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All Journal Medicina E-Jurnal Medika Udayana Jurnal Pengabdian Kepada Masyarakat (Indonesian Journal of Community Engagement) Universa Medicina ISM (Intisari Sains Medis) : Jurnal Kedokteran Vision Science and Eye Health Journal IJRETINA - International Journal of Retina Ophthalmologica Indonesiana
Ni Made Ari Suryathi
Departement Ilmu Kesehatan Mata, Fakultas Kedokteran Universitas Udayana, RSUP Sanglah Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Gambaran Fundus Okular dan Efek Midriasis dari Pemberian Tropikamid 1% setelah Kematian pada Jenazah di RSUP Prof. Dr. I.G.N.G Ngoerah Yudiskara, Ni Nyoman Elza; Alit, Ida Bagus Putu; Yulianti, Kunthi; Rustyadi, Dudut; Suryathi, Ni Made Ari
E-Jurnal Medika Udayana Vol 13 No 5 (2024): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2024.V13.i05.P01

Abstract

Memperkirakan interval waktu kematian sangat penting dilakukan, khususnya pada kasus kematian tidak wajar. Perubahan lanjut yang pertama terlihat untuk dapat memperkirakan interval waktu kematian, yaitu lebam mayat, baru menetap setelah 8-12 jam postmortem. Salah satu metode lain yang dapat dilakukan untuk dapat mempersempit perkiraan interval waktu kematian sebelum 8-12 jam postmortem, yaitu pemeriksaan fundus okular, yang idealnya memerlukan penggunaan midriatikum agar gambaran fundus okular dapat diamati dengan lebih jelas. Namun, efek midriasis dari pemberian midriatikum setelah kematian masih belum banyak diteliti. Penelitian ini merupakan penelitian deskriptif observasional dengan pendekatan cross-sectional. Data berasal dari sumber data primer berupa gambaran fundus okular dan efek midriasis dari pemberian tropikamid 1% setelah kematian. Data sekunder berupa surat keterangan kematian dari sampel. Teknik pengumpulan sampel dengan metode consecutive sampling dilakukan pada Bulan Juli hingga Oktober 2022 di Instalasi Kedokteran Forensik dan Pemulasaraan Jenazah RSUP Prof. Dr. I.G.N.G Ngoerah, dan didapatkan sejumlah 25 jenazah. Dilakukan analisis univariat untuk mengetahui distribusi frekuensi gambaran fundus okular dan efek midriasis dari pemberian tropikamid 1% dengan beberapa interval waktu kematian. Dalam penelitian ini diperoleh hasil gambaran fundus okular yang bervariasi terhadap interval waktu kematian. Efek midriasis dari pemberian tropikamid 1% pada penelitian ini, sebagian besar menunjukkan reaksi positif, tetapi belum dapat menghasilkan pelebaran ukuran diameter pupil mata yang ideal untuk pemeriksaan fundus okular.
Stereoacuity test as a screening tool for amblyopia and binocular vision in children 6-12 years of age Surasmiati, Ni Made Ayu; Wetarini , Krisnhaliani; Wijayati , Made Paramita; Suryathi, Ni Made Ari
Universa Medicina Vol. 43 No. 3 (2024)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2024.v43.280-286

Abstract

BackgroundStereoacuity is essential for depth perception and daily activities, complementing visual acuity. Assessing stereoacuity in children is vital for detecting binocular vision disorders and amblyopia. This study aimed to compare the Toegepast Natuurwetenschappelijk Onderzoek (TNO) test and the Titmus Fly test in school-based vision screening for children aged 6-12 years. MethodsA cross-sectional study was conducted in social service settings with 122 elementary school children aged 6-12 years. Examinations included visual acuity, refraction, Ishihara color vision, and stereoacuity using both the TNO and Titmus Fly tests. Statistical comparisons were made using the Wilcoxon Signed-Ranks Test, and stereoacuity differences based on demographic factors and visual acuity were assessed using the Mann-Whitney U Test. The level of agreement between the two tests was determined using Bland-Altman analyses. Results Visual acuity significantly influenced stereoacuity results in the Titmus Fly test (p=0.001), with children having abnormal visual acuity performing worse. Approximately 68% of children reported that the Titmus Fly test was easier to perform. The mean difference between TNO and Titmus Fly measurements was 79.52 ± 63.75 (95% CI = 68.14–90.90; p=0.001), demonstrating a consistent bias between the two tests. Conclusion The Titmus Fly test is easier for children (6–12 years) to perform, but it tends to overestimate stereoacuity values compared to the TNO test, making the two methods non-interchangeable and not reliable. Stereoacuity assessment remains essential in school-based vision screening for evaluating binocular vision and amblyopia, especially in children with refractive errors.
Differences of Retinal Nerve Fiber Layer and Ganglion Cell Layer-Inner Plexiform Layer Thickness in Patients without Diabetes Mellitus, with Diabetes Mellitus Type 2 without Diabetic Retinopathy and with Diabetic Retinopathy Sukmawati, Nurindah; Suryathi, Ni Made Ari; Andayani, Ari; Pantjawati, Ni Luh Diah; Widiana, I Gde Raka; Yuliawati, Putu; Juliari, IGAM
International Journal of Retina Vol 8 No 1 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss001.314

