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All Journal Medicina E-Jurnal Medika Udayana Jurnal Kesehatan Prima Callosum Neurology Journal : Jurnal Berkala Neurologi Bali ISM (Intisari Sains Medis) : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Kedokteran Universitas Palangka Raya Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Global Pharma Technology Ophthalmologica Indonesiana
Made Agus Kusumadjaja
Departemen Ilmu Kesehatan Mata, FK Universitas Udayana/RSUP Sanglah, Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Prosedur Falsanella-Servat pada pada ptosis traumatika: laporan kasus Rima Febry Lesmana; Anak Agung Ayu Sukartini Djelantik; Putu Yuliawati; Ni Made Laksmi Utari; I Made Agus Kusumadjaja
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (509.591 KB) | DOI: 10.15562/ism.v12i1.919

Abstract

Background : Ptosis is a drooping or infero displacement of the upper eyelid. Traumatic Ptosis is the second most common type after acquired aponeurotic ptosis. In this case the patient with mild traumatic ptosis had no improvement for 1 year. Surgery was performed for correction of traumatc ptosis with falsanella servat procedure. The aims of case report are to know managament patient with mild traumatic ptosis who underwent surgery with falsanella-servat procedure.Case presentation: A 18-year-old boy with dropping of left upper eyelid since 1 year ago. He had a history of hordeolum and had a curettage incision for three times. Complete opthalmology examination was perfomed on both eyes and found on right eyelid vertical palpebra fissure 12mm, horizontal palpebra fissure 35mm, levator action 18, margin limbal distance 9, margin reflect distance 4, lid crease 8, no lidlag, positive bell's phenomenon. Left eyelid examination results 8mm vertical palpebra fissure, 35mm horizontal palpebra fissure, levator action 16, margin limbal distance 7, margin reflect distance 2, lid crease 10, no lid lag, positive bell's phenomenon. Correction of traumatic ptosis with falsanella servat was performed and ptosis measurement had done after correction. Conclusion: Surgical procedure using falsanella-servat on traumatic mild ptosis gives good contour, functional and cosmetic results.  Latar belakang: Ptosis adalah penurunan kelopak mata atas dari posisi normal. Ptosis traumatika merupakan kejadian tersering kedua setelah acquired aponeurotic ptosis. Pada kasus ini pasien dengan mild ptosis traumatika yang tidak mengalami perbaikan selama 1 tahun, dilakukan pembedahan dengan teknik operasi falsanell-servat. Tujuan dari penelitian ini adalah untuk melaporkan hasil penatalaksanaan pada pasien dengan mild ptotis traumatika yang dilakukan prosedur terapi dengan tekhnik falsanella-servat.Laporan kasus: Pasien laki-laki 18 tahun dengan penurunan kelopak atas mata kiri sejak 1 tahun yang lalu. Pasien riwayat hordeolum pada kelopak atas mata kiri dan sempat di insisi-kuretase sebanyak 3x. Pemeriksaan mata lengkap dilakukan pada kedua mata dan didapatkan kelopak mata kanan fisura palpebra vertikal 12mm, fisura palpebra horisontal 35mm, levator action 18, margin limbal distance 9,  margin  reflect  distance  4,  lid  crease  8,  lid  lag  tidak ada,  bell’s phenomenon positif. Hasil pemeriksaan kelopak mata kiri didapatkan fisura palpebra vertikal 8mm, fisura palpebra horisontal 35mm, levator action 16, margin limbal distance 7,  margin  reflect  distance  2,  lid  crease  10,  lid  lag  tidak ada,  bell’s phenomenon positif. Pasien dilakukan perbaikan ptosis traumatika dengan tekhnik pembedahan falsanella-servat dan pengukuran ptosis setelah perbaikan.Simpulan: Prosedur pembedahan dengan Falsanella-servat pada mild ptosis traumatika memberikan hasil yang baik dalam segi kontur, fungsi dan kosmetik. 
Rekurensi tinggi pada melanoma maligna konjungtiva: laporan kasus Ni Putu Mariati; Putu Yuliawati; I Wayan Juli Sumadi; I Made Agus Kusumadjaja
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1896.064 KB) | DOI: 10.15562/ism.v12i3.1091

