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All Journal Ophthalmologica Indonesiana
Andi Marsa Nadhira
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Health Professions Medicine & Pharmacology Public Health

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Managing Periorbital Necrotizing Fasciitis: How Invasive Should We Go? Poster Presentation - Case Report - Resident Andi Marsa Nadhira; Lia Amanda; Muhammad Shafiq Advani; Lukman Edwar
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: 10.35749/0yb71086

Abstract

Introduction : Periorbital necrotizing fasciitis (PNF) is rapidly progressive and severe infection that may result in vision loss, serious facial disfigurement, and death. Primary management includes surgical debridement; however, here we report a case in which conservative approach resulted in favorable resolution. Case Illustration : A 24-year-old male presented with swollen right upper eyelid, with watery eye, pain, and blurry vision since 1 week prior. No history of trauma or known systemic diseases was reported. Restricted movement of the right eye (RE), slight nonaxial proptosis, and skin defect along the right superior palpebra with pus, blood, necrotic and granulation tissues were found. Visual acuity (VA) of RE decreased to 6/40 with normal intraocular pressure. No abnormalities on the left eye, fever, and other signs of systemic involvement were present. Contrast orbital computed tomography (CT) scan revealed right preseptal and postseptal tissue lesions, suggesting orbital cellulitis. Initial blood work showed leukocytosis, elevated neutrophil and lymphocyte counts, and high liver function markers. The diagnosis of right orbital cellulitis with PNF was established. Skin swabs and blood cultures were taken, while intravenous ampicillin-sulbactam, bedside wound debridement, and chloramphenicol ointment application were initiated. The swab culture later showed Acinetobactersp. The infection improved, VA was restored to 6/6, and wound closure was achieved without any surgery. Discussion : Management of necrotizing fasciitis localized in periorbita in an otherwise healthy patient may be successfully accomplished with a less invasive approach. Conclusion : Timely diagnosis and correct antibiotic therapy are mandatory to decrease morbidity and mortality related to PNF.
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.
Navigating Through The Diagnostic and Management Maze of Atypical Optic Neuritis Due To Autoimmune: Poster Presentation - Case Report - Resident Andi Marsa Nadhira; Syntia Nusanti; Salmarezka Dewiputri; Sita Paramita; Muhammad Sidik
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/ym9gge17

Abstract

Abstract Introduction : Typical and atypical optic neuritis (ON) have many overlapping characteristics; however, atypical ON have different features, with more lasting visual impairment and devastating prognosis. This paper describes a challenging case of recurrent, atypical ON due to autoimmune. Case Illustration : 42-year-old female complained of recurrent attacks of bilateral blurry vision, eye pain, and headachefor the past two years. Patient had been on multiple rounds of high-dose oral methylprednisolone, but symptoms reappeared every time it was tapered down. Visual acuity of both eyes was 3/60 and 6/45 (without and with correction, respectively), with normal intraocular pressure, anterior and posterior segment, and cranial nerves. No relative afferent pupillary defect was present. Brain magnetic resonance imaging (MRI) revealed intracerebral chronic small vessels; with no lesion in both optic nerves nor signs of neuromyelitis optica. Blood work-up showed elevated C-reactive protein, platelet aggregation, fibrinogen, D-dimer; positive rheumatoid factor, antinuclear antibody, and lupus anticoagulant; and negative Aquaporin-4 IgG. Diagnosis of atypical ON was established. Internal medicine and neurology departments diagnosed her with non-radiographic axial spondyloarthritis and migraine due to attributed autoimmune, respectively. After administration of intravenous pulse dose of methylprednisolone, her vision recovered to 6/7,5 of both eyes and symptoms alleviated. Discussion : Atypical features usually give hints for atypical ON, while laboratory examination and imaging modalities may aid in etiology identification. Early immunosuppressant therapy is commonly required. Conclusion : Recognizing symptoms of ON and necessitating further evaluation through ancillary tests, and collaborations with other specialties can minimize long-lived ailment and improve patients’ quality of life.
Co-Authors Lia Amanda Lukman Edwar Muhammad Shafiq Advani Muhammad Sidik Rina La Distia Nora Salmarezka Dewiputri Sita Paramita Syntia Nusanti Yulia Aziza