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All Journal Medicina E-Jurnal Medika Udayana Jurnal Pengabdian Kepada Masyarakat (Indonesian Journal of Community Engagement) ISM (Intisari Sains Medis) : Jurnal Kedokteran Journal of Global Pharma Technology IJRETINA - International Journal of Retina Ophthalmologica Indonesiana

I Wayan Gede Jayanegara

Department Of Ophthalmology, Universitas Udayana, Bali, Indonesia

Author-ID : 5391800

Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Health Professions Medicine & Pharmacology Public Health

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KEJADIAN RETINOPATI DIABETIK PADA PASIEN DIABETES MELLITUS Suryathi, Ni Made Ari; Budhiastra, I Putu; Jayanegara, I Wayan Gede; Widiana, I Gede Raka
Medicina Vol 46 No 2 (2015): Mei 2015
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (219.282 KB)

Retinopati diabetik adalah salah satu komplikasi mikrovaskular dari diabetes melitus (DM).Komplikasi ini terjadi karena hiperglikemia pada pembuluh darah dalam jangka waktu yang lama.Retinopati diabetik adalah penyebab kebutaan terbanyak setelah katarak. Retinopati diabetik terbagimenjadi retinopati diabetik proliferatif (RDP) dan retinopati diabetik nonproliferatif (RDNP). Penelitianini bertujuan untuk mengetahui karakteristik pasien retinopati diabetik pada pasien diabetes mellitus.Penelitian ini adalah penelitian diskriptif yang dilakukan di RSUP Sanglah dan RS Indera, Denpasardari bulan Oktober 2014 sampai dengan Januari 2015. Pada penelitian ini, didapatkan 123 pasienDM, yang terdiri dari 66 laki-laki dan 57 perempuan, rerata umur adalah 56,30 (SB 8,16) tahun danrerata menderita DM selama 9,11 (SB 3,42) tahun. Dari 123 pasien, didapatkan 60,16% pasienmengalami retinopati. Pada kelompok RDP ditemukan lama menderita DM lebih lama (9,72 (SB3,92) vs 8,50 (SB 2,92)) tahun, hemoglobin glikosilat yang lebih tinggi (9,40 (SB 2,17) vs 7,06 (SB1,97))%, rerata umur 56,00 (SB 7,60) tahun dan laki-laki mendominasi kelompok ini (51%). Simpulanpenelitian ini adalah lebih dari 50% pasien DM pada penelitian ini mengalami retinopati dengankadar hemoglobin glikosilat lebih dari 7%. [MEDICINA 2015;46:86-91].Diabetic retinopathy is one of microvascular complication on Diabetes Mellitus (DM). This complicationcauses by hyperglycemia on retinal blood artery and vein during long periods of time. Diabeticretinopathy is the second causes of blindness after cataract. It consists of Non Proliferative DiabeticRetinopathy (NPDR) and Proliferative Diabetic Retinopathy (PDR). This study has aimed to identifythe characteristics of retinopathy in DM patients. This was descriptive study which had conducted inSanglah and Indera Hospital Denpasar Bali, from October 2014 until January 2015. 123 patients DMwere included, consisted of 66 males and 57 females, with average of age was 56,30 (SD 8,16) years,average of duration diabetes was 9,11 (SD 3,42) years. Among those patients, 60,16% hadretinopathy.Those who had PDR tend to have longer duration of diabetes (9,72 (SD 3,92) vs 8,50 (SD2,92)) years, higher glycosilate hemoglobin (9,40 (SD 2,17) vs 7,06 (SD 1,97))%, average of age was56,00 (SD 7,60) years, and male dominance (51%). In conclusion, more than a half of diabetes in thisstudy has retinopathy with mean glycosilate hemoglobin more than 7%. [MEDICINA 2015;46:86-91].