Abstract

Introduction: Ocular malignant melanoma is a rare but deadly disease that most often appears in the uvea, conjunctiva or orbit. Melanoma can be asymptomatic or give symptoms and signs depending on development of neoplasm. This case report aims to discuss the clinical sign of conjunctival malignant melanoma and the treatment given to better understand the disease.Case Report: Female patient, 57 years old complained lump in the left eye since 1 month ago. Red eyes, pain and blurry vision (-). Previously, patients with a history of malignant melanoma in the left eye and had performed surgery 5 times since 2015. Ophthalmology examination obtained visual acuity on right eye 6/18 and left eye 6/45. Anterior segment evaluation of the left eye found mass on palpebra, size 2x1 cm, color according to skin, mobile (-), tenderness (-). In conjunctiva found CVI (+) and symblepharon. There are 3 masses in conjunctiva. First mass in bulbi conjunctival superior to limbus with round shape, diameter 3 mm, brown color and smooth surface. The second mass in superotemporal conjunctival fornix, brownish color, size 1,5x1,5 cm with solid consistency, mobile (+). The third mass in the superior tarsal conjunctival, oval shape, 5x3 mm, brownish color and smooth surface. Lens of right and left eye found hazy. Segmen posterior on both eye within normal limit. Patient was diagnosed with post wide excision + cryotherapy + 5 fu (8 months) + suspected conjunctival tumor ec malignant melanoma + right left eye immature senile cataract. Patient underwent tumor multiple excision + cryotherapy + PA with general anesthesia. The biopsy results showed histomorphology consistent with malignant melanoma. There were no regional or distant metastasis.Conclusion: There are several therapeutic modalities for conjunctival melanoma, such as wide local excision with adjuvant therapy (brachytherapy, cryotherapy, and the use of topical chemotherapeutic agent like Mytomicin C). If tumor become a multiple recurrence or rapidly growing local tumor, the exenteration is needed.  Pendahuluan: Melanoma maligna okular merupakan suatu penyakit yang jarang dengan angka kematian yang tinggi dan paling sering muncul pada uvea, konjungtiva maupun orbita. Melanoma dapat bersifat asimptomatis hingga menimbulkan sekumpulan gejala dan tanda tergantung dari perkembangan neoplasma. Laporan kasus ini bertujuan untuk membahas tanda klinis melanoma maligna konjungtiva dan tatalaksana yang diberikan untuk lebih dapat memahami mengenai penyakit ini. Laporan kasus: Pasien wanita, 57 tahun, mengeluh muncul benjolan pada mata kiri yang disadari sejak 1 bulan yang lalu. Mata merah, nyeri, keluhan kabur (-). Sebelumnya pasien dengan riwayat melanoma maligna pada mata kiri dan telah dilakukan operasi sebanyak 5x sejak tahun 2015. Pemeriksaan oftalmologi didapatkan tajam penglihatan mata kanan 6/18 dan mata kiri 6/45. Evaluasi segmen anterior pada mata kanan ditemukan lensa keruh minimal. Evaluasi segmen anterior mata kiri ditemukan massa pada palpebra, ukuran 2x1 cm, warna sesuai dengan kulit, mobile, padat, nyeri tekan (-). Pada konjungtiva ditemukan conjunctival vascular injection (CVI) (+) dan simblefaron inferior di konjungtiva serta ditemukan 3 buah massa. Massa pertama pada konjungtiva bulbi superior hingga limbus, bentuk bulat, diameter 3 mm, batas tegas, permukaan licin, warna kecoklatan. Massa kedua di konjungtiva fornix superotemporal, warna kecoklatan, teraba bulat, ukuran 1,5x1,5 cm, permukaan rata, konsistensi padat kenyal, mobile, nyeri tekan (-). Massa ketiga di konjungtiva tarsal superior, bentuk oval, uk 5x3 mm, warna kecoklatan, permukaan licin. Lensa keruh minimal dan segmen anterior lain dalam batas normal. Evaluasi segmen posterior mata kanan dan kiri dalam batas normal. Pasien didiagnosis dengan oculi sinistra (OS) post wide eksisi + cryotherapy + 5 fluorouracil (5fu) (8 bulan) + suspek tumor konjungtiva rekuren ec melanoma maligna dan oculi dekstra et sinistra (ODS) KSI dan dilakukan tindakan eksisi tumor multiple + cryotherapy + patologi anatomi (PA) dengan general anesthesia (GA). Hasil histopatologi dari open biopsy sesuai untuk melanoma maligna. Tidak ditemukan adanya metastase regional maupun metastase jauh.Simpulan: Terdapat beberapa modalitas terapi untuk melanoma konjungtiva yaitu wide local excision dengan terapi adjuvant seperti brachytherapy, cryotherapy, dan penggunaan agen topikal kemoterapeutik (mytomicin C). Apabila dalam perjalanannya penyakit menjadi rekurensi multipel atau tumor lokal yang berkembang pesat maka tindakan eksenterasi sangat diperlukan.
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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (311.181 KB) | DOI: 10.15562/ism.v12i3.1104

