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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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Visual Improvement Following Glaucoma Surgery: Poster Presentation - Case Report - Ophthalmologist Purnamasari, Heronita
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: 10.35749/3deae293

Abstract

Introduction : Glaucoma is a progressive optic neuropathy and a leading cause of irreversible blindness. The aim of glaucoma treatment is to slow progression and minimize the risk of further damage, not to expect functional improvement. We report the case of a patient who experienced an improvement in vision following glaucoma surgery and review the literature regarding this phenomenon. Case Illustration : A 66-year old female presented with vision loss in the left eye that could only perceive finger counting in one meter. Her intraocular pressure (IOP) measured 51,8 mmHg and she was found to have primary open angle glaucoma. Medical treatment was commenced and she underwent a successful trabeculectomy. Unexpectedly she experienced improvement in vision after treatment. At her recent visit visual acuity was 6/30 in the affected eye. Discussion : Although the mechanism of improved vision cannot be proven it is likely that successful lowering of IOP resulted in some reversal of retinal ganglion cell dysfunction. Some evidence explained that retinal ganglion cells damaged by glaucoma might undergo a period of reversible dysfunction preceding cell death. Furthermore, reversible changes in optic nerve head morphology have been reported following reduction of intraocular pressure. These observations suggest that certain structural and functional improvements may in fact be possible in some patients. The changes of anterior chamber depth, corneal radius of curvature, corneal thickness or corneal edema could be considered as other factors which influence this improvement. Conclusion : Functional improvements may occur following trabeculectomy. Glaucoma surgery should be offered early, and considered even in those with reduced visual acuity.
A Watchful Eye: A Case Report on The Management of Hypotony Maculopathy after Non-Valved Glaucoma Drainage Device Implantation: Poster Presentation - Case Report - Resident Herdian, Felicia Sesih; Amanda, Lia; Ivanovna, Regina; Gunardi, Triana Hardianti; Yunard, Ardiella; Suryono, Astrianda Nadya
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/b6ewfv90

Abstract

Introduction : Low intraocular pressure (IOP) and reduced visual acuity following glaucoma surgery have been linked to a serious complication known as hypotony maculopathy. Here, we report a case of hypotony maculopathy following glaucoma drainage implant which was successfully managed by a conservative approach utilizing oral and topical steroids, resulting in favorable outcomes. Case Illustration : A 25-year-old female with juvenile glaucoma presented with low IOP in the right eye (RE) following glaucoma drainage surgery using non-valved implant four months prior. Ophthalmic examination revealed a decrease of IOP (9mmHg to 4mmHg) and visual acuity (6/6 to 6/24). Fundus examination and optical coherence tomography (OCT) of macula was indicating hypotony maculopathy. All glaucoma medications were discontinued and the patient was given oral methylprednisolone 3x8 mg and topical prednisolone acetate three hourly for two months. Subsequent follow-up revealed an increase in IOP to 37mmHg and visual acuity improvement to 6/6. The patient was then given oral and topical antiglaucoma medications to maintain IOP control. Discussion : Hypotony and its related sequelae are more common with the non-valved drainage devices. Prompt intervention is crucial for improving visual outcomes. Treatment options include surgical and conservative approach. Closely monitored conservative therapy may also give favorable outcomes similar to surgical approach. Conclusion : In advanced cases of glaucoma, extremely low IOP is just as risky as a high IOP. Conservative therapy, including topical and oral corticosteroids, can be employed to reverse hypotony, at the expense of transient IOP rise, in corticosteroid-responsive patients. Restoring normal IOP in a timely manner may improve retinal function.
Combined Virna Glaucoma Implant (VGI) Implantation and Pars Plana Vitrectomy for Refractory Aphakic Glaucoma: Poster Presentation - Case Report - Resident Herdian, Felicia Sesih; Augiani, Amani Sakinah; Lumintang, Agnesstacia Vania; Iskandar, Ferdy; Oktariana, Virna Dwi; Djatikusumo, Ari
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: 10.35749/7e24y445