GAMBARAN KUALITAS HIDUP PADA PASIEN STRABISMUS DI RUMAH SAKIT UMUM PUSAT SANGLAH DENPASAR PERIODE 2016 - 2017 Yovita Govert; Ni Made Ayu Surasmiati; Wayan Gede Jayanegara
E-Jurnal Medika Udayana Vol 10 No 4 (2021): Vol 10 No 04(2021): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2021.V10.i4.P05

ABSTRAK Strabismus merupakan kondisi dimana terdapat ketidaksejajaran antar kedua mata. Salah satu mata dapat terlihat lurus menuju suatu objek, sedangkan mata yang lain dapat terlihat mengarah ke dalam, ke luar, ke atas, ataupun ke bawah. Kondisi ini dapat mempengaruhi kualitas hidup pasien secara negatif. Namun, hingga saat ini, penelitian terkait strabismus maupun kualitas hidup pasien strabismus di Indonesia, khususnya di Bali masih sangat jarang dilakukan. Oleh karena itu, penelitian ini dilaksanakan dengan tujuan untuk mengetahui gambaran kualitas hidup pada pasien strabismus di Rumah Sakit Umum Pusat Sanglah Denpasar periode 2016 - 2017. Desain penelitian yang digunakan adalah deskriptif potong lintang. Pengumpulan data menggunakan teknik consecutive sampling dengan menggunakan data sekunder yang didapatkan dari data rekam medis pasien strabismus Rumah Sakit Umum Pusat Sanglah Denpasar pada periode 2016 - 2017 serta menggunakan data penelitian sebelumnya yaitu data yang diambil dari kuisioner Amblyopia & Strabismus Questionnaire (A&SQ) yang telah dilakukan sebelumnya. Dari 22 sampel pasien strabismus, ditemukan karakteristik umum sampel. Gambaran kualitas hidup pasien strabismus pada penelitian ini dinilai dari total skor A&SQ yaitu sebesar 63,88 (18,21) yang berarti bahwa kondisi strabismus mempengaruhi kualitas hidup pasien secara negatif. Walau setiap domain pada A&SQ mempengaruhi kualitas hidup, domain ‘kontak sosial serta kosmetik’ merupakan kontributor terbesar terhadap rendahnya kualitas hidup pasien strabismus. Kualitas hidup pasien strabismus juga dapat digambarkan dengan membandingkan total skor A&SQ dan skor domain A&SQ bedasarkan jenis kelamin, jenis deviasi, dan status pekerjaan. Kata kunci : strabismus, kualitas hidup, gambaran, mata juling

GAMBARAN KARAKTERISTIK GLAUKOMA PRIMER DI RUMAH SAKIT MATA BALI MANDARA PERIODE 1 JANUARI 2018 – 31 DESEMBER 2018 Nyoman Astri Dewi Sanjiwani; Anak Agung Mas Putrawati Triningrat; I Wayan Gede Jayanegara; I Gusti Ayu Made Juliari
E-Jurnal Medika Udayana Vol 10 No 4 (2021): Vol 10 No 04(2021): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2021.V10.i4.P07

Background: Glaucoma is a group of optic neuropathies characterized by progressive degeneration of ganglion cells in the retina irreversibly causing cupping of the optic disc and causing vision loss. Considering glaucoma as the second cause of blindness after cataracts in the world and its irreversible nature, so this study was conducted to find out the characteristics of glaucoma, especially primary glaucoma at Bali Mandara Eye Hospital period January 1, 2018- December 31, 2018. Methods: This research is a retrospective descriptive study using medical record data. The sampling technique of this research is total sampling. The data obtained according to the inclusion and exclusion criteria were 41 data which were then analyzed using SPSS version 25. Results: This study showed that 38.1% of patients were in the 51-60 years age group. Most of the patients were male (54.8%). The majority live in the Denpasar area (21.4%). POAG was the most common type of primary glaucoma (78.6%). As many as 54.8% of patients experienced an increase in IOP. The majority of patients experienced thinning of the RNFL both in the right eye (61.0%) and the left eye (58.5%). The patient's CDR in the left (35.1%) and right (48.8%) eyes were in a severe state (?0.8). A total of 18 patients (43.9%) suggested to perform central 10-2 treshold test both in right and left eyes. Conclusion: most of the characteristics of primary glaucoma at Bali Mandara Eye Hospital were between 51-60 years old, male, residing in Denpasar, POAG type, and came in advanced clinical appearance. Keywords : characteristics, primary glaucoma, Bali Mandara Eye Hospital.