Abstract

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.
Glioma saraf optik sebagai perluasan dari glioma cerebrii: sebuah laporan kasus Anak Agung Surya Nirmala Dewi; Putu Yuliawati; Ni Made Laksmi Utari; Anak Agung Ayu Sukartini Djelantik; I Made Agus Kusumadjaja
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1556.624 KB) | DOI: 10.15562/ism.v12i3.1129

Abstract

Introduction: Optic Nerve Gliomas (ONG) are the most common primary Cerebral Nervous System tumor in childhood with greatest tendency for growth in the first 3-5 years of life (Huang, 2020). Most children diagnosed with ONGs have neurofibromatosis type 1 (NF-1) (Simmons,2013) with painless and slowly progressive decreace of vision. Imaging investigation with CT-scan or MRI is important to diagnose patient with ONG. The aim of this paper is to report a case of optic pathway glioma resulting rapid death of a child.Case Illustration: A 7-year-old girl complained that her eyes could not see in the past 1 year and protrusion with a white spot that is getting wider in the middle of the eye on her right eye since 3 months ago. Her left eye could not see in the past 3 weeks. She also complained about pain on her head. From ophthalmology examination visual acuity both eyes are no light perception. On her right eye we found protrusion with scleral show and lagophthalmos on her right eye, periconjunctival injection with corneal edema, deep anterior chamber and IOP 47. On the left eye we found midilated pupil with decreased reflex and the posterior segment we found optic nerve head hazy demarcated, cup-disc ratio difficult to be evaluated, good retina, decreased macular reflex and macular star (+). From right eye USG we found severe vitreous opacity. The MRI result from June 15th 2020 is suggested for optich pathway glioma dd/ pylocystic astrocytoma and suspected expand to internal auditory canal dextra. The patient was diagnosed with OD Proptosis ec retrobulbar tumor susp optic nerve glioma that expand from chiasma / cerebrii + vitreous bleeding+secondary glaucoma. OS Optic Nerve Edema ec intracranial mass. The patient was planned for OD extended enucleation join op Tumor Removal from Neuro Surgery under General Anesthesia. However, the surgery was postponed due to unstable condition and patient died from septic shock 2 months after the first arrival at the eye clinic.Conclusion: Optic Nerve Glioma are the most common primary Cerebral Nervous System tumor in childhood. This patient came with decrease of vision, protrusion on her right eye and pain with MRI finding suggested for optic nerve glioma. This patient should have done surgery but her condition was unstable. Good handling and multidisciplinary cooperation in the diagnosis and management of intraocular and intracranial masses are needed to provide a good outcome for the patient. Pendahuluan: Glioma Saraf Optik (GSO) merupakan tumor otak primer yang paling banyak