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Anti-VEGF Therapy In Central Retinal Vein Occlusions Rahmah, Meidina; Amin, Ramzi; Ansyori, AK
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: Central retinal vein occlusion (CRVO) is the second most common retinal vascular disease after diabetic retinopathy and is estimated to affect more than 16 million adults worldwide. Treating the underlying cause of occlusion of the central retinal vein, reducing the risk factors, and early and proper management are the keys toward a better prognosis in patients with CRVO. Repeated frequent treatment of CRVO with macular edema with intravitreal anti-vascular endothelial growth factor (anti-VEGF) is an effective treatment to improve visual outcome. In this case report we assess the 3-month efficacy of anti-VEGF therapy in CRVO. Method: In this case, a 52-year-old man presented with an acute loss of vision over the last week in his left eye. His baseline visual acuity was 1/60 and his central retinal thickness (CRT) on Optical Coherence Tomography (OCT) was 523 Î¼m. Fundus examination revealed a hemorrhage in all four quadrants, hard exudates, swelling of the optic nerve, and macular edema. Laboratory test confirms hyperlipidemia and we consult this patient to Internal Medicine Department. This patient got 3 monthly injections of 1,25 mg Bevacizumab. Results: By 3 months, the OCT appeared fairly normal and the visual acuity improved to 6/60 Conclusion: Anti-VEGF therapy is effective for treating macular edema secondary to CRVO

Urine Albumin Creatinine Ratio Among Diabetic Retinopathy Patient With And Without Diabetic Macular Edema In Moh. Hoesin Hospital Palembang Astuti, Rina; Ansyori, AK; Amin, Ramzi
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 Macular Edema is a diffuse thickening in macula which can be found in various severity of Diabetic Retinopathy. There are issue about relationship between Diabetic Macular Edema and albuminuria caused by chronic renal failure. The aim of this study is to know and compare urine albumin creatinine ratio among Diabetic Retinopathy patients with and without Diabetic Macular Edema in Moh. Hoesin Hospital. Methods: Cross sectional study with 25 sample was conducted. Diabetic Retinopathy and Diabetic Macular Edema was classified base on Early Treatment Of Diabetic Retinopathy Study (ETDRS) criteria. T-test, odd ratio and multiple logistic regretion analysis was used to analysed sociodemography characteristic (age and gender), clinical characteristic (duration of DM, hipertension, treatment, body mass indeks and antioksidan consumption), ophtalmology characteristic (visus, anterior segment anomaly and posterior segment/ severity of Diabetic Retinopathy), laboratory characteristic (HbA1c, ureum, creatinine, urine albumin creatinine ratio, and lipid profile). Result: Urine albumin creatinine ratio mean (2146.77 Â± 3796.19) in Diabetic Macular Edema and (49.0 Â± 45.35) in non-Diabetic Macular Edema; cutoff point 62.00 mg/dL. Odd ratio adjusted for urine albumin creatinine ratio = 18,8. In this research, risk factors which has significantly were urine albumin creatinine ratio (p=0.047) and High-Density Lipoprotein/HDL (p=0.028) with odd ratio 8.571 and 6.67 respectively. Urine albumin creatinine ratio showed significantly high Mann whitney analysis 0.02 (p<0.005). Conclusion: Urine albumin creatinine ratio in Diabetic Retinopathy with Diabetic Macular Edema was higher than without Diabetic Macular Edema. Urine albumin creatinine ratio and High Density Lipoprotein (HDL) are the two important risk factors associated with Diabetic Macular Edema.

