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Structure and Macular Sensitivity Characteristic After Silicone Oil Removal in Primary Rhegmatogenous Retinal Detachment Haryono, Aditia Apriyanto; Widyanatha, Made Indra; Iskandar, Erwin; Kartasasmita, Arief Sjamsulaksan; Virgana, Rova; Ihsan, Grimaldi
Oftalmologi : Jurnal Kesehatan Mata Indonesia Vol 4 No 3 (2022): Jurnal Oftalmologi
Publisher : Pusat Mata Nasional Rumah Sakit Mata Cicendo Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/ojkmi.v4i3.42

Introduction: Silicone oil (SO) is an endotamponade to manage several retinal detachments.The emulsification of silicone oil is one of the complications that may occur in several patients. Retinal macular changes may occur even with successful tamponade. Purpose: to describethe structure and macular sensitivity characteristic after silicone oil removal in primary rhegmatogenous retinal detachment (RRD). Methods: a prospective, descriptive case series study of who underwent SO tamponade for primary RRD. Optical coherence tomography (OCT) and microperimetry (MP-3) were conducted before SO removal and one week after SO removal. Result: There were nine eyes that met the criteria. The mean age of the patients was 53.3±14 years. Most of the patients use silicon 1300 (66.67%) and under six months (77.8%) duration of silicone tamponade. After silicone oil removal, mean macular sensitivity in the central fovea decreased from 12.44 dB to 12.11 dB, and parafovea increased from 18.33 dB to 19.00 dB.The mean macular thickness in the fovea decreased from 269.89μm to 260μm. The mean macular thickness in parafovea was an increase from 316.16 to 328.00μm Conclusion: There was an increase in macular sensitivity and thickness at parafovea after one- week silicone oil removal in primary rhegmatogenous retinal detachment.

Good Results in Open Globe Injury Including Intraocular Foreign Body Widhyasti, Rahayu; Widyanatha, Made Indra; S. Kartasasmita, Arief; Iskandar, Erwin; Virgana, Rova; Ihsan, Grimaldi
Oftalmologi : Jurnal Kesehatan Mata Indonesia Vol 6 No 1 (2024): Oftalmologi: Jurnal Kesehatan Mata Indonesia
Publisher : Pusat Mata Nasional Rumah Sakit Mata Cicendo Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/ojkmi.v6i1.61

Introduction: The second most frequent cause of open globe injury (OGI) is an intraocular foreign body (IOFB), a serious ocular emergency that needs to be diagnosed and treated right once to avoid blindness. It can enter the eye and cause damage later on, resulting in direct harm. When treating post-traumatic endophthalmitis, an urgent pars plana vitrectomy (PPV) procedure helps maximize visual outcome. Case report: A 55-year-old male patient came to the Emergency Room Tertiary Eye Hospital with chief complaints of blurry vision, pain, and red-eye in his right eye 3 days before admission. The patient’s right eye was hit by a fragment of the sickle knife while mowing the grass in the yard without protective eyeglasses. His chief complaints getting worse accompanied by lacrimation. The patient was diagnosed with Open Globe Injury Type C Grade D Pupil B zone 1, suspected early endophthalmitis, traumatic cataract of the right eye, and hypertension. Pars plana vitrectomy, vitreous tap, antibiotic intravitreal injection (with Ceftazidime and Vancomycin), IOFB extraction, explore, corneal scraping on the wound, cultural resistance, primary hecting of the cornea were done. The visual acuity improved and the infection was resolved. The infection was treated, and visual acuity returned after a month. Conclusion: In ophthalmology, IOFB is one of the most frequent traumas and is regarded as an emergency. To identify this problem, a thorough ophthalmology examination and the relevant ancillary testing should be performed. A patient with good care will have a favorable visual prognosis.