GAMBARAN KARAKTERISTIK PENDERITA KATARAK SENILIS DI RUMAH SAKIT DAERAH MANGUSADA BADUNG PERIODE 2018 Stacia Manggala; I Wayan Gede Jayanegara; Anak Agung Mas Putrawati T2
E-Jurnal Medika Udayana Vol 10 No 7 (2021): Vol 10 No 07(2021): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2021.V10.i7.P14

ABSTRAK Katarak adalah suatu penyakit dimana terdapat suatu bagian keruh yang berkembang pada lensa. Katarak bersifat progresif hingga mencapai suatu tahap yang dapat menyebabkan kehilangan penglihatan. Tujuan penelitian ini untuk mengetahui distribusi proporsi penderita katarak senilis berdasarkan jenis kelamin, usia, bilateralitas, tajam pengelihatan (visus), stadium, penatalaksanaan, jumlah kunjungan, serta periode di Rumah Sakit Daerah Mangusada Badung selama tahun 2018. Penelitian ini merupakan penelitian deskriptif, yang menggunakan metode cross-sectional. Sampel diambil menggunakan teknik consecutive sampling, kemudian data-data yang termasuk di kriteria inklusi akan dianalisis. Jumlah data yang memenuhi kriteria inklusi ada 609 data. Terdapat 52,1% penderita laki-laki dan 47,9% perempuan, dengan 18,4% berada pada kelompok usia 50-59 tahun, 44% pada 60-69 tahun, 32,3% usia 70-79 tahun dan 5,3% di atas 80 tahun. Sebanyak 16,4% penderita mengalami katarak di mata kanan, 13,5% di mata kiri dan 70,1% di kedua mata. Sebanyak 16,4% penderita mengalami katarak di mata kanan, 13,5% di mata kiri dan 70,1% di kedua mata. Terdapat 22,5% penderita dengan visus awal ? 6/18, 25,5% dengan visus <6/18 dan ? 6/60, 17,6% dengan visus <6/60 dan ? 3/60, serta 34,5% dengan visus <3/60. Berdasarkan stadiumnya 7% pada stadium insipien, 80,9% stadium imatur, 11,3% stadium matur dan 0,8% stadium hipermatur. Terdapat 69,8% dilakukan penatalaksanaan operatif, 29,6% observasi dan 0,7% dirujuk. Pasien Katarak Senilis melakukan beberapa kali kunjungan dalam satu tahun, antara satu kali hingga 15 kali yang terbanyak dengan kunjungan terbanyak pada bulan April (11,8%) dan pasien yang baru pertama kali datang terbanyak di bulan Januari (16,3%) Kata Kunci: katarak senilis, karakteristik, stadium, bilateralitas, visus.

