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The Unseen Danger: A Meta-Analysis of Bystander Injuries in Firework-Related Ocular Trauma Rania Ayu Permata Putri Kornia; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1409

Background: Firework-related ocular trauma represents a significant, preventable cause of severe vision loss, with incidence rates peaking during global cultural and national festivals. While the risks to active firework users are well-established, the burden of injury sustained by passive spectators, or bystanders, remains poorly quantified. This study aimed to synthesize global data to define the magnitude of this unseen danger. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, EMBASE, and Web of Science were searched for studies published between January 2015 and December 2025 that reported separable data on firework-related ocular injuries in bystanders and operators. A random-effects model calculated the pooled proportion of bystander injuries. Secondary outcomes included pooled odds ratios (ORs) for open globe injury (OGI) and severe vision loss (SVL; Visual Acuity <3/60). Results: Eleven studies, encompassing 2,440 patients, met the inclusion criteria. This meta-analysis, despite significant heterogeneity in the source data (I² = 89%), suggests that nearly half of all victims were bystanders, with a pooled proportion of 47.5% (95% CI: 41.8%–53.2%). Bystanders had significantly lower odds of sustaining an OGI compared to operators (pooled OR: 0.72, 95% CI: 0.58–0.90). However, the odds of suffering permanent SVL were not statistically different between the two groups (pooled OR: 0.91, 95% CI: 0.73–1.14), indicating a comparable risk of blinding injury. Conclusion: These findings must be interpreted with caution due to high inter-study heterogeneity and unmeasured clinical confounders. Nonetheless, the analysis strongly suggests that the risk to bystanders is unacceptably high and that public health paradigms focused solely on operator safety are insufficient. This study underscores the urgent need for prospective, standardized data collection and a shift in prevention strategies toward protecting passive spectators.

Optic Neuritis After Viral Vector versus mRNA COVID-19 Vaccines: A Systematic Review and Comparative Meta-Analysis Tiara Alexander; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1412

Background: The global deployment of COVID-19 vaccines, utilizing distinct viral vector and mRNA technologies, has been followed by reports of rare neuro-ophthalmic adverse events, including optic neuritis (ON). This study aimed to systematically compare the clinical phenotypes, autoimmune serological profiles, and visual outcomes of ON cases with onset in temporal association with viral vector versus mRNA COVID-19 vaccination. Methods: A systematic review was conducted across PubMed, Scopus, and EMBASE databases for case reports and case series published up to August 2025 detailing ON after COVID-19 vaccination. Data were extracted on clinical presentation, MRI findings, serostatus for aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) antibodies, treatments, and visual outcomes. Separate meta-analyses of proportions and comparative odds ratios (OR) were calculated for key outcomes, including distinct analyses for NMOSD and MOGAD. Results: Our analysis of published reports included 20 studies, comprising 90 patients (40 viral vector, 50 mRNA). Cases associated with viral vector vaccines had significantly higher odds of presenting with bilateral disease (OR 4.31, 95% CI [1.67, 11.11]). This platform was also associated with markedly increased odds of AQP4-IgG positivity (NMOSD) (OR 5.15, 95% CI [1.35, 19.61]) and MOG-IgG positivity (MOGAD) (OR 4.58, 95% CI [1.09, 19.21]). Consequently, these patients had higher odds of requiring aggressive immunotherapy and of suffering incomplete visual recovery (OR 3.41, 95% CI [1.14, 10.21]). Conclusion: Our analysis of published case reports suggests that while ON following COVID-19 vaccination is a very rare event, its clinical phenotype may differ based on the vaccine platform. Cases associated with viral vector vaccines appear more likely to manifest as a severe, bilateral, antibody-mediated condition characteristic of NMOSD or MOGAD. These findings, which do not establish causality, underscore the critical importance of prompt autoantibody testing to guide appropriate management. The established benefits of vaccination continue to overwhelmingly outweigh the exceptionally low absolute risk of such adverse events.

