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All Journal The Indonesian Biomedical Journal Jurnal SainHealth JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Journal of Stem Cell Research and Tissue Engineering CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL Indian Journal of Forensic Medicine & Toxicology Vision Science and Eye Health Journal Ophthalmologica Indonesiana IPSSJ
Zuhria, Ismi
Department Of Ophthalmology, Faculty Of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Biochemistry, Genetics & Molecular Biology Chemistry Economics, Econometrics & Finance Education Engineering Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Neuroscience Public Health Social Sciences Veterinary

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Recurrent Candida Parapsilopsis Corneal Ulcer cum Hypopion: A Case Report: Poster Presentation - Case Report - Resident Septian Dwi Prabowo; Ismi Zuhria
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/pv392e57

Abstract

Introduction : Candida is common in tropical and subtropical climes estimated for 20-60% of all culture-positive corneal infection. Over the past two-decades, candida parapsilosis has become a common opportunistic fungal pathogen. Case Illustration : A-60-years-old-man, came with redness and pain in the left eye since one month ago after working at field. In the left eye, visual acuity was hand movement, palpebra was spasm and oedema, conjunctiva was hyperaemia, hazy, feathery edge and fluorescein test were positive in paracentral corneal 6x7 mm and hypopyon in anterior chamber. KOH staining revealed yeast, corneal scrapping revealed candida parapsilopsis, and antifungal sensitive to fluconazole. Fluconazole intravenous 200mg 2-times-a-day, moxifloxacin eyedrop loading dose, fluconazole eyedrop fortified every-one- hour, atropine 1% eyedrop 2-times-a-day, artificial tears eyedrop every-one-hour was administered.In the fifth-day, hypopyon was improved, and patient was discharged. Tenth-days after, patient felt pain and hypopyon raised 4mm. Debridement in the ulcer, and therapy was continued. Two weeks later, hypopyon was less than 1 mm, and pain was relieved. Discussion : There was clinically improvement using antifungal therapy. Recurrent hypopyon was happen, and mechanical debridement in the ulcer was administered. In four-times within two-weeks, hypopyon was improved. Although, initial treatment was antibiotics until microbiological confirmation, antifungal therapy, combined with mechanical eradication of fungal filaments could be administered for fungal corneal ulcer. Conclusion : In this case, combination of antifungal therapy with mechanical debridement could be the right choice to treat candida parapsilopsis corneal ulcer. Better outcomes can be achieved and complications can be avoided with appropriate diagnosis and efficient therapy.
PEDIATRIC BLEPHAROKERATOCONJUNCTIVITIS WITH DESCEMETOCELE AND CORNEAL NEOVASCULARIZATION : A CASE REPORT: Poster Presentation - Case Report - Resident Fadia Ghaisani; Ismi Zuhria
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/pcfv7b13

Abstract

Introduction : Blepharokeratoconjunctivitis is a chronic and recurrent inflammatory eyelid disorder that is commonly associated with secondary conjunctival and corneal involvement that is frequently underdiagnosed in children. The objective is to report a descemetocele and corneal neovascularization as severe complications of blepharokeratoconjunctivitis in children. Case Illustration : A five years old girl complained blackish lump in the right eye since a month ago. She also had a whitish spot in her eye since a year ago with redness, glare and watery. Three years ago she had a lump in the right eyelid and eye redness intermittently that was getting better with eye drop and history of allergy of house dust mites. Visual acuity (VA) in right eye was hand movement. Anterior segment of the right eye showed telangiectasis of palpebra, hyperemic conjunctiva, with neovascularization of entire surface of the cornea, descemetocele, leucoma and corneal thinning around descemetocele. We injected subconjunctival anti-vascular endothelial growth factor (VEGF) injection then we performed amniotic membrane transplantation. Follow-up 2 months post surgery we found VA was 2 m counting finger and the corneal neovascularization was reduced. Discussion : This case represents severe blepharokeratoconjunctivitis can cause some complications, from this patient we found corneal neovascularization and descemetocele. Anti-VEGF injection was to inhibit new blood formation in the patient’s cornea and the amniotic membrane transplantation was to manage the descemetocele. Conclusion : Pediatric blepharokeratoconjunctivitis and the complications associated with its treatment can be sight threatening. Early recognition of this disease entity and adequate management may arrest the disease process and may minimize visual morbidity.
Bandage Contact Lens Associated Infection after Amnion Membrane Transplantation in Peripheral Ulcerative Keratitis Case with Spondyloarthritis Permatasari, Devi Sarah Intan; Zuhria, Ismi; Rahmawati, Lita Diah
Vision Science and Eye Health Journal Vol. 4 No. 1 (2024): Vision Science and Eye Health Journal
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/vsehj.v4i1.2024.4-12

