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Successful Management of Rhegmatogenous Retinal Detachment with Concomitant Cataract Using Combined Phacoemulsification, Pars Plana Vitrectomy, and Scleral Buckling: A Case Report Ramzi Amin; Alfin Radhian
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 2 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i2.740

Abstract

Rhegmatogenous retinal detachment (RRD) coexisting with significant cataract presents a complex surgical challenge, often necessitating combined phacoemulsification, pars plana vitrectomy (PPV), and potentially scleral buckling (SB) for optimal anatomical and visual outcomes. This report details the successful management of such a case using a combined surgical approach. A 43-year-old female presented with a one-week history of a sudden-onset black shadow in the nasal visual field of her right eye (OD), preceded by photopsia for one month. Visual acuity was 1/60 OD and 1/60 OS, non-improving with pinhole. Ophthalmic examination revealed an RRD with a superior retinal tear between the 1-2 o'clock position in the OD, associated undulation, and retinal folds. Bilateral immature senile cataracts (Nuclear Opalescence Grade 2, Nuclear Color Grade 2) were also noted. The patient underwent combined phacoemulsification with intraocular lens (IOL) implantation, 360° SB, 23-gauge PPV, endolaser photocoagulation around the break, and silicone oil tamponade in the OD. Postoperatively, the retina remained attached under silicone oil. Visual acuity improved to 6/21 OD at the 8-day follow-up. Postoperative intraocular pressure (IOP) elevation (39.4 mmHg OD) was managed medically. In conclusion, combined phacoemulsification, PPV, and SB proved effective in achieving both retinal reattachment and significant visual improvement in this patient with RRD and concomitant cataract. Careful surgical planning and postoperative management, including IOP control, are crucial for successful outcomes in these complex cases.
EFFECT OF DIABETIC RETINOPATHY PROGRESSION ON VISUAL ACUITY IN TYPE II DM PATIENTS Amin, Ramzi; Rajendra Ekki Maulana; Syarif Husin
Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Vol. 12 No. 2 (2025): Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Univers
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/jkk.v12i2.660

Abstract

This study aims to assess the effect of DR severity on visual acuity and to identify additional contributing factors. An observational analytic study with a cross-sectional design was conducted using medical records of Type II DM patients diagnosed with DR at Dr. Mohammad Hoesin General Hospital, Palembang, between January 2021 and October 2024. Statistical analysis was performed using Fisher’s exact test to evaluate significance, followed by logistic regression to determine the most influential factor. The results showed a significant association between DR severity and visual acuity (p=0.008), while other factors including macular edema (p=0.137), age (p=1.000), gender (p=1.000), intraocular pressure (p=1.000), HbA1c levels (p=1.000), and history of hypertension (p=1.000), were not significantly associated. In conclusion DR severity has a significant and dominant influence on the visual acuity of DR patients.
Successful Management of Central-Involving Diabetic Macular Edema with Sequential Anti-VEGF Injections in Moderate NPDR: A Case Study Ramzi Amin; Oliffa Salma Atthahiroh
Archives of The Medicine and Case Reports Vol. 5 No. 2 (2024): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v5i2.741

