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SITA PARAMITA AYUNINGTYAS
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Health Professions Medicine & Pharmacology Public Health

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Uncover the Hidden Veils: Ophthalmoplegia in Breast Cancer: Poster Presentation - Case Report - Ophthalmologist SITA PARAMITA AYUNINGTYAS; Syntia Nusanti; Salmarezka Dewiputri; M. 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/dcgyvr90

Abstract

Abstract Introduction : Breast cancer can metastasize to many sites, but the orbit is an infrequent location. Orbital metastases represent 1%–13% of all orbital tumors, and the prognosis is rather poor. We reported a case of orbital metastases of breast cancer that led to findings of other sites involvement. Case Illustration : A 50-year-old female presented with an inward squint and double vision for 9 months before admission. Esotropia, abduction, and elevation deficits in both eyes were observed. The visual acuity of both eyes was 6/6. Orbital MRI revealed an intraconal irregular lesion near the medial rectus muscle, which was hyperintense with contrast and thickened medial rectus muscles of both eyes. She underwent lumpectomy of breast mass two years before admission and no follow-up after surgery. Histopathology showed invasive lobular carcinoma (ILC). We referred her to hematologist- oncologist to have workup on metastases and treatment. Lung and extensive bone metastases were discovered. She was diagnosed with metastatic breast cancer (stage IV) and treated with hormonal therapy and bisphosphonates. On 3-month follow-up, diplopia and gaze limitations persist. Discussion : Diplopia and motility disturbances are the most common symptoms and signs of orbital metastases, including extraocular muscle involvement. The horizontal rectus muscles are more commonly involved. ILC is more frequent histological subtype involving orbital as the orbits are rich in fat and may attract disseminated ILC cells. Conclusion : Ocular symptoms in patients with a history of breast cancer should always be investigated for metastatic disease. A multidisciplinary approach is mandatory to achieve the best therapeutic management and long-term surveillance.
Terson Syndrome: A Rare, Treatable Visual Loss After Subarachnoid and Intraventricular Hemorrhage: Poster Presentation - Case Report - Resident DITA PERMATASARI; SYNTIA NUSANTI; MUHAMMAD SIDIK; SALMAREZKA DEWIPUTRI; SITA PARAMITA AYUNINGTYAS
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/af396t72

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Abstract Introduction : Intracranial pathologies commonly affect vision through optic neuropathy. However, visual loss could be due to vitreous hemorrhage as in Terson syndrome. This report warns us rare cases of visual loss after intracranial hemorrhage that requires totally different management than more commonly found optic neuropathies. Case Illustration : Female, 46 years old, had a severe headache and decreased consciousness two days later. CT angiography revealed wide subarachnoid hemorrhage and intraventricular hemorrhage causing hydrocephalus. She received emergency lumbar drainage followed by digital subtraction angiography and flow diverter device. Postoperative she regained consciousness, CT scan showed reduced ventricular size without residual hemorrhage, yet visual acuity of left eye reduced to hand movement and did not improve until one month later. Ophthalmologic examination showed vitreous hemorrhage of the left eye. Right eye was normal. Vitrectomy was planned to clear the vitreous hemorrhage. Discussion : Terson syndrome is intraocular hemorrhage associated with subarachnoid hemorrhage, cerebral hemorrhage, or traumatic brain injury. The proposed mechanisms were transmission of subarachnoid blood to the optic nerve sheath and rapid effusion of cerebrospinal fluid into the optic nerve sheath due to sudden increase of intracranial pressure. It compresses central retinal vein, causing vascular rupture. The manifestations could be vitreous, subhyaloid, subretinal, or intraretinal hemorrhage. Visual prognosis is good in those resolved spontaneously or receiving vitrectomy in nonresolving cases. Conclusion : Visual loss from intracranial hemorrhage or trauma could be caused by intraocular hemorrhage. It deserved different management than optic neuropathies. Prompt recognition should improve the management and the prognosis of rare cases such as Terson syndrome.
Progressive Bilateral Ptosis in Adduction Deficit: True Internuclear Ophthalmoplegia (INO) or Pseudo-INO? Poster Presentation - Case Report - Resident MARSHA RAYFA PINTARY; Salmarezka Dewiputri; Annisa Nindiana Pertiwi; Syntia Nusanti; Sita Paramita Ayuningtyas; Mohamad 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/stqqd995

Abstract

Abstract Introduction : Bilateral INO is a rare disease caused by a lesion in the medial longitudinal fasciculus (MLF) in the pons, resulting in adduction deficit. Progression to ptosis is rare and may confuse with pseudo-INO as in ocular myasthenia gravis (OMG). This case aims to report progressive ptosis in bilateral INO that mimics pseudo-INO. Case Illustration : A 36-year-old woman complained sudden binocular diplopia 4 days before admission. Bilateral adduction deficits (-3 and -2 of right and left eye, respectively) with nystagmus were seen. There was no ptosis. The patient was diagnosed with bilateral INO. One month later, the patient returned with bilateral ptosis. The marginal reflex distance 1 (MRD1) were 0 on both eyes. Post fatigue and ice pack test showed 2mm difference of MRD1. The single fiber electromyography (EMG) result came out negative with jitter <10%. Brain MRI revealed lesions in the posterior pons and periaqueductal on the level of midbrain. Discussion : The MLF controls 6th and contralateral 3rd cranial nerve nucleus for horizontal gaze. Ptosis in INO can occurred due to central caudal subnucleus involvement in midbrain that innervates levator palpebra. The result of fatigue and ice pack test may be misleading, as those are not pathognomonic for OMG. The single-fiber EMG are valuable modalities to exclude pseudo-INO in this case. Conclusion : Progressive bilateral ptosis may occur in bilateral INO. Fatigue and ice pack test may give false- positive results leading to confusion with pseudo-INO, rather than true INO. Supporting examinations are needed to confirm the diagnosis.
Co-Authors Annisa Nindiana Pertiwi Dita Permatasari M. Sidik Marsha Rayfa Pintary Mohamad Sidik Muhammad Sidik Salmarezka Dewiputri Syntia Nusanti