Abstract

Introduction: Bacterial keratitis causes around 90% of all cases of microbial keratitis. The global rise in contact lens usage has contributed to an increased risk of microbial keratitis. Peripheral ulcerative keratitis (PUK) is essential to diagnose as it can be the first presenting feature of a sight-threatening and associated with rheumatic autoimmune disease. Case Presentation: The case presents a 35-year-old woman with redness, discharge, and tenderness in her right eye (RE) since the day before, along with light sensitivity and tearing. Three months prior, she underwent multilayer amniotic membrane transplantation (AMT) surgery for corneal thinning due to peripheral ulcerative keratitis (PUK) and wore a contact lens postoperatively as a bandage. She had a history of conjunctival resection related to the PUK a year ago. She received oral cyclosporin and methylprednisolone for spondyloarthritis. Initially, her visual acuity of the RE was limited to hand movement. Diagnosis included RE keratoconjunctivitis related to contact lens and PUK post-AMT surgery; treatment comprised intravenous and topical antibiotics, artificial tears, cycloplegics, analgesics, and oral ascorbic acid. After four days of treatment, clinical signs were improved, with visual acuity progressing from hand movement to counting fingers at one meter. Conclusions: Careful management is essential for PUK patients after AMT surgery, especially those using contact lenses as bandages due to the potential risk of infection. Early PUK identification is crucial, as it may indicate sight-threatening issues and underlying systemic diseases. Meticulous examination and multidisciplinary management are required to ensure patient safety.
Multifocal Keratitis in 23-year-old Woman with β-Thalassemia Asti, Annisa Kinanti; Zuhria, Ismi
Vision Science and Eye Health Journal Vol. 4 No. 2 (2025): Vision Science and Eye Health Journal
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/vsehj.v4i2.2025.50-54

Abstract

Introduction: Multifocal keratitis can result from infectious and non-infectious causes, and its etiology is often challenging to pinpoint. Ocular complications are common in β-thalassemia and can have serious consequences. This case highlights an unusual presentation of multifocal keratitis in a patient with β-thalassemia. Case Presentation: A 23-year-old woman with β-thalassemia, diagnosed 12 years ago, was referred by a hematologist for pain in her right eye persisting for the past two weeks. She reported redness, tearing, and light sensitivity. Six months prior, she experienced similar symptoms, which had left a white spot in her right eye. Recently, this spot had multiplied and spread across the ocular surface. Visual acuity (VA) was 6/40 in the right eye on examination. Findings included palpebral spasm, conjunctival and pericorneal injection, and multiple infiltrates on the anterior corneal surface. Fluorescein staining was positive for numerous infiltrates. Schirmer and break-up time (BUT) tests indicated an unstable tear film. Treatment included antibiotic eye ointment, preservative-free artificial tears, mucous membrane pemphigoid (MMPs) inhibitors, and oral ascorbic acid. Two weeks later, VA improved to 6/9, with a reduction in infiltrates and fluorescein staining. Conclusion: Prompt management is essential for preserving vision and preventing complications in ocular surface diseases while diagnostic procedures are underway.
A Case of Chronic Incomplete Vogt-Koyanagi-Harada (VKH) Disease with Systemic Involvement in a 57-Year-Old Woman Prakoeswa, Camilla A.; Zuhria, Ismi
Vision Science and Eye Health Journal Vol. 4 No. 3 (2025): Vision Science and Eye Health Journal
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/vsehj.v4i3.2025.81-85