Ocular Manifestations of Aplastic Anemia: Rare Case of Anemic Retinopathy Juanarta, Pieter; Ihsan, Grimaldi; Iskandar, Erwin; Kartasasmita, Arief; Virgana, Rova; Indra, Made
International Journal of Retina Vol 8 No 1 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss001.280

Incidence of aplastic anemia was 1-2 cases per million population per years, and showed higher rate in Asia and 10-25 years old. Anemic retinopathy can occur in 28% of patient with severe anemia, especially if accompanied by thrombocytopenia. Most cases were asymptomatic, however decrease visual acuity were also commonly found caused by haemorrhage and Macular edema. A 65 years old female patient came with blurry vision ten days prior admission accompanied with loss of consciousness, recurrent bleeding from nose, gum, and bluish discoloration in her extremities four years ago. Visual acuity was 1/60 on the right eye and 0.4 log on the left eye. Funduscopic examination showed vitreous haemorrhage, dot blot, hard exudate, and tortuosity of vein. Laboratory Examination showed anemia and thrombocytopenia, and peripheral blood morphology showed normochromic anisopoikilocytosis caused by chronic disease. She was scheduled to underwent anti VEGF and showed improvement in her visual acuity after injection. Fundoscopic examination later shows sub-hyaloid haemorrhage, dot blot, hard exudate, and tortuosity of vein. She was scheduled to undergo pars plana vitrectomy and were consulted to internal medicine. Aplastic anemia is a rare disease that usually asymptomatic, thus causing late intervention and a high mortality rate. Early manifestation can be seen in retinal structure as anemic retinopathy thus ophthalmologist have valuable impact in early detection of this disease. Haemorrhage overlying the macula and macular edema is the most common cause of visual impairment. Anti VEGF treatment, transfusion of blood component, and immunosuppressive therapy is needed to prevent complication and increase patient survival rate. Patient visual acuity usually imporved after early transfusion and anti VEGF injection, however delayed intervention may cause irreversible vision loss.

A Rare Case Of Retinal Arterial Microaneurysm: Clinical Features And Diagnostic Insights Yuna, Uray Nabila; Ihsan, Grimaldi; Virgana, Rova; Kartasasmita, Arief S.; Iskandar, Erwin; Widyanatha, Made Indra
Indonesian Journal of Medicine Vol. 10 No. 1 (2025)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2025.10.1.773

Background: In Retinal Arterial Macroaneurysms (RAM), the central retinal artery suffers from acquired focal hypertension. Clinical manifestations of the disease are diverse and easily misdiagnosed. Several imaging modalities may be used in order to confirm the diagnosis of RAM. This article aims to describe the clinical features and method of diagnosis of an uncommon case of retinal artery microaneurysm. Case report: A 57-year-old woman presented with a progressive loss of vision in her right eye months prior. Visual acuity in the right eye was 0.8 log 13. Upon funduscopic inspection of the right eye, firm exudates with low tortuosity and submacular hemorrhage were observed. The right eye’s OCTA revealed a localized expansion and significant constriction with twisted blood vessels on the reverse side of the deformed vessel, while the OCT of the macula revealed submacular hemorrhage. The patient was diagnosed with ruptured retinal Arterial Macroaneurysm or Macular Telangiectasia Type I and Retinopathy Hypertensive Grade II of both eyes, No Diabetic Retinopathy of both eyes with Diabetes Mellitus and Hypertension. The right eye of the patient received concentrated laser photocoagulation and an intravitreal injection of anti-VEGF. Conclusion: RAM is an acquired vascular disease defined by restricted, fusiform, or saccular dilation in the first three arteries of the main retinal artery. Retinal microaneurysms can be diagnosed with various imaging modalities. Ram may be treated with intravitreal anti-VEGF drugs, combination therapy, or laser photocoagulation.

