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The Ocular Toll of Drug Tourism: A Systematic Review and Meta-Analysis of Cannabis and Methamphetamine Impact on Retinal Architecture and Pupillary Dynamics Fransiska Lavinia Gracella; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1584

Background: Drug tourism involves individuals traveling across international borders to access recreational illicit substances. While psychiatric and cardiovascular toxicities of substances like cannabis and methamphetamine are established, quantitative data regarding their impact on ocular microstructures and functional dynamics remain scarce. This study aims to systematically review and meta-analyze the structural and functional ocular alterations induced by these substances. Methods: A systematic review and meta-analysis complying with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted. Electronic databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched from inception to January 2026. Data extraction targeted pupillary dynamics and structural optical coherence tomography measurements. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tools. A DerSimonian-Laird random-effects model was utilized in Review Manager 5.4 to pool continuous data, calculating Standardized Mean Differences and 95% Confidence Intervals. Heterogeneity was evaluated via the I-squared statistic. Results: Nine primary research articles were included. The mean Newcastle-Ottawa Scale score was 8.1, indicating a low risk of bias. Chronic cannabis users exhibited significantly reduced pupillary constriction velocity (Standardized Mean Difference -0.85, 95% Confidence Interval -1.20 to -0.50, p < 0.001), prolonged reaction latency (Standardized Mean Difference 0.65, 95% Confidence Interval 0.30 to 1.00, p < 0.01), and decreased corneal endothelial cell density (Standardized Mean Difference -0.78, 95% Confidence Interval -1.15 to -0.41, p < 0.001). Methamphetamine abuse was associated with profound global retinal nerve fiber layer thinning (Standardized Mean Difference -1.12, 95% Confidence Interval -1.55 to -0.69, p < 0.001) and reduced minimum rim width (Standardized Mean Difference -0.95, p < 0.001). Conclusion: Recreational cannabis and methamphetamine abuse cause significant, quantifiable ocular morbidity. Methamphetamine induces ischemic neurodegenerative retinal loss, while cannabis disrupts autonomic pupillary pathways and corneal integrity. Comprehensive ophthalmological screening is critical for individuals with substance abuse histories.

Intraocular Pressure Dynamics and Ischaemic Risks During Air Travel Post-Gas Tamponade: A Systematic Review and Meta-Analysis Vina Yuwanda; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1606

Background: Gas tamponade is a widely used surgical intervention for retinal detachment repair. However, intraocular gas bubbles expand at altitude owing to Boyle's law, potentially causing severe intraocular pressure (IOP) elevation and ischaemic complications. The safety of air travel for patients with residual intraocular gas remains insufficiently characterised. Methods: We conducted a systematic review and meta-analysis of empirical and computational studies examining IOP dynamics during simulated or actual altitude exposure in eyes with intraocular gas. We searched MEDLINE, Embase, Web of Science, Scopus and PubMed Central through March 2024 for peer-reviewed publications without language restrictions. Study selection followed PRISMA 2020 guidelines with predefined eligibility criteria. Data were extracted in duplicate, and risk of bias assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis calculated standardised mean differences (SMD) with 95% confidence intervals (CI). Sensitivity analyses stratified findings by study type. Results: The primary analysis included three empirical studies (n = 47 eyes) showing IOP increase of SMD = 3.03 (95% CI: 2.18–3.89; I² = 17.16%, τ² = 0.11). Sensitivity analysis including all four studies (one computational model) yielded SMD = 4.67 (95% CI: 1.52–7.82; I² = 95.67%, τ² = 9.81). Individual study estimates ranged from SMD = 2.52 (Mills 2001) to SMD = 8.65 (Gsellman 2016, computational). Risk of bias was generally low to moderate. No significant publication bias was detected. Conclusion: Patients with residual intraocular gas who undertake air travel face meaningful IOP elevation at altitude. The risk of anterior segment ischaemic complications warrants careful patient counselling, altitude restriction recommendations, and prophylactic pharmacotherapy. Future prospective studies should evaluate optimal clinical protocols.

