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All Journal Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia IJRETINA - International Journal of Retina Ophthalmologica Indonesiana
Rina La Distia Nora
Division Of External Eye Disease, Department Of Ophthalmology, Cipto Mangunkusumo Hospital, Kirana, Jakarta
Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Public Health

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When Retinal Vasculitis Wears a Mask: Unveiling Retinal Vasculitis Presented as Branch Retinal Vein Occlusion in a Young Male Patient: Poster Presentation - Case Report - Resident Lia Amanda; Andi Marsa Nadhira; Yulia Aziza; Rina La Distia Nora
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: 10.35749/982cvw55

Abstract

Introduction : Retinal vasculitis can present with a range of clinical features. Correct diagnosis and prompt treatment are essential to prevent permanent visual loss. We describe a case of retinal vasculitis with branch retinal vein occlusion (BRVO) as initial diagnosis, which is a rare manifestation in a young individual without any vascular risk factors. Case Illustration : A 24-year-old male was referred to our center with a sudden onset of blurry vision of his left eye. He was previously diagnosed with BRVO. The patient denied having any chronic diseases, fever, or sore throat. Visual acuity was 6/18 on the left eye and 6/6 on the right eye, respectively. The anterior segment showed no abnormalities. However, fundus examination revealed prominent retinal sheathing, retinal whitening at the inferior quadrant, and macular star. Systemic diseases, such as Bechet disease, sarcoidosis, and systemic lupus erythematosus were excluded by ancillary tests. One month after the initial examination, the patient reported worsening of vision. Funduscopic examination revealed preretinal hemorrhages and macular star. The patient then received intravitreal injection of anti-vascular endothelial growth factor (VEGF), which helped to resolve the hemorrhage and improve vision. Discussion : Further investigations, such as fundus fluorescein angiogram, may aid in the diagnosis and management of this condition. Anti-VEGF therapy may be a useful treatment option for retinal vasculitis-associated hemorrhages. Conclusion : Our case highlights the importance of considering retinal vasculitis as a differential diagnosis in young patients presenting with BRVO, even in the absence of traditional risk factors.
Unusual Presentation of Lipemia Retinalis Presented with Visual Field Defect: Poster Presentation - Case Report - Resident Regina Ivanovna; Irma Suwandi Sadikin; Dearaini; Eduard Jordi Luminta; Rina La Distia Nora; Yulia Aziza
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/axa0en30

Abstract

Introduction : Lipemia retinalis is an ocular presentation that associated to hypertriglyceridemia. Most cases are usually asymptomatic, with changes detected only from fundus examination. This case report highlights a case of lipemia retinalis with decreased peripheral visual field. Case Illustration : Thirty four year-old female came with complaint of blurry right eye (RE) 3 months before hospital visit, especially on inferotemporal part of her right eye. She had history of diabetes mellitus and hypertriglyceridemia. Her sister also has known history of hypertriglyceridemia. Ophthalmological examination revealed 6/6 visual acuity on both eyes, with normal anterior segment of both eyes. Fundus examination showed creamy retinal vessels on both eyes. Humphrey perimetry result showed inferotemporal visual field defect of RE. At time of visit, triglyceride level was 1440 mg/dL. Patient was prescribed fenofibrate 1x300 mg daily by Endocrinology Department. After 6 months of fenofibrate therapy, serum triglyceride level was decreasing to 185 mg/dL. Ophthalmology exam revealed a significant decrease of creamy white vessel on right eye and normal vessel of left eye. Humphrey perimetry showed decreased visual field defect Discussion : Hypertriglyceridemia can result from familial or secondary to systemic diseases. Creamy vessel appearance in lipemia retinalis is resulted from presence of triglyceride-laden chylomicrons in the plasma. Lipemia retinalis rarely manifests with reduced peripheral vision, which is presented in this case. Conclusion : Lipemia retinalis is often overlooked due to its asymptomatic nature. Prompt recognition might be live saving from life-threatening condition resulting from hypertriglyceridemia. Triglyceride- lowering drug therapy is very useful in improving peripheral field defect as presented in our case report.
BOTULINUM TOXIN A FOR BLEPHAROSPASM WITH DRY EYE: A SYSTEMATIC REVIEW: Poster Presentation - Observational Study - General practitioner dr. Muthia Despi Utami; Yulia Aziza; Lukman Edwar; Made Susiyanti; Rina La Distia Nora; Ratna Sitompul
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/d2xzdv11

