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The Unseen Danger: A Meta-Analysis of Bystander Injuries in Firework-Related Ocular Trauma Rania Ayu Permata Putri Kornia; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1409

Background: Firework-related ocular trauma represents a significant, preventable cause of severe vision loss, with incidence rates peaking during global cultural and national festivals. While the risks to active firework users are well-established, the burden of injury sustained by passive spectators, or bystanders, remains poorly quantified. This study aimed to synthesize global data to define the magnitude of this unseen danger. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, EMBASE, and Web of Science were searched for studies published between January 2015 and December 2025 that reported separable data on firework-related ocular injuries in bystanders and operators. A random-effects model calculated the pooled proportion of bystander injuries. Secondary outcomes included pooled odds ratios (ORs) for open globe injury (OGI) and severe vision loss (SVL; Visual Acuity <3/60). Results: Eleven studies, encompassing 2,440 patients, met the inclusion criteria. This meta-analysis, despite significant heterogeneity in the source data (I² = 89%), suggests that nearly half of all victims were bystanders, with a pooled proportion of 47.5% (95% CI: 41.8%–53.2%). Bystanders had significantly lower odds of sustaining an OGI compared to operators (pooled OR: 0.72, 95% CI: 0.58–0.90). However, the odds of suffering permanent SVL were not statistically different between the two groups (pooled OR: 0.91, 95% CI: 0.73–1.14), indicating a comparable risk of blinding injury. Conclusion: These findings must be interpreted with caution due to high inter-study heterogeneity and unmeasured clinical confounders. Nonetheless, the analysis strongly suggests that the risk to bystanders is unacceptably high and that public health paradigms focused solely on operator safety are insufficient. This study underscores the urgent need for prospective, standardized data collection and a shift in prevention strategies toward protecting passive spectators.

Ocular Parasitoses in the Globally Mobile Population: A Systematic Review of Etiology, Pathophysiology, and Clinical Management Ervan Suryanti Umbu Lapu; I Made Ady Wirawan; I Gusti Ayu Made Julari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1411

Background: The unprecedented scale of global travel has amplified the diagnostic challenge of ocular parasitoses in non-endemic regions. These infections, while rare, can cause severe visual morbidity and are often misdiagnosed. This systematic review synthesizes the current evidence on parasitic eye infections in international travelers to create a comprehensive, state-of-the-art resource for clinicians. Methods: A systematic literature search was conducted in PubMed, Scopus, ProQuest, and the Cochrane Library in accordance with the PRISMA 2020 guidelines. The search included terms for parasitic eye diseases and international travelers. All case reports, case series, and observational studies published in English detailing confirmed ocular parasitic infections in patients with a history of international travel were eligible. Data on demographics, travel, clinical presentation, diagnosis, and management were extracted from all eligible studies, and their methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist. A qualitative narrative synthesis of the findings was performed. Results: From an initial 1,408 records, 19 studies met the full inclusion criteria and were included in the final synthesis. These studies detailed infections from a wide range of helminthic and protozoan pathogens, including Loa loa, Dirofilaria spp., Thelazia callipaeda, Gnathostoma spp., Onchocerca volvulus, Toxoplasma gondii, Trypanosoma cruzi, Acanthamoeba spp., and Taenia solium (cysticercosis). Infections were acquired across Africa, Asia, and the Americas. Clinical presentations were highly diverse, ranging from migrating subconjunctival worms to sight-threatening chorioretinitis, keratitis, and intraocular cysts. Diagnosis consistently relied on a combination of high-magnification biomicroscopy, advanced serological and molecular assays like PCR, and targeted imaging. Management was pathogen-specific, involving microsurgical extraction for accessible helminths and tailored antimicrobial therapy for protozoan and systemic infections. Conclusion: Ocular parasitoses represent a critical diagnostic challenge in returning travelers. A detailed travel and exposure history is the single most important tool to guide the differential diagnosis. Effective management requires a high index of suspicion and a collaborative, interdisciplinary approach to prevent irreversible vision loss.

Optic Neuritis After Viral Vector versus mRNA COVID-19 Vaccines: A Systematic Review and Comparative Meta-Analysis Tiara Alexander; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1412