terjadi pada 1 dekade kehidupan dengan kecenderungan terjadi pada usia 3-5 tahun. Anak-anak yang didiagnosa dengan GSO biasanya memiliki neurofibromatosis tipe 1 (NF-1) yang timbul secara sporadik. GSO memiliki gejala penurunan penglihatan tanpa adanya rasa nyeri yang dirasakan perlahan. Pemeriksaan penunjang dalam menegakkan diagnosis GSO bisa menggunakan CT-scan ataupun MRI. Tujuan dari makalah ini adalah untuk melaporkan sebuah kasus bagaimana cara mendiagnosa glioma saraf optic pada anak-anak.Ilustrasi kasus: Pasien perempuan, 7 tahun, datang (2 Juni 2020) dengan keluhan kedua mata tidak dapat melihat sejak 1 tahun yang lalu dan mata kanan menonjol sejak 3 bulan disertai bintik putih yang semakin melebar di bagian tengah mata. Mata kiri dikatakan tidak bisa melihat sejak 3 minggu yang lalu. Nyeri kepala sering dikeluhkan oleh pasien di seluruh kepala. Pemeriksaan oftalmologi didapatkan visus kedua mata no light perception (NLP), proptosis dengan scleral show dan lagoftalmos 2 mm pada mata kanan. Konjungtiva mata kanan didapatkan injeksi perikorna dengan edema kornea. Bilik mata depan mata kanan kesan dalam. Tekanan intraokular mata kanan 47 mmHg. Middilatasi dengan penurunan reflek pupil didapatkan pada mata kiri, lensa jernih dan pada pemeriksaan segmen posterior didapatkan papil nervus optik batas kabur, cup-disc ratio (CDR) sulit dievaluasi, retina kesan baik, reflex makula menurun dengan macular star. Hasil USG mata kanan didapatkan kesan kekeruhan vitreous berat. Pada 15 Juni 2020 pasien dilakukan MRI dengan kesan mengarah pada optic pathway glioma dd/ pylocytic astrocytoma dan suspek perluasan ke regio internal auditory canal dextra. Pasien didiagnosis dengan OD proptosis ec tumor retrobulber susp glioma saraf optik yang berasal dari chiasma / cerebri + perdarahan vitreus + glaukoma sekunder, OS Papil edema ec massa intracranial dan direncanakan OD extended enukleasi join op tumor removal oleh Bedah Saraf dengan General Anestesi. Namun, pasien belum dilakukan operasi karena keadaan pasien memburuk dan meninggal akibat syok sepsis 2 bulan pasca kedatangan pertama ke poli mata. Simpulan: Glioma saraf optik merupakan tumor yang sering ditemukan pada anak-anak. Pada pasien sudah didapatkan nyeri, penurunan tajam penglihatan dan proptosis serta gambaran MRI yang mendukung diagnose glioma saraf optic. Sebaiknya pasien dilakukan tindakan pembedahan namun keadaan umum pasien tidak memungkinkan. Penanganan yang baik dan kerjasama multidisiplin dalam penegakan diagnosis dan tatalaksana massa intraocular maupun intracranial dibutuhkan untuk memberikan luaran yang baik bagi pasien.
Strabismus sebagai komplikasi pemasangan sclera buckle pada ablasio retina regmatogen: laporan kasus Pande Putu Adityo Ananta Ardika; Ari Andayani; Ni Made Ayu Surasmiati; Ni Made Ari Suryathi; I Made Agus Kusumadjaja
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1379.01 KB) | DOI: 10.15562/ism.v12i3.1177