The Hidden Hazard of Celebration: A Meta-Analysis of Ocular Morbidity from Colored Powder Festivals and Implications for Global Travel Medicine Frangklin Refelino Jotlely; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1417

Background: The globalization of colored powder festivals, such as Holi, has exposed millions, including international tourists, to significant ocular health risks from synthetic industrial dyes that have replaced traditional organic powders. This study was conducted to quantify the prevalence of acute ocular morbidities from these festivals, providing an evidence base to inform clinical practice and public health policy, particularly within travel medicine. Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Google Scholar, ScienceDirect, and ProQuest for observational studies published up to July 2024. Studies reporting ocular complications from colored powder exposure were included. Data were extracted by two independent reviewers, and methodological quality was assessed using JBI checklists. A random-effects model was used to calculate pooled prevalence for key ocular injuries. Heterogeneity was investigated using sensitivity analyses, and publication bias was assessed with funnel plots. Results: Six studies from India, encompassing 189 patients, met the inclusion criteria for quantitative analysis. The patient population was predominantly young males (mean age 20-30 years). The meta-analysis revealed a high pooled prevalence of key ocular morbidities. The prevalence for chemical conjunctivitis was 95% (95% CI: 87%-100%), though with substantial but anticipated heterogeneity (I²=82%). The prevalence for corneal epithelial defects was 37% (95% CI: 23%-53%; I²=45%), and for superficial punctate keratopathy was 75% (95% CI: 57%-90%; I²=0%). Most injuries were bilateral. Conclusion: Participation in colored powder festivals, based on extensive evidence from Holi in India, presents a quantifiable and significant risk of acute ocular morbidity. The high prevalence of chemical-induced ocular surface disease necessitates urgent recognition of this "hidden hazard." Proactive, evidence-based preventive strategies, including tiered recommendations for protective eyewear and updated pre-travel health advisories, are imperative to safeguard the vision of millions of celebrants worldwide.

Ocular Vascular Occlusion Following COVID-19 and Travel Vaccinations: A Systematic Review and Exploration of Immuno-Thrombotic Mechanisms Ni Nyoman Yuniasih; I Made Ary Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1420

Background: Ocular vascular occlusion is a rare, vision-threatening emergency. While typically associated with systemic vascular comorbidities, reports have emerged suggesting a temporal link to various vaccinations. This review aims to synthesize the evidence on ocular vascular occlusion following both COVID-19 and non-COVID travel vaccinations to characterize its clinical spectrum and explore shared pathophysiological underpinnings. Methods: A systematic search adhering to PRISMA 2020 guidelines was conducted in PubMed, Scopus, Cochrane Library, and ProQuest for studies published from January 1st, 2013, to August 1st, 2024. All study designs reporting ocular vascular occlusion temporally associated with COVID-19 or travel immunizations were included. Data on demographics, vaccine type, clinical presentation, and outcomes were extracted. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Joanna Briggs Institute (JBI) checklist for case reports. Results: From an initial 1,348 records, 12 studies met the inclusion criteria, encompassing case reports, series, and large database analyses. These studies described ocular vascular occlusion in individuals aged 15 to 86 years. A significant temporal clustering was observed, with the majority of individual cases occurring within seven days post-vaccination. Central retinal vein occlusion (CRVO) was the most reported subtype. A large retrospective cohort study reported a more than two-fold increased hazard for retinal occlusion post-vaccination compared to unvaccinated cohorts (HR 2.19, 95% CI 1.85-2.59, p<0.001). Both mRNA and adenoviral vector COVID-19 vaccines, as well as various travel vaccines including Zostavax, Yellow Fever, and Meningococcal B, were implicated. Conclusion: This review characterizes a consistent temporal association between a diverse range of vaccines and subsequent ocular vascular occlusion, suggesting it is a rare but potential adverse event. The clustering of onset times and involvement of different vaccine platforms point towards a common underlying immuno-thrombotic mechanism. These findings highlight the need for clinical vigilance for acute visual changes post-vaccination, while underscoring that the absolute risk remains exceedingly low compared to the clear benefits of vaccination.