Abstract

Diabetic macular edema (DME), particularly central-involving DME (CI-DME), represents a primary cause of significant vision impairment among individuals afflicted with diabetic retinopathy (DR). The progression from non-proliferative diabetic retinopathy (NPDR) stages can be complicated by the development of CI-DME, which mandates prompt and effective intervention to preserve visual function. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have emerged as the definitive first-line therapeutic strategy for CI-DME, demonstrating considerable efficacy in reducing macular thickness and enhancing visual acuity outcomes. This report provides a detailed account of the successful clinical management of a patient presenting with moderate NPDR and concurrent CI-DME, utilizing a regimen of sequential intravitreal anti-VEGF injections. A 58-year-old female patient, with an established 3-year history of both type 2 diabetes mellitus and systemic hypertension, presented with a chief complaint of progressively deteriorating vision in her right eye (OD) over the preceding two-month period. Her pertinent ophthalmic history included cataract extraction with intraocular lens implantation OD performed three months prior, followed by an initial anti-VEGF injection administered OD one month before the current evaluation. Upon examination, her best-corrected visual acuity OD was measured at 4/60. Dilated funduscopic examination of the right eye revealed retinal findings characteristic of moderate NPDR, specifically the presence of microaneurysms distributed across two retinal quadrants and discernible venous beading within one quadrant. Optical Coherence Tomography (OCT) imaging objectively confirmed the diagnosis of CI-DME, demonstrating a central subfield thickness (CST) of 376 µm accompanied by evident intraretinal hyporeflective spaces indicative of fluid accumulation. The patient subsequently received sequential intravitreal injections of Ranibizumab 0.5mg. Following the second injection, a follow-up assessment conducted at three weeks revealed a notable improvement in visual acuity to 6/30 OD, corroborated by anatomical improvement observed on OCT, which showed a discernible reduction in intraretinal fluid. Consequently, planning for a third intravitreal injection was initiated. In conclusion, the administration of sequential intravitreal anti-VEGF therapy, specifically Ranibizumab in this patient's course, proved demonstrably effective in the management of CI-DME within the context of moderate NPDR. This intervention resulted in both clinically meaningful functional vision improvement and objective anatomical reduction of macular edema. This case serves to underscore the paramount importance of anti-VEGF agents as a foundational management strategy for CI-DME. Optimal patient outcomes are contingent upon meticulous patient selection, diligent and ongoing management of systemic comorbidities, particularly diabetes and hypertension, and adherence to a regular follow-up schedule.
Successful Visual Rehabilitation Following Pars Plana Vitrectomy and Endolaser in a Patient with Severe Vitreous Hemorrhage due to Proliferative Diabetic Retinopathy Ramzi Amin; Rafika
Archives of The Medicine and Case Reports Vol. 5 No. 3 (2024): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v5i3.742

Abstract

Proliferative diabetic retinopathy (PDR) represents an advanced stage of diabetic eye disease, frequently leading to severe visual impairment through complications such as vitreous hemorrhage (VH). Dense VH significantly obstructs vision and often requires surgical intervention. Pars plana vitrectomy (PPV) coupled with endolaser photocoagulation serves as a critical treatment modality, aiming to clear the hemorrhage, remove tractional elements, and manage the underlying ischemic drive of PDR. This report documents a case demonstrating significant visual recovery after this intervention. A 53-year-old male, diagnosed with type 2 diabetes mellitus 6 years prior and under medical control, presented with a one-month history of sudden, severe vision loss in his right eye (OD). His best-corrected visual acuity (BCVA) was profoundly reduced to 1/300 OD, while the left eye (OS) measured 6/15. Clinical examination revealed dense VH OD, preventing detailed funduscopic assessment. The fellow eye OS exhibited features consistent with high-risk PDR. The patient underwent a 23-gauge PPV, including core vitrectomy and extensive pan-retinal endolaser photocoagulation OD, performed under general anesthesia. Postoperatively, the vitreous clarity was restored, and a remarkable improvement in BCVA OD to 6/7.5 was achieved by the three-week follow-up visit. In conclusion, timely surgical management utilizing PPV with endolaser photocoagulation was effective in resolving dense VH secondary to PDR in this patient, culminating in substantial visual rehabilitation
Successful Management of Inferotemporal Rhegmatogenous Retinal Detachment with Scleral Buckle in High Myopia: A Case Report Ramzi Amin; Ririn Rahayu
Archives of The Medicine and Case Reports Vol. 4 No. 4 (2023): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v4i4.743

