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INDONESIA
IJRETINA - International Journal of Retina
Published by Indonesian Vitreoretinal Society
ISSN : 26148684     EISSN : 26148536     DOI : https://doi.org/10.35479/ijretina.2023.vol006.iss0
Core Subject : Health,
Health Professions Medicine & Pharmacology Public Health
International Journal of Retina is an open access journal, accepting article in English language from all over the worlds. The aims is to provide international researchers, doctors, and clinicians in the basic and clinical fields of ophthalmology, especially retina to publish the original article, case reports, or systematic review.
Arjuna Subject : Kedokteran - Ophthalmology
Articles 148 Documents
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POLYPOIDAL CHOROIDAL VASCULOPATHY MANIFESTATION IN EXTRA-AXIAL CAVERNOUS TUMOR: A RARE FINDINGS IN CHRONIC PAPILLEDEMA Asti, Annisa Kinanti; Agustini, Lukisiari; Firmansjah, Muhammad
International Journal of Retina Vol 8 No 1 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss001.306

Abstract

Introduction: Age-related macular degeneration (AMD) is a leading cause of blindness worldwide. Polypoidal choroidal vasculopathy (PCV), a subtype of neovascular AMD, is characterized by an abnormal branching network of vessels with aneurysmal dilations (polyps). Choroidal neovascularization can also result from chronic disc edema. This case presents a rare occurrence of PCV in a patient with an extra-axial cavernous tumor and explores the best management approach. Case Report: A 43-year-old man presented with an 8-month history of blurry vision in his right eye, double vision on left gaze, and left eye protrusion, accompanied by headaches and occasional nausea. Visual acuity was 2/60 in the right eye and 5/10 in the left improving with pinhole become 5/6.5. RAPD was found in left eye. Funduscopy revealed peripapillary atrophy in both eyes, with exudates in the right macula. OCT showed dome-shaped polyps in both eyes, larger in the right. MRI revealed a left sphenoid meningioma compressing the orbital cavity. The patient was diagnosed with both eyes PCV and compressive optic neuropathy, left eye multiple cranial nerve palsy and dyslipidemia. Intravitreal anti-VEGF injection was planned. Discussion PCV is a subtype of AMD characterized by recurrent serosanguineous detachments. Chronic papilledema, possibly due to intracranial tumors, may lead to visual loss from retinal nerve fiber damage or neovascularization. Chronic posterior globe flattening and choroidal vessel abnormalities likely contributed to PCV development. Conclusion: PCV may result from chronic papilledema due to intracranial tumors. Anti-VEGF therapy offers a viable treatment option, balancing polyp regression and visual acuity stabilization.
Differences of Retinal Nerve Fiber Layer and Ganglion Cell Layer-Inner Plexiform Layer Thickness in Patients without Diabetes Mellitus, with Diabetes Mellitus Type 2 without Diabetic Retinopathy and with Diabetic Retinopathy Sukmawati, Nurindah; Suryathi, Ni Made Ari; Andayani, Ari; Pantjawati, Ni Luh Diah; Widiana, I Gde Raka; Yuliawati, Putu; Juliari, IGAM
International Journal of Retina Vol 8 No 1 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss001.314

Abstract

Introduction : Prevention of Diabetic Retinopathy (DR) require an examination method that can identify earliest damage before clinical symptoms observed. This study aimed to determine the novel and objective way to detect those damage through RNFL and GCL-IPL thickness. Method : This analytical cross sectional study research conducted at the eye polyclinic and the Diabetic Center of IGNG Ngoerah Hospital, Denpasar. This study comparing the difference in thickness of RNFL and GCL-IPL in patients without DM, with Type 2 DM without DR and with DR in average and each quadrant thickness through Kruskal Wallis and One Way Anova test. Result : The sample was 59 people which then divided into three groups, namely 20 samples in the group without DM, 19 samples in the DM group without DR and 20 samples with DR. The samples were then examined for RNFL and GCL-IPL and the results were compared between groups. The mean age of the subjects were 58.80±9.65 years old. In the RNFL measurement, it was found that there were differences in values ​​between groups in all quadrants except the temporal quadrant (p=0.518). After covariate analysis by variables of age, HbA1c, blood pressure, visual acuity, IOP and axial length, the results change with the nasal and inferior quadrants as the only found significant. In the GCL-IPL analysis there were significant differences between groups, especially in the superotemporal, temporal and inferotemporal quadrants (p<0.005). These results remained after being controlled by covariate analysis. Conclusion : This study proved a neurodegeneration process that occured focally in certain areas that can be detected through the RNFL and GCL-IPL measurement modalities. These examinations were expected to be useful in terms of screening both primary and secondary in patients with type 2 DM.
SUPRACHOROIDAL HAEMORRHAGE CAUSED BY VALSALVA MANEUVER DURING VITRECTOMY Rahma, Nur Ainun; Sembiring, Sindy Br; Silitonga, Andrea Radotma; Bangun, Christina YY
International Journal of Retina Vol 8 No 1 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss001.311

