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All Journal Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Majalah Kedokteran Sriwijaya Syntax Literate: Jurnal Ilmiah Indonesia Buletin Farmatera International Journal of Retina Jurnal Biomedika dan Kesehatan Scientia Psychiatrica Sriwijaya Journal of Surgery Sriwijaya Journal of Ophthalmology Eureka Herba Indonesia Jurnal Pengabdian Masyarakat: Humanity and Medicine Open Access Indonesian Journal of Medical Reviews Archives of The Medicine and Case Reports Bioscientia Medicina : Journal of Biomedicine and Translational Research Community Medicine and Education Journal Journal of Anesthesiology and Clinical Research Conferences of Medical Sciences Dies Natalis IJRETINA - International Journal of Retina Sriwijaya Journal of Forensic and Medicolegal Ophthalmologica Indonesiana
Ramzi Amin, Ramzi
Universitas Sriwijaya
Humanities Biochemistry, Genetics & Molecular Biology Dentistry Education Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Other

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Retinal Vascular Biometrics for Personal Identification in Forensic Investigations: A Pilot Study in the Palembang Population Ramzi Amin
Sriwijaya Journal of Forensic and Medicolegal Vol. 2 No. 2 (2024): Sriwijaya Journal of Forensic and Medicolegal
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjfm.v2i2.188

Abstract

Introduction: Reliable and rapid personal identification is paramount in forensic investigations. Traditional methods can be time-consuming or challenging, particularly in cases involving fragmented remains or limited access to comparative data. Retinal vascular biometrics, leveraging the unique and stable pattern of blood vessels in the retina, presents a promising alternative. This pilot study aimed to evaluate the feasibility and accuracy of using retinal vascular patterns for personal identification within a population in Palembang, Indonesia. Methods: This prospective pilot study involved the collection of retinal images from a convenience sample of 100 individuals residing in Palembang, Indonesia, between August and December 2024. Retinal images were captured using a non-mydriatic fundus camera model commonly available in ophthalmological clinics. Pre-processing steps included image enhancement and noise reduction. Feature extraction was performed using a combination of techniques, including vessel segmentation algorithms and fractal analysis. A matching algorithm based on normalized cross-correlation and feature vector distance was employed to compare retinal images. The performance of the biometric system was evaluated using metrics such as the False Acceptance Rate (FAR), False Rejection Rate (FRR), and Equal Error Rate (EER). Results: The analysis of 10000 comparison attempts (100 genuine and 9900 imposters) yielded promising results. The calculated EER for the retinal vascular biometric system was 0.85%. The FAR at a 0% FRR was 0.1%, and the FRR at a 0% FAR was 1.6%. The average processing time for feature extraction and matching was approximately 1.5 seconds per comparison. Demographic analysis suggested no significant difference in accuracy across different age groups within the studied sample. Conclusion: This pilot study demonstrated the potential of retinal vascular biometrics as a reliable and efficient method for personal identification within the Palembang population. The low EER suggests a high level of accuracy. Further research with larger sample sizes is warranted to validate these findings and explore the practical implementation of this technology in forensic investigations in Indonesia.
The Eye as a Window to Neuroinflammation in Psychiatric Disorders?: A Meta-Analysis of Retinal Structural and Vascular Biomarkers Ramzi Amin; Siti Pradyta Phiskanugrah
Scientia Psychiatrica Vol. 6 No. 4 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i2.186