Abstract

Introduction : Prevention of Diabetic Retinopathy (DR) require an examination method that can identify earliest damage before clinical symptoms observed. This study aimed to determine the novel and objective way to detect those damage through RNFL and GCL-IPL thickness. Method : This analytical cross sectional study research conducted at the eye polyclinic and the Diabetic Center of IGNG Ngoerah Hospital, Denpasar. This study comparing the difference in thickness of RNFL and GCL-IPL in patients without DM, with Type 2 DM without DR and with DR in average and each quadrant thickness through Kruskal Wallis and One Way Anova test. Result : The sample was 59 people which then divided into three groups, namely 20 samples in the group without DM, 19 samples in the DM group without DR and 20 samples with DR. The samples were then examined for RNFL and GCL-IPL and the results were compared between groups. The mean age of the subjects were 58.80±9.65 years old. In the RNFL measurement, it was found that there were differences in values ​​between groups in all quadrants except the temporal quadrant (p=0.518). After covariate analysis by variables of age, HbA1c, blood pressure, visual acuity, IOP and axial length, the results change with the nasal and inferior quadrants as the only found significant. In the GCL-IPL analysis there were significant differences between groups, especially in the superotemporal, temporal and inferotemporal quadrants (p<0.005). These results remained after being controlled by covariate analysis. Conclusion : This study proved a neurodegeneration process that occured focally in certain areas that can be detected through the RNFL and GCL-IPL measurement modalities. These examinations were expected to be useful in terms of screening both primary and secondary in patients with type 2 DM.
Diabetic retinopathy: pathogenesis, pathophysiology, and treatment Yudistira, Yudistira; Hendrawan, Kevin Anggakusuma; Andayani, Ari; Suryathi, Ni Made Ari
Universa Medicina Vol. 44 No. 2 (2025)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2025.v44.270-284

Abstract

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and one of the leading causes of vision impairment worldwide. Prolonged hyperglycemia initiates a cascade of molecular events including chronic inflammation, oxidative stress, advanced glycation end products, and the activation of plasma kallikrein and protein kinase C signaling pathways, which leads to endothelial damage and pericyte loss. The resulting endothelial barrier dysfunction promotes serum leakage and retinal edema, while advanced disease stages are characterized by ischemia-driven retinal neovascularization mediated by elevated intraocular vascular endothelial growth factor (VEGF) levels. Current therapeutic strategies for diabetic retinopathy include laser therapy, intravitreal administration of anti-VEGF agents or corticosteroids, and vitreoretinal surgery. Despite their efficacy, a number of patients experience suboptimal responses. Consequently, novel therapeutic approaches are under investigation, including alternative anti-angiogenic agents, gene therapies, and visual cycle modulators currently undergoing clinical trials. A comprehensive understanding of the pathogenesis and pathophysiology of diabetic retinopathy is essential to improve existing treatment modalities and address current limitations in patient outcomes. In this review, we systematically searched and analyzed articles published in English from 2014 to 2024 using PubMed, ScienceDirect, SpringerLink, and Google Scholar. Relevant search terms included “diabetic retinopathy,” “pathophysiology,” “pathogenesis,” “treatment,” and “diabetic macular edema.” This review presents recent insights into the pathogenesis of diabetic retinopathy, including oxidative stress, inflammation, and neurodegeneration, followed by an overview of its pathophysiology such as microvascular dysfunction and neovascularization. Finally, current and emerging treatment modalities, encompassing both pharmacological and surgical approaches, are discussed. This structured approach provides essential background to understand the complexity of diabetic retinopathy and recent advances in its management.
POST-EVACUATION OF SILICONE OIL COMPLICATIONS IN RHEGMATOGENOUS RETINAL DETACHMENT PATIENTS WHO UNDERWENT PARS PLANA VITRECTOMY AT TERTIARY HOSPITAL IN BALI, INDONESIA Andayani, Ari; Wibawa, I Made Dwi Surya; Suryathi, Ni Made Ari; Triningrat, Anak Agung Mas Putrawati; Manuaba, Ida Bagus Putra
International Journal of Retina Vol 6 No 1 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss001.221