Abstract

Introduction: Suprachoroidal hemorrhage is a rare but significant complication that can occur during intraocular surgery due to valsalva maneuver while patient awake. A rapid blood accumulation in the suprachoroidal space due to increased tension such as valsalva manuever can caused by rupture of the posterior ciliary arteries or vortex veins. Case report : A 43-year-old man with drop IOL following eventful cataract surgery underwent vitrectomy, IOL explantation and iris claw IOL implantation under general anesthesia. After core vitrectomy and IOL explantation the patient suddenly awake. Iris claw IOL implantation was proceed. At the end of surgery massive suprachoroidal hemorrhage was found. One day postoperative the visual acuity was hand movement. Suprachoroidal and vitreous hemorrhage were observed. Oral and topical steroid were administered. Three months post operative the visual acuity 20/50 and residual suprachoroidal hemorrhage was observed. Discussion: Suprachoroidal Hemorrhage incidence during intraoperative is not known because it occurs very rarely. Our case highlights the Valsalva maneuver event during vitrectomy which cause sudden suprachoroidal hemorrhage. Conclusions: Valsava maneuver during vitrectomy could cause a devastating complication such as suprachoroidal hemorrhage. Although it is one of the reversible complications of anesthesia awareness during vitrectomy, it can be resulted severe visual impairment.
Prevalence and Demographic Patterns of Diabetic Retinopathy, Retinal Vein Occlusion, and Age-Related Macular Degeneration in Eastern India: An Epidemiological Study Sinha, Bibhuti Prassan; Anand, Abhishek; Kumar, Aniket; Sinha, Shivani; Yadav, Nishita
International Journal of Retina Vol 8 No 1 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss001.307

Abstract

Purpose: To elucidate the epidemiology, clinical characteristics, and treatment outcomes of retinal diseases in Eastern India. Methodology: This prospective observational study was conducted at a tertiary care hospital from August 2021 to December 2022. Adult patients (≥18 years) diagnosed with diabetic retinopathy (DR), retinal vein occlusion (RVO), or age-related macular degeneration (ARMD) were enrolled after obtaining informed consent. Comprehensive data collection, including demographic information, clinical characteristics, and treatment outcomes, was conducted. Data were analyzed using descriptive and inferential statistical methods. Results: The study cohort (N=812) exhibited a predominance of DR (60.84%, 95% CI: 57.4-64.2%), followed by branch retinal vein occlusion (BRVO, 18.72%, 95% CI: 16.1-21.6%), ARMD (12.07%, 95% CI: 10.0-14.5%), and central retinal vein occlusion (CRVO, 11.08%, 95% CI: 9.1-13.4%). Demographic analysis revealed a male predominance (73.65%, 95% CI: 70.5-76.6%) and a younger population (60.3% ≤60 years, 95% CI: 56.9-63.6%). Comorbidities were highly prevalent, with diabetes mellitus (69.83%, 95% CI: 66.6-72.9%) and hypertension (58.99%, 95% CI: 55.6-62.3%) being the most common. Clinical evaluation showed decreased vision as the primary symptom (97.17%, 95% CI: 95.8-98.1%). Best Corrected Visual Acuity (BCVA) of 0.5 or better was observed in 52.1% of patients (95% CI: 48.7-55.5%). Optical Coherence Tomography revealed Central Macular Thickness exceeding 300 µm in 34.62% of cases (95% CI: 31.4-37.9%). Laser therapy was the predominant treatment modality (11.13%, 95% CI: 9.2-13.4%). Follow-up adherence demonstrated a significant decline after the initial visit (from 76.13% to 16.77%, p<0.001). Conclusion: This study highlights the urgent need for enhanced screening protocols and multidisciplinary management strategies in Eastern India to address the high burden of retinal diseases. Targeted interventions in this region could prevent vision loss and improve healthcare outcomes.
Evaluating the accuracy of Artificial Intelligence (AI)-integrated, Smartphone-based screening for Diabetic Retinopathy: Systematic Review Samara, Shofia Medina; Laksono, Ariyoga Kun
International Journal of Retina Vol 8 No 1 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss001.294