Abstract

Introduction: Sclera buckle is one of the operative management of rhegmatogenous retinal detachment. Sclera buckle can combine with vitrectomy in young people, phakic, myopia more than 6 dioptri, axial length more than 26mm, proliferative vitreoretinopathy stage C, multiple inferior break and recurrent break. Complications from the installation of sclera buckle is one of them the occurrence of strabismus after the installation of sclera buckle. Treatment can be done to remove the sclera buckle and further surgery for extraocular muscle.Case Description: Male patients aged 31 years, patients present with complaints right eyes rolling inward since 8 months ago. The patient had a history of surgical  sclera buckle and tamponade with silicone oil. Patient also complain blurry vision since 1 month ago after removing silicone oil. The patient has a history of -5.00 glasses in both eyes. In examination obtained Hirschberg esotropia 15 degrees and retinal detachment on right eyes. Patient was diagnosed with right eye Detached Retina post evacuation of silicone oil (16 days), acquired esotropia Suspect et cause sclera buckle installation. Patients are planned to undergo Re-Vitrectomy Pars Plana (VPP), Release Sclera Buckle , Endolaser, Silicon Oil tamponade, and evaluation of extraocular muscle at surgery. During evaluation of extraocular muscle there was fibrosis cover four rectus muscle and no tear was found. Then we removed of fibrosis and released sclera buckle. Strabismus complaint did not feel better after removed of fibrosis so we planned for further action was medial rectus recess with adjustable sutureConclusion: Sclera buckle can combine with vitrectomy on young people, phakic, myopia more than 6 dioptri, axial length more than 26mm, proliferative vitreoretinopathy, multiple inferior break and recurrent break. Installation of sclera buckle can cause complications in the form of postoperative strabismus. One of the causes of this complication is fibrosis of the extraocular muscles, so there is an attachment called fat adherent syndrome. Treatment that can be taken to treat strabismus after sclera buckle surgery is one of them with the release of sclera buckle, but if strabismus complaints did not improve, surgery can be done on extraocular muscles to improve the position of the ball  Pendahuluan: Sclera buckle merupakan salah satu tindakan operatif dalam menangani ablasio retina regmatogen. Tindakan sclera buckle dapat dikombinasikan dengan vitrektomi pada orang muda, phakia, riwayat miopia lebih dari 6 dioptri, panjang bola mata lebih dari 26 milimeter, ditemukan adanya proliferatif vitreoretinopati stadium C, robekan multiple pada bagian inferior retina dan robekan berulang. Komplikasi dari pemasangan sclera buckle ini adalah salah satunya terjadinya strabismus pasca pemasangan sclera buckle. Penanganan yang dapat dilakukan berupa pelepasan sclera buckle, dan operasi strabismus jika kondisi otot ekstraokular tidak membaik.Deskripsi Kasus: Pasien laki-laki, usia 31 tahun, datang dengan keluhan mata kanan bergulir ke dalam sejak 8 bulan yang lalu. Keluhan dirasakan setelah pasien melakukan operasi pemasangan sclera buckle dan silicon oil 8 bulan yang lalu. Saat ini pasien juga mengeluhkan pandangan kabur yang sudah dirasakan sejak 1 bulan yang lalu setelah dilakukan pengangkatan silicon oil. Pada pemeriksaan ditemukan Hirschberg esotropia 15 derajat dan ditemukan ablasio retina pada mata kanan. Pasien didiagnosis dengan okuli dekstra rekuren ablasio retina pasca pengeluaran silicon oil  (16 hari), dan kecurigaan esotropia didapat (acquired esotropia)  ec pasca pemasangan sclera buckle. Pasien direncanakan untuk dilakukan Re-Vitrektomi Pars Plana (VPP), pelepasan sclera buckle, endolaser, re-tamponade silicon oil dan evaluasi otot ekstraokular durante operasi. Pada saat dilakukan evaluasi otot ekstraokular ditemukan adanya fibrosis pada keempat otot rektus dan tidak ditemukan adanya robekan pada otot ekstraokular. Kemudian dilakukan pembersihan dari fibrosis dan pelepasan dari sclera buckle. Keluhan strabismus tidak dirasakan membaik pasca dilakukan pembersihan fibrosis sehingga direncanakan untuk dilakukan tindakan lanjutan yaitu medial rectus reses dengan adjustable suture.Simpulan: Tindakan sclera buckle ini dapat dikombinasi dengan vitrektomi pada pasien muda, phakia, riwayat miopia tinggi lebih dari 6 dioptri, panjang bola mata lebih dari 26 milimeter, ditemukan adanya proliferatif vitreoretinopati, robekan multiple di bagian inferior retina dan robekan berulang. Pemasangan sclera buckle ini dapat menimbulkan komplikasi berupa strabismus pasca operasi. Penyebab dari terjadinya komplikasi ini salah satunya fibrosis pada otot ekstraokular sehingga terjadi perlekatan yang disebut dengan fat adheren syndrome. Tindakan yang dapat dilakukan untuk penanganan strabismus pasca operasi sclera buckle ini adalah salah satunya dengan pelepasan dari sclera buckle, namun apabila keluhan strabismus tidak membaik bisa dilakukan operasi pada otot ekstraokular untuk memperbaiki posisi bola mata.
Chorioretinitis with retinal ablation complications in patients with cytomegalovirus infections and high myopia: a case report Thedius Watu; I Gusti Made Ayu Juliari; I Made Agus Kusumadjaja; Ida Ayu Ari Pramita
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (453.514 KB) | DOI: 10.15562/ism.v12i3.1182