The Difference of Visual Field Defect on Diabetic Retinopathy Patients Treated with Panretinal Laser Photocoagulation with 20-Milisecond and 100-Milisecond Duration Herdana, Nova; Ansyori, AK; Amin, Ramzi; Saleh, Irsan
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: Panretinal laser photocoagulation (PRP) is a standard treatment for severe nonproliferative and proliferative diabetic retinopathy. Twenty-milisecond duration PRP show same effectiveness with 100-ms standard PRP in inhibit neovascularization progression. This shorter pulse tend to minimize retinal neuronal defect and visual field defect. This study aim to analyze the difference of visual field defect in diabetic retinopathy (DR) patients treated with 20-ms PRP compared with 100-ms PRP in Moh. Hoesin Hospital Palembang. Methods: A clinical trial with single blinding on severe-very severe NPDR and early PDR eyes treated with PRP between June and August 2016. Forty eyes (25 patients) were randomized into two groups. Twenty eyes were treated with 20-ms PRP, and other 20 eyes treated with 100-ms PRP. Visual field defect was evaluated using Humphrey Field Analyzer 30-2 SITA Standard at baseline and 2 weeks follow-up. Result: Unpaired t-test showed significant difference in mean deviation (MD) after laser on NPDR eyes (p=0.042, p<0.05), meanwhile there was no significant difference in early PDR eyes (p=0.17, p>0.05). In NPDR eyes, more MD improvement was found in 20-ms PRP group (0.79Â±0.93 dB) than in 100-ms group (-0.04Â±0.61 dB). In early PDR eyes, MD improvement was bigger (1.0Â±0.88 dB) in 20-ms PRP group than in 100-ms group (0.10Â±1.47 dB). There was no significant difference in pattern standard deviation (PSD) on both group at any DR grade (p=0.208; p=0.201; p>0.05). Conclusion: After 2 weeks, 20-ms PRP caused more improvement and lesser visual field defect (p=0.042, p<0.05) on NPDR eyes. There was no significant difference in PSD on both groups.

Effect Anti VEGF Intravitreal to Central Retinal Vein Occlusion Tiara Mayasari; Ramzi Amin; AK Ansyori
Sriwijaya Journal of Ophthalmology Vol. 1 No. 1 (2018): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Introduction. The cause of blood vessels abnormalities in the retina in addition to diabetes is obstruction in the veins. In general, retinal vein blockages are distinguished in two types i.e. blockage of retinal veins (BRVO) and obstruction of the central vein of the retina (CRVO). Reported a case of a central retinal vein occlusion with intravitreal anti-injection treatment of a VEGF Bevacizumab. Case presentation. A man, Mr. T, aged 52 years, with an address outside the city, the work of the foreman, came to RSMH's eye on October 2014. Anamnesis the main complaint of the right eye eyesight was suddenly dark since, one day before. One day before go to hospital, the sufferer complained about the right eye suddenly until it felt dark. He also complain often headaches without nausea and vomiting since before his right eye vision becomes blurred. Intravitreal anti-VEGF injection in these patients is planned to be re-done 4-6 weeks after the first injection if there has been no improvement in his vision. Evaluation of the effectiveness of intravitreal Bevacizumab anti-VEGF therapy through sharp improvement of vision, clinical features and anatomical improvement. Conclusion. A case of central retinal vein occlusion was reported in a 52-year-old male. After anamnesis, ophthalmologic examination and investigations, a diagnosis of CRVO is managed by intravitreal Anti VEGF injection.

Diagnosis and Management of Central Serous Chorioretinopathy Ammar Fardhana; AK Ansyori; Ramzi Amin
Sriwijaya Journal of Ophthalmology Vol. 3 No. 1 (2020): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Introduction: Abnormalities in the macula is a very significant disorder. One abnormality that can be found is central serous chorioretinopathy (CSC). This case report aims to explain the diagnosis and management of Central Serous Chorioretinopathy. Case presentation: A 32-year-old man, a soldier, came for treatment at hospital on May 2017. Anamnesis of major complaints right eye blurred since, 1 week before hospitalization. From the investigations, in the right eye, the armsler grid examination showed an impression of metamorphopsia. On examination of the fundus photo, an impression of macular area edema with a clear border is obtained. OCT examination revealed that there was elevation of neuroretina tissue in the macula. This patient was managed by laser photocoagulation at the point of leakage of subretinal fluid. Conclusion: The diagnosis of central serous chorioretinopathy is made through history taking, ophthalmological examination, and supporting examinations of armsler grid, photo fundus, OCT and FFA. Laser photocoagulation can be performed, especially in cases of persistent, chronic, recurrent, or occupational needs.