Abstract

Introduction : Glaucoma drainage devices (GDDs) implantation are frequently indicated for refractory glaucoma. The preferable anterior chamber may be inaccessible for patients with anterior chamber abnormalities. Case Illustration : A 6-year-old boy presented with high intraocular pressure (IOP) on the right eye (RE) four months before admission. Cataract surgery on both eye was done four years prior, due to congenital cataract. On examination, the visual acuity of the RE was hand movement with IOP 61mmHg with medications. Anterior chamber was shallow, posterior synechiae was found and posterior segment was hard to be evaluated. The fellow eye was nonfunctional with IOP 31mmHg. Pars plana vitrectomy (PPV) was performed followed by implantation of GDD (Virna Glaucoma Implant) with posterior chamber sulcus tube placement without adding a new incision. Post-operatively, IOP was 3mmHg and choroidal detachment was found. With steroid medication, satisfactory IOP control was achieved within three weeks of follow-up. Visual acuity of RE was improved to 0.5/60. Discussion : In eyes with shallow anterior segments, tube placed in the anterior chamber may increase the risk of corneal endothelial injury. Placement of the silicone tube in the posterior chamber sulcus is an effective alternative technique. Although it is relatively safe in experienced hands, vitrectomy and insertion of the tube into the posterior segment carries significant risks, including choroidal detachment. Careful monitoring and management is needed to control IOP and maintain vision. Conclusion : Combined GDD implantation and PPV may be considered for refractory aphakic glaucoma, showing favorable outcomes with a relatively safe procedure.
Silent Progressive Glaucoma in Encephalofacial angiomatosis (Sturge-Weber Syndrome): A Vision-Preserving Trabeculectomy: Poster Presentation - Case Report - Resident Gunardi, Triana Hardianti; Iskandar, Ferdy; Herdian, Felicia Sesi; Amanda, Lia; Priscilla, Florentina; Oktariana, Virna Dwi
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/h8wd8052

Abstract

Introduction : Encephalofacial angiomatosis, also known as Sturge-Weber Syndrome (SWS), is a rare, non- hereditary condition affecting multiple organs. Glaucoma occurs in almost 70% SWS children, more commonly when the port-wine stain involves the upper eyelid skin. Secondary glaucoma was present due to elevated venous pressure. Case Illustration : An 8-year-old boy with typical port-wine stain involving eyelid, came with recurrent painful right eye (RE) and headache in the past 3 months. He was diagnosed with SWS at 1 year and was on daily doses of carbamazepine and valproic acid for seizure control. His best visual acuity and intraocular pressure were 0.5/60 RE, 6/38 LE, 38 mmHg RE, 28 mmHg LE, respectively. Examination revealed Cup-disc-ratio (CDR) 0.9-1.0 RE and 0.5-0.6 LE. During the first three months, he showed favourable outcome with timolol and latanoprost (controlled IOP with target of <12 mmHg and markedly similar Cup-Disc Ratio). However, at 4th and 5th month visit, his IOP significantly increased despite of additional regiments, thus underwent trabeculectomy on both eyes for preserving his sight. After procedure, his IOP remained stable <12mmHg with maintained bleb, deep anterior chamber, also attached posterior segment. Discussion : Treatments of secondary glaucoma of SWS typically involved surgery with significantly lower success rate compared to Primary Congenital Glaucoma. Trabeculectomy or tube shunt surgery should be performed with caution due to risks of choroidal effusion and hemorrhages. Conclusion : Secondary glaucoma in children with SWS is common and challenging. Trabeculectomy should be pursued when the benefit outweighs the risks, even with a slim chance, to preserve the vision.
CONQUERING THE AMBIGUITY OF OPTIC ATROPHY IN NORMAL TENSION GLAUCOMA: FROM MYSTERY TO MASTERY: Poster Presentation - Case Report - Resident Hakim, Affannul; Komaratih, Evelyn; Nurwasis; Primitasari, Yulia
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/nha7y421

Abstract

Introduction : The dilemma in diagnosing glaucoma often arises when optic atrophy is found alongside nonspecific glaucomatous findings and normal intraocular pressure (IOP), particularly in cases of normal tension glaucoma (NTG). This gray zone often leads to doubt and misdiagnosis. Case Illustration : A 70-year-old man previously diagnosed with idiopathic bilateral optic atrophy complained of blurred vision in both eyes. The visual acuity was 5/5 in the right eye (RE) and hand movement in the left eye (LE). Both eyes had normal IOP, open angles with Sampaolesi lines on gonioscopy, fibrin deposits at pupillary margins, and a large cup-to-disc ratio with baring and peripapillary atrophy on funduscopy. The OCT examination revealed thinning in the ONH-RNFL, ILM-RPE, and GCL-IPL complexes. HFA revealed tunnel vision in RE and general depression in LE. The patient was suspected of having NTG. We performed BMO-MRW (less than 100 ?m in both eyes) and 24-hour ocular perfusion pressure (OPP) measurements (less than 50 mmHg at night) to support the diagnosis. Discussion : The BMO-MRW examination is a new parameter that can help establish the diagnosis of glaucoma. A thin BMO-MRW finding suggests that optic atrophy originates from glaucoma. It is important to perform a comprehensive examination in cases of NTG to identify risk factors and prevent the development of glaucoma. Decreased OPP to less than 50 mmHg and PEX syndrome may be risk factors for NTG. Conclusion : In cases of doubtful optical atrophy, it is important to consider the possibility of NTG by performing a comprehensive examination, including BMO-MRW and twenty-four hour OPP measurements.
ND:YAG Laser Vitreolysis as The Management of Occluded Tube After Glaucoma Drainage Device Implantation (GDD): Poster Presentation - Case Report - Resident Iskandar, Raden Fitri Fatimah; Gustianty, Elsa; Umbara, Sonie; Prahasta, Andhika; Rifada, R. Maula
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: 10.35749/1drs8325

