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Sriwijaya Journal of Ophthalmology
Published by Universitas Sriwijaya
ISSN : -     EISSN : 27229807     DOI : https://doi.org/10.37275/sjo.v2i2.35
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology
Sriwijaya Journal of Opthalmology (SJO) is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Sriwijaya Journal of Opthalmology (SJO) publishes original article, case report and review article related opthalmology.
Arjuna Subject : Kedokteran - Ophthalmology
Articles 107 Documents
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Dissociated Therapeutic Regimen: Systemic Corticosteroids and Topical Natamycin in Traumatic Fungal Keratitis Cyntia Dewi; Indira Putri
Sriwijaya Journal of Ophthalmology Vol. 8 No. 1 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i1.132

Abstract

Introduction: Penetrating ocular trauma complicated by secondary fungal keratitis presents a fundamental inflammatory paradox in ophthalmology. While corticosteroids are clinically imperative to suppress trauma-induced fibrinoid syndrome and prevent phthisis bulbi, they are traditionally contraindicated in active mycotic infections due to the risk of potentiating fungal proliferation. This report evaluates a dissociated therapeutic protocol utilizing systemic corticosteroids alongside topical antifungals to navigate this therapeutic impasse. Case presentation: We present the case of a 26-year-old male sustaining a penetrating corneal injury from a metallic nail. Following primary repair, the patient developed a severe anterior chamber reaction with Standardization of Uveitis Nomenclature (SUN) Grade 3+ cells and a corneal infiltrate exhibiting feathery margins. Potassium Hydroxide 10% wet mount confirmed the presence of fungal hyphae. A dissociated therapeutic regimen was initiated: intensive topical Natamycin 5% administered hourly to target the ocular surface infection, synchronized with oral Methylprednisolone (24 mg/day; 0.4 mg/kg) to control intraocular inflammation via the systemic circulation. The regimen successfully decoupled the immune response. Intraocular inflammation resolved within 14 days, preventing the formation of permanent synechiae or cyclitic membranes. The fungal infection was eradicated, confirmed by negative serial corneal smears and the clinical resolution of the infiltrate into a stable leucoma. Visual acuity improved from Hand Motion (LogMAR 2.30) at presentation to 6/45 (LogMAR 0.88) at Day 35. No fungal recurrence was observed during the follow-up period. Conclusion: A dissociated strategy using intermediate-dose systemic corticosteroids to manage internal inflammation, while reserving the ocular surface for aggressive topical antifungal therapy, may offer a viable strategy for globe salvage in complex traumatic fungal keratitis cases where standard protocols are undefined.
Retinal Microvascular Changes on OCT-Angiography in Preclinical Alzheimer’s Disease: A Prospective Indonesian Cohort Study Taufiq Indera Jayadi; Eva Naritawati; Akmal Hasan
Sriwijaya Journal of Ophthalmology Vol. 8 No. 1 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i1.134

Abstract

Introduction: Preclinical Alzheimer’s disease (AD) involves cerebral amyloid deposition in cognitively normal individuals 15–20 years before symptom onset. Optical coherence tomography angiography (OCT-A) may detect early retinal microvascular changes reflecting cerebral pathology. This study evaluated OCT-A parameters as biomarkers for preclinical AD in Indonesian elderly. Methods: This prospective cohort enrolled 180 cognitively normal participants aged ≥60 years (90 preclinical AD with amyloid-PET positivity, 90 controls) at two private hospital ophthalmology clinics in Palembang and Jakarta, Indonesia (January 2022–June 2024). OCT-A (RTVue XR Avanti) measured superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density, foveal avascular zone (FAZ) area, and perfusion density. SD-OCT assessed RNFL and GCL-IPL thickness. The unit of analysis was the individual eye (342 eyes after quality exclusion). Results: SCP vessel density was significantly reduced in preclinical AD (43.2 ± 3.1% vs 47.8 ± 2.9%; Bonferroni-adjusted p < 0.001; Cohen’s d = 1.53). FAZ area was enlarged (0.38 ± 0.08 vs 0.31 ± 0.06 mm²; p < 0.001). The combined model (SCP + FAZ + GCL-IPL) achieved a bootstrap-validated AUC of 0.898 (95% CI: 0.859–0.937). SCP vessel density was the strongest predictor (OR 0.72; 95% CI: 0.63–0.82; p < 0.001). Conclusion: OCT-A parameters, particularly SCP vessel density, demonstrated strong discriminative ability for preclinical AD. These findings support OCT-A as a potential non-invasive screening biomarker, warranting validation in community-based populations.
Continuous 24-Hour Intraocular Pressure Monitoring with a Smart Contact Lens Predicts Visual Field Progression in Normal-Tension Glaucoma Taryudi Suharyana; Agnes Mariska
Sriwijaya Journal of Ophthalmology Vol. 8 No. 2 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i2.135

