Iwan Sovani
Department Of Ophthalmology, Faculty Of Medicine, Padjadjaran University Cicendo National Eye Center, Bandung, West Java

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Giant Retinal Tear Management at Referral Eye Hospital Purnama, Mia; Iskandar, Erwin; Virgana, Rova; Ihsan, Grimaldi; Sovani, Iwan; Kartasasmita, Arief
International Journal of Retina Vol 1 No 1 (2018): International Journal of Retina (IJRetina) - INAVRS
Publisher : International Journal of Retina

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Introduction: to report the characteristics, management and outcome in giant retinal tear (GRT) associated retinal detachment patients at Cicendo Eye Hospital Methods: this retrospective study was performed on medical records who had undergone retinal detachment surgery between January 2014 and March 2017. Age, sex, etiologies, size of GRT, quadrant involvement, lens status, proliferative vitreo-retinopathy (PVR), managements and outcomes were evaluated in association with giant retinal tears Result: Twenty-six patients (23 males, 3 females) age between 11-59 years with follow up from 2 months to 18 months were enrolled in this study. Twenty-five eyes have retinal detachment with macular involvement and 11 patients had high myopia. Majority of patients had 90° of GRTs. Most retinal tears were located at temporal quadrant (73%). Nineteen patients had undergone pars plana vitrectomy (PPV) and 7 patients had combined PPV with encircling buckle. Fifteen patients had used heavy liquid, 24 patients had silicon oil and 2 had gas tamponade. Intraoperative complications included lens trauma, retinal slippage and choroidal detached were found in 1 eye respectively. Fourteen eyes had recurrent retinal detachment. At the last follow up, 14 patients had anatomically attached retina. Twelve patients had total retinal detachment and marked PVR. Five fellow eyes were treated with prophylactic laser. Visual acuity improved in 11 eyes. Conclusion: Giant retinal tears were more common in patients with high myopia. Management of GRT currently with PPV and PPV combined with encircling buckle. The success rate of anatomy and visual acuity was less than other previous studies
Correlation Between Systemic Risk Factors and Diabetic Retinopathy in Patients with Diabetes Mellitus at Cicendo National Eye Hospital Nauli, Rizki Rahma; Virgana, Rova; Kartasasmita, Arief; Sovani, Iwan; Iskandar, Erwin; Ihsan, Grimaldi
International Journal of Retina Vol 1 No 2 (2018): International Journal of Retina (IJRetina) - INAVRS
Publisher : International Journal of Retina

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Introduction: Diabetic Retinopathy (DR) is a highly specific microvascular complication of both type 1 and type 2 diabetes mellitus (DM) that can cause significant visual impairment in adult populations worldwide. The risk of having and/or developing DR is influenced by many systemic features. Identification and management of particular systemic risk factors as early as possible during the course of DM might lower incidence of further progression and severity of DR. The aim of this study is to describe the correlation between systemic risk factors and DR in patients with DM in Cicendo National Eye Hospital on December 1st 2017 – January 31st 2018. Methods: An analytical cross-sectional study. The subjects were all patients diagnosed with DR based on ophthalmology examination at outpatient clinic of Vitreoretinal Division in Cicendo National Eye Hospital. The data were analyzed using chi-square (x2) with significances of p < 0.05. Result: Seventy-one eyes were included in this study, among of which has been classified as mild NPDR (n= 1), moderate NPDR (n= 9), severe NPDR (n= 27), and PDR (n= 34). Severe NPDR group had older age distribution at range 51-60 years old (n= 18, 66.7%, p = 0.001). Stage 1 hypertension was found to be dominant in PDR group (n= 18, 66.7%, p = 0.043). Both high total serum cholesterol group (n= 27, 76.5%, p = 0.048) and high fasting blood glucose (n= 27, 79.4%, p = 0.01) were significantly present in patients with PDR. Positive (+1) urine glucose was statistically significant in PDR group. Conclusion: There were several systemic risk factors from laboratory findings correlated in patient with DR in this study, however further study is needed to determine their role for predicting progression and severity of DR.
Surgical Approach In Vitreous Hemorrhage Metita, Mirza; Sovani, Iwan; Kartasasmita, Arief; Iskandar, Erwin; Virgana, Rova
International Journal of Retina Vol 1 No 1 (2018): International Journal of Retina (IJRetina) - INAVRS
Publisher : International Journal of Retina

