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Neuropati Optik Traumatik: Gambaran 13 Kasus Berdasarkan Radiologi dan Awitan Terapi Kortikosteroid di Rumah Sakit Cipto Mangunkusumo Made Paramita Wijayati; Syntia Nusanti; M. Sidik
Majalah Oftalmologi Indonesia Vol 47 No 2 (2021): Ophthalmologica Indonesiana
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/journal.v47i2.100313

Introduction and Objection: Traumatic Optic Neuropathy is a rare and potentially vision-threatening condition caused by ocular or head trauma. The optic nerve axons may be damaged either directly or indirectly. The management of traumatic optic neuropathy could be observed, giving steroids or decompression. At center which optic nerve decompression is not routinely performed, high dose steroid is preferred for traumatic optic neuropathy patients. The study aims to analyze characteristics (mean age and gender, onset trauma, most symptom, visual acuity, consensual reflex as a sign), radiology feature, and onset corticosteroid therapy on patient traumatic optic neuropathy. Methods: This study was a descriptive observational case series which data retrospectively analysis from medical record. Result: From 13 cases most common gender affected were males (76,9%). The mean age group 32.85±14.67 years old with blurry vision and bleeding are the most common symptom, the onset of trauma below 24 hours (76.9%), the initial visual acuity is no light perception and hand movement with a negative consensual reflex (76.9%). Visual acuity improves with initial corticosteroid therapy below 24 hours are 7 cases and more than 24 hours are 2 cases. From 9 cases with visual acuity improvement, there are 4 cases with orbital fracture and 5 cases without orbital fracture. Conclusion: Visual improvement in our cases happened more on initial corticosteroid therapy more than 24 hours and no orbital fracture.

Searching The New Culprit of Optic Neuritis: The Role of Vitamin D: Poster Presentation - Case Report - Ophthalmologist ANAK AGUNG MAS PUTRAWATI TRININGRAT; Made Paramita Wijayati; Putu Ayu Wulansari
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/ga8bd617

Abstract Introduction : Low vitamin D status has long been associated in multiple sclerosis patient with higher risk of disease progression and frequent relapses. Vitamin D plays an important role in modulating the immune process responsible for demyelination. To this date, the study on vitamin D deficiency in optic neuritis case is still rare. Case Illustration : Female, 20 years old, presenting with bilateral sudden visual loss since 1 week prior. The patient looked relatively pale and complained of accompanying headache and myalgia. Visual acuity in both eyes were light perception with dilated pupils and posterior segment showing optic disc swelling. CBC, infection and autoimmune screening came within normal limit and brain MRI further confirmed the presence of optic neuritis. The patient was given high dose intravenous steroid but showed no improvement. Later, she was screened for nutrient deficiency and found sign of low serum 25-hydroxyvitamin D. After one week of oral supplementation and neuroprotective agents, her vision drastically improved to 6/6 in both eyes. Discussion : Vitamin D deficiency nowadays is getting more prevalent in high risk individuals with low dietary intake and sunlight exposure. Recent study found that mean serum vitamin D level were significantly lower in autoimmune optic neuritis (ON) and were associated with ON attack severity. Vitamin D sufficiency is associated with better inflammatory outcome and long term neurodegenerative measures in demyelinating diseases, as shown by improvement in RNFL thickness after attack. Conclusion : Screening for vitamin D deficiency is essential to consider in managing patient with atypical optic neuritis.

Orbital Apex Syndrome in a diabetic patient, Is It Tolosa Hunt? Poster Presentation - Case Report - Ophthalmologist MADE PARAMITA WIJAYATI; AA Mas Putrawati
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/t39cd404

