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All Journal Indonesian Journal of Case Reports Grimsa Journal of Science Engineering and Technology
Eva Imelda
Department of Ophthalmology, General Hospital Dr. Zainoel Abidin, Banda Aceh 23126, Indonesia
Agriculture, Biological Sciences & Forestry Chemical Engineering, Chemistry & Bioengineering Engineering Health Professions Medicine & Pharmacology Neuroscience Physics Public Health

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Delayed Bilateral Congenital Cataract with Asymmetric Morphology (Membranous and Nuclear) Managed with Different Surgical Techniques in a 19-Year-Old Female: A Case Report Eva Imelda; Sarra Mutiara Adev; Navneet Shamsundar Toshniwal
Indonesian Journal of Case Reports Vol. 4 No. 1 (2026): June 2026
Publisher : Heca Sentra Analitika

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60084/ijcr.v4i1.420

Abstract

Congenital cataract is a major cause of preventable childhood blindness, and delayed treatment may lead to irreversible amblyopia and complex lens degeneration. We report a 19-year-old female with long-standing bilateral congenital cataract and marked intra-individual asymmetry. The left eye (OS) had absolute sensory deprivation since infancy, while the right eye (OD) retained partial vision until late adolescence. Examination showed alternating exotropia of 45 prism diopters and intraocular pressures of 18 mmHg OD and 27 mmHg OS. The elevated OS pressure, attributed to secondary lens-induced angle crowding, was controlled to 19 mmHg with topical timolol 0.5%. B-scan ultrasonography confirmed flat, intact retinas and normal optic disc excavation bilaterally. Using SRK/T biometry, staged bilateral cataract surgery was performed under general anesthesia one month apart. OS showed a fully resorbed membranous cataract and required manual irrigation–aspiration with a Simcoe cannula, micro-scissor membranectomy, automated anterior vitrectomy, and sulcus-fixated IOL implantation (20.0 D). OD showed a mature nuclear cataract and was managed with phacoemulsification-assisted irrigation–aspiration and in-the-bag single-piece IOL implantation (22.50 D). Postoperatively, both eyes achieved a clear visual axis and stable IOL position without early complications. At 6 months, IOP remained stable (14 mmHg OD, 15 mmHg OS), with healthy pink optic discs. Corrected visual acuity reached 6/6 OD but remained 2/60 OS due to irreversible deprivation amblyopia. Delayed congenital cataract surgery in adulthood requires morphology-based planning. Nuclear cataracts may be safely treated with phacoemulsification, whereas membranous cataracts require meticulous manual extraction and anterior vitrectomy. Early red-reflex screening remains essential.
From Leukocoria to Orbital Retinoblastoma: Consequences of Delayed Treatment in a 3-Year-Old Child Eva Imelda; Sarra Mutiara Adev; Navneet Shamsundar Toshniwa
Indonesian Journal of Case Reports Vol. 4 No. 1 (2026): June 2026
Publisher : Heca Sentra Analitika

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60084/ijcr.v4i1.421

Abstract

Retinoblastoma is the most common primary intraocular malignancy of childhood, and delayed treatment can shift management from globe preservation to survival-oriented intervention. We report a 3-year-and-4-month-old girl with bilateral advanced retinoblastoma who re-presented after an 18-month default from recommended treatment. She had progressive left-eye proptosis and severe cancer-related cachexia, weighing 9.2 kg, below the 3rd percentile for age. She had initially been evaluated at 1 year of age for bilateral leukocoria, when urgent enucleation was advised but declined by caregivers. On re-presentation, contrast-enhanced CT of the brain and orbits showed a 24 × 18 mm retrobulbar soft-tissue mass surrounding a collapsed left globe. At the same time, the right eye contained an advanced calcified intraocular tumor filling the vitreous cavity, consistent with ICRB Group E disease. Systemic staging confirmed locoregionally confined disease. The patient received four cycles of neoadjuvant pediatric VEC chemotherapy. Subsequent assessment showed no light perception in either eye, tumor- and chemotherapy-induced phthisis bulbi in the left eye, and an unsalvageable Group E tumor in the right eye. Because severe malnutrition and systemic frailty made simultaneous bilateral surgery high risk, sequential bilateral enucleations were performed under general anesthesia with a four-week interval to optimize physiological recovery. Histopathology confirmed poorly differentiated bilateral retinoblastoma, with transmural scleral invasion in the left eye and massive choroidal invasion in the right eye; both elongated optic nerve margins were tumor-free. Dermis-fat graft reconstruction was not feasible due to the absence of subcutaneous adipose tissue. At 6 months, the sockets were stable with no clinical or radiological recurrence. This case highlights the consequences of treatment delay and supports individualized staged enucleation in fragile pediatric patients.
Surgical Management of Manifest Exotropia and Its Effect on Cosmetic Appearance in Amblyopic Patients Eva Imelda; Cut Salsabila Mahfiza; Eka Fadliyani; Nikhil Toshnowal
Grimsa Journal of Science Engineering and Technology Vol. 4 No. 1 (2026): April 2026
Publisher : Graha Primera Saintifika

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61975/gjset.v4i1.101

Abstract

Constant exotropia, defined by persistent outward deviation of the eye, can cause cosmetic concerns and disrupt binocular function if untreated. We report a case of a 26-year-old male with long-standing left-eye exotropia and amblyopia since early childhood. Preoperative assessment revealed a visual acuity of 6/30 in the left eye, 15° exotropia on Hirschberg testing, 30 prism diopters on prism alternate cover testing, alternating fixation with right-eye dominance, and left-eye suppression on the Worth Four Dot test. The patient underwent unilateral lateral rectus recession and medial rectus resection. One week postoperatively, ocular alignment was orthotropic with satisfactory cosmetic and motor outcomes, while functional binocular vision remained limited. This case demonstrates the effectiveness of surgical intervention in restoring alignment and appearance in adult sensory exotropia and emphasizes the importance of early detection and timely management to prevent irreversible sensory deficits.
Beyond Hyperglycemia: Bilateral Total Cataract in an Adolescent with Type 1 Diabetes Mellitus Eva Imelda; Sarra Mutiara Adev; Navneet Shamsundar Toshniwal
Grimsa Journal of Science Engineering and Technology Vol. 4 No. 2 (2026): October 2026
Publisher : Graha Primera Saintifika

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61975/gjset.v4i2.144

Abstract

Cataracts in children and adolescents with type 1 diabetes mellitus (T1DM) are uncommon but can cause profound visual impairment. This case report describes the clinical presentation, surgical management, and short-term outcomes of bilateral total cataracts in a 16-year-old female with an approximately two-year history of T1DM. Clinical data were retrospectively obtained from medical records, including ophthalmologic examinations, ocular biometry, operative reports, and postoperative assessments. At presentation, visual acuity was limited to hand movements in both eyes, and dense lens opacities prevented fundus visualization. The patient underwent sequential bilateral cataract extraction with posterior chamber intraocular lens implantation under general anesthesia. Uncorrected visual acuity improved to 6/6 in each eye during the first postoperative week and remained 6/6 at the one-month follow-up for each eye. This case highlights the potential for substantial visual recovery following surgery in an adolescent with bilateral total cataracts and T1DM. Although diabetes may have contributed to cataract formation, the available clinical information does not establish a causal relationship. Continued diabetes management and individualized ophthalmic follow-up remain important for long-term ocular health.
Co-Authors Cut Salsabila Mahfiza Eka Fadliyani Navneet Shamsundar Toshniwa Navneet Shamsundar Toshniwal Nikhil Toshnowal Sarra Mutiara Adev