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Ophthalmologica Indonesiana
Published by Perhimpunan Dokter Spesialis Mata Indonesia
ISSN : 01261193     EISSN : 2460545X     DOI : 10.35749
Core Subject : Health,
Health Professions Medicine & Pharmacology Public Health
Ophthalmologica Indonesiana is an open accessed online journal and comprehensive peer-reviewed ophthalmologist journal published by the Indonesian Ophthalmologist Association / Perhimpunan Dokter Spesialis Mata (PERDAMI). Our main mission is to encourage the important science in the clinical area of the ophthalmology field. We welcome authors for original articles (research), review articles, interesting case reports, special articles, clinical practices, and medical illustrations that focus on the clinical area of ophthalmology medicine.
Arjuna Subject : Kedokteran - Ophthalmology
Articles 869 Documents
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Spontaneous Globe Rupture due to Neglected Glaucoma: How can it be? Poster Presentation - Case Report - General practitioner Firdausi, Asri Ayu; Kunhermawan, Cosmas Hascaryanto; Lestari, Chindhia Rima Rochmatika Bunga
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/rczz4a47

Abstract

Introduction: Globe rupture is usually associated with spontaneous traumatic processes with the worst prognosis. The occurrence without prior trauma is only reported in small numbers of cases. This paper will describe a globe rupture in glaucomatous eye and share our experience with its management. Case Illustration: A 66-year-old male presented to the emergency department (ED) with reddish and progressive pain in the right eye (RE) followed by severe headaches for the last three days. On history taking, the patient complained of a progressive blurry vision to total blindness of his RE for 1 year. The patient admitted to having a history of glaucoma on previous primer examination but did not routinely control it. On initial examination, the patient was hypertensive , and suddenly began bleeding within 10 minutes upon arrival at ED. The diagnosis of globe rupture was made and he underwent emergency evisceration. Discussiona: Spontaneous globe rupture is very rare, with an incidence of 3 per 100.000 in the United States, while no definite number is found in Indonesia due to the rarity. In glaucoma patients, spontaneous globe rupture is postulated to occur due to suprachoroidal hemorrhage. Our patients had multiple risk factors such as advanced age, systemic hypertension, and chronic untreated glaucoma. Evisceration went down to reduce pain, stop bleeding and prevent the spread of infection. Performing surgery within 10 days of the initial injury suggests a lower risk of post-operative endophthalmitis or sympathetic ophthalmia. Conclusion: Spontaneous globe rupture in neglected chronic glaucoma has a very poor outcome but preventable.
Recurrence of Malignant Glaucoma After Vitrectomy Intervention: A Challenging Case Series: Poster Presentation - Case Series - Resident Zulfa, Mazidah; P, Satya Hutama; Wildan, Arief; Rahmi, Fifin L; Puspasari, Denti; Maharani
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/571xr814

Abstract

Introduction : Malignant glaucoma most commonly occurs after glaucoma filtration surgery. Most cases require surgical intervention such as vitrectomy. However, even after successful treatment, it can reoccur in some cases. We present two cases of recurrent malignant glaucoma. Case Illustration : The first case involved a 48-year-old female with primary angle closure glaucoma who developed malignant glaucoma 1-week after undergoing combined glaucoma surgery. The second case involved a 70-year-old man with primary angle closure glaucoma and pseudophakia who developed malignant glaucoma 4-month after trabeculectomy. They received total vitrectomy treatment. We observed anterior chamber deepening in these 2 cases, but intraocular pressure remained increased 2-week after intervention. Discussion : We found improvement in anatomy by deepening the anterior chamber, but the intraocular pressure increased in the 2 weeks. Although the problem of releasing aqueous accumulations from the vitreous has been resolved after vitrectomy, but there is no permanent passage between the anterior chamber and the vitreous cavity. So, recurrences can occur. It is possible to manage this condition by restoring aqueous flow from the anterior vitreous to the anterior chamber. YAG laser capsulo- hyaloidotomy or vitrectomy combined with hyaloido-zonula-iridectomy are frequently effective in treating underlying causes. Conclusion : Vitrectomy can help to improve the deepening anterior chamber, but intraocular pressure may remain increased after 2-week follow-up. The recurrence of malignant glaucoma may be related to incomplete resolution of the underlying condition.
A Challenging case of essensial iris atrophy ICE Syndrome with secondary angle closure glaucoma at Pasar Rebo General Hospital : A Case Report: Poster Presentation - Case Report - General practitioner Indrianti, Dayu Fitria; Nasrudin; Simanjuntak, Dicky Budiman
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/40xn7330