Systemic HIV-1 Viremia as an Independent Predictor of Reduced Intraocular Pressure: A Multivariable Regression Analysis in Cohorts with and without Cytomegalovirus Retinitis Nyoman Tarita Dewi; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (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.v9i11.1428

Background: The association between human immunodeficiency virus (HIV) and reduced intraocular pressure (IOP) is recognized, yet its independence from confounding opportunistic infections like cytomegalovirus retinitis (CMVR) remains unquantified. This study aimed to determine the independent association between systemic HIV-1 viral load and IOP by employing a robust multivariable analysis in cohorts with and without CMVR. Methods: A comparative, cross-sectional study was conducted on 100 HIV-positive patients (50 with CMVR, 50 without CMVR) at a tertiary referral hospital. Data included demographics, HIV clinical stage (WHO), quantitative HIV-1 viral load, and IOP measured by applanation tonometry. The primary analysis utilized a multivariable linear regression model to assess the association between log-transformed viral load and continuous IOP, adjusting for age, gender, HIV stage, and CMVR status. An interaction term was used to test for effect modification by CMVR. Results: After adjusting for all covariates, log₁₀ HIV-1 viral load was a powerful and highly significant independent predictor of lower IOP. For every 10-fold increase in viral load, IOP decreased by an average of 0.88 mmHg (β = -0.88; 95% CI: -1.15 to -0.61; p < 0.001). Advanced HIV stage was also independently associated with lower IOP (Stage IV vs. Stage I: β = -1.25; 95% CI: -2.10 to -0.40; p = 0.004). The effect of viral load on IOP did not significantly differ between the CMVR and non-CMVR groups (p for interaction = 0.762), confirming its independent systemic effect. Conclusion: Systemic HIV-1 viremia is a dominant, independent predictor of reduced intraocular pressure, irrespective of CMVR status. This dose-dependent relationship highlights a direct pathophysiological link between viral replication and aqueous humor dynamics. IOP measurement represents a potential adjunctive clinical indicator for monitoring systemic HIV-1 disease activity.

Systemic HIV-1 Viremia as an Independent Predictor of Reduced Intraocular Pressure: A Multivariable Regression Analysis in Cohorts with and without Cytomegalovirus Retinitis Nyoman Tarita Dewi; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (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.v9i11.1428

Background: The association between human immunodeficiency virus (HIV) and reduced intraocular pressure (IOP) is recognized, yet its independence from confounding opportunistic infections like cytomegalovirus retinitis (CMVR) remains unquantified. This study aimed to determine the independent association between systemic HIV-1 viral load and IOP by employing a robust multivariable analysis in cohorts with and without CMVR. Methods: A comparative, cross-sectional study was conducted on 100 HIV-positive patients (50 with CMVR, 50 without CMVR) at a tertiary referral hospital. Data included demographics, HIV clinical stage (WHO), quantitative HIV-1 viral load, and IOP measured by applanation tonometry. The primary analysis utilized a multivariable linear regression model to assess the association between log-transformed viral load and continuous IOP, adjusting for age, gender, HIV stage, and CMVR status. An interaction term was used to test for effect modification by CMVR. Results: After adjusting for all covariates, log₁₀ HIV-1 viral load was a powerful and highly significant independent predictor of lower IOP. For every 10-fold increase in viral load, IOP decreased by an average of 0.88 mmHg (β = -0.88; 95% CI: -1.15 to -0.61; p < 0.001). Advanced HIV stage was also independently associated with lower IOP (Stage IV vs. Stage I: β = -1.25; 95% CI: -2.10 to -0.40; p = 0.004). The effect of viral load on IOP did not significantly differ between the CMVR and non-CMVR groups (p for interaction = 0.762), confirming its independent systemic effect. Conclusion: Systemic HIV-1 viremia is a dominant, independent predictor of reduced intraocular pressure, irrespective of CMVR status. This dose-dependent relationship highlights a direct pathophysiological link between viral replication and aqueous humor dynamics. IOP measurement represents a potential adjunctive clinical indicator for monitoring systemic HIV-1 disease activity.