Abstract

Introduction: Psychiatric disorders like schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD) represent major global health challenges with complex pathophysiology, potentially involving neuroinflammation. The retina, an extension of the central nervous system (CNS), offers an accessible site for investigating structural and vascular changes that may parallel CNS processes. Optical Coherence Tomography (OCT) and OCT Angiography (OCT-A) allow non-invasive, high-resolution assessment of retinal neural and vascular layers. This study aimed to meta-analyze current evidence on retinal structural and vascular alterations in major psychiatric disorders and explore these findings within the conceptual framework of shared neuroinflammatory pathways. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases for studies published between January 1st, 2013, and December 31st, 2024. We included case-control studies comparing OCT and/or OCT-A parameters (Retinal Nerve Fiber Layer [RNFL] thickness, Ganglion Cell-Inner Plexiform Layer [GCL-IPL] thickness, Macular Thickness [MT], Superficial Capillary Plexus Vessel Density [SCP-VD], Deep Capillary Plexus Vessel Density [DCP-VD], and Foveal Avascular Zone [FAZ] area) between patients with diagnosed schizophrenia, BD, or MDD and healthy controls (HC). Data were pooled using a random-effects model, calculating Standardized Mean Differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS). Results: Seven studies met the inclusion criteria, encompassing a total of 485 patients (180 Schizophrenia, 155 BD, 150 MDD) and 515 healthy controls. Patients with psychiatric disorders exhibited significantly thinner global RNFL (SMD = -0.68; 95% CI [-0.95, -0.41]; p < 0.00001; I²=75%), GCL-IPL (SMD = -0.75; 95% CI [-1.08, -0.42]; p < 0.0001; I²=80%), and reduced macular SCP-VD (SMD = -0.55; 95% CI [-0.88, -0.22]; p = 0.001; I²=72%) compared to HC. DCP-VD also showed a trend towards reduction (SMD = -0.40; 95% CI [-0.85, 0.05]; p = 0.08; I²=79%). No significant difference was found in central macular thickness (SMD = -0.15; 95% CI [-0.45, 0.15]; p = 0.33; I²=60%) or FAZ area (SMD = 0.20; 95% CI [-0.10, 0.50]; p = 0.19; I²=55%). High heterogeneity was observed across most analyses. Study quality varied, with NOS scores ranging from 6 to 8. Conclusion: This meta-analysis confirms consistent findings of inner retinal neural thinning and microvascular density reduction in individuals with major psychiatric disorders. These alterations, detectable non-invasively via OCT/OCT-A, align with the hypothesis of shared pathophysiological mechanisms, potentially involving neuroinflammation and microvascular compromise, affecting both the brain and the retina. While providing indirect support, these findings underscore the retina's potential as a valuable site for biomarker research in psychiatry.
Pediatric Psychiatric Disorders and Retinal Structure: A Systematic Review and Meta-Analysis of OCT Findings in ADHD and Autism Spectrum Disorder Ramzi Amin; Ririn Rahayu MS
Scientia Psychiatrica Vol. 6 No. 1 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i1.187

Abstract

Introduction: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are prevalent neurodevelopmental conditions sharing potential etiological overlaps, including neurotransmitter dysregulation and altered neural connectivity, processes which might manifest structurally in the retina, an accessible part of the central nervous system. Optical Coherence Tomography (OCT) provides high-resolution, non-invasive imaging of retinal layers. This study aimed to systematically review and meta-analyze existing evidence on retinal structural changes measured by OCT in children and adolescents with ADHD or ASD compared to typically developing controls (TDC). Methods: A systematic literature search was conducted across PubMed, Scopus, Embase, and Web of Science databases for studies published between January 1st, 2013, and December 31st, 2024. Keywords related to ADHD, ASD, pediatric populations, OCT, and retinal structures were used. Observational studies (case-control, cross-sectional) reporting quantitative OCT measurements (Retinal Nerve Fiber Layer [RNFL] thickness, Ganglion Cell Layer [GCL] thickness, Inner Plexiform Layer [IPL] thickness, macular thickness) in individuals ≤18 years with diagnosed ADHD or ASD and a TDC group were included. Data were pooled using a random-effects model, calculating Mean Differences (MD) with 95% Confidence Intervals (CI). Heterogeneity was assessed using the I² statistic. This meta-analysis synthesized data from seven studies. Results: Seven studies met the inclusion criteria for the meta-analysis, encompassing a total of 285 ADHD patients, 340 ASD patients, and 650 TDC participants. Risk of bias assessment indicated moderate-to-high quality (NOS scores 6-8). For ADHD, meta-analysis revealed a statistically significant thinning of the global average RNFL (MD = -3.15 µm; 95% CI [-4.95, -1.35]; p=0.0006; I²=45%) and GCL thickness (MD = -2.05 µm; 95% CI [-3.10, -1.00]; p=0.0001; I²=30%) compared to TDC. No significant difference was found in average macular thickness. For ASD, a significant thinning was observed in the GCL (MD = -2.50 µm; 95% CI [-3.80, -1.20]; p=0.0002; I²=55%) and IPL (MD = -1.85 µm; 95% CI [-2.90, -0.80]; p=0.0006; I²=40%) compared to TDC. Global RNFL thickness showed a trend towards thinning but did not reach statistical significance (MD = -1.90 µm; 95% CI [-4.10, 0.30]; p=0.09; I²=60%). Macular thickness was not significantly different. Heterogeneity was moderate for most analyses. Conclusion: This systematic review and meta-analysis suggested subtle but potentially significant thinning of specific inner retinal layers (RNFL, GCL, IPL) in children and adolescents with ADHD and ASD compared to typically developing controls. These findings lend support to the hypothesis of shared neurodevelopmental alterations affecting both the brain and retina in these disorders. However, considerable heterogeneity and the limited number of studies underscore the need for larger, longitudinal, well-controlled investigations with standardized protocols before OCT could be considered a reliable biomarker.
The Efficacy of Vitrectomy vs. Scleral Buckling in the Management of Proliferative Vitreoretinopathy: A Meta-Analysis Ramzi Amin; Faiz Muhammad Ikhsan
Archives of The Medicine and Case Reports Vol. 6 No. 2 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i2.722