CLINICAL CHARACTERISTICS OF CYTOMEGALOVIRUS RETINITIS IN HUMAN IMMUNODEFICIENCY VIRUS (HIV) PATIENTS UNDERGOING INTRAVITREAL GANCICLOVIR INJECTION effendi, yulia; Widyanatha, Made Indra; Ihsan, Grimaldi; Virgana, Rova; Iskandar, Erwin; Kartasasmita, Arief S
International Journal of Retina Vol 7 No 2 (2024): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2024.vol007.iss002.270

Introduction: Cytomegalovirus (CMV) retinitis is the most common ocular opportunistic infection in patients with Human immunodeficiency virus (HIV). The disease is causing blindness and current management commonly characterized by delayed diagnosis and inadequate treatment. Purpose: to describe the clinical characteristic and visual outcome of CMV retinitis with HIV treated with intravitreal ganciclovir injection. Methods: This is a retrospective study included 23 patients (34 eyes) who presented with CMV Retinitis with HIV from January 2020 to July 2023 who received intravitreal ganciclovir in both the induction and maintenance phases until declared cured, characterized by lesion inactivation and CD4+ T-cell counts reaching >100/µL within period of 3 to 6 months. Data were collected including age, gender, affected eye laterality, CD4+ T-cell count at the initial visit at vitreoretinal polyclinic and the 6-month follow-up, total number of intravitreal ganciclovir injections, HAART history at the initial visit, visual acuity at the initial visit, 6-month follow-up, and systemic comorbidities. Result: The median age was 29 years old with 82,6% of them male. Bilateral lesions were observed in 60.9% of the patients. Median CD4 count initial visit was 50 with 52% below 50 cell/µL. Fifteen patients (65,2%) already treated with highly active antiretroviral therapy (HAART) before injection. Tuberculosis was the most common opportunistic infection. Mean intraviteral ganciclovir injection 9,12±3,40 in each eye. Eleven eyes (32.4%) with initial visual acuity ≤1.00 logMAR increased to 19 eyes (55.9%) at the 6-month follow-up. There were statistically significant difference between baseline visual acuity and 6-months follow up after intravitreal ganciclovir. (p= 0,008). Conclusion: Retinitis cytomegalovirus tend to have more severe clinical presentations in patients with CD4 counts below 50 cells/µL. Intravitreal ganciclovir is effective in controlling CMV retinitis.

Ocular Manifestations of Von Hippel-Lindau Disease: a Rare Sight- Threatening Condition: Poster Presentation - Case Report - Resident Elsyanty, Firda Muthia; Widyanatha, Made Indra; Ihsan, Grimaldi; Virgana, Rova; Iskandar, Erwin; Kartasasmita, Arief S.
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/hc3z9k23

Introduction : Von Hippel-Lindau (VHL) disease is a rare phacomatosis characterized by multi-organ neoplasia which usually manifests in young adulthood. Ocular manifestations of this disease are frequently presented initially before the involvement of other organ systems. Case Illustration : An 18-year-old girl came with a chief complaint of photopsia in the left eye and complete vision loss in the right eye for five years. The visual acuity of the right eye was no light perception and the left eye was 0.8. The anterior segment of the right eye showed iris neovascularization. The posterior segment of the left eye demonstrated multiple elevated red-yellowish lesions fed by a dilated and tortuous vessel. The head CT scan revealed multiple lesions at the pons and cerebellum. The patient was diagnosed with multiple retinal and brain hemangioblastomas due to VHL disease, neovascular glaucoma, and chronic retinal detachment of the right eye due to sequelae of VHL. The patient was treated with cryotherapy and laser photocoagulation of the left eye. Five-month post-cryotherapy follow-up showed the lesions were still active then she underwent the second cryotherapy. The lesions became whitish in appearance with smaller feeder vessels one month after the second cryotherapy and the visual acuity was preserved. Discussion : Retinal hemangioblastoma is the most common ocular manifestation of VHL disease. Prolonged ischemia causes sight-threatening complications including neovascular glaucoma and exudative retinal detachment. Prompt treatment of detected lesions is crucial for visual preservation. Conclusion : Early detection of VHL ocular manifestations plays a critical role in establishing the diagnosis and initiating treatment for a better prognosis.