Abstract

Background: Diabetic retinopathy (DR is the most common microvascular complication of diabetes that can cause vision problems and blindness that poses a significant health risk and financial burden, increasing the needs to effectively screen and manage diabetic eye disease. The current method of screening for diabetic eye disease relies on human experts to analyze the results. Alternatively, recent advancements in artificial intelligence (AI) especially deep learning (DL) and retinal imaging using smartphones offer a promising solution for both patients and ophthalmologists, potentially improving patient compliance and making telemedicine more efficient for DR screening. Purpose : To represent on accuracy of AI‑integrated process in smartphone-based DR screening and to compare the various study methods and settings used to achieve this accuracy. Method: Literature search on current DR screening programs was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) framework on Google Scholar, Scopus, Web of Science, PubMed, Medline, and Embase with most recent search was updated on June 1st, 2024. Key information was extracted from the studies included author names, journal, year of publication, country, sensitivity, specificity, positive and negative predictive values (if available), study methods, and settings. Result: The study identification process resulting in 9 selected studies. The performance metrics reported included intergrader/intramodality agreement, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The sensitivity of AI in detecting DR ranged from 77-100%, while specificity ranged from 61.4 - 95.5%. PPV and NPV were reported less frequently, with ranges of 48.1 - 92.92% and 91.3 - 99.46%, respectively. Intergrader agreement was within range ĸ= 0.45 – 0.91. Conclusion: The studies reviewed in this paper collectively represents the potential of smartphone based integrated with AI in revolutionizing DR screening. The high sensitivity and specificity achieved by various AI algorithms, often exceeding the standards set by regulatory bodies like the FDA and ETDRS, highlight their accuracy in detecting DR and its severity levels. The accessibility and user-friendliness of smartphone-based retinal imaging further enhance the coverage of DR screening, particularly in underserved areas with limited resources and internet connectivity.
RETINAL NERVE FIBER LAYER THICKNESS ASSOCIATED WITH SEVERITY OF DIABETIC PERIPHERAL NEUROPATHY IN DIABETES MELLITUS TYPE 2 Putri, Mutiara Kristiani; Arfan, Muhammad; Rahmasari, Herisa; Dewi, Nadia Artha; Rosandi, Rulli; Kurniawan, Shahdevi Nandar
International Journal of Retina Vol 8 No 1 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss001.320

Abstract

Purpose: To identify whether the Retinal Nerve Fiber Layer is useful in detecting severity of peripheral neurodegeneration in diabetic patients Methods: A cross-sectional study was conducted. 36 people were enrolled in this study which is divided into two groups. 18 people with type 2 diabetes mellitus (DM) with Diabetic Peripheral Neuropathy (DPN) and 18 people with type 2 DM non-DPN. All subjects were 40-60 years old, and the best corrected visual acuity was better than 0,2 logMAR. An Optical Coherence Tomography (OCT) examination was carried out to determine the Retinal Nerve Fiber Layer (RNFL) thickness, and an Electroneuromyography examination was applied to establish a diagnosis of DPN. Data were analyzed with independent T-test and Spearman correlation analysis. Results: The average RNFL thickness in the DM with DPN was thinner than the RNFL thickness in the DM non-DPN group (100.22 ± 38; vs 102.61±9.11; p 0.444). At temporal quadrant and nasal quadrant, RNFL was also thinner in DM DPN group than DM non-DPN group (71.78±12.21, vs 76.33 ± 8.53, p 0.203; and 75.11±11.38 vs 77.39 ± 14, p 0.596). Sural and tibial amplitude (14.44±2.87 and 6.85± 4.98) , were the most significant predictor values in determining the severity of DPN (p=0.000). Average, temporal, and nasal RNFL thinning has an inverse association with DPN severity (r=-0,285; -0,258;and -0,126) Conclusion: RNFL was thinner at average, temporal, nasal quadrant in the DM group with DPN compared to DM non-DPN group. RNFL thickness has an inverse association with the severity of the DPN although they were not statistically significant. Keywords: Diabetes Mellitus, Diabetic Peripheral Neuropathy, Retinal Nerve Fiber Layer
Ocular Manifestations of Aplastic Anemia: Rare Case of Anemic Retinopathy Juanarta, Pieter; Ihsan, Grimaldi; Iskandar, Erwin; Kartasasmita, Arief; Virgana, Rova; Indra, Made
International Journal of Retina Vol 8 No 1 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss001.280