Abstract

Introduction: Normal-tension glaucoma (NTG) may progress despite normal office intraocular pressure (IOP), suggesting that 24-hour IOP dynamics captured by a smart contact lens (SCL) sensor may improve risk stratification. This study evaluated whether SCL-derived nocturnal IOP parameters independently predict Humphrey 24-2 visual field (VF) progression in NTG. Methods: This prospective observational cohort enrolled 62 NTG eyes (62 patients; one eye per patient) who underwent 24-hour SCL monitoring and serial Humphrey 24-2 SITA-Standard VF testing over 24 months at a private hospital in Palembang, Indonesia. The primary outcome was VF mean deviation (MD) slope (dB/year). Multivariable linear regression and receiver operating characteristic (ROC) analysis were performed. Results: Eyes with a nocturnal IOP acrophase (n = 36) had a significantly faster MD decline (−1.24 ± 0.31 dB/year) than eyes without acrophase (n = 26; −0.42 ± 0.19 dB/year; mean difference −0.82 dB/year, 95% CI −0.97 to −0.67, p < 0.001; Cohen d = 3.20). Independent predictors of MD slope were nocturnal acrophase (β = −0.71, p < 0.001), number of long peaks (β = −0.18, p < 0.001), and baseline RNFL thickness (β = +0.034, p = 0.002); adjusted R² = 0.64. Nocturnal amplitude yielded an AUC of 0.83 (95% CI 0.74–0.91). Conclusion: SCL-derived nocturnal IOP parameters independently predict VF progression in NTG. Integration of 24-hour SCL monitoring may enhance risk stratification beyond office IOP measurement.
Diagnostic Accuracy of a Federated Learning Algorithm for Proliferative Diabetic Retinopathy Detection: A Multicenter Indonesian Study Rachmat Hidayat; Dedi Sucipto; Alexander Mulya; Ifah Shandy
Sriwijaya Journal of Ophthalmology Vol. 8 No. 2 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i2.136

Abstract

Introduction: Proliferative diabetic retinopathy (PDR) remains a leading cause of preventable blindness in resource-limited settings. Federated learning (FL) enables collaborative artificial intelligence (AI) model training without sharing patient data. This study evaluated the diagnostic accuracy of an FL-based algorithm for PDR detection across three Indonesian ophthalmology centers. Methods: This multicenter, prospective, diagnostic accuracy study enrolled 512 eyes from 289 patients with type 2 diabetes at three private hospital ophthalmology clinics in Palembang, Jakarta, and Surabaya, Indonesia (January 2023–December 2024). All eyes underwent standardized fundus photography, spectral-domain optical coherence tomography, and comprehensive ophthalmic examination. The FL-based deep learning algorithm was evaluated against two independent retinal specialists using the International Clinical Diabetic Retinopathy classification. Primary outcomes were sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Results: The FL-based AI achieved a sensitivity of 94.6% (95% CI 81.8–99.3), specificity of 91.2% (95% CI 88.2–93.6), and AUC of 0.962 (95% CI 0.943–0.981) for PDR detection. Agreement with retinal specialists was substantial (κ = 0.87). Performance was consistent across centers (AUC 0.955–0.968; p = 0.841). Media opacity was the strongest predictor of misclassification (OR 3.42; 95% CI 1.87–6.25; p < 0.001). Conclusion: The FL-based AI demonstrated high diagnostic accuracy for PDR detection comparable to retinal specialists across multiple Indonesian centers. This privacy-preserving approach may facilitate scalable diabetic retinopathy screening in resource-limited ophthalmology settings.
Safety and Efficacy of Subretinal AAV-CRISPR/Cas9 Gene Editing for Rhodopsin-Mutant Retinitis Pigmentosa: A Phase I/IIa Dose-Escalation Triall Khairiel Anwar; Sony Sanjaya; Rizky Ayu; Fachruddin Sani
Sriwijaya Journal of Ophthalmology Vol. 8 No. 2 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i2.137