Lower Body Negative Pressure for Spaceflight Associated Neuro-ocular Syndrome: A Systematic Review and Meta-Analysis Fabiola Supit; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (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.v9i12.1454

Background: Spaceflight associated neuro-ocular syndrome (SANS) is a critical health risk for astronauts on long-duration missions, characterized by potentially vision-altering ocular changes. Lower body negative pressure (LBNP) is a primary countermeasure designed to reverse the foundational cephalad fluid shifts. This study provides the first rigorous, quantitative synthesis of LBNP's efficacy on key SANS-related ocular parameters. Methods: Following PRISMA guidelines, a systematic search of PubMed, ScienceDirect, and the Cochrane Library (2015–2025) was conducted. Studies quantifying the effect of LBNP on intraocular pressure (IOP), optic nerve sheath diameter (ONSD), or choroidal thickness (CT) in microgravity or its ground-based analogs were included. A random-effects meta-analysis calculated the pooled mean difference (MD). Leave-one-out sensitivity analysis and assessment of publication bias were performed to ensure robustness. Results: Seven studies (N=89 subjects) met the criteria. The meta-analysis demonstrated that LBNP application resulted in statistically significant reductions in IOP (MD = -2.15 mmHg; 95% CI [-3.01, -1.29]; p < 0.001), ONSD (MD = -0.31 mm; 95% CI [-0.45, -0.17]; p < 0.001), and subfoveal Choroidal Thickness (MD = -18.50 µm; 95% CI [-25.65, -11.35]; p < 0.001). Subgroup analysis revealed a more pronounced effect in ground-based studies. The results were robust in sensitivity analyses, and funnel plots suggested a low risk of publication bias. Conclusion: This meta-analysis provides robust, quantitative evidence supporting LBNP's efficacy in acutely mitigating the cardinal structural signs of SANS. By directly counteracting the underlying pathophysiology, LBNP is affirmed as a cornerstone countermeasure technology essential for preserving astronaut ocular health during the upcoming era of deep space exploration.

Therapeutic Keratoplasty for Severe, Travel-Associated Fungal Keratitis: A Meta-Analysis of Globe Salvage and Visual Acuity Outcomes Putu Rima Adilitha Widyasari; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (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.v9i12.1457

Background: Severe, travel-associated fungal keratitis represents a formidable diagnostic and therapeutic challenge, often progressing to corneal perforation despite aggressive medical therapy. Therapeutic keratoplasty (TK) is frequently required to preserve globe integrity. However, its efficacy in this specific, epidemiologically distinct cohort of patients remains poorly quantified. This meta-analysis aimed to synthesize the available evidence on globe salvage and visual acuity outcomes following TK for severe fungal keratitis acquired during international travel. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2015 and December 2024, reporting outcomes of TK for travel-associated fungal keratitis. The primary outcome was the proportion of cases achieving globe salvage, defined as the avoidance of enucleation or evisceration. The secondary outcome was the mean improvement in Best-Corrected Visual Acuity (BCVA) measured in LogMAR units. Data were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic. Results: Seven retrospective case series met the inclusion criteria, comprising a total of 102 eyes. The included studies were geographically diverse, with patient travel histories predominantly linked to tropical and subtropical regions in Southeast Asia and South America. The pooled proportion for globe salvage was 89.2% (95% Confidence Interval [CI]: 82.5% to 94.1%). There was low to moderate heterogeneity among the studies for this outcome (I² = 31%, p=0.19). The pooled mean improvement in BCVA from pre-operative assessment to final follow-up was 1.21 LogMAR (95% CI: 0.98 to 1.44). Substantial heterogeneity was observed for the visual acuity outcome (I² = 78%, p<0.001). The most commonly identified fungal genera were Fusarium and Aspergillus. Conclusion: Therapeutic keratoplasty demonstrates a high rate of anatomical success, effectively salvaging the globe in the vast majority of patients with severe, travel-associated fungal keratitis. While visual acuity is significantly improved, the final outcomes remain guarded and are highly variable. These findings underscore the critical role of TK in the management of this sight-threatening condition and highlight the need for strategies to improve post-operative visual prognosis.