Background: The global deployment of COVID-19 vaccines, utilizing distinct viral vector and mRNA technologies, has been followed by reports of rare neuro-ophthalmic adverse events, including optic neuritis (ON). This study aimed to systematically compare the clinical phenotypes, autoimmune serological profiles, and visual outcomes of ON cases with onset in temporal association with viral vector versus mRNA COVID-19 vaccination. Methods: A systematic review was conducted across PubMed, Scopus, and EMBASE databases for case reports and case series published up to August 2025 detailing ON after COVID-19 vaccination. Data were extracted on clinical presentation, MRI findings, serostatus for aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) antibodies, treatments, and visual outcomes. Separate meta-analyses of proportions and comparative odds ratios (OR) were calculated for key outcomes, including distinct analyses for NMOSD and MOGAD. Results: Our analysis of published reports included 20 studies, comprising 90 patients (40 viral vector, 50 mRNA). Cases associated with viral vector vaccines had significantly higher odds of presenting with bilateral disease (OR 4.31, 95% CI [1.67, 11.11]). This platform was also associated with markedly increased odds of AQP4-IgG positivity (NMOSD) (OR 5.15, 95% CI [1.35, 19.61]) and MOG-IgG positivity (MOGAD) (OR 4.58, 95% CI [1.09, 19.21]). Consequently, these patients had higher odds of requiring aggressive immunotherapy and of suffering incomplete visual recovery (OR 3.41, 95% CI [1.14, 10.21]). Conclusion: Our analysis of published case reports suggests that while ON following COVID-19 vaccination is a very rare event, its clinical phenotype may differ based on the vaccine platform. Cases associated with viral vector vaccines appear more likely to manifest as a severe, bilateral, antibody-mediated condition characteristic of NMOSD or MOGAD. These findings, which do not establish causality, underscore the critical importance of prompt autoantibody testing to guide appropriate management. The established benefits of vaccination continue to overwhelmingly outweigh the exceptionally low absolute risk of such adverse events.

The Hidden Hazard of Celebration: A Meta-Analysis of Ocular Morbidity from Colored Powder Festivals and Implications for Global Travel Medicine Frangklin Refelino Jotlely; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1417

Background: The globalization of colored powder festivals, such as Holi, has exposed millions, including international tourists, to significant ocular health risks from synthetic industrial dyes that have replaced traditional organic powders. This study was conducted to quantify the prevalence of acute ocular morbidities from these festivals, providing an evidence base to inform clinical practice and public health policy, particularly within travel medicine. Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Google Scholar, ScienceDirect, and ProQuest for observational studies published up to July 2024. Studies reporting ocular complications from colored powder exposure were included. Data were extracted by two independent reviewers, and methodological quality was assessed using JBI checklists. A random-effects model was used to calculate pooled prevalence for key ocular injuries. Heterogeneity was investigated using sensitivity analyses, and publication bias was assessed with funnel plots. Results: Six studies from India, encompassing 189 patients, met the inclusion criteria for quantitative analysis. The patient population was predominantly young males (mean age 20-30 years). The meta-analysis revealed a high pooled prevalence of key ocular morbidities. The prevalence for chemical conjunctivitis was 95% (95% CI: 87%-100%), though with substantial but anticipated heterogeneity (I²=82%). The prevalence for corneal epithelial defects was 37% (95% CI: 23%-53%; I²=45%), and for superficial punctate keratopathy was 75% (95% CI: 57%-90%; I²=0%). Most injuries were bilateral. Conclusion: Participation in colored powder festivals, based on extensive evidence from Holi in India, presents a quantifiable and significant risk of acute ocular morbidity. The high prevalence of chemical-induced ocular surface disease necessitates urgent recognition of this "hidden hazard." Proactive, evidence-based preventive strategies, including tiered recommendations for protective eyewear and updated pre-travel health advisories, are imperative to safeguard the vision of millions of celebrants worldwide.

Ocular Vascular Occlusion Following COVID-19 and Travel Vaccinations: A Systematic Review and Exploration of Immuno-Thrombotic Mechanisms Ni Nyoman Yuniasih; I Made Ary Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1420

Background: Ocular vascular occlusion is a rare, vision-threatening emergency. While typically associated with systemic vascular comorbidities, reports have emerged suggesting a temporal link to various vaccinations. This review aims to synthesize the evidence on ocular vascular occlusion following both COVID-19 and non-COVID travel vaccinations to characterize its clinical spectrum and explore shared pathophysiological underpinnings. Methods: A systematic search adhering to PRISMA 2020 guidelines was conducted in PubMed, Scopus, Cochrane Library, and ProQuest for studies published from January 1st, 2013, to August 1st, 2024. All study designs reporting ocular vascular occlusion temporally associated with COVID-19 or travel immunizations were included. Data on demographics, vaccine type, clinical presentation, and outcomes were extracted. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Joanna Briggs Institute (JBI) checklist for case reports. Results: From an initial 1,348 records, 12 studies met the inclusion criteria, encompassing case reports, series, and large database analyses. These studies described ocular vascular occlusion in individuals aged 15 to 86 years. A significant temporal clustering was observed, with the majority of individual cases occurring within seven days post-vaccination. Central retinal vein occlusion (CRVO) was the most reported subtype. A large retrospective cohort study reported a more than two-fold increased hazard for retinal occlusion post-vaccination compared to unvaccinated cohorts (HR 2.19, 95% CI 1.85-2.59, p<0.001). Both mRNA and adenoviral vector COVID-19 vaccines, as well as various travel vaccines including Zostavax, Yellow Fever, and Meningococcal B, were implicated. Conclusion: This review characterizes a consistent temporal association between a diverse range of vaccines and subsequent ocular vascular occlusion, suggesting it is a rare but potential adverse event. The clustering of onset times and involvement of different vaccine platforms point towards a common underlying immuno-thrombotic mechanism. These findings highlight the need for clinical vigilance for acute visual changes post-vaccination, while underscoring that the absolute risk remains exceedingly low compared to the clear benefits of vaccination.