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Introduction: To report cases of retinal disorders that cause vitreous hemorrhage and the timing of pars plana vitrectomy in Cicendo Eye Hospital Methods: Retrospective observational study of all patients diagnosed with the vitreous hemorrhage who had undergone pars plana vitrectomy in 2016. Data were collected from medical record. Result: The mean age of this study is 54.65 years old from 260 vitreous hemorrhage patients. The most common retinal abnormalities are proliferative diabetic retinopathy (49.6%), wet age related macular degeneration (AMD) (13.5%), undetected retinal abnormalities (12.7%), retinal vein occlusion (8.8%), rhegmatogen retinal detachment (6.5%), trauma (3.45%), vasculitis (3.1%), idiopathic polypoidal choroidal vasculopathy (3.1%), and drop IOL (1.2%). PPV performed 1-3 months after initial assessment (31.25%), less than 1 month (13.2%), more than 3 months (14.6%) Conclusion: The most common etiology of vitreous hemorrhage is proliferative diabetic retinopathy. Pars plana vitrectomy was performed 1 – 3 months after an initial assessment of the patients.
Peripapillary Retinal Nerve Fiber Layer Thickness in Diabetic Retinopathy Patients measured by Optical Coherence Tomography Dwijayanti, Sindi; Kartasasmita, Arief; Sovani, Iwan; Iskandar, Erwin; Virgana, Rova; Ihsan, Grimaldi
International Journal of Retina Vol 1 No 2 (2018): International Journal of Retina (IJRetina) - INAVRS
Publisher : International Journal of Retina

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Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes and one of the leading causes of blindness. Retinal function loss in diabetic patients is not only caused by microvascular abnormality but also retinal neurodegeneration. Optical coherence tomography (OCT) can detect retinal neural tissue loss caused by diabetes by measuring the retinal nerve fiber layer (RNFL) thickness on the cross-sectional imaging of the retina. This study is to evaluate the changes of peripapillary retinal nerve fiber layer (RNFL) thickness in diabetic retinopathy patients using OCT and compare it to age matched healthy controls. Methods: A cross-sectional study of 16 eyes from 11 diabetic retinopathy patients and 10 eyes from 7 aged matched healthy subjects for control. Patients underwent optic nerve OCT imaging, RNFL  thickness was recorded globally (average thickness) and segmented for superior, inferior, nasal, and temporal quadrants Result: There were no significant difference of  the average RNFL thickness in diabetic retinopathy group compared to healthy subjects. However, at the nasal quadrant, there were a significant increased thickness of RNFL compared to healthy subject (p value=0.009). Conclusion: Optical coherence tomography can be used to detect neurodegeneration progression in diabetic retinopathy patients by quantitatively measuring the peripapillary RNFL thickness. This can be used as a diagnostic and prognostic factor in cases of DR.
Quantitative Analysis of Retinal Microvascular Changes in Optical Coherence Tomography Angiography Of Diabetic Retinopathy Yollamanda, Prettyla; Kartasasmita, Arief; Sovani, Iwan; Iskandar, Erwin; Virgana, Rova; Ihsan, Grimaldi
International Journal of Retina Vol 1 No 1 (2018): International Journal of Retina (IJRetina) - INAVRS
Publisher : International Journal of Retina