Complete Resolution of Central Serous Chorioretinopathy Cases Treated with Low Power Mode Laser Technology : A Novel Approach: Poster Presentation - Case Series - Resident Setiawan, Grace; Virgana, Rova; Widyanatha, Made Indra; Ihsan, Grimaldi; Kartasasmita, Arief Sjamsulaksan; Iskandar, Erwin
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/qr43j813

Introduction : Central serous chorioretinopathy (CSC) is an idiopathic condition mostly affecting men in their 20s to 50s. It is characterized by serous fluid accumulation behind the neurosensory retina resulting in a localized macular detachment. Aldosterone-receptor antagonist and photodynamic laser therapy are the current mainstay of treatments, although most CSC cases can resolves spontaneously within 2 to 3 months. Low power mode (LPM) laser has emerged as a new effective technology to treat CSC. Case Illustration : Case 1: A 50-year-old male was diagnosed with recurrent chronic CSC since 2 months ago. His visual acuity declined even after given oral aldosterone receptor antagonist for two weeks, so he was scheduled to undergo LPM. After three weeks of laser treatment, CSC resolved and the visual acuity improved (Figure1). Case 2 : A 47-year-old male complained of decreased vision and metamorphopsia on his right eye since two weeks ago. He was diagnosed with CSC and underwent LPM. Three weeks after LPM, his vision improved and the metamorphopsia resolved (Figure2). LPM helps the migration of retinal pigment epithelium (RPE) cells to restore the outer blood-retinal barrier through expression of heat shock proteins. We used MC-500ViXi laser system (Nidek Co., Gamagori, Japan) and the laser parameters used in this study were 100?m spot size, 0.01s exposure time, 0.25-0.5 spacing, and 30% LPM ratio. Discussion : Conclusion : LPM is a new yet promising treatment modalities to treat acute and chronic CSC. Its low power nature makes LPM a safe choice of treatment with less damage to the surrounding retina.

THE OUTCOME OF INTRAVITREAL BROLUCIZUMAB FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION TREATMENT: Poster Presentation - Case Report - Resident Graziani, Gabriella; Ihsan, Grimaldi; Widyanatha, Made Indra; Virgana, Rova; Kartasasmita, Arief S.; Iskandar, Erwin
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/nvxrf729

Introduction : Age-related macular degeneration (AMD) is a disease that results in irreversible severe loss of central vision in people over 50 years old. Hence, anti-VEGF therapy has become a standard treatment for neovascular AMD. Brolucizumab is a single-chain antibody fragment that inhibits VEGF-A binding to VEGF receptors. It has a higher molar concentration that allows a greater reduction in the central subfield thickness (CST) Case Illustration : A 59-year-old male with a chief complaint of gradually blurred vision in the left eye for 2 years. BCVA of the left eye was 0.3, OCT showed a hyperreflective band in the sub-neurosensory space with subretinal fluid in the left eye (Figure 1), and OCT-A revealed choroidal neovascularization (Figure 2). The patient was diagnosed with AMD AREDS IV in the left eye. He had undergone three monthly injections of brolucizumab. BCVA of the left eye after injection improved to 1.0 and OCT imaging showed no subretinal fluid, no intraretinal fluid, and no pigment epithelial detachment. Discussion : Brolucizumab has a greater reduction in CST because of its high molecular concentration. Results of HAWK and HARRIER concluded that brolucizumab was non-inferior towards aflibercept in BCVA change at week 48. According to the HAWK trial, a greater reduction of CST was seen in week 16 among eyes treated with brolucizumab. Brolucizumab was also well tolerated and adverse event rates were similar to aflibercept. Conclusion : Brolucizumab could be an alternative treatment option considering its efficacy in improving visual acuity and reducing CST.

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