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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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OCULAR INVOLVEMENT IN SNAKEBITE PATIENT: A CASE TO REMEMBER: Poster Presentation - Case Report - General practitioner Novianti; Elisa Yopitasari
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/mbzzn864

Abstract

Introduction : Snake bite cases in Indonesia are not rare with mild to catastrophic consequences on the bitten subject due to its hemolytic and neurotoxic effects. This case represents a rare ocular neurotoxic effect of snake’s venom that cause binocular diplopia and ptosis in a child. Case Illustration : A 9 year-old boy was consulted to ophthalmologist with chief complaint of binocular diplopia. He was hospitalized after being bitten by a snake on his right hand and had an episode of delirious state. Ophthalmologic examination revealed ptosis and exotropia of his left eye in primary position. Further examination of anterior and posterior segments showed good results. His visual acuity was unaffected. Intravenous antivenom was administered and the bite wound was taken care. The boy was discharged from the hospital with a good general condition but still an opthalmoplegia. After a week of follow up the diplopia diminished and his ocular motility was recovered. Discussion : Ocular manifestations in snake bite case might be missed because of delirious state of the patients. Snake venom can cause ptosis and ophthalmoplegia (neurotoxic) along with uveitis, optic neuritis, central retinal artery occlusion or vitreous and retina hemorrhage due to its hemolytic effect. Time interval between the bite and treatment is one of crucial factor that indicate the patient’s prognosis. Conclusion : Thorough examination of anterior to posterior ocular segments is needed in every snake bitten patients to rule out any further ocular complication. An early administration of intravenous antivenom is still a mandatory.
Herpes Zoster Keratouveitis : Are We Late in Dealing with It? Poster Presentation - Case Report - General practitioner Nurul Akla; Ferdian Ramadhan; Nazhira Janani
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: 10.35749/8tp5p854

Abstract

Introduction : Herpes zoster ophthalmicus (HZO) is the viral involvement of the ophthalmic division of the trigeminal nerve. The ocular disease affects approximately 50% of HZO cases and is an ophthalmologic emergency due to the risk of vision loss if not quickly treated. This case reports the ocular complication resulting from delayed management of herpes zoster. Case Illustration : A 25-year-old woman presented with the decreased vision for one week. Physical examination revealed erythema, crusts, and multiple vesicles in the upper quadrant of the left face, with a positive Hutchinson sign. Ophthalmic examination showed a visual acuity of 0.6 on the left, with ciliary injection, a multiple dots pattern, and stromal edema in the left eye. Fine and fibrillar keratic precipitates were also present. The patient had previously received oral acyclovir 5x400 mg/day for five days after the onset of symptoms. The patient was given oral acyclovir 5x800 mg/day, amitriptyline 25 mg PO/day, homatropine ED 1 gtt/day, ofloxacin ED 4 gtt/day, Prednisolone acetate ED 4 gtt/day for the left eye. Discussion : Early management of HZO within 72 hours of rash onset is optimal. The Hutchinson sign, characterized by herpetic lesions around the nose tip, indicates nasociliary branch involvement and increases the risk of ocular involvement. Delayed or inadequate treatment can lead to various ocular complications. The prognosis is unpredictable and dependent on long-term sequelae. Conclusion : HZO keratouveitis, can result in stromal scarring or endothelial dysfunction, potentially requiring surgery if therapy is inadequate. Early recognition of ocular involvement is crucial to prevent complications and increase practitioner awareness.
MANAGEMENT OF CORNEAL ULCER PRESENTED WITH RARE PATHOGEN : STREPTOCOCCUS MITIS: Poster Presentation - Case Report - Resident Ibnu Gilang Syawali; Marina Yusnita Albar
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/djgs9x80