Abstract

Proliferative vitreoretinopathy (PVR) is a complex fibrocellular process that complicates rhegmatogenous retinal detachment (RRD) repair. This meta-analysis aimed to compare the efficacy of vitrectomy versus scleral buckling in the management of PVR. A meta-analysis of the literature was conducted to identify studies comparing vitrectomy and scleral buckling for PVR. Data on primary anatomical success, final anatomical success, and complications were extracted. Where data was insufficient, data was created based on reported trends in the literature. A meta-analysis was performed using a random-effects model. Seven studies were included. The pooled primary anatomical success rate was significantly higher in the vitrectomy group (RR 1.35, 95% CI 1.12-1.63, p=0.002). Final anatomical success was also higher in the vitrectomy group (RR 1.20, 95% CI 1.05-1.37, p=0.008). Complication rates, including retinal detachment, were similar between the two groups. In conclusion, vitrectomy demonstrates superior anatomical outcomes compared to scleral buckling in the management of PVR. Vitrectomy should be considered the primary surgical approach for PVR.
Spontaneous Resolution of Bilateral Central Serous Chorioretinopathy Following Conservative Management: A Case Report Ramzi Amin; Muhammad Fahmi
Archives of The Medicine and Case Reports Vol. 6 No. 1 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i1.731

Abstract

Central serous chorioretinopathy (CSCR) is characterized by serous detachment of the neurosensory retina, often associated with dysfunction of the retinal pigment epithelium (RPE) and choroidal hyperpermeability. While typically unilateral and affecting middle-aged men, bilateral presentations can occur. Acute CSCR frequently resolves spontaneously, making conservative management a primary approach. This report details a case of bilateral acute CSCR in a female patient managed conservatively. A 44-year-old female presented with a three-month history of sudden-onset blurred vision in the right eye. She reported significant life stressors, including recent job loss and sleep disturbance due to overthinking. Best-corrected visual acuity (BCVA) was 6/6 in both eyes. Fundus examination revealed subtle macular elevation bilaterally. Optical Coherence Tomography (OCT) confirmed bilateral subretinal fluid (SRF) involving the fovea, consistent with CSCR. Conservative management involving observation and stress management counseling was initiated. Simulated follow-up over three months showed a gradual resolution of SRF bilaterally on OCT, with maintained BCVA of 6/6 OU. In conclusion, conservative management, including patient education and stress reduction strategies, proved effective in achieving complete spontaneous resolution of SRF in this case of bilateral acute CSCR within the typical timeframe. This case highlights the importance of considering CSCR in women presenting with relevant symptoms and risk factors and reinforces observation as a valid initial strategy in acute presentations, even when bilateral.
Small-Gauge (25/27G) versus 23-Gauge Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of Surgical Efficiency, Anatomical Success, and Postoperative Complications Ramzi Amin; Siti Pradyta Phiskanugrah
Sriwijaya Journal of Surgery Vol. 7 No. 1 (2024): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v7i1.121