Lower Body Negative Pressure for Spaceflight Associated Neuro-ocular Syndrome: A Systematic Review and Meta-Analysis Fabiola Supit; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (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.v9i12.1454

Background: Spaceflight associated neuro-ocular syndrome (SANS) is a critical health risk for astronauts on long-duration missions, characterized by potentially vision-altering ocular changes. Lower body negative pressure (LBNP) is a primary countermeasure designed to reverse the foundational cephalad fluid shifts. This study provides the first rigorous, quantitative synthesis of LBNP's efficacy on key SANS-related ocular parameters. Methods: Following PRISMA guidelines, a systematic search of PubMed, ScienceDirect, and the Cochrane Library (2015–2025) was conducted. Studies quantifying the effect of LBNP on intraocular pressure (IOP), optic nerve sheath diameter (ONSD), or choroidal thickness (CT) in microgravity or its ground-based analogs were included. A random-effects meta-analysis calculated the pooled mean difference (MD). Leave-one-out sensitivity analysis and assessment of publication bias were performed to ensure robustness. Results: Seven studies (N=89 subjects) met the criteria. The meta-analysis demonstrated that LBNP application resulted in statistically significant reductions in IOP (MD = -2.15 mmHg; 95% CI [-3.01, -1.29]; p < 0.001), ONSD (MD = -0.31 mm; 95% CI [-0.45, -0.17]; p < 0.001), and subfoveal Choroidal Thickness (MD = -18.50 µm; 95% CI [-25.65, -11.35]; p < 0.001). Subgroup analysis revealed a more pronounced effect in ground-based studies. The results were robust in sensitivity analyses, and funnel plots suggested a low risk of publication bias. Conclusion: This meta-analysis provides robust, quantitative evidence supporting LBNP's efficacy in acutely mitigating the cardinal structural signs of SANS. By directly counteracting the underlying pathophysiology, LBNP is affirmed as a cornerstone countermeasure technology essential for preserving astronaut ocular health during the upcoming era of deep space exploration.

Therapeutic Keratoplasty for Severe, Travel-Associated Fungal Keratitis: A Meta-Analysis of Globe Salvage and Visual Acuity Outcomes Putu Rima Adilitha Widyasari; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (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.v9i12.1457

Background: Severe, travel-associated fungal keratitis represents a formidable diagnostic and therapeutic challenge, often progressing to corneal perforation despite aggressive medical therapy. Therapeutic keratoplasty (TK) is frequently required to preserve globe integrity. However, its efficacy in this specific, epidemiologically distinct cohort of patients remains poorly quantified. This meta-analysis aimed to synthesize the available evidence on globe salvage and visual acuity outcomes following TK for severe fungal keratitis acquired during international travel. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2015 and December 2024, reporting outcomes of TK for travel-associated fungal keratitis. The primary outcome was the proportion of cases achieving globe salvage, defined as the avoidance of enucleation or evisceration. The secondary outcome was the mean improvement in Best-Corrected Visual Acuity (BCVA) measured in LogMAR units. Data were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic. Results: Seven retrospective case series met the inclusion criteria, comprising a total of 102 eyes. The included studies were geographically diverse, with patient travel histories predominantly linked to tropical and subtropical regions in Southeast Asia and South America. The pooled proportion for globe salvage was 89.2% (95% Confidence Interval [CI]: 82.5% to 94.1%). There was low to moderate heterogeneity among the studies for this outcome (I² = 31%, p=0.19). The pooled mean improvement in BCVA from pre-operative assessment to final follow-up was 1.21 LogMAR (95% CI: 0.98 to 1.44). Substantial heterogeneity was observed for the visual acuity outcome (I² = 78%, p<0.001). The most commonly identified fungal genera were Fusarium and Aspergillus. Conclusion: Therapeutic keratoplasty demonstrates a high rate of anatomical success, effectively salvaging the globe in the vast majority of patients with severe, travel-associated fungal keratitis. While visual acuity is significantly improved, the final outcomes remain guarded and are highly variable. These findings underscore the critical role of TK in the management of this sight-threatening condition and highlight the need for strategies to improve post-operative visual prognosis.