Abstract

Introduction : ICE syndrome is a unique ophthalmic disorder that involves an iris atrophy, irregular corneal oedema, and secondary angle-closure mainly occurs unilaterally in young and middle-aged women, with no family history. Approximately 50% of ICE syndrome patients will later develop secondary angle closure glaucoma. The following case report presents a patient with essential iris atrophy and secondary angle closure glaucoma. Case Illustration : A 50 year old woman presented with painful and redness of the right eye (RE) since 1 week. Her visual acuity was 6/40 of RE and 6/30 of left eye (LE). Her intraocular pressure (IOP) was 61,3 mmHg and 19 mmHg for the RE and LE. On the slit lamp, we had a proper RE finding, the iris atrophy with deformity in the direction from 12 to 6 hours, with minimal corneal edema. We performed gonioscopy, fundus photographs and papillary optical coherence tomography. The patient was diagnosed with ICE syndrome with essential iris atrophy type and secondary angle closure glaucoma then was given anti glaucoma agents.DiscussionICE syndrome treatments focus on managing the corneal edema and secondary glaucoma. We treated our patient with maximal oral and topical combination therapy such as carbonic anhydrase inhibitors, beta blockers, cholinergic, prostaglandin analogs for 6 months the IOP and corneal oedema were well maintained. However, maintaining long term success can be challenging, surgical therapy with a filtering procedure can be considered if the IOP is uncontrolled. Conclusion : We confirmed the diagnosis of essential iris atrophy based on its clinical findings and abnormalities in complementary exams.
Bleb Needling Procedure in Juvenile Open Angle Glaucoma (JOAG) for Failed Bleb in Trabeculectomy: Poster Presentation - Case Report - General practitioner Putri, Rizqi Suryani; Nuradianti, Lydia
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/m1y43690

Abstract

Introduction : JOAG is less responsive to medications and often requires surgical therapy. The main choice of surgery is trabeculectomy. One of its success rates is determined by the formation of bleb. Failed bleb causes an increase in IOP. To repair the bleb, bleb needling can be performed as a simple procedure. Case Illustration : A 7-year-old boy came with a chief complaint of pain accompanied by redness of the left eye. The patient was diagnosed with JOAG and had underwent trabeculectomy with mitomycin-C (MMC) 3 months ago on the right eye and 2 months ago on the left eye with complete success surgery. On physical examination, intraocular pressure (IOP) was 12 mmHg / 29 mmHg with flat bleb on the left eye. Visual acuity on the right eye was 3/10 with cc C-2.00 X 0° ? 7/10 while on the left eye was light perception without possible refractive correction. Timolol maleate and latanoprost eye drops were given for 2 weeks but the IOP remained high. Therefore, the patient underwent bleb needling with 5- Fluorouracil (5-FU) on the left eye. Post-operatively, the IOP was 12 mmHg without antiglaucoma medication. Discussion : Failure of the trabeculectomy bleb can occur due to fibrotic proliferation as part of the wound healing response. Studies stated 5-FU bleb needling provide clinically significant IOP lowering and minimal complication. Reduced IOP post needling and formation of bleb indicate successful needling. Conclusion : Bleb is an important indicator of a success trabeculectomy surgery. Bleb needling with 5-FU could be considered as effective and safe procedure after trabeculectomy failure.
The Effects of Bevacizumab in Augmenting Trabeculectomy for Glaucoma : Systematic Review and Meta-Analysis: Poster Presentation - Observational Study - Resident Rusli, Richardo; Kasih, Franky Richard
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/byaet056