Abstract Introduction : The presence of that specific sign in neuro ophthalmology cases can easily determine the differential diagnosis. But the challenge is how do we found the cause. We describe a case of visual loss with ophthalmoplegia in a diabetic patient suspected of having Tolosa Hunt syndrome. Case Illustration : Woman, 63 years old with acute visual loss and feel a "heavy eyelid" in the left eye for 2 weeks. The Visual Acuity is no light perception on the left and ophthalmoplegia with mild proptosis. We do the laboratory test and MRI. No specific result of infection was found but the patient was diagnosed with diabetes mellitus (DM) type 2. MRI shows a lesion in the left cavernous sinus. Diagnosis of Orbital Apex syndrome was made. We give the patient a high dose of steroid and then continue with prednisone orally. In 24 hours after treatment the "heavy eyelid" decreased. One month after therapy there are improvements in eye movement but still no light perception. Discussion : In cases of orbital apex syndrome with DM, we need to consider mucormycosis as the cause. In this case, the symptoms and signs as well as the MRI led to a Tolosa Hunt. Steroid administration was able to reduce heavy eyelids and cranial nerve palsy even though visual acuity had not improved after 1 month of therapy. Conclusion : Laboratory test and Neuroimaging plays an important role to find out the cause. High-dose steroid therapy in a diabetic patient with Tolosa Hunt Syndrome can be given with tight hyperglycemic control.

Ocular Involvement as the Primary Presentation of Suspected Systemic Lupus Erythematosus: A Case of Bilateral Papilledema and Macular Edema Junetta Airene Priskila Taba; Anak Agung Mas Putrawati Triningrat; Made Paramita Wijayati; I Made Agus Kusumadjaja
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 6 (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.v9i6.1303

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease known for its varied clinical presentations, often affecting multiple organ systems. Ocular involvement is common in SLE, but posterior segment manifestations like papilledema are rare, occurring in only about 1% of SLE patients. This case report details a unique instance of bilateral papilledema and macular edema as the primary presentation of suspected SLE in a young female patient. Case presentation: A 24-year-old female presented with a one-week history of sudden-onset blurry vision in both eyes. Ophthalmological examination revealed reduced visual acuity (6/45 in both eyes), bilateral optic disc swelling, and macular edema. Further investigations, including Optical Coherence Tomography (OCT) and Magnetic Resonance Imaging (MRI), confirmed macular edema and optic nerve sheath distention. A positive Antinuclear Antibody (ANA) test suggested an autoimmune etiology. Lumbar puncture results were normal, ruling out idiopathic intracranial hypertension. The patient was diagnosed with bilateral papilledema and macular edema, with suspected underlying SLE. Prompt treatment with high-dose corticosteroids and acetazolamide led to significant clinical improvement. Conclusion: This case highlights the rarity of bilateral papilledema and macular edema as initial presenting features of suspected SLE. It emphasizes the importance of thorough ophthalmological examination and relevant investigations in patients with sudden vision loss. Early recognition of such rare presentations is crucial to prevent potentially sight-threatening complications. This case underscores the need for a multidisciplinary approach for accurate diagnosis and management of complex presentations of systemic autoimmune diseases.

Ocular Involvement as the Primary Presentation of Suspected Systemic Lupus Erythematosus: A Case of Bilateral Papilledema and Macular Edema Junetta Airene Priskila Taba; Anak Agung Mas Putrawati Triningrat; Made Paramita Wijayati; I Made Agus Kusumadjaja
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 6 (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.v9i6.1303

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease known for its varied clinical presentations, often affecting multiple organ systems. Ocular involvement is common in SLE, but posterior segment manifestations like papilledema are rare, occurring in only about 1% of SLE patients. This case report details a unique instance of bilateral papilledema and macular edema as the primary presentation of suspected SLE in a young female patient. Case presentation: A 24-year-old female presented with a one-week history of sudden-onset blurry vision in both eyes. Ophthalmological examination revealed reduced visual acuity (6/45 in both eyes), bilateral optic disc swelling, and macular edema. Further investigations, including Optical Coherence Tomography (OCT) and Magnetic Resonance Imaging (MRI), confirmed macular edema and optic nerve sheath distention. A positive Antinuclear Antibody (ANA) test suggested an autoimmune etiology. Lumbar puncture results were normal, ruling out idiopathic intracranial hypertension. The patient was diagnosed with bilateral papilledema and macular edema, with suspected underlying SLE. Prompt treatment with high-dose corticosteroids and acetazolamide led to significant clinical improvement. Conclusion: This case highlights the rarity of bilateral papilledema and macular edema as initial presenting features of suspected SLE. It emphasizes the importance of thorough ophthalmological examination and relevant investigations in patients with sudden vision loss. Early recognition of such rare presentations is crucial to prevent potentially sight-threatening complications. This case underscores the need for a multidisciplinary approach for accurate diagnosis and management of complex presentations of systemic autoimmune diseases.

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