Abstract

Introduction: Vogt–Koyanagi–Harada (VKH) disease is a systemic disorder that involves tissues containing pigmented cells. It is thought to be caused by an autoimmune T-cell-mediated process against melanocytes in systemic organs, particularly the eyes. VKH disease is a chronic, bilateral, diffuse, granulomatous panuveitis that involves integumentary, neurologic, and auditory aspects, which affects females and darkly pigmented ethnic groups. Here, we presented a rare case of VKH disease in a seronegative spondyloarthropathy patient. Case Presentation: A 57-year-old woman complaining of blurry vision in both eyes for three years. She was previously diagnosed with spondyloarthropathy, osteoarthritis, type 2 diabetes, hypertension, and dyslipidemia. Both eyelids exhibited periocular vitiligo and poliosis and were slightly hyperemic. Both eyes had perilimbal vitiligo and fine brown keratic precipitates. The anterior chambers were deep and quiet; however, the patient had posterior synechiae in both eyes. The fundus examination showed a sunset glow fundus appearance. Conclusions: VKH is a chronic disease that can relapse and recur. While the disease's prognosis is overall favorable, it is determined by the duration and frequency of recurrent inflammation episodes; thus, early detection and prompt treatment are essential for success. Poor visual prognosis is predicted by a larger number of complications, an older age at disease onset, a longer median duration of the disease, delayed treatment initiation, and a higher number of recurrent episodes of inflammation. To preserve vision, patients often require lifelong immunosuppressive therapy and need to be educated about the signs and symptoms to watch for when their condition relapses.
Neurotrophic Keratopathy Post-Herpes Zoster Ophthalmicus Infection Sarasati, Fani; Zuhria, Ismi
Vision Science and Eye Health Journal Vol. 4 No. 3 (2025): Vision Science and Eye Health Journal
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/vsehj.v4i3.2025.91-94

Abstract

Introduction: Neurotrophic keratopathy (NK) is a degenerative disease of the corneal epithelium caused by disruption of corneal trigeminal innervation, resulting in reduced corneal sensitivity, epithelial damage, and impaired corneal healing. It can be caused by various factors, such as viral infections (e.g. herpes simplex keratoconjunctivitis and herpes zoster), chemical or physical trauma, corneal surgery, and intracranial lesions. Management of NK is based on clinical severity to promote corneal healing and prevent progression to stromal melting or perforation. Case Presentation: A 64-year-old male presented with a three-month history of a whitish plaque on the right eye, accompanied by redness, foreign body sensation, and decreased vision. The patient had a history of herpes zoster ophthalmicus (HZO) on the left side of the forehead in June 2022. Ophthalmologic examination revealed a 4 x 5 mm corneal epithelial defect with stromal infiltrates and decreased corneal sensitivity in the left eye, consistent with stage 2 neurotrophic keratopathy. Ancillary tests revealed reduced tear production and instability of the tear film. The patient was treated with topical antibiotics, lubricants, cycloplegics, and systemic doxycycline, with weekly follow-up and no evidence of active bacterial or fungal infection. Conclusion: Neurotrophic keratopathy can occur as a complication of post-HZO infection. Early diagnosis, severity-based treatment, and close monitoring are crucial for achieving epithelial healing and preventing further corneal damage. Prognosis depends on the degree of sensory impairment and the response to treatment.
The CD4 Count and Viral Load Differences in HIV Patients with and without Infectious Posterior Uveitis at a Tertiary Hospital in Indonesia Hidayat, Shofa Annesa; Zuhria, Ismi; Arfijanto, Muhammad Vitanata; Prastyani, Reni
Current Internal Medicine Research and Practice Surabaya Journal Vol. 6 No. 2 (2025): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v6i2.65918

