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Robby Tumewu
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Health Professions Medicine & Pharmacology Public Health

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Terson’s Syndrome due to Ependymoma: A Rare Case Report: Poster Presentation - Case Report - Resident Priscillia Tondolambung; Robby Tumewu
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/h6a0e355

Abstract

Abstract Introduction : Terson's syndrome is often associated with subarachnoid hemorrhage. Other reported causes, include trauma, tumors, hypertension, perioperative and postoperative intracranial hemorrhage, or increased intracranial pressure. This case demonstrates a unique pathogenesis of Terson's syndrome. Case Illustration : A 14-year-old boy presented with the blurred vision on both eyes 3 weeks ago, accompanied with nausea, vomiting, and headache, with normal blood pressure measurement (126/80mmHg). He also had a history of head injury. His visual acuity was 6/20 uncorrected with pinhole on both eyes. Both intraocular pressures within normal limits. The anterior segment showed bilateral mid-dilated reactive pupil. Funduscopy revealed bilateral papilledema with peripapillary hemorrhage, similar to retinal vein occlusion, which is suggestive with Terson’s Syndrome. Magnetic Resonance Imaging (MRI) scan showed an ependymoma mass. We consulted this case with Pediatric Neurosurgeon, who planned for ventriculoperitoneal shunt with craniotomy tumor removal. Discussion : Terson's syndrome now defined as any intraocular hemorrhage associated with intracranial hemorrhage or elevated intracranial pressures. In this case, the etiology was thought to be increased intracranial pressure, which may be caused by ependymoma. Ependymoma is one of the most common central nervous system tumors in children. Intraocular hemorrhage in Terson’s syndrome is often self-limiting, but ependymoma needs neurosurgical intervention, which has lower survival rates for children with posterior fossa tumors. Conclusion : There are still controversies regarding the pathogenesis of Terson's syndrome. Not the occlusion, but the compression of the central retinal vein, by the increased pressure of cerebrospinal fluid due to high intracranial pressure, which increases the retinal venous pressure and causes retinal hemorrhage.
Bilateral Chronic Papilledema caused by Space Occupying Lesion: A Case Report: Poster Presentation - Case Report - Resident BEATRICE MARIA POLUAN; STEVANUS PALILIEWU; ROBBY TUMEWU
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/vj122y63

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Abstract Introduction : Papilledema is edema of optic disc due to raised intracranial pressure (ICP). Papilledema threatens both life and vision, therefore workup for the etiology of raised ICP is needed, including neuroimaging. Intracranial tumors cause increased ICP leads to papilledema. This case report caseof bilateral chronic papilledema as manifestation of space occupying lesion (SOL). Case Illustration : A 36 years old female presented with blurry black vision on the both eyes since 3 months ago. Complaints were felt suddenly with dominance on the left eye and accompanied with headache. Patient with 12 times history of motorcycle accidents without using helmet in the last 2 years. Funduscopy shows bilateral papilledema. MRI shows orbital within normal limit and solid lobulated mass extra-axial impression in the left posterior parietal region pressing on the left parietooccipital lobe with perifocal edema that obliterates the left lateral ventricle and results in a midline shift to the right. Neurosurgeon had planned for elective craniotomy tumor removal. Discussion : Increase in the total amount of intracranial tissue by SOL as underlying mechanism of raised ICP. SOL often causes intracranial hemorrhage, which frequently leads to papilledema. High ICP also produces a rise in CSF pressure surrounding the optic nerves leading to axoplasmic flow stasis, causing visual loss. High ICP due to SOL is typically treated surgically. Conclusion : This case explain that raised ICP caused by SOL leading to manifestation of papilledema.
Neuromyelitis Optica with Negative AQP-4 Antibody: Poster Presentation - Case Report - Resident Mokolensang Gabriella Olivia; Stevanus Paliliweu; Robby Tumewu
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/gtzbsd89

Abstract

Abstract Introduction : Neuromyelitis Optica (NMO) or neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system that causes demyelination of the optic nerve and spinal cord. Approximately 75% of cases have antibodies against aquaporin 4 (AQP-4 Antibody). Case Illustration : A 42 years old male presented with progressing blurred vision in his right eye for 3 weeks. He described there was a black spot in his central vision which gradually enlarged to his peripheral vision, headache for 4 months, and transient tingling sensation and weakness on the left arm for 1 week. Positive RAPD in the right eye and signs of optic neuritis on funduscopy in Opthalmology examination. Campimetry examination revealed generalized depression in the right eye. The visual evoked potential (VEP) was consistent with right optic nerve demyelination. Spine MRI showed extensive transverse myelitis lesions >3 spinal cord hyperintensity on the level of C2-C6. However, the serum AQP-4 antibody was negative. The patient was treated with corticosteroid, and neuroprotector and was also being treated alongside the neurology department. Discussion : NMO is a rare autoimmune disease. NMO is characterized by segmented demyelination and inflammation of the spinal cord and the optic nerves which gives many ocular signs and symptoms like optic neuritis. A negative test result does not rule out the diagnosis of NMO. Brain and spine MRI plays an important role in diagnosing NMO. Treatment of NMO consists of corticosteroid and plasmapheresis or intravenous immunoglobulin. Conclusion : This case describes a diagnosis of NMO with a Negative AQP-4 antibody.
DIRECT CAROTID CAVERNOSUS FISTULA: Poster Presentation - Case Report - Resident Monica Camilla Chandra; Stevanus Paliliewu; Robby Tumewu; Gilbert Tangkudung
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/n632gc31

Abstract

Abstract Introduction : Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system, most commonly due to head trauma from a basal skull fracture creating a tear in the internal carotid artery (ICA) within the cavernous sinus. Case Illustration : A 15 years old girl presented with orbital pain, swelling, swishing or buzzing sounds, headache, and vision loss. Five months ago, she had a history of traumatic injury and undergone craniotomy. From physical examination Orbital ultrasound presence with dilated superior ophthalmic vein, which appears as a hollow tubular structure with no internal echo. MRI scan show a mass suggestive carotid cavernosus fistula dextra. DSA result confirmed the diagnose as direct carotid cavernosus fistula dextra as communication between internal carotid artery and sinus cavernosus. The patient was treated with neuroprotective along medication followed by endovascular treatment from the neurointervention department. Discussion : The classic triad of CCF includes pulsatile exophthalmos, chemosis and orbital bruit. Ophthalmic manifestations of CCFs vary widely depending on underlying aetiology, type, size, location, blood flow rate and drainage route of the CCF. Patient initially undergo noninvasive imaging with orbital ultrasound and magnetic resonance imaging (MRI). Digital subtraction angiography is the gold standard in the diagnosis of CCF and must be performed before any potential intervention. Conclusion : This case describes a patient who was diagnose with direct carotid cavernous fistula of the right eye.
Co-Authors BEATRICE MARIA POLUAN Gilbert Tangkudung Mokolensang Gabriella Olivia Monica Camilla Chandra Priscillia Tondolambung STEVANUS PALILIEWU Stevanus Paliliweu