Abstract

Background: Chorioretinitis is uveitis that causes choroidal and retinal inflammation. Chorioretinitis in general due to cytomegalovirus (CMV) infection has been recognized as a major cause of congenital virus infections. A common complication in patients with uveitis is retinal detachment. In addition, high myopia can also cause retinal detachment.Case Illustration: We reported a 33-year-old male patient who came with chief complaints of a sudden blurred left eye the couple of weeks before admission. The patient had a history of high myopia -5D in both eyes and was HIV positive. One week before the complaint, patient underwent laser therapy because of retinal detachment and was also given Neomicin and Potassium Iodide eye drops. Patients presented with vision 1/60. In funduscopy examination, we found vasculitis, retinal detachment, bleeding and exudate. The patient was then diagnosed with OS Rhegmatogenous Retinal Detachment (RRD) caused by CMV chorioretinitis and high myopia ODS. The patient was treated with valganciclovir 1x900mg, methylprednisolone 2x32mg, prednisone eye drops 6x1 OD and underwent pars plana vitrectomy (VPP). The patient had complicated cataracts, therefore phacoemulsification, evacuation and reinjection of silicon oil and endolaser were performed. Unfortunately, the results obtained are not optimal where the patient's vision becomes the patient's no light perception (NLP).Discussion: Retinal detachment is a frequent complication in patients with CMV chorioretinitis. The main therapy is HAART, anti-CMV and operative management. This therapy regimen is proven to improve overall patients’ prognosis.Conclusion: Early diagnosis and appropriate treatment have a very important role in determining the prognosis of patients with CMV chorioretinitis.
Case report: a rare case of ocular leptospirosis I Made Surya Dinajaya; Ida Ayu Ary Pramita; I Gusti Ayu Made Juliari; Ni Ketut Niti Susila; I Made Agus Kusumadjaja
Intisari Sains Medis Vol. 13 No. 1 (2022): (Available Online : 1 April 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/ism.v13i1.1320

Abstract

Background: Ocular leptospirosis is a rare condition. Transmission of leptospirosis is caused by the bacterium leptospira interrogans transmitted directly or indirectly from animals to humans (zoonosis). Ocular manifestations often caused by leptospirosis are conjunctivitis, keratitis, uveitis (anterior, intermediate, posterior, and panuveitis), complicated cataracts, choroiditis, papillitis, and macular edema. Uveitis is a latent manifestation of leptospirosis. Proper management can lead to a good prognosis of visual.Case Presentation: Male patient, 55 years old, with complaints of both red and blurry eyes since 5 days. Blurring comes slowly with pain, glare, and seeing shadows like spider webs. The patient's previous medical history was hospitalized because of Weil's disease. Examination of the anterior segment of both eyes revealed eyelid spasm, conjunctival injection, corneal infiltrate, keratic precipitate, and posterior synechiae on both eyes. While in the posterior segment found cells 4+ in the vitreous. The patient was treated with antibiotics and topical steroids, and visual acuity was improved.Conclusion: Leptospirosis uveitis can have various presentations during the acute and chronic phases of the disease. Even when ocular involvement is extensive and severe, most patients have a good visual prognosis with appropriate therapy. Timely diagnosis is essential to maximize the potential for visual acuity improvement and appropriate systemic monitoring and treatment of extraocular involvement in this potentially fatal condition. Good sanitation in the community plays an important role in preventing exposure to leptospirosis.
Effect of uncontrolled glycemic on cataract surgery outcome in patient with diabetic retinopathy NLP Wistya Eka Mahadewi; I Wayan Gede Jayanegara; Siska; I Made Agus Kusumadjaja
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (380.077 KB) | DOI: 10.15562/ism.v13i2.1374

