essential manuscripts encompassing randomized controlled trials and comparative cohort studies published between 1999 and 2025. The primary outcome was the standardized mean difference (SMD) in IOP reduction at 12 months and beyond. Secondary outcomes included medication burden reduction and success rates of repeat treatments. Statistical analysis utilized a random-effects model to calculate pooled SMD and 95% confidence intervals (CI). Results: The analysis comprised data from over 800 eyes across diverse demographic cohorts. In the direct comparison of long-term efficacy, SLT demonstrated a non-inferior IOP reduction profile compared to ALT (Pooled SMD: -0.12; 95% CI: -0.28 to 0.05). However, SLT demonstrated statistically superior outcomes in medication reduction, with patients requiring significantly fewer adjuvant hypotensive drops post-laser (SMD: -0.45; 95% CI: -0.68 to -0.22). Repeatability analysis indicated that repeat SLT achieved a 67% success rate in maintaining drop-free status for 18 months, whereas repeat ALT efficacy was negligible due to trabecular scarring. Conclusion: While both modalities effectively lowered IOP initially, SLT demonstrated superior long-term utility driven by significant medication reduction and a favorable safety profile for repeatability. The absence of coagulative damage in SLT supports its positioning as the primary laser intervention, offering a sustainable paradigm that ALT cannot match.
Co-Authors Cokorda Istri Winny Prabasari I Ketut Anom Widyantara Eka Dana Weka Mona Ida Ayu Prama Yanthi Made Agus Kusumadjaja Ni Made Ayu Surasmiati