Abstract

Introduction & Objectives : Essential blepharospasm is a neurological condition that is defined by uncontrolled and abnormal eyelid closure from a central cerebral disorder. Between 40%-85% of blepharospasm occurs in conjunction with dry eye symptoms. Botulinum neurotoxin (BoNT) injections are commonly used treatment for reducing spasms in blepharospasm. Furthermore, it is often suggested for dry eye therapy due to their ability to reduce lacrimal drainage. The purpose of this review is to assess the effectiveness of BoNT treatment for blepharospasm with dry eye symptoms. Methods : A literature research was conducted on online databases such as PubMed, Cochrane library and Google scholar. All studies of BoNT and dry eye with full-text journals published in English within the last 10 years were included. We assessed Tear Breakup Time (TBUT), Schirmer Test, and Blepharospasm Disability Index (BSDI). Results : 204 patients from 6 publications were analyzed. In five trials, the BoNT treatment statistically significant increased TBUT (p<0,5), with mean final TBUT 5,7 ±1.1 s. Furthermore, the Schirmer test also increased with the mean final score 6,29 ± 4,6 mm. The mean BSDI score dropped by 6,05 ± 3,7 in two studies. Conclusion : It is confirmed that BoNT injection is an effective treatment for essential blepharospasm with dry eye symptoms. Clinicians should be screened for dry eye in all blepharospasm patients prior to BoNT treatment.
Determining The Etiology of Uveitis in Indonesia: The Role of Clinical Manifestation and Serological Test in Infectious Uveitis Anissa, Gisela Haza; Rina La Distia Nora
Majalah Oftalmologi Indonesia Vol 51 No 1 (2025): Ophthalmologica Indonesiana
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/journal.v51i1.101692

Abstract

Introduction: Uveitis is a heterogeneous group of intraocular diseases that significantly causes vision disabilities in patients worldwide. Establishing an etiological diagnosis can be challenging because of the extensive and varied clinical patterns and differential diagnoses across regions. Knowledge of these patterns is crucial in aiding physicians with diagnosis, reducing the need for costly ancillary tests, and facilitating timely management.   Methods: We conducted a retrospective descriptive study using medical records data from a tertiary referral hospital in Indonesia over two years (2016-2017), involving 299 patients with uveitis.   Discussion: Among the 299 patients, 152 were men (152/299, 50.8%) with a median age of 36. Panuveitis was the most frequent anatomical entity (152/199, 53.2%). Infectious etiology, primarily toxoplasmosis and tuberculosis, remained prevalent. Despite various final diagnoses, serological tests for IgG Toxoplasma and CMV were predominantly reactive in 192/251 (76.5%) and 228/236 (96.6%) of tested patients. At presentation, 106/299 (35%) of patients were categorized as blind, and 64/106 (60%) were without improvement. Complications were observed in 167/299 (55%) of patients, including cataracts (133/299, 44%) and glaucoma (32/299, 10%), contributing to 70/106 (66%) of blindness in our series.   Conclusion: Panuveitis and infectious etiology, particularly toxoplasmosis and tuberculosis, were the most common causes of uveitis. Clinical patterns were better able to distinguish them than laboratory results. Understanding these uveitis patterns can guide physicians in diagnosing before performing expensive ancillary tests. Ocular complications were related to severe visual function; thus, timely referral in severe cases is essential.   Keywords: Uveitis, Indonesia, epidemiology
Development and Application of Targeted Multi-plex Polymerase Chain Reaction to Help Diagnose Infectious Uveitis Ethelind, Rachel; Rina La Distia Nora
Majalah Oftalmologi Indonesia Vol 51 No 1 (2025): Ophthalmologica Indonesiana
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/journal.v51i1.101730