Abstract

Objective: This study aims to report a case of catarct surgey outcome in cataract diabetic patient with uncontrolled glycemic. Case Presentation: A 54-year-old woman has catarct on both eye and history of diabetes mellitus for 15 years. The patients was planned for cataract surgery when blood sugar below 200mg/dL in left eye,blood sugar patients from 248 mg/dL become 168 mg/dL. One week post operation evaluation revealed corneal edema, due to phaco time intra surgery in this patient increased. Visual acuity was 6/120 BCVA on the right eye and 6/18 BCVA on the left eye. Visual acuity has decreased in 2 months after surgery, 1/60 BCVA on the right eye and 6/18 BCVA on the left eye, as well as funduscopy presence of dot blot, flame-shaped, and traction on both eyes. This outcome was contributed by an uncontrolled blood glucose of the patient. Conclusion: Preoperative preparations in diabetic cataract patients are mandatory, including blood sugar and HbA1C control, to achieve a better outcome of ocular surgery in patients with diabetes mellitus.
Ablasio retina rhegmatogen bilateral: sebuah laporan kasus Amicipta Sanjaya; Ari Andayani; I Made Agus Kusumadjaja
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (734.527 KB) | DOI: 10.15562/ism.v13i2.1376

Abstract

Background: Rhegmatogenous retinal detachment in children is rare, accounting for less than ten percent of all rhegmatogenous retinal detachments. While the majority of retinal detachments in the adult population are associated with posterior vitreous detachments, pediatric rhegmatogenous retinal detachments are often associated with trauma or an underlying congenital abnormality, although in some cases they are associated with idiopathic conditions. Case Description: A 16-year-old male patient complained about blurry vision in the right eye in the last 6 months and in the left eye in the last 5 months. Ophthalmology examination in the right eye found an inferior retinal detachment (+) at 3-9 o’clock, multiple breaks at 7-9 hours, PVR grade C, subretinal fibrosis (+), traction (+), macula off, RM (-). Meanwhile, ophthalmology examination in the left eye found an inferior retinal detachment in the left eye (+) at 3-9 o’clock, break at 5 o'clock, PVR grade C, traction (+), RM (+). The patient underwent pars plana vitrectomy in both eyes and the patient experienced an increase in visual acuity after surgery on both eyes. Conclusion: This case describes a healthy adolescent male with bilateral rhegmatogenous retinal detachment secondary to spontaneous non-traumatic retinal dialysis. The Pars Plana Vitrectomy (VPP) technique that used in this case could give high final reattachment rate and relatively good functional outcomes. VPP also has the intraocular ability to manipulate tissues and reduce immediate vitreous traction.   Latar Belakang: Ablasio retina rhegmatogenous pada anak-anak jarang terjadi, terhitung kurang dari sepuluh persen dari semua ablasio retina rhegmatogen. Sementara sebagian besar ablasio retina pada populasi orang dewasa terkait dengan ablasio vitreous posterior, ablasio retina hegmatogen pediatrik sering kali berhubungan dengan trauma atau kelainan kongenital yang mendasari, walaupun pada beberapa kasus didapatkan dengan kondisi idiopatik. Laporan Kasus: Pasien laki-laki berusia 16 tahun mengeluhkan penurunan pengelihatan pada mata kanan sejak 6 bulan sebelumnya dan pada mata kiri 5 bulan sebelumnya. Pemeriksaan oftalmologi didapatkan AAR di mata kanan dengan retinal detachment (+) di inferior pada jam 3-9, multiple break pada jam 7-9, PVR grade C, fibrosis subretina (+), traksi (+), macula off, RM (-). Pemeriksaan pada mata kiri didapatkan retinal detachment di mata kiri (+) di inferior pada jam 3-9, break pada jam 5, PVR grade C, traksi (+), RM (+). Pasien menjalani vitrektomi pars plana pada kedua mata dan pasien mengalami peningkatan tajam penglihatan setelah dilakukan tindakan operasi pada kedua mata. Kesimpulan: Kasus ini menjelaskan remaja laki-laki sehat dengan bilateral ablasio retina rhegmatogen sekunder akibat retinal spontan non-trauma dialisis. Teknik Vitrektomi Pars Plana (VPP) digunakan pada kasus ini dan mampu memberikan tingkat attachment akhir yang tinggi dan hasil fungsional yang relatif baik serta kemampuan intraokular untuk memanipulasi jaringan dan mengurangi traksi vitreous secara langsung.
NEUROMYELITIS OPTICA SPECTRUM DISORDER (NMOSD) DENGAN ANTIBODI AQP4 POSITIF Rima Febry Lesmana; Anak Agung Mas Putrawati Triningrat; Made Paramita Wijayanti; I Made Agus Kusumadjaja; Ida Ayu Sri Indrayani; Gede Kambayana
Callosum Neurology Vol 4 No 2 (2021): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29342/cnj.v4i2.138

