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Nazhira Janani
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Health Professions Medicine & Pharmacology Public Health

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A Rare Case of Congenital Bilateral Upper Eyelids Ectropion in Down’s Syndrome : Conservative or Operative? Poster Presentation - Case Report - General practitioner Mischka Scalvinni Suvero Suyar; Nazhira Janani; Ferdian Ramadhan; Balgis Desy Sulistyowati
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/wkk9y007

Abstract

Introduction : Congenital upper eyelids ectropion, is a very rare congenital condition characterized by everted upper eyelids associated with Ichthyosis, Blepharophymosis Syndrome, birth trauma and prominently appears in Down’s syndrome. This case aimed to report a rare case of congenital ectropion in an Down’s syndrome with further management considerations, conservative or operative. Case Illustration : A three-month-old baby with bilateral red upper eyelids swelling since birth with conjunctival swelling followed by yellowish discharge. Born through section caesarean from a mother with history of pre-eclampsia and being incubated for 24 days. Ophthalmic examination revealed bilateral upper eyelids eversion, minimal conjunctival chemosis, epicantal fold. The upper eyelids able to be repositioned in relaxed state and re-everted with forced lid closure. Treatment of the eyelids eversion was conservative, combining antibiotics, topical steroids and lubricants. We referred to the pediatrician for the management of Down’s Syndrome, the further management for the eyelids eversion still debatable. Discussion : Most infants with congenital ectropion showed excellent anatomic and functional results with conservative treatment if managed timely and promptly. However, infants with Down’s syndrome have a more complicated course due to complex periorbital anatomy and facial anomalies such as flattened face, almond shaped eyes and large nose’s bridge. If congenital ectropion accompanied by lagophthalmos and exposure keratopathy, surgical management should be considered. Conclusion : Congenital eyelids ectropion can be managed conservatively or surgically depend on the clinical courses. Mild case able to be managed conservatively with excellent results if managed timely but surgical management supposed to be considered in complicated case.
Herpes Zoster Keratouveitis : Are We Late in Dealing with It? Poster Presentation - Case Report - General practitioner Nurul Akla; Ferdian Ramadhan; Nazhira Janani
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: 10.35749/8tp5p854

Abstract

Introduction : Herpes zoster ophthalmicus (HZO) is the viral involvement of the ophthalmic division of the trigeminal nerve. The ocular disease affects approximately 50% of HZO cases and is an ophthalmologic emergency due to the risk of vision loss if not quickly treated. This case reports the ocular complication resulting from delayed management of herpes zoster. Case Illustration : A 25-year-old woman presented with the decreased vision for one week. Physical examination revealed erythema, crusts, and multiple vesicles in the upper quadrant of the left face, with a positive Hutchinson sign. Ophthalmic examination showed a visual acuity of 0.6 on the left, with ciliary injection, a multiple dots pattern, and stromal edema in the left eye. Fine and fibrillar keratic precipitates were also present. The patient had previously received oral acyclovir 5x400 mg/day for five days after the onset of symptoms. The patient was given oral acyclovir 5x800 mg/day, amitriptyline 25 mg PO/day, homatropine ED 1 gtt/day, ofloxacin ED 4 gtt/day, Prednisolone acetate ED 4 gtt/day for the left eye. Discussion : Early management of HZO within 72 hours of rash onset is optimal. The Hutchinson sign, characterized by herpetic lesions around the nose tip, indicates nasociliary branch involvement and increases the risk of ocular involvement. Delayed or inadequate treatment can lead to various ocular complications. The prognosis is unpredictable and dependent on long-term sequelae. Conclusion : HZO keratouveitis, can result in stromal scarring or endothelial dysfunction, potentially requiring surgery if therapy is inadequate. Early recognition of ocular involvement is crucial to prevent complications and increase practitioner awareness.
Chiari I Malformation Presenting Vertical Gaze-Evoked Nystagmus : A Case Report: Poster Presentation - Case Report - General practitioner Mischka Scalvinni Suvero Suyar; Nazhira Janani; Ferdian Ramadhan; Balgis Desy Sulistyowati
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/r6k69294

Abstract

Abstract Introduction : Chiari malformation is characterized by herniation of posterior cerebellar vermis in which type 1 malformation has coexisting syringomyelia of cervicothoracic spinal cord. This malformation can be congenital or acquired, in which gaze-evoked nystagmus is the typical movement deficit. This case aimed to report a case of vertical gaze-evoked nystagmus as a primary symptom to detect Type I Chiari Malformation. Case Illustration : A 44-year-old woman presented with involuntary movements of both eyes in the last 5 months with vision problems in which objects appear to jump or vibrate. Visual acuity was 20/50 in both eyes with 12 prism diopters BI exotropia. We recognized vertical and torsional nystagmus in upgaze without any movement in primary gaze. While performing supraduction, the oscillation was detected and increased. Brain MRI revealed Type I Chiari Malformation. Discussion : Nystagmus was seen in many diseases of the central nervous system, in particular those affecting the brainstem and cerebellum. Vertical gaze evoked nystagmus was a disorder of the gaze holding function, purely vertical gaze-evoked nystagmus is observed in midbrain lesions involving the interstitial nucleus of Cajal (INC) as the neural integrator for vertical gaze-holding function. Based on this pathophysiology, the Brain MRI of this patient revealed some degrees of compression in midbrain, and cervico medullary junction due to her brain malformation. Conclusion : A sustained gaze-evoked nystagmus is an important ocular finding that may indicate serious neurologic pathology. It is important for an eye care provider to thoroughly examine additional tests to determine the underlying cause of the nystagmus.
Co-Authors Balgis Desy Sulistyowati Ferdian Ramadhan Mischka Scalvinni Suvero Suyar Nurul Akla