High-Altitude Maculopathy in Mountaineers: A Systematic Review and Meta-Analysis Rataya Paramitha Maliawan; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1613

Background: High-altitude maculopathy (HAM) represents a distinct form of high-altitude retinopathy affecting mountaineers at extreme elevations. Despite increased mountaineering activity, the prevalence and clinical significance of HAM remain poorly characterised in systematic reviews. Methods: A comprehensive systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Cochrane Library, and manual review of reference lists through April 2026. Eligible studies were prospective and retrospective cohorts reporting HAM prevalence in mountaineers at altitude ≥3,500 metres. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis employed the Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects modelling. Results: Three prospective studies (n=50 mountaineers) were analysed with a pooled prevalence of 73.37% (95% confidence interval: 60.28–84.72%). Heterogeneity was absent (I²=0%, Q=0.78, p=0.678). Subgroup analysis demonstrated a higher prevalence at extreme altitude (≥5,000 m: 78.6%) versus very high altitude (3,500–4,999 m: 70%). Sensitivity ranged 67.48–83.76%. Funnel plot inspection revealed no evidence of publication bias. Conclusion: Approximately three-quarters of mountaineers experience HAM at high altitude, with prevalence increasing at extreme elevations. HAM represents a common but underrecognised altitude-related ocular complication. Future prospective studies should employ standardised diagnostic criteria and investigate the mechanistic pathways of macular involvement.

Effect of Simulated and Real Aircraft Cabin Environments on Tear Film Parameters in Dry Eye Disease: A Meta-Analysis Jelly Vianti Fransisca Oeitano; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1617

Background: Air travel exposes passengers to environmental stressors, such as reduced cabin pressure and low humidity, which may exacerbate ocular surface conditions, particularly pre-existing dry eye disease (DED). This meta-analysis quantifies the impact of real and simulated aircraft cabin environments on tear film parameters, ocular surface biomarkers, and intraocular pressure (IOP). Methods: Following PRISMA 2020 guidelines, a systematic search (January 2000–March 2026) identified ten eligible studies comprising 445 participants, with two providing complete quantitative data for meta-analytic pooling (10 effect sizes). Results: Using a random-effects model, the overall pooled standardised mean difference (SMD) was 0.97 (95% CI: -0.67 to 2.61), indicating a large but non-significant effect with substantial heterogeneity (I2 = 97.23%). Subgroup analyses revealed a non-significant pooled effect for tear film outcomes (Hedges' g = 0.71), contrasted by a significant elevation in IOP for gas-filled eyes (g = 1.92; p = 0.001). Despite the non-significant overall pooled estimate, individual effect sizes demonstrated large, clinically meaningful reductions in tear break-up time (TBUT) and significant increases in both corneal staining and inflammatory biomarkers (MMP-9 and IL-6). Egger's test showed no publication bias, though GRADE certainty remained low to very low. Conclusion: Aircraft cabin environments induce clinically significant deteriorations in tear film stability, ocular surface integrity, and inflammation, alongside significant IOP elevations in susceptible individuals. These findings underscore the necessity of pre-flight ocular counselling and targeted preventive strategies for at-risk passengers, highlighting the need for future large-scale, standardised investigations.

Successful Management of Culture-Negative Fungal Keratitis with Epithelial Keratectomy and Intracameral Fluconazole Injection: A Case Report Kristian Dernitra; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1619

Background: Fungal keratitis is a major cause of corneal blindness in tropical regions. Microbiological culture often yields negative results in up to 40% of clinically suspected cases, creating diagnostic and therapeutic challenges. This report describes successful management of culture-negative suspected fungal keratitis using epithelial keratectomy combined with intracameral fluconazole injection. Case presentation: A 58-year-old male presented with progressive visual loss in the left eye following mud exposure and irrigation with river water. Examination revealed a 3×3 mm paracentral corneal ulcer with stromal infiltration exceeding one-third depth, satellite lesions, and 1.5 mm hypopyon. Gram stain, potassium hydroxide preparation, and culture were all negative. Based on clinical suspicion of fungal etiology, the patient underwent epithelial keratectomy with intracameral fluconazole injection, supplemented by intensive topical and systemic antifungal therapy. Progressive improvement was observed, with complete hypopyon resolution by day 26 and visual acuity improving from 1/300 to 6/30 over four months. Conclusion: This case demonstrates that timely invasive antifungal intervention guided by clinical judgment can achieve favorable outcomes in culture-negative suspected fungal keratitis. The preservation of useful vision without corneal transplantation is particularly significant in resource-limited settings, underscoring the critical role of clinical decision-making when laboratory confirmation is unavailable.