Abstract

Introduction: Clinical pattern recognition is paramount in uveitis diagnosis. Pathogen detection from ocular fluid samples is often necessary to support infectious uveitis diagnosis, particularly in cases presenting with atypical clinical appearance. This study aims to present the process of developing targeted multiplex PCR and evaluate its application in infectious uveitis diagnosis.   Methods: This was a cross-sectional study to evaluate the diagnostic performance of targeted multiplex PCR in infectious uveitis. We obtained ocular fluid samples and reviewed medical records of uveitis patients who underwent ocular fluid analysis at Cipto Mangunkusumo Hospital from February 2022 to March 2023. PCR detection threshold values (DNA copies/mL) were 10.9 for Mycobacterium tuberculosis (Mtb), 672 for Epstein-Barr virus (EBV), 4.77 for Cytomegalovirus (CMV), 6.37 for Toxoplasma gondii (T. gondii), and 5.53 for Herpes simplex virus (HSV). With multiple pathogen selection, this method requires a lower volume of samples than single-plex PCR, as the latter will increase the sample volume linearly with each additional pathogen tested.   Discussion: Forty-seven aqueous or vitreous samples were analyzed. The positivity rate was 23.4% (11/47) with Mtb yielding the highest positivity (7/41; 17.1%). With final diagnosis as a reference, targeted multiplex PCR resulted in 32.3% (95% CI: 16.7 – 51.4%) sensitivity, 93.8% (95% CI: 69.8 – 99.8%) specificity, 90.9% (95% CI: 58.4 – 98.6%) positive predictive value, and 41.7% (95% CI: 35.2 – 48.4%) negative predictive value.   Conclusion: With its high specificity, targeted multiplex PCR is useful as a confirmatory but not screening tool in uveitis diagnosis. Ocular fluid analysis is an important part of the stepwise diagnostic approach in uveitis.
Affordable HLA-B27 Detection in Resource-Limited Settings: Evaluating Conventional PCR for Uveitis and Spondyloarthropathy in Indonesia Nora, Rina La Distia; Edwar, Lukman; Susiyanti, Made; Aziza, Yulia; Putera, Ikhwanuliman; Sifyana, Ulifna Alfiya; Riasanti, Mei; Waliyuddin, M Zakiy; Wibawa, Maria Valentina; Ethelind, Rachel; Widodo, Erica; Sitompul, Ratna
Majalah Oftalmologi Indonesia Vol 52 No 1 (2026): Ophthalmologica Indonesiana
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/oi.v52i1.102039

Abstract

Introduction: HLA-B27 is a genetic marker strongly associated with spondyloarthropathy (SpA) and acute anterior uveitis (AAU). Detection of this allele can support earlier diagnosis and targeted management. However, commercially available HLA-B27 tests are costly and often inaccessible in low- and middle-income countries, including Indonesia. Methods: A cross-sectional study was conducted involving 42 subjects: 14 with SpA, 19 with AAU, and 9 healthy controls. DNA was extracted from peripheral blood samples and analyzed using both conventional PCR (targeting exon 3 of HLA-B27) and a commercial HLA-B27 strip assay. Sensitivity, specificity, and diagnostic accuracy of conventional PCR were calculated against the commercial kit as the reference standard. Results: Conventional PCR showed high sensitivity (100%) and accuracy (85.71%) in SpA patients, indicating its potential as a reliable screening tool in this group. However, its performance in AAU patients was suboptimal, with lower sensitivity (40%) and specificity (55.56%). False positives and false negatives were observed, likely due to limitations in allele coverage by conventional primers. Conclusion: Conventional PCR is a promising, affordable alternative for HLA-B27 detection in SpA patients, particularly in resource-limited settings. However, its lower reliability in AAU cases highlights the need for careful clinical application and further optimization. Larger studies and local allele mapping are recommended to enhance diagnostic precision in diverse populations.
Karakteristik Klinis dan Kesintasan Keratoplasti Tembus Optik di Layanan Tingkat Tersier di Indonesia: Studi Retrospektif 4 Tahun Syska Widyawati; Tjahjono D. Gondhowiardjo; Rina La Distia Nora; Yulika Harniza; Cut Putri Samira; Ivana Beatrice Alberta
Majalah Kedokteran Indonesia Vol 72 No 6 (2022): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.72.6-2022-785