Abstract

Introduction & Objectives : Anti-vascular endothelial growth factor (VEGF) agents have been used to slow the healing response and postoperative scar tissue formation. To determine the effectiveness of adding Anti VEGF bevacizumab to the results of trabeculectomy in glaucoma. Methods : Searches were conducted in a structured way using keywords across several data sources, including Pubmed, Proquest and Cochrane library. The keywords used for searching were “Bevacizumab”, “Trabeculectomy” and “Glaucoma”. The reviewed articles are Randomized Control Trial in english, conducted on humans in the last 15 years. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results : From a total of 353 articles, there were 6 studies with 362 eyes of 352 patients been evaluated for the effectiveness of bevacizumab addition to trabeculectomy. The primary outcome of all articles was the assessment of Intra Ocular Pressure (IOP). No significant difference in IOP was found between the subconjunctival bevacizumab + Mytomycin-c group and mytomycin-c alone group (MD 0.11 ; 95% CI -0.10 to 0.33), as well as subconjunctival comparison with mytomycin-c (MD 0.11 ; 95% CI -0.29 to 0.50). Similar results were also found in the intracameral and placebo groups (MD 0.08 ; -0.22 to 0.38). However, 3 articles reported significant differences in peripheral vascularity of the bleb both by the Moorfields Bleb Grading System and by the Indiana Bleb Appearance System. Conclusion : The addition of bevacizumab to trabeculectomy did not show any benefit in reducing IOP when compared with MMC. But it gives better peripheral vascularity of the bleb.
TRABECULECTOMY IN CLOSED ANGLE UVEITIS GLAUCOMA A CASE REPORT: Poster Presentation - Case Report - Ophthalmologist SAMOSIR, ALEXANDER THEODORE; NATAN, PRISCILLA CHRISTINA
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/wwarcp46

Abstract

Introduction : Glaucoma uveitis is caused by increased outflow resistance, which distorts the balance between water production and outflow. Trabeculectomy is better than LPI in controlling IOP in glaucoma uveitis Case Illustration : Male patient aged 45 years, came to the Eye Polyclinic at Serui Hospital with complaints of very painful right eye since 2 weeks ago, the patient also complained of being unable to see at all, red eyes, headache, stiff neck, nausea and vomiting. Ophthalmological examination reveal right eye vision no light perception (NLP), palpebral edema, spasm, conjunctival hyperemia, corneal edema, shallow anterior chamber angle, iris-corneal contact, negative pupillary reflex, total pupillary block, negative fundus reflex, schiotz IOP 81 mmHg. Discussion : The patient diagnosed as right eye acute glaucoma and treated with acetazolamide, timolol maleate eye drops, potassium aspar tablets, prednisolone acetate drops, diclofenac sodium drops in the right eye, paracetamol tablets, re-evaluate in 2 hours. The patient chose to be referred to a hospital in Surabaya. The patient came back with the same complaint and was treated the same as before, right eye surgery trabeculectomy + peripheral iridectomy with releaseable suture flap limbal base with controlled IOP results, releaseable suture sutures were removed in 2 weeks. Trabeculectomy of the uveitic eye is generally less successful because of accelerated wound healing by the postoperative fibrinous and cellular response. Antimetabolites such as 5FU and Mitomycin C are used to enhance the success of trabeculectomy in uveitis eyes (5FU, MMC). 95% success (IOP less than 21 mm Hg with 1 or no treatment) was achieved with MMC augmented trabeculectomy. Conclusion : Increased IOP due to pupillary block causes acute glaucoma with signs of high IOP, middilated pupils, decreased pupillary reflexes, and irregular shape, corneal epithelial edema, episcleral and conjunctival vascular congestion, shallow anterior chamber, small number of flares and cells.
Prostaglandin analogs regimen for open-angle glaucoma or hypertensive ocular, is it still effective nowadays?: a systematic review: Poster Presentation - Observational Study - General practitioner Tikha, Fidya Ainun; Rahadi, Aditia Rizka
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/z96hev50

Abstract

Introduction & Objectives : Open-angle glaucoma and hypertensive ocular therapy are still developing. There are new medications that offer fast and safe in lowering intraocular pressure. Prostaglandin analogs regimenis a well-known medication that we use in lowering intraocular pressure and still use in this era. Methods : A literature search was performed in PubMed, Chocraine, and Google Scholar for studies that fit our inclusion criteria. The Literature must be Randomized controlled trials, Systematic reviews, and meta-analyses from 2013 until 2023 that report data on prostaglandin analogs regimen uses medications for open-angle glaucoma or ocular hypertension. That consists of data on intraocular pressure (IOP) lowering effect by the use of prostaglandin analogs regimen monotherapy or combination. Results : We included Ten literature that consists 5 RCTs (1514 participants), and 5 systematic reviews with meta-analysis (235 RCT literature), that overall make intraocular pressure (IOP) reduction. There are differences in duration to reduce IOP between prostaglandin analogs regimen types and combinations with other classes of regimen. Conclusion : prostaglandin analogs regimen effective in IOP lowering effect in open-angle glaucoma and hypertensive ocular both monotherapy and combination.
The Challenges of Handling Neovascular Glaucoma at Undaan Eye Hospital Surabaya, Indonesia: Poster Presentation - Observational Study - General practitioner Malika, Rosalia Adriani; Nuradianti, Lydia
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/cmqb7053