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Introduction: Diabetic Retinopathy (DR) is a common microvascular complication in patients with Diabetes Mellitus (DM) that can cause visual impairment and blindness in adult populations. Retinal microvascular changes, reflecting capillary drop out, non perfusion, and retinal ischemia seen in patients with DM can be assessed not only qualitatively, but also quantitatively with the introduction of a new, non invasive imaging modality Optical Coherence Tomography Angiography (OCTA), avoiding potential advese risks that can occur with the use of dye-injection imaging technique. We quantified retinal microvascular changes in healthy control eyes and Diabetic Retinopathy using OCTA. Methods: A cross sectional study included 13 eyes of 9 patients with DR, consists of 11 eyes with Non Proliferative Diabetic Retinopathy (NPDR) and 2 eyes with Proliferative Diabetic Retinopathy (PDR) and 5 eyes of 5 age-matched controls. Participants were imaged with commercial OCTA device (CIRRUS HD-OCT 5000 Angioplex). We analyzed in the Superficial Capillary Plexus (SCP) the following OCTA parameters : Vessel Density (VD), Foveal Avascular Zone (FAZ) area, and FAZ circularity. Result: Normal eyes had a higher mean VD, FAZ circularity (p >0.05) and lower mean FAZ area ( p <0.05) in the SCP compared with the DR (NPDR + PDR) group. If we excluded the PDR eyes from the analytic data, mean VD and FAZ area were found to be lower in control group, and mean FAZ circularity was higher. However, no quantitative parameters were statistically significant between control group and NPDR group. Conclusion: Microvascular changes in DR can be assessed with the use of Optical Coherence Tomography Angioraphy, which is non invasive and provides high quality of images acquired from the chosen level of retina.
Intraocular Foreign Fody : A case Series Purnama Sari, Mega Wulan; Sovani, Iwan; Kartasasmita, Arief; Iskandar, Erwin; Virgana, Rova; Ihsan, Grimaldi
International Journal of Retina Vol 1 No 2 (2018): International Journal of Retina (IJRetina) - INAVRS
Publisher : International Journal of Retina

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Introduction: The incidence of Intraocular Foreign Body (IOFBs) among open-globe injuries ranges from 18% to 41%. In addition to clinical examination at the slit-lamp and indirect ophthalmoscopy, various imaging modalities are valuable for the identification and localization of IOFB. Vision loss can be devastating as a result of endophthalmitis, retinal detachment or proliferative vitreoretinopathy (PVR). Timely and appropriate management often leads to favorable anatomic outcomes with restoration of good visual function in the majority of cases. This case report presents the clinical and diagnostic finding, management, outcomes and further plan of the patients with posterior segment IOFB. Purpose: To report some cases of posterior segment intraocular foreign body. Case report: Three patients with history of ocular  trauma of the right eye that happened at workplace. All of patients were men in age range 20-55 years old . There were also loss of vision, pain, redness, and from ophthalmological examinations revealed two scleral injuries and one corneal injury that suggest an IOFB in posterior segment. Two patients were suggest endophtalmitis before operation. The plain x ray film examination showed intraocular foreign body in the right eyes. The Ultrasonography (USG) examination also showed intraocular foreign body in the right eyes. All of patient were underwent pars plana vitrectomy. Durante operation 2 of 3 patients were succeed to extract IOFB from the posterior segment, while one patient was not. Conclusion: Preoperative, intraoperative and postoperative management should be done correctly for some cases of IOFB. Prompt treatment and full assessment of patients is important to provide good prognosis.
EFEKTIVITAS PENAMBAHAN NATRIUM DIKLOFENAK TERHADAP LARUTAN OBAT DILATASI PUPIL PADA PASIEN RETINOPATI DIABETIK Kartasasmita, Arief S.; Sovani, Iwan; Setyohadji, Bambang; Karfiati, Feti; Prahasta, Andika
Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (14.925 KB) | DOI: 10.15395/mkb.v49n3.1122