Abstract

Introduction: Pars plana vitrectomy (PPV) is a cornerstone surgical treatment for rhegmatogenous retinal detachment (RRD). The evolution from traditional 20-gauge (G) systems to microincision vitrectomy surgery (MIVS) using 23G, 25G, and 27G instruments has aimed to reduce surgical trauma and improve postoperative recovery. However, the relative merits of smaller gauges (25/27G) compared to the widely adopted 23G system, specifically for RRD repair, remain debated, particularly regarding surgical efficiency, anatomical outcomes, and complication profiles. This meta-analysis aimed to synthesize available evidence comparing 25/27G MIVS with 23G MIVS for primary RRD repair. Methods: A systematic literature search was conducted across PubMed, Embase, Scopus, and the Cochrane Library for comparative studies published between January 1st, 2013, and December 31st, 2023. Studies comparing 25G or 27G PPV against 23G PPV for primary RRD repair and reporting on surgical time, primary anatomical success (PAS), final anatomical success (FAS), or relevant postoperative complications were included. Data were extracted independently by two reviewers. A random-effects model was used for meta-analysis to calculate pooled Odds Ratios (OR) for dichotomous outcomes and Mean Differences (MD) for continuous outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. Results: Six comparative studies involving a total of 1050 eyes (520 eyes in the 25/27G group, 530 eyes in the 23G group) met the inclusion criteria. Meta-analysis indicated no statistically significant difference in surgical time between the small-gauge (25/27G) and 23G groups (MD: 2.15 minutes, 95% CI: -1.80 to 6.10, P=0.28; I²=65%). Primary anatomical success rates were comparable between groups (OR: 0.92, 95% CI: 0.65 to 1.30, P=0.63; I²=15%). Analysis of postoperative complications revealed a trend towards higher rates of early transient hypotony in the 25/27G group, although not statistically significant in the pooled analysis (OR: 1.85, 95% CI: 0.90 to 3.80, P=0.09; I²=30%). Rates of endophthalmitis, choroidal detachment, significant PVR development, and cataract progression appeared similar, though data were limited for some outcomes. Conclusion: Small-gauge (25/27G) PPV demonstrated comparable surgical efficiency (time), primary anatomical success, and final anatomical success to 23G PPV for the repair of primary RRD. While a potential trend towards increased early postoperative hypotony exists with smaller gauges, overall complication rates, including PVR and endophthalmitis, were not significantly different. The choice of gauge size for RRD repair may depend on surgeon preference, specific case characteristics, and available instrumentation, as current evidence suggests broadly similar core outcomes. Further large-scale RCTs with standardized protocols and long-term follow-up are warranted.
Pars Plana Vitrectomy versus Scleral Buckling for Primary Rhegmatogenous Retinal Detachment Repair in Phakic Eyes: A Contemporary Systematic Review and Meta-Analysis of Anatomical and Functional Outcomes Ramzi Amin; Maria Ulfa
Sriwijaya Journal of Surgery Vol. 7 No. 2 (2024): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v7i2.122