Abstract

Incidence of aplastic anemia was 1-2 cases per million population per years, and showed higher rate in Asia and 10-25 years old. Anemic retinopathy can occur in 28% of patient with severe anemia, especially if accompanied by thrombocytopenia. Most cases were asymptomatic, however decrease visual acuity were also commonly found caused by haemorrhage and Macular edema. A 65 years old female patient came with blurry vision ten days prior admission accompanied with loss of consciousness, recurrent bleeding from nose, gum, and bluish discoloration in her extremities four years ago. Visual acuity was 1/60 on the right eye and 0.4 log on the left eye. Funduscopic examination showed vitreous haemorrhage, dot blot, hard exudate, and tortuosity of vein. Laboratory Examination showed anemia and thrombocytopenia, and peripheral blood morphology showed normochromic anisopoikilocytosis caused by chronic disease. She was scheduled to underwent anti VEGF and showed improvement in her visual acuity after injection. Fundoscopic examination later shows sub-hyaloid haemorrhage, dot blot, hard exudate, and tortuosity of vein. She was scheduled to undergo pars plana vitrectomy and were consulted to internal medicine. Aplastic anemia is a rare disease that usually asymptomatic, thus causing late intervention and a high mortality rate. Early manifestation can be seen in retinal structure as anemic retinopathy thus ophthalmologist have valuable impact in early detection of this disease. Haemorrhage overlying the macula and macular edema is the most common cause of visual impairment. Anti VEGF treatment, transfusion of blood component, and immunosuppressive therapy is needed to prevent complication and increase patient survival rate. Patient visual acuity usually imporved after early transfusion and anti VEGF injection, however delayed intervention may cause irreversible vision loss.
RETINAL THICKNESS AND RNFL EVALUATION BY OCT IN RADIOLOGY TECHNICIANS EXPOSED TO X-RAYS WITHOUT EYE PROTECTION IN AMAZONIAN CLINICS Almeida, Leidiana Silva de; Alves, Luana Cristina Lucas; Rissino, Jonathan Miranda; Ferreira, Gustavo Miranda de Azevedo; Rodrigues, Anderson Raiol; Teixeira, Cláudio Eduardo Corrêa
International Journal of Retina Vol 8 No 2 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss002.327

Abstract

Introduction: While the ocular effects of ionizing radiation have been widely studied, little is known about its impact on the retinas of radiology professionals exposed daily without protective eyewear. This study aimed to assess potential morphological retinal changes using optical coherence tomography (OCT) in radiology technicians working without X-ray protective glasses. Methods: A total of 11 radiology technicians routinely exposed to X-rays without eye protection were compared with 9 age-matched controls not exposed to ionizing radiation. Subjects with systemic conditions affecting the retina (e.g., diabetes, hypertension) were excluded. OCT scans were performed using Heidelberg Spectralis OCT to assess retinal nerve fiber layer (RNFL) thickness and global retinal thickness.Given the small sample sizes, a descriptive comparison approach was used. Results: RNFL thickness was thinner in the exposed group compared to controls, particularly in the superior and nasal quadrants. Three individuals in the exposed group showed global retinal thickness below normal limits, compared to one in the control group. The proportion of subjects with retinal thinning was higher in the exposed group, especially in the macula and RNFL. A qualitative assessment revealed temporal macular thinning and superior RNFL thinning around the optic disc. Conclusion: These findings suggest that chronic X-ray exposure without protective eyewear may be associated with retinal thinning and RNFL loss in radiology technicians. Given the small sample size, further research with larger cohorts is needed to confirm long-term effects and establish preventive measures.
CORRELATION BETWEEN GLYCAEMIC CONDITIONS WITH SIRT-1 GENE EXPRESSION LEVELS IN THE PROGRESSION OF DIABETIC RETINOPATHY Shaik, Mahaboob Vali; S, Skandha Harshita; Shaik, Munni; shaik, John basha; Molli, Nissi; Kuragayala, Swarna deepak; G, Jayaram; Kola, Vijaya Shekar
International Journal of Retina Vol 8 No 2 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss002.317