Abstract

Pemeriksaan fundus memerlukan akses visualisasi yang baik. Pada penderita diabetes melitus, pupil sulit lebar menggunakan obat pelebar pupil standar sehingga perlu ditambahkan agen pelebar pupil. Penelitian ini dilakukan di Rumah Sakit Mata Cicendo periode Januari sampai Juli 2014 menggunakan metode double masked rendomized cotrolled trial terhadap 64 mata dari 32 subjek penelitian yang telah didiagnosis menderita retinopati diabetika dengan tingkat yang sama antara mata kiri dan kanan. Dibuat larutan kombinasi campuran 10 mL tropikamid 0,5%/fenilefrin 0,5%, 10 mL fenilefrin 5% dan 10 ml 0,1% Na diklofenak (larutan I) dan campuran 10 mL tropikamid 0,5%/fenilefrin 0,5%, dan 10 mL fenilefrin 5% (larutan II). Setiap subjek mendapat salah satu larutan pada mata dan larutan yang lain pada sebelahnya secara acak. Dilakukan pemantauan dengan cara memotret pupil pada menit ke-15, 20, dan 25 pada kedua mata. Lebar pupil kedua kelompok perlakuan diukur dengan perangkat lunak khusus (image processing). Dari penenelitian terdapat perbedaan bermakna antara penggunaan larutan I dan larutan II dalam melebarkan pupil baik pada menit ke-15 (t=2,02; p=0,047), menit ke 20 (t=2,23; p=0,029), dan pada menit ke-25 (t=2,041; p=0,045). Larutan kombinasi fenilefrin, tropikamid, dan natrium diklofenak menghasilkan efek dilatasi pupil yang lebih baik dibanding dengan larutan kombinasi fenilefrin dan tropikamid saja pada kasus retinopati diabetes. [MKB. 2017;49(3):199?207]Kata kunci: Dilatasi pupil, natrium diklofenak, retinopati diabetika Effectiveness of Sodium Diclofenac Addition to Pupil Dilatation Agent on Diabetic Retinopathy PatientsFundus examination requires good visualization of fundus. In diabetic patients, it is difficult for the pupil to dilate using the standard pupilarry dilating agent. To achieve proper dilation, special agents have to be added to the standard dilation agent. The study was conducted in Cicendo Eye Hospital from January to July 2014, using double masked randomized controlled trial to 32 patients (64 eyes) who were diagnosed as suffering from diabetic retinopathy with the same grade on both eyes. Eye drop solutions were developed beforehand by mixing 10 mL of 0.5% tropicamide/0.5% phenylephrine, 10 mL of 5% phenylephrine, and 10 mL of 0.1% diclofenac-natrium (solution I) and also by mixing 10 mL of 0.5% tropicamide/0.5% phenylephrine and 10 mL of 5% phenylephrine (solution II). Every subject received one drop of one solution on one eye and the other solution on the other eye in randomly fashion. The observation was performed by taking photographs of the pupil on both eyes 15, 20, and 25 minutes of observation. The resulting pupil photographs were then analyzed and measured using special image processing software and compared. It was revealed that there were statistical differences in pupil dilation between solution I and solution II at 15 minutes (t=2.02; p=0.047), 20 minutes (t=2.23, p=0.029), and 25 minutes (t=2.041, p=0.045). Phenilefrine, tropicamide and diclofenac-natrium combination solution provides better dilation effect on the pupil compared to the combination of phenilefrine and tropicamide alone in diabetic retinopathy patient. [MKB. 2017;49(3):199?207]Key words: Diabetic retinopathy, natrium diclofenac, pupil dilatation
Manifestasi Okular dan Non Okular Sindrom Rubella Kongenital Pada Penderita Katarak Kongenital Josiah Irma; Iwan Sovani; Maya Sari Wahyu; Feti Karfiati
Medicinus Vol 6, No 3 (2017): June 2017 - September 2017
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v6i3.1148

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Background: Maternal infection with rubella in the first trimester of pregnancy result in congenital rubella syndrome (CRS). It caused blindness, deafness, congenital heart dissease and mental retardation. One of the main cause of blindness in CRS is congenital cataract. Infant affected with CRS worldwide estimated 238.000 each year and 46.000 live in South East Asia.Objective: This study aimed to looked for other ocular and non ocular manifestation from 0-11months old congenital cataract infants based on World Health Organization (WHO) CRS case definiton: suspected, clinically confirmed and labaratory confirmed.Methods:This is a retrospective observational study. We colected all data from computer base medical record, patient with congenital cataract 0-11 months old that came to Pediatric Ophthalmology unit Cicendo Eye Hospital from January 2012 until December 2013. Age, sex, laterality, axial length, cataract morphology, retinopathy pigmentary, cardiac dissorder, hearing impairment, mental dissorder and laboratory serology rubella for IgM and IgG were recorded.Results: We found ninety three patients diagnosed with CRS from congenital cataract cases. Ocular manifestation include microphthalmia in 63 eyes (33.9%), microcornea in 30 eyes (16.1%), and pigmentary retinopathy in 1 eye (0.5%) . The most common type of cataract morphology was nuclear type (49.9%.). Non-ocular manifestation include cardiac dissorder in 16 cases (17.2%), hearing impairment in 1 case (1.1%) and mental retardation in 6 cases (6.4%). Case definition based on WHO criteria were 93 cases (100%) for suspected, 20 cases (25.8%) for clinically confirmed and 15 cases (42,8%) for laboratory confirmed.Conclusion: Ocular manifestation for CRS in congenital cataract 0-11 months old were microphthalmia, microcornea, pigmentary retinopathy. Other manifestation found were cardiac disorder, hearing impairment and mental retardation.
Visual Improvement in Retinal Vein Occlusion Patient Who Had Intravitreal Bevacizumab with and without Laser Photocoagulation Marita Febiana; Iwan Sovani; M Rinaldi Dahlan; Feti Karfiati
Majalah Oftalmologi Indonesia Vol 41 No 2 (2015): Ophthalmologica Indonesiana
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/journal.v41i2.34