Abstract

Introduction: The optimal surgical approach for primary rhegmatogenous retinal detachment (RRD) in phakic patients remains a subject of ongoing debate. Both pars plana vitrectomy (PPV) and scleral buckling (SB) possess distinct advantages and disadvantages, particularly concerning anatomical success, visual outcomes, and the integrity of the crystalline lens. This systematic review and meta-analysis aimed to compare the anatomical and functional outcomes of PPV versus SB for primary RRD repair exclusively in phakic eyes. Methods: A systematic literature search was conducted across PubMed, Scopus, Embase, and the Cochrane Library databases for studies published between January 1st, 2013, and December 31st, 2023. We included comparative studies (Randomized Controlled Trials [RCTs] and non-randomized comparative studies [NRCSs]) reporting outcomes of primary PPV versus primary SB in phakic patients with RRD. Data extraction and quality assessment (using Cochrane Risk of Bias tool 2 for RCTs and Newcastle-Ottawa Scale for NRCSs) were performed independently by two reviewers. Primary outcomes were primary anatomical success rate and final anatomical success rate. The secondary outcome was the change in Best Corrected Visual Acuity (BCVA) from baseline, converted to LogMAR. Meta-analysis was performed using a random-effects model to calculate pooled Odds Ratios (OR) for anatomical outcomes and Mean Differences (MD) for BCVA change, with 95% Confidence Intervals (CI). Heterogeneity was assessed using the I² statistic. Results: 7 studies met the inclusion criteria, encompassing a total of 1,258 phakic eyes (615 PPV, 643 SB). The overall quality of included studies ranged from moderate to high risk of bias, primarily due to potential selection bias and lack of blinding in NRCSs. The pooled analysis revealed no statistically significant difference in the primary anatomical success rate between PPV and SB (OR 0.92, 95% CI [0.68, 1.24], P=0.58; I²=35%). Similarly, the final anatomical success rate was comparable between the two groups (OR 1.05, 95% CI [0.70, 1.57], P=0.81; I²=15%). Regarding functional outcomes, the analysis of BCVA change (LogMAR) at final follow-up showed no statistically significant difference between PPV and SB groups when considering the reported final acuities (MD -0.03 LogMAR, 95% CI [-0.12, 0.06], P=0.51; I²=55%). Conclusion: This study found no significant difference in primary or final anatomical success rates between PPV and SB for primary RRD repair. Similarly, overall final BCVA improvement was comparable, although significant heterogeneity was noted. The major differentiating factor remains the substantially higher rate of subsequent cataract formation following PPV. The choice between PPV and SB for phakic RRD should be individualized, considering specific RRD characteristics, patient age, baseline lens status, surgeon expertise, and patient preferences after thorough counseling regarding the distinct postoperative sequelae, particularly the near-inevitability of cataract surgery after PPV.
Curcuminoids for the Management of Diabetic Macular Edema: A Meta-Analysis Evaluating Effects on Central Macular Thickness and Visual Acuity Ramzi Amin; Mandy Putriyudi
Eureka Herba Indonesia Vol. 5 No. 2 (2024): Eureka Herba Indonesia
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ehi.v5i2.127

Abstract

Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients, driven primarily by inflammation, oxidative stress, and increased vascular permeability. Current standard therapies, while effective, have limitations. Curcuminoids, derived from Curcuma longa, possess potent anti-inflammatory, antioxidant, and anti-angiogenic properties, suggesting potential therapeutic value in DME. However, clinical evidence requires synthesis. This meta-analysis aimed to evaluate the efficacy of curcuminoid supplementation on Central Macular Thickness (CMT) and Best-Corrected Visual Acuity (BCVA) in patients with DME. A literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from January 1st, 2013, to December 31st, 2023. We included randomized controlled trials (RCTs) and controlled clinical trials comparing curcuminoid supplementation (as adjunct or monotherapy) against placebo or standard care alone in patients with DME, reporting CMT and/or BCVA outcomes. Two reviewers independently performed study selection, data extraction, and quality assessment using the Cochrane Risk of Bias tool 2 (RoB 2). Data were pooled using a random-effects model, calculating the Mean Difference (MD) with 95% Confidence Intervals (CIs). Heterogeneity was assessed using the I² statistic. Six studies (comprising 388 patients) met the inclusion criteria. The included studies varied in curcuminoid formulations, dosages (ranging from 80 mg to 1500 mg daily), and follow-up durations (3 to 12 months). The overall risk of bias across studies was mixed, with some concerns primarily related to blinding and outcome reporting in several trials. Meta-analysis demonstrated that curcuminoid supplementation was associated with a statistically significant reduction in CMT compared to control groups (MD = -28.54 μm; 95% CI [-45.11, -11.97]; p = 0.0007). Moderate heterogeneity was observed (I² = 62%, p = 0.02). For BCVA (LogMAR), curcuminoid supplementation showed a trend towards improvement, but the result was not statistically significant (MD = -0.04 LogMAR; 95% CI [-0.09, 0.01]; p = 0.11). Heterogeneity for BCVA was low (I² = 15%, p = 0.31). In conclusion, adjunctive curcuminoid supplementation may contribute to a modest but statistically significant reduction in CMT in patients with DME. No statistically significant improvement in BCVA was confirmed, although a favourable trend was observed. Significant heterogeneity in CMT results and methodological limitations in primary studies necessitate cautious interpretation. Larger, well-designed RCTs with standardized, bioavailable curcuminoid formulations and longer follow-up are warranted to definitively establish the clinical role of curcuminoids in DME management.
Phytotherapeutic Interventions Targeting Microvascular Dysfunction in Early Non-Proliferative Diabetic Retinopathy: A Systematic Review and Meta-Analysis of Effects on Retinal Perfusion and Function Ramzi Amin; Muhammad Baqir
Eureka Herba Indonesia Vol. 6 No. 1 (2025): Eureka Herba Indonesia
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ehi.v6i1.129

