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All Journal Majalah Kedokteran Bandung Jurnal Medika Malahayati Ophthalmologica Indonesiana
Sugiarti, Emmy Dwi
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Ocular Manifestation In Marfan Syndrome: A Case Report Wicaksana, Muhammad Akbar; Sugiarti, Emmy Dwi
Jurnal Medika Malahayati Vol 8, No 3 (2024): Volume 8 Nomor 3
Publisher : Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jmm.v8i3.14525

Abstract

Sindrom Marfan adalah gangguan kongenital autosomal dominan yang memengaruhi jaringan ikat dalam beberapa sistem. Kelainan pada protein fibrilin-1 dapat menyebabkan kelainan dalam beberapa sistem. Tujuan laporan ini adalah untuk mendokumentasikan manifestasi klinis pada pasien sistem okular dan tatalaksana pasien dengan sindroma marfan. Seorang pria berusia 26 tahun datang ke Rumah Sakit Mata Cicendo, dirujuk dari Unit Kardiologi di Rumah Sakit Hasan Sadikin, dengan keluhan utama penglihatan kabur sejak sekolah dasar. Saat pemeriksaan fisik, subluksasi lensa teramati di kedua mata terutama saat dilatasi pupil. Evaluasi biometrik mengungkapkan kornea yang relatif datar dengan panjang aksial yang panjang. Tajam penglihatan pasien membaik dengan kacamata. Pasien diberikan kacamata dan diberi edukasi tentang sifat progresif penyakit dan risiko pewarisan penyakit. Tidak semua pasien dengan sindrom Marfan yang mengalami gejala okular memerlukan intervensi bedah. Terapi non-bedah dapat membantu pasien mencapai ketajaman visual yang layak. Evaluasi sistemik dapat membantu pasien memahami dan mitigasi penyakit.
Comparison of Phaco-Chop versus Stop-and-Chop Nucletomy Techniques in Patients with Soft to Moderate Nucleus Cataracts Budiman, Budiman; Knoch, Andrew M. H.; Sugiarti, Emmy Dwi; Tjokrovonco, Ludwig Melino
Majalah Kedokteran Bandung Vol 56, No 2 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v56.3184

Abstract

Various phacoemulsification techniques are commonly used, with phaco-chop and stop-and-chop techniques as the most popular ones. Phacoemulsification inevitably leads to endothelial cell destruction, which, in severe cases, might result in vision impairment. This study aimed to compare endothelial cell characteristics between two phacoemulsification procedures, phaco-chop, and stop-and-chop, in patients with soft to moderate nucleus cataracts. This study was conducted on 142 patients at the National Eye Center of Cicendo Hospital between April and August 2018. Of those, 66 patients underwent the phaco-chop technique, while 76 patients underwent the stop-and-chop technique. Intraoperative parameters such as effective phaco time (EPT), phaco time, average power, and duration were recorded. Endothelial density, hexagonality, coefficient of variation (CV), and central cornea thickness (CCT) were also recorded before surgery, as well as one week and four weeks after surgery. Mean power, EPT, phaco time, and duration in the phaco-chop group were significantly lower than in the stop-and-chop group. Mean (SD) endothelial density at one-week and four-week evaluation in the phaco-chop group were considerably lower than in the stop-and-chop group (p-value=0.024 and p-value=0.000, respectively). Mean (SD) CV at one-week evaluation in the phaco-chop group was significantly higher compared to a stop-and-chop group, 43.3 (8.0) versus 40.0 (6.7) % (p-value=0.009). Mean (SD) hexagonality at four-week evaluation in the phaco-chop group was significantly higher compared to a stop-and-chop group (43.1 (17.6) versus 48.7 (13.2) respectively, p-value=0.045). Phaco-chop technique have significantly lower EPT, average power, phaco time, and surgery duration than stop-and-chop techniques at one-week and four-week evaluation after phacoemulsification.
Secondary Piggyback Intraocular Lens for Correcting Refractive Surprise Post Silicone Oil Removal: Poster Presentation - Case Report - Resident Juanarta, Pieter; Knoch, Andrew M.H.; Budiman; Sugiarti, Emmy Dwi; Tjokrovontjo, Ludwig Melino
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: 10.35749/03djjh28