Abstract

Introduction: Pars plana vitrectomy with silicone oil injection has become a standard procedure to treat retinal detachment with complex cases. Considerations related to the use of silicone oil are the need for additional surgical procedures to remove silicone oil after the retinal condition is declared stable or because emulsification of silicone oil has occurred. Methods: An analytical observational study with a cross-sectional approach. Data were collected retrospectively by collecting medical records of patients who underwent silicone oil evacuation in 2021. Result: The research subjects were 23 people, where 52.2% of the subjects were women with a median age of 51 years. Most of the subjects (65.2%) had no complications, with the most complications occurring were secondary glaucoma (13%) and redetached retina (13%). There was no statistically significant difference between visual acuity before and after the evacuation of silicone oil with a P value of 0.202 and there was no statistically significant difference between IOP before and after evacuation of silicone oil with a P value of 0.132. Conclusion: Evacuation of silicone oil is a follow-up action after PPV with SO tamponade. Complications which may arise are detach dan glaucoma. There was no significant difference in visual acuity and IOP before and after SO evacuation.
The Association Between Vitreous Vascular Endothelial Growth Factor Levels with Visual Acuity Before and After Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy Noviantari, I Gusti Agung Ratna; Suryathi, Ni Made Ari; Triningrat, A.A. Mas Putrawati; Widiana, I Gde Raka; Andayani, Ari; Jayanegara, I Wayan Gede; Pantjawati, Ni Luh Diah
International Journal of Retina Vol 7 No 2 (2024): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2024.vol007.iss002.257

Abstract

Introduction: Vascular endothelial growth factor (VEGF) plays a crucial role in the development of proliferative diabetic retinopathy. Elevated levels of VEGF in the vitreous have been found to be associated with the severity of ischemia and neovascularization, which can lead to a decline in visual acuity. This study aims to determine the association between vitreous VEGF levels and improvement in visual acuity before and after PPV in PDR patients. Methods: This research is an analytic observational study with a pre-post single group design. The subjects of this study were all PDR patients who received PPV therapy at three hospital in Bali Province, Indonesia. Consecutive sampling method were conducted. The independent variable is vitreous VEGF, whilst pre and post-PPV visual acuity is the outcomes. We performed mean comparison and multivariable statistical test using IBM SPSS version 25. Result: 45 people were included in this study. Improvement in visual acuity after PPV compared to before PPV with an average improvement of 0.54 logMAR (p=0.001). Based on the ANCOVA multivariate analysis, factors affecting visual acuity improvement after PPV were preoperative vision (p<0.001), postoperative vision (p<0.001), HbA1c level (p=0.036), and DM duration (p=0.024). There was no association between high vitreous VEGF levels and visual acuity improvement (PR=0.95; 95% CI=0.55-1.63;p=0.841). Conclusion: This study concluded that there is an association between PPV and visual acuity improvement. However, clinicians should be aware of several confounding factors that affect visual acuity improvement, including pre-PPV visual acuity, post-PPV visual acuity, duration of DM, and HbA1c level. There is no relationship between vitreous VEGF and visual acuity before and after PPV in PDR, but it is necessary to keep good records of lens status and intraocular pressure status. Further research is needed and the research time is extended to evaluate a better visual outcome.
Clinical Outcome in Lens Drop evacuation after a High-Risk Characteristics Proliferative Diabetic Retinopathy Post Pars Plana Vitrectomy Case: Poster Presentation - Case Report - Ophthalmologist Suryathi, Ni Made Ari; Andayani, Ari; Anasary, Anak Agung Ayu Putri Prematura Sri
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/bwb6as90