The Unseen Danger: A Meta-Analysis of Bystander Injuries in Firework-Related Ocular Trauma Rania Ayu Permata Putri Kornia; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1409

Background: Firework-related ocular trauma represents a significant, preventable cause of severe vision loss, with incidence rates peaking during global cultural and national festivals. While the risks to active firework users are well-established, the burden of injury sustained by passive spectators, or bystanders, remains poorly quantified. This study aimed to synthesize global data to define the magnitude of this unseen danger. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, EMBASE, and Web of Science were searched for studies published between January 2015 and December 2025 that reported separable data on firework-related ocular injuries in bystanders and operators. A random-effects model calculated the pooled proportion of bystander injuries. Secondary outcomes included pooled odds ratios (ORs) for open globe injury (OGI) and severe vision loss (SVL; Visual Acuity <3/60). Results: Eleven studies, encompassing 2,440 patients, met the inclusion criteria. This meta-analysis, despite significant heterogeneity in the source data (I² = 89%), suggests that nearly half of all victims were bystanders, with a pooled proportion of 47.5% (95% CI: 41.8%–53.2%). Bystanders had significantly lower odds of sustaining an OGI compared to operators (pooled OR: 0.72, 95% CI: 0.58–0.90). However, the odds of suffering permanent SVL were not statistically different between the two groups (pooled OR: 0.91, 95% CI: 0.73–1.14), indicating a comparable risk of blinding injury. Conclusion: These findings must be interpreted with caution due to high inter-study heterogeneity and unmeasured clinical confounders. Nonetheless, the analysis strongly suggests that the risk to bystanders is unacceptably high and that public health paradigms focused solely on operator safety are insufficient. This study underscores the urgent need for prospective, standardized data collection and a shift in prevention strategies toward protecting passive spectators.

Optic Neuritis After Viral Vector versus mRNA COVID-19 Vaccines: A Systematic Review and Comparative Meta-Analysis Tiara Alexander; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1412

Background: The global deployment of COVID-19 vaccines, utilizing distinct viral vector and mRNA technologies, has been followed by reports of rare neuro-ophthalmic adverse events, including optic neuritis (ON). This study aimed to systematically compare the clinical phenotypes, autoimmune serological profiles, and visual outcomes of ON cases with onset in temporal association with viral vector versus mRNA COVID-19 vaccination. Methods: A systematic review was conducted across PubMed, Scopus, and EMBASE databases for case reports and case series published up to August 2025 detailing ON after COVID-19 vaccination. Data were extracted on clinical presentation, MRI findings, serostatus for aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) antibodies, treatments, and visual outcomes. Separate meta-analyses of proportions and comparative odds ratios (OR) were calculated for key outcomes, including distinct analyses for NMOSD and MOGAD. Results: Our analysis of published reports included 20 studies, comprising 90 patients (40 viral vector, 50 mRNA). Cases associated with viral vector vaccines had significantly higher odds of presenting with bilateral disease (OR 4.31, 95% CI [1.67, 11.11]). This platform was also associated with markedly increased odds of AQP4-IgG positivity (NMOSD) (OR 5.15, 95% CI [1.35, 19.61]) and MOG-IgG positivity (MOGAD) (OR 4.58, 95% CI [1.09, 19.21]). Consequently, these patients had higher odds of requiring aggressive immunotherapy and of suffering incomplete visual recovery (OR 3.41, 95% CI [1.14, 10.21]). Conclusion: Our analysis of published case reports suggests that while ON following COVID-19 vaccination is a very rare event, its clinical phenotype may differ based on the vaccine platform. Cases associated with viral vector vaccines appear more likely to manifest as a severe, bilateral, antibody-mediated condition characteristic of NMOSD or MOGAD. These findings, which do not establish causality, underscore the critical importance of prompt autoantibody testing to guide appropriate management. The established benefits of vaccination continue to overwhelmingly outweigh the exceptionally low absolute risk of such adverse events.

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