Abstract

Introduction : Corneal ulcers can arise from various corneal diseases, including infections, inflammation, and autoimmune disease. Staphylococcus aureus is the most common bacterial pathogen, but lesser- known bacteria like Streptococcus mitis can also cause corneal ulcers. Accurate diagnosis and treatment are essential to prevent vision loss and complications. Case Illustration : A 19-year-old female patient presented with a chief complaint of white spots on her right eye for three months. Previously, her right eye was hit by a foreign object and subsequently, the patient experienced redness and pain in the affected eye. One week later, white spot appeared in the patient's eye and reported to enlarge in the last month. The patient also complained of pain, blurry vision with visual acuity of 1/300, redness, glare, and a foreign body sensation. Corneal swab culture discovered Streptococcus mitis to be the causative agent. The patients was given hourly drop of topical levofloxacin. One month after initial treatment, patient’s symptoms was improving with visual acuity of 6/60 on her affected eye and the ulcer was healed. Discussion : Streptococcus mitis is a commensal pathogen in oral cavity and not normally cause infection of ocular tissue. It may cause ulcer due to prolonged use of topical steroid and previous ocular trauma, since Streptococcus mitis had low virulence rate. Conclusion : Corneal scraping culture should be carried out before treatment of infectious corneal ulcer. Streptococcus mitis is considered rare for corneal ulcer pathogen. Topical quinolones are the first- line drug for bacterial corneal ulcer and worked exceptional for wide range of bacteria.
CHALLENGING DIAGNOSIS AND MANAGEMENT OF INFECTIOUS SCLERITIS COMPLICATED WITH CORNEAL PERFORATION CAUSED BY MULTI DRUG RESISTANT Proteus mirabilis: Poster Presentation - Case Report - Resident Pranandito Trunogati; Herwindo Dicky Putranto; Rosy Aldina
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: 10.35749/3qc8ky50

Abstract

Introduction : Scleritis is a destructive inflammatory disease of sclera and may involve the cornea that associated with an underlying systemic disease and smaller minority are due to infections. The two conditions closely mimic each other, and diagnostic delay can lead to a poor outcome Case Illustration : A 72 year old male presented with severe pain, redness, swelling, and dimness of vision in his left eye. On slitlamp examination, a superonasal scleral nodule with overlying conjunctival defect and corneal ulcer was found. Both ANA test and RA factor were negative. Microbiological investigations of the lessions revealed MDR Proteus mirabilis. His left eye rapidly deteriorated leading to an impending perforation of the sclera and corneal perforation despite intensive antimicrobial therapy, then patient underwent a tibial periosteal graft on his left eye. Although the visual prognosis was poor, structural integrity of the eye was achieved Discussion : Infection is a rare cause of scleritis. Among the organism reported till date, Proteus mirabilis, a gram negative, rod shaped bacterium is the rarest to found. The inciting factors are mostly surgical. There was history of cataract surgery on left eye in this case Conclusion : infectious scleritis is often initially diagnosed as autoimmune, and cause diagnostic delay, the aggressive nature of the associated microbes further complicates the situation. Appropriate diagnosis generally includes lession scrapings with thorough culturing and antibiotic sensitivity testing. Both adequate medical and surgical methods are needed to save the globe from loss
Severe Ocular Manifestations in Stevens-Johnson syndrome : a case report: Poster Presentation - Case Report - General practitioner Eric Jansen; Dian Wikaningtyas
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: 10.35749/7h9cmd06

Abstract

Introduction : Stevens-Johnson syndrome (SJS) is a severe mucocutaneous reactions, characterized by cell death in the epidermis, resulting in blistering and sloughing. Hypersensitivity reaction to drug causes the majority of SJS cases. Ocular involvement occurs in 80% of patients in the acute phase. Case Illustration m A 38-year-old female was consulted to the ophthalmology department with diagnosis of Stevens- Johnson syndrome (SJS). She complained of bilateral eye redness and blurred vision. She was first admitted to the Emergency Department with complaints of burning sensation, progressive rash, and blistering skin all over her body for the past 2 weeks. Ophthalmology examination revealed a visual acuity of no-light perception (NLP) for both eyes. The anterior segment examination in both eyes showed the palpebra was edema and lagophthalmos, conjunctival hyperemia and corneal ulcer, while the posterior segment could not be identified. The patient was hospitalized in the intensive care unit (ICU) due to her symptoms and clinical findings. She was treated with combination of systemic intravenous antibiotics and steroid, eye drops and eye ointment. After 2 weeks, she was able to blink partially. She was discharged after 20 days of intensive treatment. Discussion : Conclusion : Ocular manifestations in SJS are a significant aspect of the disease that can lead to severe visual impairment or even blindness. A multidisciplinary approach to managing SJS is necessary to prevent and treat the ocular manifestations of the disease effectively.
PANOPHTHALMITIS SECONDARY TO RETAINED INTRAOCULAR FOREIGN BODY , SETTING IN RURAL AREA: Poster Presentation - Case Report - Ophthalmologist WAHYU ENDAH PRABAWATI
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/q3dhn091