Abstract

Introduction: Autosomal dominant retinitis pigmentosa (adRP) from rhodopsin (RHO) mutations lacks an approved gene therapy. This Phase I/IIa trial evaluated subretinal AAV5-CRISPR/Cas9 for RHO-adRP. Methods: An open-label, 3+3 dose-escalation design with expansion at the recommended Phase II dose (RP2D) was used. Eighteen patients (18 study eyes; one eye per patient) received subretinal AAV5-CRISPR/Cas9 at low (1.5×1010 vg, n = 3), mid (5.0×1010 vg, n = 3), or high (1.5×1011 vg, n = 6) doses, plus an expansion cohort (n = 6) at RP2D, at a private hospital in Palembang, Indonesia. The primary endpoint was dose-limiting toxicities (DLTs); secondary endpoints were BCVA (LogMAR), SD-OCT ellipsoid zone (EZ) width, microperimetry, and ffERG. Results: No DLTs occurred. The high-dose cohort showed a BCVA improvement of −0.14 LogMAR (95% CI −0.22 to −0.06, p = 0.003; Cohen d = 1.82), an EZ width increase of +312 µm (95% CI +187 to +437, p < 0.001; d = 2.45), and a microperimetry gain of +3.8 dB (95% CI +2.1 to +5.5, p < 0.001; d = 1.94). Dose-response trends were significant (Jonckheere–Terpstra p-trend: BCVA 0.008, EZ 0.002). Conclusion: Subretinal AAV5-CRISPR/Cas9 demonstrated acceptable safety with dose-dependent structural and functional improvements at 12 months. Phase II/III trials are warranted.
Sustained Anti-VEGF Delivery via Hydrogel Implant Achieves Non-Inferior Visual and Anatomical Outcomes in Neovascular AMD: A 24-Month Randomized Controlled Trial Habiburrahman Said; Oliva Azalia Putri; Linda Purnama
Sriwijaya Journal of Ophthalmology Vol. 8 No. 2 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i2.138

Abstract

Introduction: Neovascular age-related macular degeneration (nAMD) requires frequent anti-VEGF intravitreal injections, creating substantial treatment burden. This study compared the 24-month efficacy and safety of a sustained-release anti-VEGF hydrogel implant versus monthly ranibizumab in treatment-naive nAMD eyes. Methods: This prospective randomized controlled trial enrolled 126 eyes (96 patients; 30 bilateral) with treatment-naive nAMD at a private hospital in Palembang, Indonesia (January 2022–December 2024). Eyes were randomized 1:1 to a biodegradable anti-VEGF hydrogel implant (n=64) or monthly ranibizumab 0.5 mg (n=62). The primary outcome was non-inferiority of the mean best-corrected visual acuity (BCVA) change (LogMAR) at 24 months (margin: 0.10 LogMAR). Analyses used linear mixed-effects models with generalized estimating equations to account for inter-eye correlation. Results: Mean BCVA improved by −0.24±0.18 LogMAR (≈12 letters) in the hydrogel group and −0.22±0.20 LogMAR (≈11 letters) in the ranibizumab group (difference: −0.02; 95% CI: −0.09 to 0.05; p=0.578; non-inferiority confirmed). The hydrogel group required 77.8% fewer injections (4.8±1.2 vs 21.6±3.4; p<0.001). Safety profiles were comparable. Conclusion: The sustained-release anti-VEGF hydrogel implant achieved non-inferior visual and anatomical outcomes versus monthly ranibizumab while reducing injection burden by 77.8% over 24 months. Multicenter validation is warranted.
Machine Learning Prediction of Binocular Vision Recovery in Accommodative Esotropia: A Prospective Multicenter Study Karina Chandra; Pham Uyen; Annisa Annisa
Sriwijaya Journal of Ophthalmology Vol. 8 No. 2 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i2.139