Abstract

Introduction: Purpose, to evaluate patient demographic characteristics, indications and variables related to penetrating keratoplasty (PK) survival. Study design, this study was retrospective case series. Methods: We trace all medical records of PK patients from 2015 to 2018 in Cipto Mangunkusumo Hospital Jakarta. The traced variables were indications of surgery, corneal vascularization, previous failed graft, glaucoma after PK, and other complication. PK survival rate is shown in the Kaplan Meier curve using SPSS v20.0. Results: A total of 214 patients underwent PK (men 67.3%, woman 32,7%) with mean age of 42.11 (0-85) years were included in this study. Three most common indications of keratoplasty were corneal scar (32.7%), infectious corneal ulcer (25.5%), and failed graft (19.2%). The overall graft survival rate for PK is 61.7%. The mean graft survival time was 14.388 ± 0.580 months (95% CI; 13.252-15.524). Conclusion: The graft survival rate for penetrating optic keratoplasty was 61.7%. Establishing an appropriate early diagnosis, reasonable surgical procedures, close monitoring, and early detection of complications with proactive interventions lead to better outcomes. Further research is needed to determine the relationship between the risk factors for corneal graft failure.
Peripheral Lesion Finding Discrepancies between Ultra-Widefield and Simulated 50° Fluorescein Angiography in Uveitis Rina Wulandari; Rina La Distia Nora; Lukman Edwar
International Journal of Retina Vol 9 No 1 (2026): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2026.vol009.iss001.238

Abstract

Introduction: With the advance of ultra-widefield fundus imaging, its usefulness for fluorescein angiography study compared to the conventional (50°) for uveitis management is not fully studied. We aimed to compare ultra-widefield fluorescein angiography (UWFFA) and simulated conventional (50°) FA in terms of peripheral fundus findings and its correlation with clinical activity and therapeutic decision changes in uveitis cases. Methods: We performed a descriptive retrospective study in uveitis patients who underwent UWFFA (Optos P200DTx California) in March-May 2021. We compared the presence of peripheral abnormalities between UWFFA images and its simulated 50° FA. We correlated them with clinical uveitis activities and therapeutic decision changes by two uveitis experts. Results: We included 12 uveitis patients and found that 44.4% of peripheral vascular leakage, 83.3% of the peripheral lesion, and 100% of peripheral neovascularization in UWFFA were missed in simulated 50° FA. From 5 clinically inactive patients, 4 out of 5 were assessed as active uveitis on simulated 50° FA interpretation, and all the inactive patients were active uveitis based on UWFFA. 1 out of 12 had a diagnosis and therapeutic changes after UWFFA. Conclusions: We found more peripheral findings in UWFFA than in conventional ones. This discrepancy could alter clinical activity and therapy decisions, and long-term studies are needed to assess the clinical benefit.
Co-Authors Andi Marsa Nadhira Anissa, Gisela Haza Aziza, Yulia Cut Putri Samira Dearaini dr. Muthia Despi Utami Eduard Jordi Luminta Ethelind, Rachel Ikhwanuliman Putera Irma Suwandi Sadikin Ivana Beatrice Alberta Lia Amanda Lukman Edwar Made Susiyanti Ratna Sitompul Regina Ivanovna Riasanti, Mei Rina Wulandari Sifyana, Ulifna Alfiya Tjahjono D. Gondhowiardjo Waliyuddin, M Zakiy Wibawa, Maria Valentina Widodo, Erica Widyawati, Syska Yulia Aziza Yulika Harniza