Abstract

Rhegmatogenous retinal detachment (RRD) represents a significant ophthalmic emergency, characterized by the separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE) due to a full-thickness retinal break. High myopia is a major risk factor, particularly in younger individuals, owing to associated vitreoretinal changes and axial elongation. Surgical intervention is mandatory to prevent permanent vision loss. While pars plana vitrectomy (PPV) has gained popularity, conventional scleral buckling (SB) remains a highly effective and often preferred primary treatment, especially in young, phakic patients with peripheral breaks and uncomplicated detachments. This report details the successful management of an inferotemporal RRD using SB in a young female patient with high myopia. A 25-year-old female presented with a two-week history of progressively worsening blurred vision, preceded by floaters and photopsia in her left eye (OS). She had a history of high myopia (manifest refraction -7.50 D sphere OS) but no prior ocular surgery or trauma. Best-corrected visual acuity (BCVA) was counting fingers at 1 meter OS and 6/30 OD. Intraocular pressure (IOP) was 8.1 mmHg OS and 18.3 mmHg OD. Funduscopic examination OS revealed a bullous RRD involving the inferior and temporal quadrants, extending across approximately 6 clock hours, with the macula appearing clinically off. A single flap tear was identified in the inferotemporal quadrant at the 7 o'clock position, consistent with Lincoff's Rule 3. Optical Coherence Tomography (OCT) confirmed subretinal fluid involving the fovea. B-scan ultrasonography corroborated the presence of retinal detachment. The patient underwent conventional scleral buckling surgery with cryotherapy to the retinal break and subretinal fluid drainage under general anesthesia. Postoperatively, the retina achieved complete anatomical reattachment. BCVA OS improved slightly to counting fingers at 1 meter by day 12 post-operation, with expectations for further gradual improvement. In conclusion, conventional scleral buckling provided successful anatomical reattachment for an inferotemporal RRD secondary to a flap tear in this young, highly myopic patient. SB remains a crucial and effective surgical option for primary RRD, particularly in phakic eyes with peripheral breaks, offering excellent anatomical outcomes while avoiding the cataractogenic effects and potential intraocular manipulation risks associated with primary vitrectomy in this demographic. Careful case selection and meticulous surgical technique are paramount for success.
Impact of Glycemic Control on Amsler Grid Findings in Patients with Diabetic Retinopathy in Palembang, Indonesia Ramzi Amin; Ayu Aliyah
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (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.v9i7.1330

Abstract

Background: Diabetic retinopathy (DR) remains a principal cause of vision impairment globally, frequently affecting the macula and central vision. This study aimed to investigate the association between glycemic control status and the presence of Amsler grid abnormalities in patients diagnosed with diabetic retinopathy in Palembang. Methods: This cross-sectional study was conducted at the outpatient ophthalmology and internal medicine clinics of a tertiary referral hospital in Palembang between January 2023 and December 2024. Patients aged 18 years or older with a confirmed diagnosis of type 1 or type 2 diabetes mellitus and any stage of diabetic retinopathy, capable of performing Amsler grid testing, were included after providing informed consent. Patients with other significant ocular pathologies affecting the macula or media opacities precluding fundus examination were excluded. Data collected included demographics, diabetes history, comprehensive ophthalmic examination findings, standardized Amsler grid testing results, and recent HbA1c levels. Glycemic control was categorized as good (<7.0%), fair (7.0-9.0%), and poor (>9.0%). Statistical analysis involved descriptive statistics, chi-square tests, t-tests/Mann-Whitney U tests, and multivariable logistic regression to assess the association between HbA1c levels and abnormal Amsler grid findings, adjusting for potential confounders. Results: A total of 385 patients with DR (mean age 58.2 ± 9.5 years; 53.8% female) were included. The mean duration of diabetes was 12.4 ± 6.8 years, and the mean HbA1c was 8.9% ± 2.1%. Abnormal Amsler grid findings were reported by 161 participants (41.8%). Patients with abnormal Amsler grid findings had significantly higher mean HbA1c levels compared to those with normal findings (9.8% ± 1.9% vs. 8.3% ± 1.8%, p < 0.001). In the multivariable logistic regression analysis, after adjusting for age, diabetes duration, DR severity, and hypertension, poor glycemic control (HbA1c >9.0%) was independently associated with significantly higher odds of having abnormal Amsler grid findings compared to good glycemic control (HbA1c <7.0%) (Adjusted Odds Ratio [aOR] = 3.45, 95% CI: 1.98-6.01, p < 0.001). Fair glycemic control (HbA1c 7.0-9.0%) also showed increased odds, although to a lesser extent (aOR = 1.82, 95% CI: 1.05-3.15, p = 0.032). Each 1% increase in HbA1c was associated with a 35% increased odds of abnormal Amsler findings. Conclusion: This study demonstrated a significant association between poorer glycemic control, as indicated by higher HbA1c levels, and the presence of abnormal Amsler grid findings among diabetic retinopathy patients in Palembang. These findings underscore the critical role of meticulous glycemic management in preserving not only retinal structure but also central visual function detectable through simple psychophysical tests. The Amsler grid serves as a valuable, accessible tool for functional monitoring in this patient population.
Management Of Eales’ Disease Grade III B: A Rare Case Evasha, Agung Putra; Amin, Ramzi; Ansyori, A.K.
International Journal of Retina Vol 6 No 2 (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.iss002.248