Abstract

Introduction & Objectives : The management of neovascular glaucoma is challenging because frequently it is incurable with poor visual prognosis. Delay in treatment can lead to sight threatening glaucoma. This study aimed to provide an overview of incidence and management of neovascular glaucoma at Undaan Eye Hospital. Methods : This descriptive epidemiology study comprised 111 eyes of 102 patients. The inclusion criteria were patients diagnosed with NVG who came to Undaan Eye Hospital for 1 year (January 2021 to December 2021). Patients with incomplete medical records were excluded. The patient’s age, gender, risk factors, and treatment were reviewed. Results : There were 102 patients (111 eyes) diagnosed with NVG. The patients were mostly men (53,2%) and the mean age was 54.98 ± 12,4 years. Diabetes Mellitus (DM) was observed in 70 (63,1%) eyes, hypertension in 60 (54,1%) eyes, central retinal vein occlusion (CRVO) in 11 (9,9%) eyes, cholesterol in 7 (6,3%) eyes, and branch retinal vein occlusion (BRVO) in 1 (0,9%) eyes. Mean IOP at the time of diagnosis was 42,8 ± 11,2 mmHg. Anti-VEGF (25,2%), trabeculectomy (59,5%), glaucoma drainage device (17,1%), micropulse transscleral cyclophotocoagulation (5,4%) were done as an option of the treatment. Conclusion : NVG is more common in men. Most patients presenting NVG had DM and hypertension with mean IOP of 42,8 mmHg. Trabeculectomy is the most commonly performed procedure.
DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE: Poster Presentation - Case Series - Resident Wardani, Sabrina Indri; Rifada, R. Maulana; Prahasta, Andhika; Gustianty, Elsa; Umbara, Sonie
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/9x275355

Abstract

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important. Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery. Discussion : Age older than 60 years old, female gender, short axial length (<23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals. Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.
Ab-Interno Bleb Needling in A Failed Trabeculectomy: A Case Report: Poster Presentation - Case Report - General practitioner Natan, Priscilla Christina; Yinvill; Rahayu, Ni Kompyang; Wetarini, Krisnhaliani
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/pcxffx48

Abstract

Introduction : Trabeculectomy remains a gold standard of glaucoma surgical management despite a steady rate of bleb failure due to conjunctival scarring. In this case, we report a case of a failed trabeculectomy managed with ab-interno bleb needling followed by antimetabolite injection of mitomycin C. Case Illustration : A 18-year-old male patient with a history of blurry vision in his right eye and vision loss in his left eye. The patient had previously undergone cataract surgery due to juvenile cataracts and developed persistent high intraocular pressure (IOP) in both of his eyes. A trabeculectomy was performed on his right eye six months prior to the examination; however, the IOP remained at 22 mmHg. Ocular examination revealed a shallow anterior chamber and flat conjunctival bleb. An ab-interno bleb needling technique was performed followed by antimetabolite injection of mitomycin C under local anesthesia in an operating theatre. Follow-up results showed a significant reduction of IOP on the first day (13.3 mmHg) and a week after surgery (18.5 mmHg), maintained by one anti-glaucoma eye drop. Discussion : Trabeculectomy filtration surgery has a high failure rate in younger patients due to a high risk of conjunctival scarring. The ab-interno needling approach with mitomycin C injection is a novel technique that can be performed and offers the advantage of increasing aqueous outflow through a direct opening of the trabecular meshwork from within the anterior chamber. Conclusion : This technique provides effective management of failed trabeculectomy to achieve intraocular pressure lowering effect and a corresponding decrease in the risk of progressive glaucomatous optic neuropathy.

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