Profil penderita katarak traumatika di Rumah Sakit Umum Pusat Sanglah Kota Denpasar, Bali-Indonesia Maria Septiana Parmonang Aroean; I Wayan Eka Sutyawan; Putu Budhiastra; I Wayan Gede Jayanegara
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Traumatic cataract is a cataract that occurs as a result of injury to the eye which can be a sharp or blunt trauma that is seen after a few days or several years. This traumatic cataract can occur acute, subacute, or residual symptoms of eye trauma, often due to an injury caused by a foreign object that hits the lens or blunt trauma to the eyeball. The purpose of this study was to determine the profile of traumatic cataract sufferers which included the characteristics of age, sex, and occupation at the Sanglah Central Hospital in Denpasar, Bali.Method: This study was descriptive with a cross-sectional study design. This research is retrospective and uses secondary data obtained from medical records.Result: Results of the study with cross sectional descriptive test showed that 58.3% of cases occurred in the male sex and 41.7% in women. The age ranges from 5 years to 69 years with an average sample age of 38.25 + 2.6 years. The occupations that dominated were students and farmers with a percentage of 25% each, followed by housewives with a percentage of 16.7%.Conclusion: In this study traumatic cataracts were found to be more common in male rice, with an average age of 38 years and occupations as students and farmers. Based on clinical characteristics, the eyes most affected by traumatic cataracts are the left eye and the most common cause is blunt trauma.Â Â Latar Belakang: Katarak traumatika merupakan katarak yang terjadi sebagai akibat cedera pada mata yang dapat merupakan trauma tajam ataupun tumpul yang terlihat sesudah beberapa hari ataupun beberapa tahun. Katarak traumatika ini dapat terjadi akut, subakut, atau pun gejala sisa dari trauma mata, sering terjadi karena adanya cedera yang disebabkan oleh benda asing yang mengenai lensa atau trauma tumpul pada bola mata. Tujuan penelitian ini adalah untuk mengetahui profil penderita katarak traumatika yang meliputi karakteristik usia, jenis kelamin, dan pekerjaan di Rumah Sakit Umum Pusat Sanglah Kota Denpasar, Bali.Metode: Penelitian ini adalah deskriptif dengan rancangan penelitian potong lintang (cross-sectional). Penelitian ini bersifat retrospektif Â dan menggunakan data sekunder yang diperoleh dari rekam medis.Hasil: Hasil penelitian dengan uji deskriptif cross sectional menunjukkan bahwa 58,3% kasus terjadi pada jenis kelamin laki-laki dan 41,7% pada perempuan. Usia berkisar dari 5 tahun hingga 69 tahun dengan usia sampel rata-rata 38,25 + 2,6 tahun. Pekerjaan yang mendominasi adalah siswa dan petani dengan persentase masing-masing 25%, diikuti oleh ibu rumah tangga dengan persentase 16,7%.Simpulan: Pada studi ini ditemukan katarak traumatika lebih sering terjadi padi laki-laki, dengan rata-rata usia 38 tahun dan pekerjaan sebagai pelajar dan petani. Berdasarkan karakteristik klinis, mata yang paling banyak terkena katarak traumatika adalah mata kiri dan penyebab tersering adalah trauma tumpul.

Characteristics retinometry pre and post cataract surgery on senile cataract patients in Sanglah Hospital, Bali-Indonesia Ni Made Ari Suryathi; Wayan Gede Jayanegara; Ida Bagus Putra Manuaba
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: WHO, with program Vision 2020-the Right to Sight, has a responsibility to control the most cause of blindness, which is a cataract. General-purpose of this research is to identify the retinometry pre and post cataract surgery on senile cataract patients.Method: This study design is an analytical cross sectional study. All data were collected retrospectively from the medical report of retinometry of pre and post cataract surgery in Sanglah General Hospital.Results: A total number of 60 eyes from 59 patients were included in this study. The majority of the patients were male (63.3%), aged 61-70, and came from Denpasar District (38.3%). The grading of cataract (Burrato) in this study is Burrato III (60%). A nuclear cataract is common in this study (41.7%). There were relationships between the differences of retinometry post dan pre cataract surgery with the grading of cataract (Burrato) (p<0.05), but there is no relationship with the type of cataract (p>0.05).Conclusions: There is a significant difference between retinometry pre and post cataract surgery, no significant difference between retinometry post-cataract surgery with BCVA and type of cataract. Higher grades of cataract (Burrato V) significantly correlate with higher retinometry pre and post-cataract surgery.

Clinical characteristics and demographics figures of patients with age-related macular degeneration at a tertiary-level hospital in Denpasar, Bali Bobby Kristianto; Ari Andayani; Anak Agung Mas Putrawati Triningrat; Ni Made Ari Suryathi; I Wayan Gede Jayanegara; I Gusti Ayu Ratna Suryaningrum
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Introduction: Age-Related Macular Degeneration (AMD) is a macular disease that characteristically affects the loss of central vision of the elderly. Unlike the western world, Indonesia has a relatively undocumented AMD epidemiology due to a lack of scientific attention, as indicated by few AMD publications. As a result, it is difficult to determine AMD's features and characteristics in the Indonesian population. This study aimed to evaluate AMD patients' characteristics and demographics at a tertiary hospital in Bali.Methods: This is a Cross-Sectional study. Data were collected from medical records on Sanglah General Hospital from January 2017 until December 2019. The characteristics and features were collected and analyzed. The characteristics and demo-figure were analyzed with descriptive statistics and a Chi-square test.Results: This study data consist of 172 patients, 90 (52.33 %) male and 82 (47.67 %) female. Most of the patients in the age group 66-83 years. The distribution of dry AMD showed the highest number on males, but the inverse occurs in wet AMD. Subjects had a smoking lifestyle in 50% of the patients. The smoking history more likely in dry AMD, but the inverse occurs in wet AMD. Hypertension occurs in more than half (51.16 %), with larger distribution in wet AMD. The proportion of gender, smoking history, hypertension but not age are significantly different between wet and dry AMD.Conclusion: Age-related macular degeneration is a common cause of blindness in the elderly population. This study found that the prevalence of AMD increases with age. The significant factors associated with AMD were sex, hypertension and smoking habit.