Abstract

Introduction: Eales' disease is an idiopathic, bilateral, occlusive retinal vasculopathy that primarily affects young, predominately male patients. It seems to have multiple causes and is probably immunologic in nature. Recurrent vitreous hemorrhages, macular degeneration, and tractional or mixed retinal detachments involving the macula can all cause some patients to experience severe vision loss. Case Report: A 39-year-old male with vitreous hemorrhage caused by Eales Disease grade III Bwith an initial visual acuity 1/300 came to our department. Ultrasound imaging showed themembrane like lesion with 1/2 retinal reflectivity, after moderate movement and vitreoushemorrhage on both eyes. The photo-fundus showed there is decreased fovea reflex andperimacular exudate with visible contours of sclerotic blood vessels, visible cotton wall spot, andmacroaneurysm. There is also haze grade 3 on media, visible folds in the inferior part, visibleshadows of cotton wall spots. The patient underwent pars plana vitrectomy with endolaser tomanage the disease. Discussion: In this case, patient was diagnosed as vitreous hemorrhage caused by Eales Diseasegrade III B on both eyes but it getting worse on left eye further. We chose to perform PPV withendolaser on right eye. Based on improved visual acuity and less hemorrhage, the right eye'soutcome was favorable, while the left eye, which was not treated, had a worsening of thesituation. Only eyes with a non-resolving vitreous hemorrhage after three months should have avitrectomy.Conclusion: The treatment of this patient's case produced good anatomical and functionaloutcomes for the right eye, but the left eye, unfortunately, has a major issue. In order to furtherconfirm the results, longer follow-up is still required.
Pengaruh Estradiol Terhadap Sepsis Haloho, Agustina Br.; Amin, Ramzi; Saleh, Mgs. Irsan; Murti, Krisna
Jurnal Biomedika dan Kesehatan Vol 7 No 1 (2024)
Publisher : Fakultas Kedokteran Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/JBiomedKes.2024.v7.104-112

Abstract

Sepsis is an emergency condition as a result of host dysregulation systemic immune response to infection that is related to the end stage of organ dysfunction. Both sepsis and septic shock conditions are the main problems in ICU especially, those that affect millions of people in the whole world every year. Studies in line with immune-neuroendocrine related to sepsis get high attention about factors that play roles in sepsis pathogenesis and prognosis, like correlation to gender, hormones, and other factors. In this case, lots of experimental studies and clinical studies showed that sepsis has significant sexual dysmorphic. The female gender has proven protective against sepsis, meanwhile, males could have worse sepsis because of decreasing immunologic response that mediates cell and cardiovascular function. Estrogen is a hormone in women that plays important roles in not only reproductive function but also non-reproductive function. Physiological estrogen in women is divided into three forms: estrone (E1), estradiol (E2 or 17β- estradiol), and estriol (E3). Several experimental studies in animals showed that estradiol has a protective response when infection occurs. Estrogen generally stimulates cytokine release, induction of HO-1, and restoration of organ function due to sepsis. Potential pathogenesis for this condition is a specific expression of cytokine pro and anti-inflammation. This pathological inflammatory condition is related to gender that is found in surgical patients at the molecular level.
Efficacy of Sambiloto Extracts, Andrographis paniculate, (Burm. F) in Inhibiting Diabetic Retinopathy Progression: An in Vivo Study: Oral Presentation - Experimental Study - Resident Shariff, Muhammad Apriliandy; Amin, Ramzi; Ansyori, AK.
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: 10.35749/1ww79n21

