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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.

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.

Baseline Visual Acuity as an Independent Predictor of Therapeutic Outcomes in HIV-Associated Cytomegalovirus Retinitis: A Three-Year Cohort Study in Indonesia Anak Agung Ayu Putri Prematura Sri Anasary; 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.v9i12.1464

Background: Cytomegalovirus (CMV) retinitis is a severe opportunistic infection causing irreversible blindness in patients with advanced human immunodeficiency virus (HIV). In the modern era of highly active antiretroviral therapy (HAART), understanding the key determinants of visual prognosis is critical for effective patient management, particularly in resource-limited settings. This study aimed to evaluate the clinical spectrum of CMVR and identify independent predictors of short-term visual outcomes in a cohort of HIV-positive patients in Indonesia. Methods: A retrospective cohort study was conducted on HIV-positive patients diagnosed with CMV retinitis between January 2021 and December 2023 at a tertiary referral hospital in Bali, Indonesia. Data on demographics, clinical features, CD4+ T-cell counts, HAART status, and visual acuity (VA) at baseline and three months were collected. Visual acuity was converted to the Logarithm of the Minimum Angle of Resolution (LogMAR) for analysis. A multivariable linear regression model was employed to identify independent predictors of three-month visual outcomes. Results: The study included 26 patients (38 eyes). The cohort was predominantly male (61.5%) with a mean age of 36.73 years. Severe immunosuppression was common, with 65.4% of patients having a CD4+ count below 50 cells/mm³. Posterior uveitis was the most frequent presentation (68.4%). In the multivariable linear regression analysis, baseline LogMAR VA was the only significant independent predictor of three-month LogMAR VA (β = 0.71, p < 0.001) after adjusting for age, CD4+ count, and HAART status. The baseline CD4+ T-cell count was not a significant independent predictor of visual outcome (p = 0.841). Conclusion: Baseline visual acuity, a direct functional measure of existing retinal damage, is the most powerful independent predictor of short-term visual prognosis in patients with HIV-associated CMV retinitis. This finding highlights the irreversible nature of retinal necrosis and underscores that the opportunity to save sight lies in preemptive action. We advocate for the urgent integration of routine ophthalmological screening into the care protocols for high-risk HIV populations to detect and treat CMVR before significant vision loss occurs.

Baseline Visual Acuity as an Independent Predictor of Therapeutic Outcomes in HIV-Associated Cytomegalovirus Retinitis: A Three-Year Cohort Study in Indonesia Anak Agung Ayu Putri Prematura Sri Anasary; 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.v9i12.1464

Background: Cytomegalovirus (CMV) retinitis is a severe opportunistic infection causing irreversible blindness in patients with advanced human immunodeficiency virus (HIV). In the modern era of highly active antiretroviral therapy (HAART), understanding the key determinants of visual prognosis is critical for effective patient management, particularly in resource-limited settings. This study aimed to evaluate the clinical spectrum of CMVR and identify independent predictors of short-term visual outcomes in a cohort of HIV-positive patients in Indonesia. Methods: A retrospective cohort study was conducted on HIV-positive patients diagnosed with CMV retinitis between January 2021 and December 2023 at a tertiary referral hospital in Bali, Indonesia. Data on demographics, clinical features, CD4+ T-cell counts, HAART status, and visual acuity (VA) at baseline and three months were collected. Visual acuity was converted to the Logarithm of the Minimum Angle of Resolution (LogMAR) for analysis. A multivariable linear regression model was employed to identify independent predictors of three-month visual outcomes. Results: The study included 26 patients (38 eyes). The cohort was predominantly male (61.5%) with a mean age of 36.73 years. Severe immunosuppression was common, with 65.4% of patients having a CD4+ count below 50 cells/mm³. Posterior uveitis was the most frequent presentation (68.4%). In the multivariable linear regression analysis, baseline LogMAR VA was the only significant independent predictor of three-month LogMAR VA (β = 0.71, p < 0.001) after adjusting for age, CD4+ count, and HAART status. The baseline CD4+ T-cell count was not a significant independent predictor of visual outcome (p = 0.841). Conclusion: Baseline visual acuity, a direct functional measure of existing retinal damage, is the most powerful independent predictor of short-term visual prognosis in patients with HIV-associated CMV retinitis. This finding highlights the irreversible nature of retinal necrosis and underscores that the opportunity to save sight lies in preemptive action. We advocate for the urgent integration of routine ophthalmological screening into the care protocols for high-risk HIV populations to detect and treat CMVR before significant vision loss occurs.

Intraocular Pressure Dynamics and Ischaemic Risks During Air Travel Post-Gas Tamponade: A Systematic Review and Meta-Analysis Vina Yuwanda; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1606