The Unseen Danger: A Meta-Analysis of Bystander Injuries in Firework-Related Ocular Trauma Rania Ayu Permata Putri Kornia; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i10.1409

Background: Firework-related ocular trauma represents a significant, preventable cause of severe vision loss, with incidence rates peaking during global cultural and national festivals. While the risks to active firework users are well-established, the burden of injury sustained by passive spectators, or bystanders, remains poorly quantified. This study aimed to synthesize global data to define the magnitude of this unseen danger. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, EMBASE, and Web of Science were searched for studies published between January 2015 and December 2025 that reported separable data on firework-related ocular injuries in bystanders and operators. A random-effects model calculated the pooled proportion of bystander injuries. Secondary outcomes included pooled odds ratios (ORs) for open globe injury (OGI) and severe vision loss (SVL; Visual Acuity <3/60). Results: Eleven studies, encompassing 2,440 patients, met the inclusion criteria. This meta-analysis, despite significant heterogeneity in the source data (I² = 89%), suggests that nearly half of all victims were bystanders, with a pooled proportion of 47.5% (95% CI: 41.8%–53.2%). Bystanders had significantly lower odds of sustaining an OGI compared to operators (pooled OR: 0.72, 95% CI: 0.58–0.90). However, the odds of suffering permanent SVL were not statistically different between the two groups (pooled OR: 0.91, 95% CI: 0.73–1.14), indicating a comparable risk of blinding injury. Conclusion: These findings must be interpreted with caution due to high inter-study heterogeneity and unmeasured clinical confounders. Nonetheless, the analysis strongly suggests that the risk to bystanders is unacceptably high and that public health paradigms focused solely on operator safety are insufficient. This study underscores the urgent need for prospective, standardized data collection and a shift in prevention strategies toward protecting passive spectators.

Optic Neuritis After Viral Vector versus mRNA COVID-19 Vaccines: A Systematic Review and Comparative Meta-Analysis Tiara Alexander; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i10.1412

Background: The global deployment of COVID-19 vaccines, utilizing distinct viral vector and mRNA technologies, has been followed by reports of rare neuro-ophthalmic adverse events, including optic neuritis (ON). This study aimed to systematically compare the clinical phenotypes, autoimmune serological profiles, and visual outcomes of ON cases with onset in temporal association with viral vector versus mRNA COVID-19 vaccination. Methods: A systematic review was conducted across PubMed, Scopus, and EMBASE databases for case reports and case series published up to August 2025 detailing ON after COVID-19 vaccination. Data were extracted on clinical presentation, MRI findings, serostatus for aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) antibodies, treatments, and visual outcomes. Separate meta-analyses of proportions and comparative odds ratios (OR) were calculated for key outcomes, including distinct analyses for NMOSD and MOGAD. Results: Our analysis of published reports included 20 studies, comprising 90 patients (40 viral vector, 50 mRNA). Cases associated with viral vector vaccines had significantly higher odds of presenting with bilateral disease (OR 4.31, 95% CI [1.67, 11.11]). This platform was also associated with markedly increased odds of AQP4-IgG positivity (NMOSD) (OR 5.15, 95% CI [1.35, 19.61]) and MOG-IgG positivity (MOGAD) (OR 4.58, 95% CI [1.09, 19.21]). Consequently, these patients had higher odds of requiring aggressive immunotherapy and of suffering incomplete visual recovery (OR 3.41, 95% CI [1.14, 10.21]). Conclusion: Our analysis of published case reports suggests that while ON following COVID-19 vaccination is a very rare event, its clinical phenotype may differ based on the vaccine platform. Cases associated with viral vector vaccines appear more likely to manifest as a severe, bilateral, antibody-mediated condition characteristic of NMOSD or MOGAD. These findings, which do not establish causality, underscore the critical importance of prompt autoantibody testing to guide appropriate management. The established benefits of vaccination continue to overwhelmingly outweigh the exceptionally low absolute risk of such adverse events.

The Hidden Hazard of Celebration: A Meta-Analysis of Ocular Morbidity from Colored Powder Festivals and Implications for Global Travel Medicine Frangklin Refelino Jotlely; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i10.1417

Background: The globalization of colored powder festivals, such as Holi, has exposed millions, including international tourists, to significant ocular health risks from synthetic industrial dyes that have replaced traditional organic powders. This study was conducted to quantify the prevalence of acute ocular morbidities from these festivals, providing an evidence base to inform clinical practice and public health policy, particularly within travel medicine. Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Google Scholar, ScienceDirect, and ProQuest for observational studies published up to July 2024. Studies reporting ocular complications from colored powder exposure were included. Data were extracted by two independent reviewers, and methodological quality was assessed using JBI checklists. A random-effects model was used to calculate pooled prevalence for key ocular injuries. Heterogeneity was investigated using sensitivity analyses, and publication bias was assessed with funnel plots. Results: Six studies from India, encompassing 189 patients, met the inclusion criteria for quantitative analysis. The patient population was predominantly young males (mean age 20-30 years). The meta-analysis revealed a high pooled prevalence of key ocular morbidities. The prevalence for chemical conjunctivitis was 95% (95% CI: 87%-100%), though with substantial but anticipated heterogeneity (I²=82%). The prevalence for corneal epithelial defects was 37% (95% CI: 23%-53%; I²=45%), and for superficial punctate keratopathy was 75% (95% CI: 57%-90%; I²=0%). Most injuries were bilateral. Conclusion: Participation in colored powder festivals, based on extensive evidence from Holi in India, presents a quantifiable and significant risk of acute ocular morbidity. The high prevalence of chemical-induced ocular surface disease necessitates urgent recognition of this "hidden hazard." Proactive, evidence-based preventive strategies, including tiered recommendations for protective eyewear and updated pre-travel health advisories, are imperative to safeguard the vision of millions of celebrants worldwide.