Abstract

Introduction & ObjectivesDiabetic retinopathy (DR) is one of diabetes mellitus complication and occurred in retinalmicrovascular. This study was aimed to investigate the efficacy of Sambiloto, Andrographispaniculate (A. paniculata) extract on glycemic profile, antioxidant and inflammatory cytokineparameters in diabetic rats, and phytochemical analysis of A. paniculata. MethodsA. paniculata extract (APE) was carried out by maceration with ethanol. Diabetes mellitus in Wistarmale rats was induced with streptozotocin. Retinal vessel diameters were estimated using a methodby Vucetic. Inflammatory cytokine and antioxidant parameters were evaluated in retinal tissue. Thealkaloid and flavonoid contents in extract were analyzed using thin layer chromatography method. ResultsFunduscopic examination presented some changes in the diameter of the blood vessels. The vesseldiameter in the diabetic retinopathy group with APE in concentration of 100 and 200 mg/kg BWgroups was significantly lower than in the DR group (p<0.05). The administration of APE in dosagesof 100 and 200 mg/kg BW showed reduced glutathione, SOD, and catalase levels compared to theDR group (p<0.05). ConclusionA. paniculata extract doses of 100 and 200 mg/kg BW improved diabetic retinopathy in rats throughhypoglycemic effects, antioxidant effects, and anti-inflammatory mechanisms.
Anti-RAGE (Receptor Advanced Glycation End products) Antibody Improves Diabetic Retinopathy in Rats via Hypoglycemic and Anti-inflammatory Mechanism Indiarsih, Tiara Bunga; Amin, Ramzi; Ansyori, A.K.
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/xny05743

Abstract

Background: Receptor advanced glycation end products (RAGE) activation plays an essential role in diabetic retinopathy (DR) progression. This study was aimed to explore the role of anti-RAGE antibodies (RAGE antagonists) in inhibiting DR progression through their hypoglycemic and anti- inflammatory mechanism in diabetic retinopathy induced rats. Methods: A total of 30 male Wistar rats were randomly divided into five group. The group was consisted of normal control group, DR group without treatment, DR group with anti-RAGE 1 g/kg BW, 10 g/kg BW, and 100 g/kg BW. To assess the diabetic retinopathy, fundus photographs were taken every week using a camera with 16x magnification placed in front of the rat's eyes. Blood glucose was checked by the glucose oxidase-peroxidase method. Retinal TNF-? levels and VEGF were examined using an enzyme-linked immunosorbent assay (ELISA) kit. Results: The finding of this study showed that anti-RAGE treatment at dose of 10 and 100 g/kg BW, HbA1c levels were significantly higher (p< 0.05) compared to the normal control group but significantly lower (p< 0.05) than in the diabetes group. The mean blood vessel diameter in the DR+anti-RAGE 10 and 100 g/kg BW groups was significantly lower than in the diabetic retinopathy group (p< 0.05). The administration of anti-RAGE 10 and 100 g/kg BW showed the ability to significantly reduce VEGF levels compared to the DR group (p< 0.05). Conclusions: This study revealed at doses of 10 and 100 g/kg BW, anti-RAGE antibodies improved diabetic retinopathy in Wistar rats through hypoglycemic effects and anti-inflammatory mechanisms.
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