Background: Gas tamponade is a widely used surgical intervention for retinal detachment repair. However, intraocular gas bubbles expand at altitude owing to Boyle's law, potentially causing severe intraocular pressure (IOP) elevation and ischaemic complications. The safety of air travel for patients with residual intraocular gas remains insufficiently characterised. Methods: We conducted a systematic review and meta-analysis of empirical and computational studies examining IOP dynamics during simulated or actual altitude exposure in eyes with intraocular gas. We searched MEDLINE, Embase, Web of Science, Scopus and PubMed Central through March 2024 for peer-reviewed publications without language restrictions. Study selection followed PRISMA 2020 guidelines with predefined eligibility criteria. Data were extracted in duplicate, and risk of bias assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis calculated standardised mean differences (SMD) with 95% confidence intervals (CI). Sensitivity analyses stratified findings by study type. Results: The primary analysis included three empirical studies (n = 47 eyes) showing IOP increase of SMD = 3.03 (95% CI: 2.18–3.89; I² = 17.16%, τ² = 0.11). Sensitivity analysis including all four studies (one computational model) yielded SMD = 4.67 (95% CI: 1.52–7.82; I² = 95.67%, τ² = 9.81). Individual study estimates ranged from SMD = 2.52 (Mills 2001) to SMD = 8.65 (Gsellman 2016, computational). Risk of bias was generally low to moderate. No significant publication bias was detected. Conclusion: Patients with residual intraocular gas who undertake air travel face meaningful IOP elevation at altitude. The risk of anterior segment ischaemic complications warrants careful patient counselling, altitude restriction recommendations, and prophylactic pharmacotherapy. Future prospective studies should evaluate optimal clinical protocols.

High-Altitude Maculopathy in Mountaineers: A Systematic Review and Meta-Analysis Rataya Paramitha Maliawan; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1613

Background: High-altitude maculopathy (HAM) represents a distinct form of high-altitude retinopathy affecting mountaineers at extreme elevations. Despite increased mountaineering activity, the prevalence and clinical significance of HAM remain poorly characterised in systematic reviews. Methods: A comprehensive systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Cochrane Library, and manual review of reference lists through April 2026. Eligible studies were prospective and retrospective cohorts reporting HAM prevalence in mountaineers at altitude ≥3,500 metres. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis employed the Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects modelling. Results: Three prospective studies (n=50 mountaineers) were analysed with a pooled prevalence of 73.37% (95% confidence interval: 60.28–84.72%). Heterogeneity was absent (I²=0%, Q=0.78, p=0.678). Subgroup analysis demonstrated a higher prevalence at extreme altitude (≥5,000 m: 78.6%) versus very high altitude (3,500–4,999 m: 70%). Sensitivity ranged 67.48–83.76%. Funnel plot inspection revealed no evidence of publication bias. Conclusion: Approximately three-quarters of mountaineers experience HAM at high altitude, with prevalence increasing at extreme elevations. HAM represents a common but underrecognised altitude-related ocular complication. Future prospective studies should employ standardised diagnostic criteria and investigate the mechanistic pathways of macular involvement.

Effect of Simulated and Real Aircraft Cabin Environments on Tear Film Parameters in Dry Eye Disease: A Meta-Analysis Jelly Vianti Fransisca Oeitano; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1617

Background: Air travel exposes passengers to environmental stressors, such as reduced cabin pressure and low humidity, which may exacerbate ocular surface conditions, particularly pre-existing dry eye disease (DED). This meta-analysis quantifies the impact of real and simulated aircraft cabin environments on tear film parameters, ocular surface biomarkers, and intraocular pressure (IOP). Methods: Following PRISMA 2020 guidelines, a systematic search (January 2000–March 2026) identified ten eligible studies comprising 445 participants, with two providing complete quantitative data for meta-analytic pooling (10 effect sizes). Results: Using a random-effects model, the overall pooled standardised mean difference (SMD) was 0.97 (95% CI: -0.67 to 2.61), indicating a large but non-significant effect with substantial heterogeneity (I2 = 97.23%). Subgroup analyses revealed a non-significant pooled effect for tear film outcomes (Hedges' g = 0.71), contrasted by a significant elevation in IOP for gas-filled eyes (g = 1.92; p = 0.001). Despite the non-significant overall pooled estimate, individual effect sizes demonstrated large, clinically meaningful reductions in tear break-up time (TBUT) and significant increases in both corneal staining and inflammatory biomarkers (MMP-9 and IL-6). Egger's test showed no publication bias, though GRADE certainty remained low to very low. Conclusion: Aircraft cabin environments induce clinically significant deteriorations in tear film stability, ocular surface integrity, and inflammation, alongside significant IOP elevations in susceptible individuals. These findings underscore the necessity of pre-flight ocular counselling and targeted preventive strategies for at-risk passengers, highlighting the need for future large-scale, standardised investigations.

Successful Management of Culture-Negative Fungal Keratitis with Epithelial Keratectomy and Intracameral Fluconazole Injection: A Case Report Kristian Dernitra; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1619

Background: Fungal keratitis is a major cause of corneal blindness in tropical regions. Microbiological culture often yields negative results in up to 40% of clinically suspected cases, creating diagnostic and therapeutic challenges. This report describes successful management of culture-negative suspected fungal keratitis using epithelial keratectomy combined with intracameral fluconazole injection. Case presentation: A 58-year-old male presented with progressive visual loss in the left eye following mud exposure and irrigation with river water. Examination revealed a 3×3 mm paracentral corneal ulcer with stromal infiltration exceeding one-third depth, satellite lesions, and 1.5 mm hypopyon. Gram stain, potassium hydroxide preparation, and culture were all negative. Based on clinical suspicion of fungal etiology, the patient underwent epithelial keratectomy with intracameral fluconazole injection, supplemented by intensive topical and systemic antifungal therapy. Progressive improvement was observed, with complete hypopyon resolution by day 26 and visual acuity improving from 1/300 to 6/30 over four months. Conclusion: This case demonstrates that timely invasive antifungal intervention guided by clinical judgment can achieve favorable outcomes in culture-negative suspected fungal keratitis. The preservation of useful vision without corneal transplantation is particularly significant in resource-limited settings, underscoring the critical role of clinical decision-making when laboratory confirmation is unavailable.

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