Abstract

Introduction: Accommodative esotropia is the most common childhood convergent strabismus, yet predicting binocular vision recovery after treatment remains challenging. This study developed and validated machine learning (ML) models to predict binocular vision recovery using baseline clinical parameters. Methods: This prospective multicenter study enrolled 156 patients (aged 2–12 years) with accommodative esotropia across three private hospitals in Indonesia. The unit of analysis was patients. Baseline binocular vision parameters were used to train four ML models (gradient boosting, random forest, neural network, logistic regression) with 5-fold stratified cross-validation. Treatment success was defined as stereoacuity ≤100 arc seconds at 12 months. Model performance was evaluated using AUC-ROC and SHAP feature importance. Results: Treatment success was achieved in 104 patients (66.7%). Gradient boosting achieved the highest AUC of 0.903 (95% CI: 0.854–0.952; sensitivity 0.875; specificity 0.827). The strongest predictors were baseline stereoacuity ≤400 arc seconds (OR = 4.15; p < 0.001), deviation angle ≤20 PD (OR = 3.42; p < 0.001), and Worth 4-dot fusion (OR = 3.21; p = 0.001). Conclusion: ML models accurately predicted binocular vision recovery in accommodative esotropia, identifying clinically interpretable predictors that may optimize treatment selection in pediatric strabismus management.
Eyelid Squamous Cell Carcinoma in Palembang, Indonesia: A 5-Year Retrospective Study Zahratul Riadho; Adinda Dwivana Malika; Wardiansah
Sriwijaya Journal of Ophthalmology Vol. 8 No. 1 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Ophthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i1.128

Abstract

Introduction: Eyelid squamous cell carcinoma (SCC) is a prevalent malignancy with potentially severe consequences if not detected and managed early. This study aimed to investigate the prevalence, clinical characteristics, and histopathological features of eyelid SCC patients at Dr. Mohammad Hoesin General Hospital Palembang, Indonesia, over a 5-year period. Methods: A retrospective analysis of medical records was conducted on 20 patients diagnosed with eyelid SCC between 2020 and 2024. Data on demographics, clinical presentation, tumor characteristics, and histopathological findings were collected and analyzed. Univariate analysis was performed to describe the characteristics of the study population. Correlation tests were conducted to explore the relationships between various factors and eyelid SCC. Results: The prevalence of eyelid SCC was 16.67%, with the highest incidence in 2024 (25%). The majority of patients were ≥ 50 years old (60%), with an equal distribution between males and females. Outdoor occupations (45%) and lower education levels (60% with primary education) were common characteristics. Lesions were mostly multiple (45%), >3cm in size (55%), and located on the right side (60%). Histopathological analysis revealed well-differentiated (25%) and poorly differentiated (25%) SCC as the most common subtypes. Correlation analysis revealed significant associations between age and tumor size, occupation and tumor size, education level and tumor size, smoking status and differentiation, tumor size and lymphovascular invasion, and perineural invasion and differentiation. Conclusion: Eyelid SCC in Palembang predominantly affects older individuals with outdoor occupations and lower education levels. Multiple, large, and right-sided lesions are frequent findings. Emphasis on sun protection and early detection is crucial, particularly for outdoor workers.
Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Retinopathy of Prematurity: A Systematic Review Ayu Diah Permatasari; I Wayan Eka Sutyawan; Ni Made Ayu Surasmiati
Sriwijaya Journal of Ophthalmology Vol. 8 No. 1 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Ophthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i1.130