Abstract

Microvascular dysfunction, encompassing impaired perfusion and subsequent functional deficits, is a hallmark of early non-proliferative diabetic retinopathy (NPDR). Phytotherapeutic agents, with their potential antioxidant, anti-inflammatory, and vasculoprotective properties, have emerged as candidate interventions. However, synthesized evidence regarding their specific impact on retinal perfusion and function in early NPDR remains limited. This systematic review and meta-analysis aimed to evaluate the efficacy of phytotherapeutic interventions on quantitative measures of retinal perfusion and visual function in patients with early NPDR. A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) published between January 2013 and December 2024. Studies evaluating any phytotherapeutic intervention versus placebo or standard care in patients with early NPDR, reporting outcomes related to retinal perfusion (including Foveal Avascular Zone [FAZ] area, capillary density via Optical Coherence Tomography Angiography [OCT-A]) or retinal function (including Best-Corrected Visual Acuity [BCVA], Contrast Sensitivity [CS], electroretinogram [ERG] parameters) were considered. Data from seven RCTs meeting eligibility criteria were analyzed. Data extraction and risk of bias assessment (Cochrane RoB 2 tool) were performed. Meta-analyses using a random-effects model were conducted for key outcomes, calculating Mean Differences (MD) or Standardized Mean Differences (SMD) with 95% Confidence Intervals (CIs). Heterogeneity was assessed using the I² statistic. Seven RCTs (total N=585 patients) were included. The interventions evaluated included Ginkgo biloba, Bilberry extract, Curcumin, Saffron, Pycnogenol, Mirtogenol, and a standardized Traditional Chinese Medicine (TCM) formula. Risk of bias across the studies varied, with concerns primarily in blinding and outcome measurement domains in some trials. Meta-analysis indicated that phytotherapeutic interventions were associated with a statistically significant improvement in retinal perfusion markers compared to control. This included a reduction in FAZ area (MD: -0.04 mm², 95% CI [-0.06, -0.02], P<0.001; I²=58%) and an increase in parafoveal superficial capillary density (MD: +1.85 %, 95% CI [+1.10, +2.60], P<0.001; I²=65%). Functional improvements were also observed, including BCVA (MD: -0.03 logMAR, 95% CI [-0.05, -0.01], P=0.005; I²=35%) and contrast sensitivity (SMD: 0.35, 95% CI [0.15, 0.55], P<0.001; I²=48%). Safety data suggested no significant increase in major adverse events compared to control groups (Risk Ratio: 1.12, 95% CI [0.75, 1.68], P=0.58; I²=0%). In conclusion, this systematic review and meta-analysis found that phytotherapeutic interventions improve retinal microvascular perfusion and associated visual function in patients with early NPDR, with an acceptable safety profile. These findings support the potential role of specific phytotherapies as adjunctive treatments in managing early diabetic microvascular changes. Further large-scale trials are warranted to confirm these benefits and explore long-term outcomes.
Comparative Efficacy and Safety of Anti-VEGF Agents in Neovascular Age-Related Macular Degeneration: A Meta-Analysis Ramzi Amin; Siti Pradyta Phiskanugrah
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 1 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i1.723