Abstract

Introduction: The human immunodeficiency virus (HIV) compromises the immune system, making the monitoring of cluster of differentiation (CD4) counts and viral loads critical for assessing disease progression and opportunistic infection risks. Eye-related manifestations, such as uveitis, are common among HIV patients. The purpose of this study was to investigate the differences in CD4 count and viral load between HIV patients with infectious posterior uveitis and those without at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Methods: A retrospective study with an analytical observational design was conducted using the medical records of 75 HIV patients. The examined variables included CD4 count and viral load as independent variables, alongside the incidence and absence of infectious posterior uveitis as dependent variables. The inclusion criteria were HIV patients with regular follow-ups, thereby excluding those with irregular follow-ups. The analysis used the Mann-Whitney test, with p<0.05 indicating a statistically significant difference. Results: All 75 samples met the inclusion criteria for analysis. The majority of the patients were male (64%) and within the age range of 31 to 40 years (44%). Patients with infectious posterior uveitis had significantly lower CD4 counts (p<0.05) compared to those without the disease. However, no significant differences in viral loads (p>0.05) were observed between patients with posterior uveitis and those without. Conclusion: CD4 counts differ significantly between patients with infectious posterior uveitis and those without, while viral loads show no considerable differences.   Highlights: 1. This study highlights the differences in cluster of differentiation (CD4) lymphocyte count and viral load between HIV patients with infectious posterior uveitis and those without. 2. The findings may provide new insights into the immunological mechanisms underlying infectious posterior uveitis in persons living with HIV. 3. This work contributes to determining the factors that affect the development of infectious posterior uveitis and explores the potential use of CD4 lymphocyte count and viral load as biomarkers for the diagnosis and management of the disease.
OCULAR COMPLICATION AS A LONG-TERM SEQUELAE OF STEVEN-JOHNSON SYNDROME: WHAT SHOULD WE DO? Monica Rizky Wigianita; Ismi Zuhria
Integrative Perspectives of Social and Science Journal Vol. 2 No. 03 Agustus (2025): Integrative Perspectives of Social and Science Journal
Publisher : PT Wahana Global Education

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

Abstract

Ocular surface abnormalities in SJS is a sequelae that has a high chance of progressing, especially in eyes with partial keratinization and conjunctivalization. Even after recovering from skin problems without sequelae, patients can have serious ocular complications leading to blindness despite local and systemic therapy. A 51 years old woman complained that both eyes were red and watery since three years. She also said that her both eyes felt stuck because the eyelashes turned inward for the past 3 years. Initially the patient suffered from SJS (Steven-Johnson Syndrome) in early 2020 with complaints of whole body blisters After the body condition gradually improved after SJS, the patient began to feel changes in the condition of both eyes. The visual acuity of the patient was 5/5 in both eyes. The Schirmer test were 15 mm in right eye and 5 mm in left eye. The Tear Break Up Time (TBUT) examination showed 3 second in right eye and 1 second in left eye. The eyelid had meibomian gland dysfunction for both eyes and the conjunctiva had symblepharon in both eyes. From fluorescein test showed multiple punctate in both eyes. The chronic ocular complications of SJS is characterized by a vicious cycle of ocular surface scarring and inflammation that disturbs the delicate structure and function of the eyelids and tear film and then progresses to further ocular surface damage and swelling. The long-term prognosis of the eye depends on early detection and intensive treatment. To identify the cicatrical abnormalities that cause chronic ocular surface failure, such as limbal cell deficiency and total ocular surface keratinization, the eyelid margin, palpebral conjunctiva, and fornix should be carefully examined.
COMPARISON OF INFLAMMATORY RESPONSE BETWEEN PLATELET RICH PLASMA 20% AND AUTOLOGUS SERUM 20% IN EXPERIMENTALLY-INDUCED CORNEAL ALKALI BURN Ramadhani, Amelia Safitri; Zuhria, Ismi; Rahniayu, Alphania
Journal of Stem Cell Research and Tissue Engineering Vol. 7 No. 1 (2023): JOURNAL OF STEM CELL RESEARCH AND TISSUE ENGINEERING
Publisher : Stem Cell Research and Development Center, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jscrte.v7i1.45698