Baseline Visual Acuity as an Independent Predictor of Therapeutic Outcomes in HIV-Associated Cytomegalovirus Retinitis: A Three-Year Cohort Study in Indonesia Anak Agung Ayu Putri Prematura Sri Anasary; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (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.v9i12.1464

Background: Cytomegalovirus (CMV) retinitis is a severe opportunistic infection causing irreversible blindness in patients with advanced human immunodeficiency virus (HIV). In the modern era of highly active antiretroviral therapy (HAART), understanding the key determinants of visual prognosis is critical for effective patient management, particularly in resource-limited settings. This study aimed to evaluate the clinical spectrum of CMVR and identify independent predictors of short-term visual outcomes in a cohort of HIV-positive patients in Indonesia. Methods: A retrospective cohort study was conducted on HIV-positive patients diagnosed with CMV retinitis between January 2021 and December 2023 at a tertiary referral hospital in Bali, Indonesia. Data on demographics, clinical features, CD4+ T-cell counts, HAART status, and visual acuity (VA) at baseline and three months were collected. Visual acuity was converted to the Logarithm of the Minimum Angle of Resolution (LogMAR) for analysis. A multivariable linear regression model was employed to identify independent predictors of three-month visual outcomes. Results: The study included 26 patients (38 eyes). The cohort was predominantly male (61.5%) with a mean age of 36.73 years. Severe immunosuppression was common, with 65.4% of patients having a CD4+ count below 50 cells/mm³. Posterior uveitis was the most frequent presentation (68.4%). In the multivariable linear regression analysis, baseline LogMAR VA was the only significant independent predictor of three-month LogMAR VA (β = 0.71, p < 0.001) after adjusting for age, CD4+ count, and HAART status. The baseline CD4+ T-cell count was not a significant independent predictor of visual outcome (p = 0.841). Conclusion: Baseline visual acuity, a direct functional measure of existing retinal damage, is the most powerful independent predictor of short-term visual prognosis in patients with HIV-associated CMV retinitis. This finding highlights the irreversible nature of retinal necrosis and underscores that the opportunity to save sight lies in preemptive action. We advocate for the urgent integration of routine ophthalmological screening into the care protocols for high-risk HIV populations to detect and treat CMVR before significant vision loss occurs.

Baseline Visual Acuity as an Independent Predictor of Therapeutic Outcomes in HIV-Associated Cytomegalovirus Retinitis: A Three-Year Cohort Study in Indonesia Anak Agung Ayu Putri Prematura Sri Anasary; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (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.v9i12.1464

Background: Cytomegalovirus (CMV) retinitis is a severe opportunistic infection causing irreversible blindness in patients with advanced human immunodeficiency virus (HIV). In the modern era of highly active antiretroviral therapy (HAART), understanding the key determinants of visual prognosis is critical for effective patient management, particularly in resource-limited settings. This study aimed to evaluate the clinical spectrum of CMVR and identify independent predictors of short-term visual outcomes in a cohort of HIV-positive patients in Indonesia. Methods: A retrospective cohort study was conducted on HIV-positive patients diagnosed with CMV retinitis between January 2021 and December 2023 at a tertiary referral hospital in Bali, Indonesia. Data on demographics, clinical features, CD4+ T-cell counts, HAART status, and visual acuity (VA) at baseline and three months were collected. Visual acuity was converted to the Logarithm of the Minimum Angle of Resolution (LogMAR) for analysis. A multivariable linear regression model was employed to identify independent predictors of three-month visual outcomes. Results: The study included 26 patients (38 eyes). The cohort was predominantly male (61.5%) with a mean age of 36.73 years. Severe immunosuppression was common, with 65.4% of patients having a CD4+ count below 50 cells/mm³. Posterior uveitis was the most frequent presentation (68.4%). In the multivariable linear regression analysis, baseline LogMAR VA was the only significant independent predictor of three-month LogMAR VA (β = 0.71, p < 0.001) after adjusting for age, CD4+ count, and HAART status. The baseline CD4+ T-cell count was not a significant independent predictor of visual outcome (p = 0.841). Conclusion: Baseline visual acuity, a direct functional measure of existing retinal damage, is the most powerful independent predictor of short-term visual prognosis in patients with HIV-associated CMV retinitis. This finding highlights the irreversible nature of retinal necrosis and underscores that the opportunity to save sight lies in preemptive action. We advocate for the urgent integration of routine ophthalmological screening into the care protocols for high-risk HIV populations to detect and treat CMVR before significant vision loss occurs.

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