Abstract

Background: Neuromyelitis optica (NMO) is an in?ammatory demyelinating autoimmune disease of the central nervous system that most commonly affects the optic nerves and spinal cord. Seropositive antiAQP4 differentiates NMO from MS and the presence of manifestation in the postrema, brainsteam or diencephalic areas extend to NMO Spectrum Disorder (NMOSD). Case Description: A 18 years old male complain sudden vision loss on his left eye since 2 weeks ago. The examination show the visual acuity on the right eye was 6/6 and LPBP on the left eye. Positive RAPD on the left eye, funduscopy and the OCT RNFL within normal limits. Head MRI focus orbita with contrast show optic neuritis. Patient was diagnosed with left eye retrobulbar optic neuritis and ONTT therapy was given. The visual acuity improved to 1/60 then therapy change to oral steroid. Four months later, the patient suddenly got vision loss on the right eye accompanied by paraparesis. The visual acuity on the right eye was NLP and the left eye was 1/300, with mid-dilated papil. The results of the OCT RNFL show on the right eye edema papil and left eye atrophy papil. An MRI of the head focus orbital and whole spain was reexamined followed by VEP examination and an AntiAQP4 which showed an NMOSD. He was given ONTT then continued with immunosuppressants. The visual acuity of the right eye improved to 3/60 and the left eye remained 1/300. Discussion: This patient first presented with complain on the left eye with clinical and supporting symptoms suggesting an optic neuritis. The presence of a new attack on the right eye with paraparesis is a clinical feature of NMO supported by MRI results and seropositive AQP4 indicates an NMOSD. Conclusion: Establishment of diagnosis and administration of therapy quickly and precisely can reduce the severity and risk of recurrence which leads to greater disability and blindness. Key Words: Neuromyelitis Optica, Neuromyelitis Optica Spectrum Disorder, AQP4
Co-Authors Abdi Sastra Gunanegara Alexander Theodore Samosir Amicipta Sanjaya Anak Agung Ayu Githasari Dewi Anak Agung Ayu Sukartini Djelantik Anak Agung Ayu Surya Nirmala Dewi Anak Agung Mas Putrawati Triningrat Anak Agung Surya Nirmala Dewi Ari Andayani Ari Suryathi, Ni Made Ariesanti Tri Handayani, Ariesanti Tri Arleni Putri, Ni Putu Apriliantini Christine Natalia Gunawan Cokorda Istri Dewiyani Pemayun Gde Aditya Putra Deva Gde Ngurah Idraguna Pinatih Gede Kambayana Harumi Purwa Prahesthy, Harumi Purwa I Gde Raka Widiana I Gusti Ayu Made Juliari I Gusti Ayu Ratna Suryaningrum I Gusti Ayu Ratna Suryaningrum I Kadek Agus Setiawan I Made Surya Dinajaya I Putu Budhiastra I Wayan Eka Sutyawan I Wayan Gede Jayanegara I Wayan Juli Sumadi Ida Ayu Ari Pramita Ida Ayu Ary Paramita Ida Ayu Ary Pramita Ida Ayu Sri Indrayani Juliari, I Gusti Ayu Made Junetta Airene Priskila Taba Komang Putra Tridiyoga Krisnhaliani Wetarini Made Juliari, I Gusti Ayu Made Paramita Wijayanti Made Paramita Wijayati Mahesadhana Ardika, Putu Abhinaya Matthew Sebastian Maura Marda Mayangsari N. K. Niti Susila, N. K. Ni Ketut Putri Ariani Ni Kompyang Rahayu Ni Made Ari Suryathi Ni Made Ayu Surasmiati Ni Made Laksmi Utari Ni Made Suryanadi Ni Putu Mariati NLP Wistya Eka Mahadewi Pande Putu Adityo Ananta Ardika Putu Adhi Surya Pradana Putu Dian Megasafitri Putu Yuliawati Rima Febry Lesmana Rima Febry Lesmana Satya Nugraha Siska Siti Fatima Suryawijaya, Ernes Erlyana Thedius Watu