Laser Pan-Retinal Photocoagulation to Treat Central Retinal Vein Occlusion Roland Iqbal; AK Ansyori; Ramzi Amin
Sriwijaya Journal of Ophthalmology Vol. 2 No. 2 (2019): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Introduction. Retinal Vein Occlusion (RVO) is the second most common retinal blood vessel disease after diabetic retinopathy. CRVO is an acute blockage of the central retinal vein that causes abnormalities in the retina, characterized by sudden decreased vision. Based on the potential for vision loss from this retinal disease, proper diagnosis and management is needed to prevent further complications. Case Presentation. A man, age 50 years old, a civil servant, came to the eye clinic of Mohammad Hosein Hospital on February 2017. The main complaint was vision of right eye suddenly blurred since 5 months before. Based on the above examination found decreased vision in one eye, with visual acuity better than 6/60 and no RAPD. The funduscopic examination above shows the presence of dilatation and tortousity in the central retinal vein, dot / blot bleeding and flame shaped hemorrhages in all quadrants, exudates, neovascularization of the retina and optic disk, and the presence of edema in the optic disc and macula. Conclusion. Management performed on these patients is by performing a Pan-Retinal Photocoagulation (PRP) laser and Grid-Pattern Photocoagulation. The selection of this therapy is based on the consideration that the patient has been suffering from CRVO for more than 3 months.

Diagnosis and Management of Bleeding Vitreous by Trauma Closed Eyeball Rika Anggraini; AK Ansyori; Ramzi Amin
Sriwijaya Journal of Ophthalmology Vol. 2 No. 2 (2019): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Introduction. Diagnosis of vitreous bleeding is generally straightforward and it can be made through history, ophthalmological examination and fundoscopy. However, the management is determined by the underlying etiology. The most common causes as factors that cause opposite vitreous bleeding include retinopathy of proliferative diabetes, posterior vitreous detachment (PVD) and trauma in 59-88.5% of cases. Reported a case of vitreous hemorrhage due to closed eyeball trauma performed by pars plana vitrectomy and endolaser with significant vision improvement. Case Presentation. A male, 21 years old, student, lived in suburban, came to the Polyclinic of RSMH on July 2019. Approximately 1 month ago the patient complained that his right eye vision suddenly felt blurry after being hit by volleyball from the front from a distance of 1 meter while playing volleyball with his friends. Patients complain of the view of the right eye as if it were covered with a red shadow accompanied by pain around the right eye. Ophthalmological examination obtained vision of this patient is a wave of the hand that is 1/300 in the right eye and 6/6 in the left eye that shows the disorder is unilateral with a fairly poor decrease in vision. During intraoperative right eye hemorrhage was found to nearly cover the retina with the source of bleeding in peripheral retinal blood vessels which when found intraoperatively were not found extravasation or active bleeding. Conclusion. The operative action of pars plana vitrectomy gives a clinically significant result that is obtained very good sharp eyesight and from the examination results obtained echofree on vitreous. Proper timing is very important in determining the management of vitreous bleeding in order to get good results and minimize the risk of complications that can occur.