Abstract

Introduction : Vitrectomy surgery affects zonular strength, which increases the risk of lens drop and can be sight- threatening if not managed correctly. Pars plana vitrectomy (PPV) and evacuation of dislocated lens fragments have to be done very carefully. Case Illustration : A 42-year-old female with blurred vision in the right eye for two months and a history of right-eye surgery three months ago due to proliferative diabetic retinopathy (PDR) was tamponed with SF6 gas. On examination was found visual acuity (VA) was 6/120, with cloudy lens and attached retina. The patient was diagnosed with a right-eye complicated cataract with advanced PDR post-PPV and planned to undergo phacoemulsification. While waiting for the surgery, the lens dropped into the posterior chamber, then planned to do the evacuation immediately. Dropped lens evacuation, PPV, retro-pupil IOL implantation, and silicone oil (SO) tamponing were done. Two months after the SO evacuation, the best corrected VA improved to 6/15. Discussion : Cataract progression after vitrectomy is common. In a vitrectomized eye, there is a lack of vitreous tamponade and a less stable lens. Peripheral zonules are attached to the pars plana, which can be disrupted during the vitrectomy surgery. Improvements in visual acuity and lower rates of complications were found if the lens fragment was evacuated soon. Conclusion : Cataract surgery is better done soon after PPV to prevent dropped lenses into the posterior chamber, whether the zonulisis sign is seen or not. The interval between the dropped lens incident and evacuation was associated with better final visual outcomes.
Cataract Progression dan Lens Drop after Pars Plana Vitrectomy and Gas Tamponade : A Case Report: Poster Presentation - Case Report - Resident Suryawijaya, Ernes Erlyana; Suryathi, Ni Made Ari; Andayani, Ari
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/m3zsvh92

Abstract

Introduction : Vitreous Hemorrhage (VH) in proliferative diabetic retinopathy (PDR) is common cause of acute vision loss.If the retina cannot be visualized and the etiology of the VH is unknown, pars plana vitrectomy (PPV) is indicated. 1Intraocular gases like SF6 or C3F8 are one of the most useful adjuncts in vitreoretinal surgery. Exposure to intraocular gases additionally increases retrolental oxygen levels, resulting in development of lens opacities. Case Illustration : Patient female 52 y.o, came with sudden blurry vision in the left eye since two weeks ago. History of Diabetes Mellitus 10 years with insulin treatment. From the examination left eye visual acuity 1/60, zonulysis, VH, and negative fundus reflect. On ultrasonography found vitreous opacity. The patient was diagnosed with left eye VH ec advanced PDR and scheduled PPV with C3F8 gas tamponade. Patient difficult to maintain prone position after surgery. 2 month after the surgery the patient scheduled with phacoemulsification surgery because progressive lens opacity. While prepare to the second operation, the lens found drop to the vitreous. The second surgery done with lens evacuation and Intraocular lens implantation. Last follow up, best correction visual acuity was 6/18. Discussion : PPV and Gas tamponade are presdisposing lens opacity progression. Lens opacity after gas tamponade include longer intraocular longevity gas and patients who fail to maintain a prone position. Risk factors for zonulysis in this patient increase the occurrence of lens drop after PPV with gas tamponade. Conclusion : Regular slit-lamp examination needs to be performed for early detection of cataract after PPV with gas tamponade.
BARRAGE LASER PHOTOCOAGULATION IN HIGH-MYOPIC PATIENT WITH SYMPTOMATIC RETINAL TEARS BEFORE PHACOEMULSIFICATION: A CASE REPORT: Poster Presentation - Case Report - Ophthalmologist Budhiastra, I Putu; Tridiyoga, Komang Putra; Jayanegara, I wayan Gede; Suryathi, Ni Made Ari; Andayani, Ari; Pitanatri, Nyoman Brahmani
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/zdtpyp85