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Background: Intravitreal bevacizumab (IVB) appears to be an effective and safe drug for reducing macular edema and improving visual acuity secondary to RVO. Grid photocoagulation to macular edema caused by BRVO significantly improved long-term visual prognosis. In CRVO, reduced the angiographic evidence of macular edema, but did not lead to improvement in the vision of treated eyes. Methods: an observational, retrospective study from medical record of patients RVO underwent IVB and combined treatment at Cicendo National Eye Center conducted between January and December 2012. A total of 49 eyes from 49 patients met the inclusion criteria. Data was compiled on demographic characteristics, pre and postoperative visual acuities. The main outcome was proportion of visual gain in 1 month after therapy. Result: All patients (49 eyes) completed the 1 months follow-up with 17 patients BRVO who had treatment IVB and 11 patients with combined treatment. And 14 patients CRVO who had treatment IVB and 7 patients had combined treatment. The proportion of BRVO and CRVO eyes have the same visual improvement in IVB and combined treatment groups (BRVO 58.8% vs 72.7%, p=0.120 and CRVO 57.1% vs 57.1%, p=1.000). Conclusion: There was no significant difference in the proportion of visual improvement between IVB and combined treatment groups in BRVO and CRVO at one months follow up. Keywords: branch retinal vein occlusion, central retinal vein occlusion, intravitreal bevacizumab, laser photocoagulation
Immediate Vs Delayed Vitrectomy for The Management of Vitreous Hemorrhage Due to Proliferative Diabetic Retinopathy Vina Karina Apriyani; Grimaldi Ihsan; Rova Virgana; Iwan Sovani
Majalah Oftalmologi Indonesia Vol 48 No 2 (2022): Ophthalmologica Indonesiana
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/journal.v48i2.100666

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Introduction: Surgical approach in vitreous hemorrhage (VH) secondary to diabetic retinopathy remains the procedure of choice for non-clearing VH. However, the most appropriate timing of vitrectomy is yet to be defined. With improvements in surgical techniques, it is reasonable to operate on such patients that have no spontaneous improvement. Objective: To compare the characteristics between groups of patients who underwent immediate and delayed vitrectomy for the management of vitreous hemorrhage due to proliferative diabetic retinopathy (PDR). Methods: Retrospective review of 35 patients who underwent vitrectomy for VH secondary to PDR. Patients were excluded if they had prior vitrectomy, follow up < 1 month post-operatively, other retinal pathology, VH secondary to other causes, uveitis, or advanced glaucoma. Primary outcome was visual acuity in patients receiving immediate (< 30 days) versus delayed (> 30 days) vitrectomy. Secondary analyses included post-surgical complications. Results: 35 eyes were included, 13 eyes had immediate vitrectomy while 22 eyes had delayed vitrectomy. There was no difference between the groups in terms of age, gender, diabetes control, or diabetes duration. Pre-operative and final visual acuities were evaluated, including 7 days, 30-days and 3-months in both Groups. Complications within 3 months were dominantly seen in the delayed vitrectomy Group. Conclusion: Immediate vitrectomy for VH due to PDR decreases time spent with vision loss, and decreases post-surgical complications. Modern vitrectomy surgery is safe and may be considered earlier in VH management.