Abstract

Introduction: Retinopathy of prematurity (ROP) remains a leading cause of childhood blindness, with its pathogenesis linked to aberrant vascular development and systemic inflammation. There is a critical need for accessible biomarkers to improve risk stratification beyond current screening standards. This systematic review critically appraises the evidence for the neutrophil-to-lymphocyte ratio (NLR), a widely available inflammatory marker, as a predictor of ROP. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, ScienceDirect, ProQuest, and SpringerLink for observational studies published between January 1st, 2015, and December 31st, 2024. Studies assessing the association between NLR and ROP in preterm infants were included. Two reviewers independently performed study selection, data extraction, and a formal risk-of-bias assessment using the Newcastle-Ottawa Scale (NOS). A narrative synthesis was performed due to significant heterogeneity. Results: The search identified 32 records, with 6 retrospective studies ultimately meeting the inclusion criteria, encompassing a total reported sample of 1,065 infants. The methodological quality of the included studies was low to moderate, with NOS scores ranging from 5 to 7 out of a possible 9. The evidence base was defined by profound methodological heterogeneity, particularly in the timing of blood sample collection, which was unspecified in half of the studies, and inconsistent reporting of core population data. A narrative synthesis of the findings showed that several studies reported a statistical association between an elevated NLR or related inflammatory markers and ROP. However, one study reported no significant association, and the interpretation of others was complicated by a focus on different biomarkers or a lack of statistical significance. Conclusion: The available evidence, derived exclusively from retrospective studies of varying quality, suggests a possible association between elevated NLR and ROP, a link supported by strong biological plausibility. However, the current evidence base is severely limited by methodological flaws and profound heterogeneity, making it insufficient to support the adoption of NLR into clinical practice. NLR is not a standalone diagnostic or predictive tool for ROP. Its potential utility can only be realized through large-scale, methodologically rigorous prospective studies designed to overcome the limitations identified in this review.
Navigating Therapeutic Challenges in Adult-Onset Coats' Disease: Successful Vitrectomy for Tractional Retinal Detachment Following Laser Photocoagulation Albatool Alqahtani; Faisal Al-Qahtani; Abdullah Al Hilali; Alwaleed Alsulaiman
Sriwijaya Journal of Ophthalmology Vol. 8 No. 1 (2025): Sriwijaya Journal of Ophthalmology
Publisher : Department of Ophthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v8i1.131

Abstract

Introduction: Adult-onset Coats' disease, an infrequent variant of idiopathic exudative retinopathy, presents a unique management paradigm. While laser photocoagulation is a primary treatment for the characteristic retinal telangiectasia, it can paradoxically trigger a severe inflammatory and fibrotic cascade, leading to vision-threatening complications. This report addresses a critical clinical question: What is the optimal management strategy when first-line ablative therapy not only fails but leads to iatrogenic tractional retinal detachment? Case presentation: A 35-year-old male presented with a 15-day history of metamorphopsia in his right eye. Best-corrected visual acuity (BCVA) was 20/20. Multimodal imaging confirmed Stage 2B Coats' disease. Following sectoral argon laser photocoagulation, his BCVA declined to a nadir of 20/60. Within two months of laser, optical coherence tomography (OCT) documented the rapid development of an epiretinal membrane and a subsequent superior macular tractional retinal detachment (TRD). A 23-gauge pars plana vitrectomy (PPV) with membrane peeling was performed. Anatomical success was achieved, and at the six-month follow-up, the retina remained attached, and BCVA improved to 20/40. Conclusion: This case demonstrates that laser-induced inflammation can rapidly convert an exudative process into a complex fibro-proliferative state in adult-onset Coats' disease. When confronted with iatrogenic fibrosis, medical management is insufficient. This report validates that timely and definitive surgical intervention with PPV is not merely an option but an essential strategy for reversing the disease trajectory, achieving anatomical restoration, and salvaging vision.

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