Diagnosis and Management of Macular Holes Traumatic Reny Violeta; AK Ansyori; Ramzi Amin
Sriwijaya Journal of Ophthalmology Vol. 2 No. 1 (2019): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Introduction. Macular hole is a defect in the retina involving the macula and fovea, in the form of damage to full thickness from the internal limiting membrane (ILM) to the outermost part of the photoreceptor layer . It was more often found in women. In patients with myopia disorders can be found at a younger age. In this case we report the macular hole caused by blunt trauma, as was the first time a macular hole case was discovered. Case Presentation. A man 24-year-old, Mr. C, came to Palembang RSMH eye clinic on August 15, 2014 with complaints of blurred right eye vision. Main Complaints: Right eye blurred. History Disease: Right eye blurred for about 3 months before entering the hospital. Blur is felt after the patient had a motorcycle accident 3 months ago. At that time the collision sufferer avoided the truck, the right eye hit the motorcycle handlebar, the patient then fell from the motorcycle and hit the highway head. A history of frequent headaches is denied, nausea, vomiting is denied, history of seeing in tunnels is denied. Supporting examination is Amsler Grid Oculi Dextra: there is a black hole in the middle of the image. differential diagnosis is Traumatic Macular Hole OD, Lamellar Macular Hole OD, work diagnosis is Traumatic Macular Hole stage 3 OD. Conclusion. Traumatic macular holes can occur immediately after blunt trauma to the eyeball, the accuracy of the diagnosis and the speed of the timing for surgery, greatly determining the prognosis. Vitrectomy and combined with internal limiting membrane peeling have been shown to provide excellent results in macular surgery in macular hole cases.

Anti-Vascular Endothelial Growth Factor Injection in Wet Age-Related Macular Degeneration M. Usman Salim; AK Ansyori; Ramzi Amin
Sriwijaya Journal of Ophthalmology Vol. 2 No. 2 (2019): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Introduction. AMD is a macular progressive degeneration that arises at the age of more than 50 years, which is characterized by the presence of drusen which is a deposit of material between the retinal pigment epithelium (RPE) and the Bruch membrane. The prevalence of AMD is 29.2% unilateral and 70.8% bilateral. In unilateral wet AMD, 50% will develop on the other eye in a period of 5 years. Case Presentation. A woman, Mrs. S, 59 years old, civil servant working, located in the city, came to the Polyclinic RSMH on January 21, 2019. Anamnesis (Auto-anamnesis) the main complaint of vision of the left eye blurred since, 2 months ago. Since about two months ago, sufferers complained of vision in the left eye blurred, blurred felt suddenly, darker vision in the middle. Since about two weeks ago, sufferers complained that his left eye vision had become blurred. The view in the middle is covered with black shadows and accompanied by waves. Working diagnosis of macular oculi sinistra ec wet age-related macular degeneration. The treatment is informed consent, Pro injection of anti-VEGF intravitreal oculi sinistra, Pro laboratory check, Pro X-ray of thorax PA, Pro consul of internal medicine. Conclusion. A clinically significant case of macular edema (CSME) has been reported that is treated with intravitreal anti-VEGF combined with focal photon photocoagulation laser. A woman aged 55 years, with complaints of vision both eyes blurred since ± 6 months ago.

Optical Coherence Tomography Angiography Dita Mintardi; AK Ansyori; Ramzi Amin
Sriwijaya Journal of Ophthalmology Vol. 2 No. 1 (2019): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Optical Coherence Tomography Angiography (OCTA) is a new high-resolution imaging method for visualizing retinal and choroidal circulation without any dye injection By detecting intravascular flow quickly when needed and being able to repeat images, as often as needed, without risk to patients, doctors will value OCTA as one of the most important applications of OCT imaging because of its ability to offer precise visualization of intravascular flow in the inner retina layer and outside, as well as the inner choroid. OCTA uses high-speed structural OCT imaging and provides three-dimensional data about microvascular structures, enabling visualization of the en face apart from the retinal capillary plexus and choriocapillaris, combined with co-registered en face and cross-sectional structural OCT. Although OCTA is a strong modality, it can have imaging artifacts and provide information that is inherently more complex than structural OCT alone. Successful interpretation of OCTA findings requires an understanding of how OCTA works, the relationship of various ocular pathologies to its angiographic features, and integrated assessment of angiographic and structural OCT data.

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