Abstract

Background: Diabetic retinopathy (DR), a microvascular disorder, is commonly linked to diabetes. Diabetes mellitus' complex, progressive, and asymptomatic neurovascular effects make DR the leading cause of blindness and visual impairment in people of working age. Retinal neovascularisation determines whether DR is proliferative, non-proliferative, or diabetic macular oedema. Aim: To evaluate the levels of SIRT-gene mRNA expression and how they relate to glycaemic status in patients with diabetic retinopathy. Methods: The 60 cases in this study included 30 patients with diabetic retinopathy, 30 diabetic cases without retinopathy, and 30 non-diabetic controls. SIRT1 mRNA expression and basic laboratory measures were recorded. Results: It was demonstrated that DR patients have down-regulated SIRT1 mRNA expression. The results of the study suggest that DR results from an imbalance between SIRT1 and IL-17 expression levels, with SIRT1 perhaps offering protection by preventing the production of IL-17. The DR cases had significantly lower levels of SIRT1 gene mRNA expression than the controls. The association between SIRT1 mRNA expression and four putative functional SNPs (rs12778366, rs3758391, rs2273773, and rs4746720) was examined. The findings showed that the allelic genes of rs3758391 showed substantial changes in SIRT1 mRNA expression in the healthy subjects (p<0.01). Compared to the controls (0.91±0.75 fold), SIRT1 mRNA expression levels were lower in the RD (0.61 ± 0.29 fold). SIRT1 gene expression decreases when HbA1c rises, indicating a negative connection between SIRT1 expression and HbA1c. This suggests that SIRT1 plays a protective function in preventing diabetic retinopathy (r = -0.245, p = 0.004). When comparing the Diabetes with Retinopathy Group to the Diabetes without Retinopathy Group1, SIRT1 Gene Expression was considerably lower, but IL17 was significantly greater (0.62±0.30 vs. 0.60±0.27, p=0.012). Conclusion: In conclusion, the present data provide credence to the idea that the rs3758391 SNP affects mRNA expression in healthy people and that the SIRT1 gene guards against DR. In connection with the pathophysiology of DR, they also clarified the processes controlling the genetic regulation of the SIRT1 gene.
The use of Artificial Intelligence for Diagnosing Retinopathy of Prematurity – A Systematic Review Pertiwi, Adinda Mulya; Yulia, Dian Estu; Lestari, Yeni Dwi
International Journal of Retina Vol 8 No 2 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss002.316

Abstract

Purpose: Retinopathy of prematurity (ROP) is a vaso-proliferative disease of the retina associated with prematurity and is well known to be the leading cause of childhood blindness worldwide. Given the prevalence of ROP and the increasing demand for efficient screening solutions, this systematic review aims to update the current development of Artificial Intelligence (AI) technologies for ROP diagnosis and screening, considering the appropriate AI types that align with the specific needs and workloads of ROP screening programs. Methods: We performed a systematic literature review of the English online literature databases by applying a general search strategy on April 20, 2024. Search phrases included multiple variants of terms including "ROP", "retinopathy of prematurity", "artificial intelligence", "diagnosis", "sensitivity analysis", "specificity", "area under the curve". Findings: A total of 12 studies were identified from varied countries. Summary: Review of the published literature demonstrate high sensitivity across different studies, indicating their strong potential for early detection of ROP but demonstrating variability in specificity. The review also underscores the importance of domain adaptation and validation across diverse populations to ensure generalizability. AI integration in clinical practice, especially in telemedicine, can enhance early detection, standardize diagnoses, and alleviate the burden on healthcare professionals, particularly in low-resource settings.

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