Abstract

Introduction : Retinal tears can be present in up to 2.4% of cases of lattice degeneration, which is considered an important risk of retinal detachment in a high-myopic patient. Laser photocoagulation has been shown to reduce the risks of retinal detachment before phacoemulsification thus improve in the visual outcome. We report a case of a high myopic patient with symptomatic retinal tears who underwent phacoemulsification that was treated prophylactically with barrage laser photocoagulation. Case Illustration : A 43 years-old female with a history of high myopia complained of flashes and floaters on both eyes. She had high myopia measuring -13.0 dioptres and -28.0 dioptres in the right and left eyes respectively. Unaided visual acuity was 2/60 in both eyes. Fundus examination showed lattice degenerations with a small tear found on both eyes with no retinal detachments. She was treated with a barrage laser on both eyes followed by phacoemulsification. On the last follow-up, the retina remained stable and the visual acuity was significantly improved with no development of macular edema or retinal detachment in both eyes. Discussion : Although most cases of lattice degeneration do not need intervention, some present a risk of retinal detachment. Barrage laser photocoagulation may have a place in high myopic patient lattice degeneration with symptomatic retinal tears to maintain retinal stability and to obtain the optimal outcome after phacoemulsification. Conclusion : Barrage laser photocoagulation is beneficial as a prophylactic treatment of symptomatic retinal tears before phacoemulsification in high-myopic patients.
SCREENING FOR DIABETIC RETINOPATHY AND PROPTOSIS TO PREVENT BLIND IN JERO MANGKU CULTURE INTARAN VILLAGE, WEST SANUR Noviantari, I Gusti Agung Ratna; Suryathi, Ni Made Ari; Suryanadi, Ni Made
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/zwpr8k38

Abstract

Introduction and Objective: The social service of diabetic retinopathy (DR) and proptosis screening by going directly to the community is one of the efforts to reduce blindness. The aim of this study is reporting the result of DR and proptosis screening toward priests in Intaran Village, Sanur Kauh, Bali. Method: This is an observational study with cross-sectional approach conducted in April 2022.We performed DR screening using portable funduscopy and proptosis screening using Herthel exophthalmometry. Collected data were analyzed descriptively. Results: In the diabetic retinopathy screening, a total of 8 participants had their eyes examined. Based on the results of the examination, 3 people and 5 eyes were found to have diabetic retinopathy. Of the 3 participants who had RD, two participants had bilateral RD, while 1 had unilateral RD. Of the 5 eyes that had RD, four eyes had a mild degree, while 1 eye had a moderate degree. None of the eyes had severe degrees. Participants with RD were given referrals for further treatment. The average Hertel exophthalmometry examination result in the right eye was 14.30 ± 2.14 mm while in the left eye was 14.46 ± 2.11 mm. This data can be used as a reference for normal values in the population. Conclusion: DR screening is important because it can detect the disease before the appearance of complaints. DR screening by going directly to the community can also reach people who have difficulty in accessing health care facilities.
Co-Authors Agung Bagus S. Satyarsa Alit, Ida Bagus Putu Anak Agung Ayu Githasari Dewi Anak Agung Ayu Sukartini Djelantik Anak Agung Mas Putrawati Triningrat Anasary, Anak Agung Ayu Putri Prematura Sri Angelo Doniho Anthea Casey Ari Andayani Ariesanti Tri Handayani, Ariesanti Tri Bobby Kristianto DUDUT RUSTYADI, DUDUT Fabiola Supit Gde Aditya Putra Deva Giovani Faustine Haikal Hamas Putra Iqra Hendrawan, Kevin Anggakusuma I Gde Raka Widiana I Gusti Ayu Ratna Suryaningrum I Putu Budhiastra I Putu Budhiastra, I Putu I Wayan Eka Sutyawan I Wayan Gede Jayanegara Ida Bagus Putra Manuaba Juliari, IGAM Kadek Tresna Yuwana Kunthi Yulianti Made Agus Kusumadjaja Ni Made Ayu Surasmiati Ni Made Suryanadi Noviantari, I Gusti Agung Ratna Pande Putu Adityo Ananta Ardika Pantjawati, Ni Luh Diah Pitanatri, Nyoman Brahmani Siska Takarai Sukmawati, Nurindah Suryanadi, Ni Made Suryawijaya, Ernes Erlyana Tridiyoga, Komang Putra Triningrat, A.A. Mas Putrawati Triningrat, Anak Agung Mas Putrawati Wetarini , Krisnhaliani Wibawa, I Made Dwi Surya Wijayati , Made Paramita Winly Yudiskara, Ni Nyoman Elza Yudistira Yudistira Yuliawati, Putu