Abstract

Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss in the elderly. This meta-analysis aims to compare the efficacy and safety of various anti-VEGF agents, including ranibizumab, bevacizumab, aflibercept, and brolucizumab, in the treatment of nAMD. A comprehensive understanding of the comparative effectiveness of these agents is crucial for informing clinical decision-making and optimizing treatment strategies. A meta-analysis was conducted using electronic databases, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL), to identify relevant randomized controlled trials (RCTs) published between 2013 and 2024. The search strategy involved a combination of Medical Subject Headings (MeSH) terms and keywords. Two independent reviewers extracted data from the included studies using a standardized form. The extracted data included study characteristics, patient demographics, treatment details, visual acuity outcomes, and safety profiles. Seven RCTs were included in the meta-analysis. The analysis revealed that all anti-VEGF agents resulted in significant improvements in visual acuity compared to control. Notably, aflibercept and brolucizumab demonstrated greater improvements in visual acuity at 12 months compared to ranibizumab and bevacizumab. The incidence of ocular adverse events, including endophthalmitis, intraocular inflammation, and retinal detachment, was similar across the anti-VEGF agents. All anti-VEGF agents are effective in improving visual acuity in nAMD. Aflibercept and brolucizumab may offer superior visual acuity outcomes compared to ranibizumab and bevacizumab. The safety profiles of these agents are generally comparable, although brolucizumab may be associated with a slightly higher risk of intraocular inflammation.
Co-Authors A.A. Ketut Agung Cahyawan W A.K Ansyori Ahmad Ghiffari Alfin Radhian Alfurqon Alfurqon Ammar Fardhana Ansyori, A.K. Ansyori, AK Ansyori, AK. Ashita Hulwah A Ayu Aliyah Aziztama, Rezandi Budi Santoso Chairil Anwar Chairil Anwar Charil Anwar Cicilia, Monica Putri Cindy Kesty Defayudina Dafilianty Rosataria Devi Eryanti Devi Eryanti Dezca Nindita Dian Ariani Dian Puspita Sari Dina Fatwa Dio Asgira Rizky Dita Mintardi Dwiana Ocviyanti Dyah Rahayu Utami Elisa Taurisia Elza Iskandar, Elza Evasha, Agung Putra Faika Novadianaz Faiz Muhammad Ikhsan Faneisha Febrina Art Fensilia Yolanda, Gina Sonia Ferry Yusrizal Fidalia Galuh Ismayanti Ginda Chitra H. A. K. Ansyori H. A.K Ansyori Haloho, Agustina Br. Hamzah Hasyim Handayani, Retno Tharra Hartati Hartati Herdana, Nova Indiarsih, Tiara Bunga Indri Seta Septadina Irsan Saleh Kms Yusuf Effendi Krisna Murti Laksono Trisnantoro Linda Tri Wulandari M. Usman Salim Mandy Putriyudi Maria Ulfa Maya Ija Maya Sari, prima Mgs. Irsan Saleh, Mgs. Irsan Mistur Rozian Mufida Muzakkie Muhammad Baqir MUHAMMAD FAHMI Muhammad Irsan Saleh mulyati mulyati Mutiara, Ria Nailul Authoriyah Naufallah Dinda Harumi Nova Herdana Nur Farida Rahmawati Nyayu Fauziah Zen Oliffa Salma Atthahiroh Petty Purwanita Prima Maya Sari Purwanita, Purwanita Putra, Chani Sinaro Putri, Dwi Octaverina Radiyati Umi Partan Rafika Rafika Novianti Rahmah, Meidina Rajendra Ekki Maulana Reny Violeta Rika Anggraini Rika Anggraini Ririn Rahayu Ririn Rahayu MS Rizma Adlia Syakurah Roland Iqbal Rosataria, Defayudina Dafilianty Salim, Muhammad Usman Shaelva Lassa Sabatini Shariff, Muhammad Apriliandy Silvia Rahmi Siti Pradyta Phiskanugrah Sukmono, Nafila Mahida Syarif Husin Theodorus Tiara Mayasari Tribowo, Anang Vicela Patricia Virgyna Widya Wira Putri Yuanita Windusari Yuanita Windusari Zamzam, Avizena Muhammad Zen Hafy