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All Journal IJRETINA - International Journal of Retina Ophthalmologica Indonesiana
Ayuningtyas, Sita Paramita
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Health Professions Medicine & Pharmacology Public Health

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Giant Intracranial Aneurysm Presenting as Temporal Hemianopia: When the Eyes Reveal a Hidden Danger Pertiwi, Annisa Nindiana; Nusanti, Syntia; Pintary, Marsha Rayfa; Dewiputri, Salmarezka; Ayuningtyas, Sita Paramita; Sidik, Muhammad
Majalah Oftalmologi Indonesia Vol 51 No 2 (2025): 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.v51i2.101687

Abstract

Introduction: Giant intracranial aneurysms (GIA) are rare and deadly diseases due to the high risk of rupture. The purpose of this report is to describe a case of GIA presenting as temporal hemianopia. Case Report: A 52-year-old male presented with worsening blurry vision three weeks before admission. Visual acuity was light perception in the right eye and 6/18 in the left eye. Neuro-ophthalmic examination revealed a relative afferent pupillary defect in the right eye and bilateral optic atrophy. At the next visit, the visual acuity of the right eye recovered to 6/18. Visual field testing showed temporal hemianopia in the left eye and generalized depression in the right eye. Magnetic resonance imaging demonstrated a 0,4 cm x 2,5 cm x 1,9 cm saccular aneurysm, on the medial side of the left internal carotid artery (ICA). Discussion: A giant (diameter ≥2.5 cm) ICA aneurysm may compress the optic chiasm, leading to various stages of visual loss. Several factors are known to delicate balance between thrombogenesis and thrombolysis within the aneurysmal sac. Spontaneous intra-saccular thrombosis in an unruptured GIA may be induced by calcification within the atherosclerotic wall of the aneurysm and loss of elastic lamina. It is prone to occur in a narrow aneurysm neck (<0.4 cm). Thrombosis reduces the size of the aneurysm sac, in which the accumulated fluid is reabsorbed. This may explain the decompression effect on optic chiasm and spontaneous visual recovery.   Conclusion: Intracranial aneurysms are a rare cause of optic chiasm compression but can still be considered in cases of temporal hemianopia.
DAPSONE-INDUCED TOXIC MACULOPATHY IN LEPROSY PATIENT Ayuningtyas, Sita Paramita; Djatikusumo, Ari; Nusanti, Syntia; Dewiputri, Salmarezka; Sidik, Mohamad
International Journal of Retina Vol 6 No 1 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss001.226

Abstract

Introduction: Dapsone has been widely used as a part of multidrug therapy for leprosy patients. Ocular side effects are rare. Ocular toxicity manifestations include retinal necrosis, optic atrophy, macular infarction, bilateral exudative retinal detachment, and choroidal detachment. We reported a rare case of dapsone-induced toxic maculopathy in a leprosy patient. Case Report: A 32-year-old male complained of blurred vision and a gray spot in central vision in the left eye (LE) for one month prior to admission. He had been treated with multidrug therapy (MDT) for leprosy for seven months. The MDT consists of dapsone, clofazimine, and rifampicin. The best-corrected visual acuity (BCVA) of the right eye (RE) and the LE were 6/6 and 6/12, respectively. A funduscopy of the LE showed decreased macular reflex. A color vision defect following the tritan axis was found in the LE. The Humphrey visual field (HVF) test of the LE revealed a central scotoma. Macular optical coherence tomography (OCT) showed intraretinal hyperreflectivity and subretinal fluid. Dapsone was then stopped in collaboration with a dermatologist. Two months after the discontinuation of Dapsone, the BCVA of the LE improved to 6/7.5, then 6/6 three months later. Color vision, macular OCT, and HVF tests revealed improvements. Multifocal ERG of both eyes (BE) also showed improvement in N1 and P1 wave amplitude in both eyes on 9-month follow-up after dapsone discontinuation. Discussion: Instead of direct drug toxicity, the mechanism of ocular side effects is thought to be ischemia caused by two distinct mechanisms. Macular ischemia is caused by acute, severe peripheral hypoxia and the physical effect of red cell fragmentation due to the hemolytic process. After discontinuation of dapsone, this case showed improvement in visual function and macular structure. Conclusion: Toxic maculopathy may be present in leprosy patients receiving dapsone treatment, although it is uncommon. Regular follow-up and evaluation of visual function and macular involvement are essential. Early detection of dapsone-induced toxic maculopathy and prompt discontinuation of dapsone may result in an improvement of visual functions.
Co-Authors Dewiputri, Salmarezka Djatikusumo, Ari Muhammad Sidik Pertiwi, Annisa Nindiana Pintary, Marsha Rayfa Sidik, Mohamad Syntia Nusanti