Abstract

Introduction : Glaucoma Drainage Devices (GDD) implantation surgery can be an alternative therapy for patients with uncontrolled IOP after trabeculectomy. However, tube occlusion is a common complication of GDD implantation. Management of tube occlusion can be done using laser or with surgery. This case presents the management of vitreous occlusion of tube implant using ND:YAG laser-vitreolysis. Case Illustration : A 63 year-old male patient came with chief complaint of pain in his right eye. The patient had a history of cataract surgery on the right eye and was diagnosed with glaucoma. An examination showed IOP in the right eye was increased, vitreous in COA and lens was aphakic with posterior capsule rupture. The patient had undergone trabeculectomy, but IOP remained high, so an Aurolab Aqueous Drainage Implant (AADI) GDD implantation was performed. However, six weeks after the procedure, the IOP still increased, and an examination revealed vitreous occlusion of the GDD tube (Figure 1) . The patient underwent Zeiss ND-YAG laser-vitreolysis on his right eye (Figure 2) with laser spot size of 50?m and power of 2.1 MJ. Post laser IOP was decreased. Discussion : GDD implantation is a surgical option for primary or secondary therapy, but tube occlusion can cause implantation failure. Laser-vitreolysis is a non- invasive modality to treat tube occlusion caused by vitreous. Conclusion : GDD occlusion can occur due to various etiologies, but laser-vitreolysis is a non-invasive treatment option aimed at restoring tube patency and aqueous outflow.
Phacodonesis in Angle-Closure Glaucoma: Phacomorphic or Other Lens- Induced? Poster Presentation - Case Report - General practitioner Claudia, Alyssa; Caesaria, Aquirina; Noerdiyani, Niken Indah; Koesoemowardani, Dianawati
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/pr0ygp29

Abstract

Introduction : Glaucoma is defined as progressive optic neuropathies characterized by optic disk cupping, reduced visual field, and visual loss. As a “silent thief of sight”, glaucoma ranked second worldwide and third in Indonesia as the cause of blindness. The cause of glaucoma varies, one of which is lens-induced which presents as loss of vision and red eye. Case Illustration : A 53-year-old female complained about blurred and pained red eyes. Examination of the right eye revealed VOD 1/300, cloudy-milky lens, phacodonesis, and IOP 26.3 mmHg. She was diagnosed with angle-closure glaucoma suspected as phacomorphic or other lens-induced and was treated by topical hypotensive agents and phacoemulsification with IOL implantation procedure. Right eye examination on day one post operation showed VA 2/60 and IOP 13.6 mmHg. Improvement on two weeks follow- up revealed VA 6/15 with best VA of 6/6, IOP 15.7 mmHg, CD ratio 0.5, and negative glaucoma optic neuropathy (GON) finding. Discussion : When accompanied by phacodonesis, angle-closure glaucoma is mainly caused by a secondary process. It involves zonule of Zinn fragility, which usually occurs in subluxation but also appear in hypermature cataract. Dilated eye examination showed no sign of subluxation, therefore the final diagnosis was phacomorphic glaucoma and hypermature cataract. Cataract surgery as the definitive treatment must be done at an appropriate time as was done for this patient with a favorable outcome. Conclusion : The presence of phacodonesis in angle-closure glaucoma should be thoroughly evaluated. Meticulous decisions on definitive treatment can be planned afterward.
DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE: Poster Presentation - Case Series - Resident Wardani, Sabrina Indri; Rifada, R. Maula; 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: 10.35749/349t6495

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.
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/p8vwdw41

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/y57p1107

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.

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