Abstract

Introduction : Pseudophakic refractive error can be caused by IOL malposition and inaccurate biometric examination. Treatment consists of IOL exchange, refractive laser correction, and secondary piggyback IOL. Secondary Piggyback IOL consist of customized IOL implantation on ciliary sulcus. Case Illustration : A Male, 62 years old, complains of blurry right eye. He underwent retinal surgery with silicone oil tamponade surgery 5 years ago and underwent silicone oil evacuation, phacoemulsification, and intraocular lens implantation one year later. The visual acuity of the right eye was 1/60 with BCVA of 0.2. He was diagnosed with Pseudophakia of both eyes and Hypermetropia Surprise of the right eye. He was planned to undergo piggyback intraocular lens implantation in the right eye (Figure 1). The visual acuity one week after operation of the patient's right eye was 0.32 (Figure 2). Discussion : Biometric examination in eye with silicon oil tamponade have longer axial length, causing pseudophakic refractive errors. Treatments consist of IOL replacement, refractive laser correction, and piggyback IOL implantation. IOL replacement has a high risk and requires quite high operator skills. Refractive laser correction is performed in small refractive errors. Piggyback IOL implantationis easier, safer, have more accurate IOL power, and reversible. Conclusion : Power of the intraocular lens is influenced by axial length, keratometry reading, lens thickness, and other parameters. Axial length measurement in patients with silicone oil tamponade requires greater accuracy to prevent pseudophakic refractive errors. IOL Piggyback implantation procedure is an alternative in person that can’t undergo laser correction or IOL exchange.
Ab Externo Scleral-Fixated Intraocular Lens As A Management in Aphakic Eye: Poster Presentation - Case Report - Resident Sudjana, Briska; Knoch, Andrew M.H.; Budiman; Sugiarti, Emmy Dwi; Melino, Ludwig
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: 10.35749/435khp24

Abstract

Introduction : Varied technique of secondary intraocular lens (IOL) implantation are exist. Scleral-fixated IOL implantation become popular both with or without sutures. The one of sutures technique is ab externo Case Illustration : A 68 year old man came with blurry vision on left eye (LE) since one month ago. He had history of primary angle closure suspect and posterior subcapsular cataract on LE and managed with Intracapsular Cataract Extraction in January 2021. Ophthalmology examination of LE revealed uncorrected visual acuity (UCVA) 1/60, irregular updrawn pupil with diameter 7.4mm x 5.3 mm, and aphakic lens. The best corrected visual acuity (BCVA) with S+12.00 C-0.75 x 80 was 0.4f. The patient underwent secondary IOL by using 3 pieces IOL with ab externo scleral- fixated on his left eye (Figure 1). Power IOL determined was +24.00 diopter with target of refraction was emmetropia. One day postoperatively, the UCVA was 0.08 pinhole 0.125 with good centration of scleral fixation IOL. First month postoperatively, BCVA with S-1.75 C-1.00 x 50 was 0.4 on snellen chart. Discussion : Aphakia with inadequate capsular support can be seen in several conditions. Technique of introducing two suture loops for scleral fixation of an IOL by ab externo procedure, which proved safe and effective. Scleral fixation of IOL in the posterior chamber, although technically demanding, allows good visual outcomes. Conclusion : Ab externo scleral-fixated IOL implantation is an effective rescue procedure for eyes with deficient capsular support.
INTRAOCULAR LENS EXCHANGE PROCEDURE AS A MANAGEMENT FOR INTRAOCULAR LENS DISCOLORATION: Poster Presentation - Case Report - Resident Arrizasyifaa, Raden Muhammad Tanri; Sugiarti, Emmy Dwi; Tjokrovonco, Ludwig M.; Knoch, Andrew MH.; Budiman
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/a8c7tp70

Abstract

Introduction : Intraocular lens (IOL) discoloration is a rare complication of cataract surgery. It may result in severe visual function impairment and potentially lower the patient's quality of life. IOL exchange is an unusual procedure as the incidence rate was 2 per 1000 surgeries over 8 years. It is the surgical procedure of choice for symptomatic IOL discoloration. Case Illustration : A 50-year-old man came to the hospital complaining of a right eye blurry vision for the previous two months. His right eye had undergone cataract surgery seven years earlier. After having cataract surgery, the patient's vision was clear, but five years later, it began to feel blurry and glare. The patient has a history of well-controlled type II diabetes and hypertension. An intraocular lens discoloration was discovered after a careful examination of the eye (figure 1). For his right eye, the patient underwent an IOL exchange procedure (figure 2). A square-edge single-piece foldable IOL was obtained from the surgery. Follow-up examinations after surgery revealed an improved visual function and a clear intraocular lens (figure 3). Discussion : IOL discoloration may occur years after surgery. It is related to the type of IOL, local ocular factors, and the patient's systemic condition. The IOL exchange procedure consists of IOL extraction and secondary IOL implantation. The extraction can be done by cutting, splitting (bisecting), or folding the IOL. Different methods of fixation can be used for secondary IOL implantation. Conclusion : The IOL exchange procedure can optimally restore visual functions after a severe decline caused by IOL discoloration.
Co-Authors Arrizasyifaa, Raden Muhammad Tanri Budiman Budiman Budiman Juanarta, Pieter Knoch, Andrew M. H. Knoch, Andrew M.H. Knoch, Andrew MH. Melino, Ludwig Sudjana, Briska Tjokrovonco, Ludwig M. Tjokrovonco, Ludwig Melino Tjokrovontjo, Ludwig Melino Wicaksana, Muhammad Akbar