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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Community Medicine and Education Journal Scientific Journal of Pediatrics
Ni Made Ayu Surasmiati
Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Humanities Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Neuroscience Nursing Public Health

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Pediatric Steroid High-Responder: Irreversible Visual Loss and Secondary Glaucoma Following Chronic Cutaneous-Ocular Dexamethasone Misuse I Ketut Anom Widyantara Eka Dana Weka Mona; Ni Made Ayu Surasmiati; I Gusti Ayu Ratna Suryaningrum
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.v10i3.1539

Abstract

Background: Chronic misuse of potent topical corticosteroids can lead to irreversible visual loss, particularly in the pediatric population which exhibits a more aggressive trabecular meshwork remodeling response than adults. This case aims to delineate the silent progression of steroid-induced ocular hypertension in the absence of red-eye symptoms and emphasizes the critical pharmacokinetic risks of cutaneous-ocular absorption in children. Case presentation: We report a catastrophic case of a 7-year-old male presenting with irreversible vision loss following six years of unsupervised, intermittent use of a combined Neomycin-Polymyxin B-Dexamethasone ointment for recurrent hordeolum. The cumulative exposure exceeded 125 mg of Dexamethasone. Examination revealed bilateral dense posterior subcapsular cataracts (PSC) and advanced glaucomatous optic neuropathy in left eye. Following sequential phacoaspiration, the left eye showed persistently elevated IOP (IOP elevated up to 59 mmHg) attributed to decompensated outflow facility. Management required Trabeculectomy with intraoperative 5-Fluorouracil (5 mg/0.1 mL). The high- responder phenotype in children involves rapid formation of Cross-Linked Actin Networks (CLANs) and MYOC gene upregulation. We discuss the double-hit mechanism where cataract extraction washes out hyposecretory factors, unmasking total trabecular blockage. The choice of 5-Fluorouracil over Mitomycin C is defended based on the safety profile regarding hypotony maculopathy in pediatric myopic eyes. Conclusion: Dexamethasone carries a high risk of transcutaneous-ocular absorption in pediatric eye and eyelids. Regulatory reform reclassifying antibiotic-steroid combinations as non-repeatable prescriptions is imperative to prevent such preventable blindness.
ICROP Third-Edition Phenotypes of Retinopathy of Prematurity and Their Association with Gestational Age in Indonesian Preterm Infants: A Retrospective Study I Wayan Eka Sutyawan; I Wayan Ardy Paribrajaka; Ni Made Ayu Surasmiati; Willy Yahya
Scientific Journal of Pediatrics Vol. 4 No. 1 (2026): Scientific Journal of Pediatrics
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjped.v4i1.333

Abstract

Background: Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness, and middle-income countries face a third epidemic as neonatal survival outpaces screening capacity. Indonesian data using the third ICROP edition are scarce. Objective: To describe the ICROP third-edition phenotype distribution among Indonesian infants with ROP and evaluate the associations of severity with gestational age and birth weight using exact inference and partial identification. Methods: This retrospective STROBE-compliant study characterised the ICROP phenotype of 39 infants with ROP at a tertiary referral hospital in Denpasar between January 2020 and December 2022, and examined severity against gestational age and birth weight. Proportions carry 95% Wilson intervals; the gestational-age-by-stage cross-classification was reconstructed under the published marginals, tested by exact methods, and bounded across every reconstruction. Results: Mean gestational age was 28.7 ± 2.7 weeks and mean birth weight was 1091 ± 320 g; 94.9% were of very low birth weight. Stage was documented for 38 infants: stage 1, 68.4%; stage 2, 28.9%; and stage 3, 2.6%. Pre-plus and plus disease each affected 7.7%, and aggressive ROP affected 2.6%. Stage ≥2 occurred in 70.0% of infants born before 28 weeks versus 17.9% of those born later (odds ratio 9.16, 95% CI 1.90–44.10; exact P = 0.005; Cramér’s V = 0.370), with a monotone trend across strata (exact P = 0.004). Across all 30 admissible reconstructions, the exact P ranged from 0.004 to 0.115 and the odds ratio from 0.03 to 9.16. Birth weight carried no usable information because 94.9% of the cohort occupied a single stratum. Conclusion: Gestational age, not birth weight, should anchor ROP surveillance intensity in Indonesian tertiary units, while a broad birth-weight entry threshold is retained.
Telemedicine and Artificial Intelligence for Retinopathy of Prematurity Screening in Low-Resource Settings: A Systematic Review and Meta-Analysis of Diagnostic Accuracy with Cost-Effectiveness Perspectives I Wayan Eka Sutyawan; Ni Made Ayu Surasmiati; Ivana Beatrice Alberta; Calvin Prasetio
Community Medicine and Education Journal Vol. 7 No. 2 (2026): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v7i2.953

Abstract

Background: Screening for retinopathy of prematurity (ROP) in low- and middle-income countries (LMICs) is limited by the shortage of trained examiners. Objective: We assessed the diagnostic accuracy of telemedicine and artificial intelligence (AI) for ROP screening in LMICs and summarised economic evaluations of screening. Methods: PubMed, Europe PMC, OpenAlex and Scopus were searched for accuracy studies from LMICs comparing remote grading of retinal images (telemedicine) or AI with ophthalmoscopy or expert grading, and for economic evaluations. Sensitivity and specificity were pooled with bivariate random-effects models; risk of bias was assessed with QUADAS-2 and certainty with GRADE. Results: Twenty-four accuracy studies from nine countries and 13 economic evaluations were included. For clinically significant ROP, telemedicine (6 datasets; 927 units) had a sensitivity of 92.8% (95% CI 82.6–97.3) and a specificity of 95.8 (87.6–98.7)%; AI (6 datasets; 7,346 units) had a sensitivity of 93.0 (81.5–97.6)% and a specificity of 77.3 (55.6–90.3)%. Specificity was higher in upper-middle-income settings. For any-stage ROP and plus disease, pooled sensitivities were 92.2% and 81.4%, and specificities 97.6% and 99.1%. Fifteen studies were at high risk of bias, and certainty was low to very low. Telemedicine was cost-effective in all five cost-utility analyses; no economic evaluation of AI from LMICs was found. Conclusion: Telemedicine detected clinically significant ROP with high sensitivity and specificity and was cost-effective in LMICs, although the certainty of evidence was low. AI achieved similar sensitivity with more false-positive referrals; its use as a triage step within telemedicine programmes requires prospective evaluation.
Co-Authors Calvin Prasetio I Gusti Ayu Ratna Suryaningrum I Ketut Anom Widyantara Eka Dana Weka Mona I Wayan Ardy Paribrajaka I Wayan Eka Sutyawan Ivana Beatrice Alberta Willy Yahya