Ocular Vascular Occlusion Following COVID-19 and Travel Vaccinations: A Systematic Review and Exploration of Immuno-Thrombotic Mechanisms Ni Nyoman Yuniasih; I Made Ary Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i10.1420

Background: Ocular vascular occlusion is a rare, vision-threatening emergency. While typically associated with systemic vascular comorbidities, reports have emerged suggesting a temporal link to various vaccinations. This review aims to synthesize the evidence on ocular vascular occlusion following both COVID-19 and non-COVID travel vaccinations to characterize its clinical spectrum and explore shared pathophysiological underpinnings. Methods: A systematic search adhering to PRISMA 2020 guidelines was conducted in PubMed, Scopus, Cochrane Library, and ProQuest for studies published from January 1st, 2013, to August 1st, 2024. All study designs reporting ocular vascular occlusion temporally associated with COVID-19 or travel immunizations were included. Data on demographics, vaccine type, clinical presentation, and outcomes were extracted. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Joanna Briggs Institute (JBI) checklist for case reports. Results: From an initial 1,348 records, 12 studies met the inclusion criteria, encompassing case reports, series, and large database analyses. These studies described ocular vascular occlusion in individuals aged 15 to 86 years. A significant temporal clustering was observed, with the majority of individual cases occurring within seven days post-vaccination. Central retinal vein occlusion (CRVO) was the most reported subtype. A large retrospective cohort study reported a more than two-fold increased hazard for retinal occlusion post-vaccination compared to unvaccinated cohorts (HR 2.19, 95% CI 1.85-2.59, p<0.001). Both mRNA and adenoviral vector COVID-19 vaccines, as well as various travel vaccines including Zostavax, Yellow Fever, and Meningococcal B, were implicated. Conclusion: This review characterizes a consistent temporal association between a diverse range of vaccines and subsequent ocular vascular occlusion, suggesting it is a rare but potential adverse event. The clustering of onset times and involvement of different vaccine platforms point towards a common underlying immuno-thrombotic mechanism. These findings highlight the need for clinical vigilance for acute visual changes post-vaccination, while underscoring that the absolute risk remains exceedingly low compared to the clear benefits of vaccination.

Prevalence and Etiology of Ocular Morbidity in Maritime Environments: A Systematic Review and Meta-Analysis of Passenger and Crew Data Iska Novi Udayani; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1526

Background: The maritime environment constitutes a unique epidemiological enclosure characterized by isolation, specific occupational hazards, and distinct environmental stressors including hyper-salinity and high ultraviolet (UV) albedo. While gastrointestinal and respiratory outbreaks at sea are well-documented, the burden of ocular morbidity remains under-quantified. This study aims to determine the prevalence and etiology of ocular emergencies, stratifying risks between industrial seafarers (crew) and recreational travelers (passengers). Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Data were extracted from eight observational studies (2014–2024) covering expedition cruises, commercial shipping, and leisure voyages. To address population heterogeneity, a stratified analysis was performed: Track A analyzed occupational trauma in crew, while track B analyzed environmental morbidity in passengers. A random-effects model was used to calculate pooled proportions with 95% Confidence Intervals (CI), accompanied by a leave-one-out sensitivity analysis. Results: The dataset represented a combined population of over 5,000 maritime subjects. The pooled prevalence of ocular involvement in maritime trauma cases was 18.4% (95% CI: 12.1%–25.5%). Etiological analysis of crew injuries revealed a dominance of mechanical trauma, specifically metallic foreign bodies (40.5%), followed by chemical burns (26.2%). In contrast, passenger morbidity was driven by environmental factors (photokeratitis, dry eye) and infectious conjunctivitis. Conclusion: Ocular emergencies represent a significant, preventable burden in maritime travel, with distinct risk profiles for crew and passengers. The high rate of occupational trauma suggests a failure in personal protective equipment (PPE) compliance, while the environmental burden reflects the dry ship phenomenon. Mandatory protective eyewear policies and the integration of anterior-segment tele-ophthalmology are critical interventions.

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