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.

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.

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.

Visual Acuity Improvement of Cataract Patients After Cataract Surgery at Sumbawa Hospital in 2018 Siska Takarai; I Wayan Gede Jayanegara; Anak Agung Mas Putrawati Triningrat; Ni Made Ari Suryathi; Ariesanti Tri Handayani; Anak Agung Ayu Sukartini Djelantik; Angelo Doniho; Anthea Casey; Giovani Faustine
Jurnal Pengabdian kepada Masyarakat (Indonesian Journal of Community Engagement) Vol 8, No 4 (2022)
Publisher : Direktorat Pengabdian kepada Masyarakat Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jpkm.72478

A cataract is the most common cause of vision impairment and blindness worldwide. The Rapid Assessment of Avoidable Blindness survey held in 2014 - 2016 showed that the prevalence of blindness in West Nusa Tenggara was the second highest in Indonesia. This prevalence was expected to be higher in rural areas due to cultural barriers, patient education, and accessibility to eye-care facilities. This study aims to evaluate visual acuity improvement after cataract surgery and observe the sight restoration rate. The participants of this study were cataract patients who underwent surgery at Sumbawa Hospital West Nusa Tenggara between 27 - 30 August 2018 in a social service program held by the Sanglah General Hospital team. Surgery was not performed on patients who did not desire surgery, in cases where the surgery would not improve visual function, and on patients who were known to be medically unfit for safe surgical intervention. Demographic data and visual acuity at admission and postoperative day one were recorded and analyzed. The output of this program was qualitatively measured by analyzing the SRR. A total of 86 patients were included in this study. Visual acuity postoperative day one showed improvement, and the blindness percentage dropped to 51.16%. The sight restoration rate observed in this study was 58.14%. Although the benefits of cost-effective cataract surgery are straightforward, challenges to executing the procedure remain high, such as unaffordability surgery costs and accessibility to eye-care facilities and infrastructures. Equitable growth in other fields can automatically increase healthcare services in rural areas and encourage healthcare workers to spread evenly.

Co-Authors Anak Agung Ayu Githasari Dewi Anak Agung Ayu Sukartini Djelantik Anak Agung Mas Putrawati T2 Anak Agung Mas Putrawati Triningrat Angelo Doniho Anthea Casey Ari Andayani Ariesanti Tri Handayani, Ariesanti Tri Bobby Kristianto Gde Ngurah Idraguna Pinatih Giovani Faustine I Gde Raka Widiana I Gusti Ayu Made Juliari I Gusti Ayu Ratna Suryaningrum I Putu Budhiastra, I Putu I Wayan Eka Sutyawan Ida Bagus Putra Manuaba Kusumadjadja, I Made Agus Made Agus Kusumadjaja Maria Septiana Parmonang Aroean Ni Made Ari Suryathi Ni Made Ayu Surasmiati Ni Made Suryanadi NLP Wistya Eka Mahadewi Noviantari, I Gusti Agung Ratna Nyoman Astri Dewi Sanjiwani Pantjawati, Ni Luh Diah Pitanatri, Nyoman Brahmani Putu Adhi Surya Pradana Putu Budhiastra Siska Siska Takarai Stacia Manggala Sutyawan, I Wayan Eka Tridiyoga, Komang Putra Triningrat, A.A. Mas Putrawati Valentina, Clara Yovita Govert

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