Abstract

Objective to compare the inflammatory response between platelet rich plasma 20% and autologous serum 20% on cornea after sodium hydroxide exposure. Methods a true experimental study with two groups post-test design. A total of 18 rabbits were used in this study and allocated into two groups. After collecting intravenous blood samples from both group, platelet rich plasma 20% and autologous serum 20%, respectively, were obtained by centrifugation and dilution. Alkali burns were inflicted on the central cornea of each rabbit's right eye by applying a round filter paper, 7.0 mm in diameter, soaked in 1N NaOH for 60 s. Clinical outcome of the inflammation were observed everyday for seven days. On the seventh day, corneal tissue was collected for histopathological examination to evaluate amount of PMN neutrophils that infiltrate the central cornea. All data were statistically analyzed for difference between the study groups. Resuls statistical analysis shows statistically difference in clinical inflammatory feature of conjunctival hyperemia at day 3 until day 7, in which the group that received PRP 20% got lower conjunctival hyperemia grading compared to the group that received AS 20%. Other clinical features, corneal opacity and epithelial defect, shows no statistically difference between two groups. Histopathological examination shows lower amount of PMN neutrophil infiltration to the central cornea on PRP group, compared to AS group. Conclusio Platelet-rich plasma 20% eyedrop can be used as one of adjuvant therapies and has better control of inflammatory response towards alkaline injury of the cornea during acute phase.
UNILATERAL CMV RETINITIS IN HIV/AIDS PATIENT WITH MULTIPLE OPPORTUNISTIC INFECTIONS: Poster Presentation - Case Report - Resident Bening, Daya Banyu; Firmansjah, Muhammad; Zuhria, Ismi
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/n3kv9x42

Abstract

Introduction : CMV Retinitis is the most common opportunistic infection in HIV/AIDS patient. Ocular manifestations in HIV/AIDS have similar clinical features though the management therapies are different. Case Illustration : A 47-year-old man was presented with blurred vision on LE since 4 months. Patient was diagnosed with HIV/AIDS since 2 years. Patient only had light perception on LE, and 5/10 on RE. The LE anterior segment showed flare and cell indicating active anterior uveitis. The LE posterior segment revealed extensive hemorrhage and exudate known as ‘pizza pie’ appearance, and cotton wool spot with multiple ischemic areas on RE. Laboratory tests revealed reactive IgG CMV and very low CD4 count (4 cell/?l). Patient was also diagnosed with Tinea Corporis, Scabies, and Pneumocystis carinii pneumonia. Oral Valganciclovir 900 mg was administered twice a day for 3 weeks, along with anti- retroviral therapy. Discussion : The anterior uveitis and ‘pizza pie’ appearance with positive CMV IgG indicate CMV Retinitis in fulminant form. Cotton wool spot found in the RE leads to retinal microvasculopathy due to HIV invading the vascular endothelium and causing increased plasma viscosity. This patient only had 4 cell/?l CD4 which indicates severe immune deficiency. If not treated immediately, patients with CD4 count <50 are at higher risk of contralateral eye involvement. Oral Valganciclovir was chosen considering the multiple opportunistic infections the patient had. Conclusion : It is important to distinguish CMV retinitis with other HIV/AIDS ocular manifestations. The choice of therapy needs be considered with the overall condition of patient.
Co-Authors Alphania Rahniayu Angeline Hartadhi Asti, Annisa Kinanti Athi Purnasari Bambang Hermanto Bening, Daya Banyu Cinintha Nandini Devi Sarah Intan Permatasari Doemilah, Ratna Dwita Permatasari Eddy Bagus Wasito Fadia Ghaisani Ferdian Ramadhan Firmansjah, Muhammad Hari Basuki Notobroto Hendrian Dwikoloso Soebagjo Hidayat, Shofa Annesa I'tishom, Reny Indriaswati, Dyah Kusworini Jamaluddin Jamaluddin Komaratih, Evelyn Lutfi, Delfitri Maria Astrid Claudia Monica Rizky Wigianita Muhammad Fariz Muhammad Vitanata Arfijanto, Muhammad Vitanata Nila Kurniasari Nurwasis Nurwasis Nyilo Purnami Prakoeswa, Camilla A. Prastyani, Reni Rahmawati, Fika Rahmawati, Lita Diah Ramadhani, Amelia Safitri Ratih Justitia Kartika Rifat Nurfahri Ruth Anastasia S.Pd. M Kes I Ketut Sudiana . Sarasati, Fani Septian Dwi Prabowo Soebagjo, Hendrian Dwikoloso Susy Fatmariyanti Widjaja, Sauli Ari WINARTO Yustiarini, Ima