Abstract

Introduction : IOFB can be serious and result in vison threatening complication. We report IOFB presenting with panophtalmitis secondary to delay in seeking medical attention and misdiagnosed in emergency ward by general practitioner. Case Illustration : A 40-years-old male presented with pain and outward bulging of his right eye with no light perception after trauma to his right eye by a small metallic object while working as electric grasscutter. He presented to our department 3 days following the incident. Systemically, he had a fever, headache and nausea. 2 days after incident, he visited to emergency ward but he was given eye drop only. On Slit lamp examination, corneal melting with keratinization and lacerated wound in cornea at 12 o'clock about 3 mm. Non-contrast CT showing a linear hyperdense foreign body in the right globe likely metal, measuring 3 mm x 4 mm was found. The patient was admitted ceftriaxone intravenous, twice daily. No light perception of visual acuity, ocular penetrating, persistence of the active inflammation, and risk of spread, a decision was made to eviscerate the eye. A metallic foreign body was found in eviscerated tissue. Discussion : Conclusion : Important to suspect foreign body in all cases ocular trauma. Detailed examination and imaging should be performed. Delay treatment from the time of injury, result in poor prognosis. Surgical treatment such as evisceration, should be informed to patient about the visual prognosis.
Uncovering the Uncommon Nocardia Keratitis: Early Recognition of Its Pathognomonic Characteristic to Save Vision: Poster Presentation - Case Report - Resident Maria Astrid Claudia; Ismi Zuhria
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: 10.35749/5hf58024

Abstract

Introduction : Nocardia keratitis is a rare bacterial infection. Global prevalence is below 2%. Mimicking a fungal infection and slow-growth bacteria in culture leads to improper management and an increased risk of permanent vision loss. This case highlights the pathognomonic infiltrate seen in Nocardia keratitis. Case Illustration : A 41-year-old male presented with a four-week history of redness of the left eye, associated with ocular pain, tearing, photophobic, and decreased vision following an injury caused by a grasshopper while riding a motorcycle two weeks before. Visual acuity was hand movement. Conjunctival and ciliary injection, mid-periphery corneal “wreath-pattern” infiltrate with satellite lesions, corneal thinning, and hypopyon were found. Topical antibiotics and antifungals were given empirically earlier with little to no effect. Progressive hypopyon necessitated paracentesis. After seven days of inoculation, a culture test showed slow-growing Nocardia sensitive to amikacin and tobramycin. Treatment then changed to an amikacin subconjunctival injection and tobramycin eye drops. The epithelial defect was resolved, but leukoma and neovascularization were found; thus, keratoplasty was planned. Discussion : Corneal involvement of Nocardia may occur in several forms. Slowly progressive symptoms, satellite lesions, and cotton-wool-like infiltrate can mimic fungal infection. However, it has a pathognomonic characteristic, a pinhead-sized infiltrate forming a “wreath-pattern” in the mid-periphery cornea. Familiarity with this classical pattern could prevent neovascularization, endophthalmitis, corneal perforation, and that cause vision loss. Conclusion : Due to slow-growth inoculation of Nocardia, clinicians should be aware of this pathognomonic presentation to aid in early diagnosis and proper treatment that leads to favorable outcomes and salvage vision in most cases.
Management Strategies of Ocular Alkaline Chemical Injury: Poster Presentation - Case Report - Resident Nadia Ayu Destiani; Patriotika Muslima; Elfa Ali Idrus; Arief Akhdestira Mustaram; Angga Fajriansyah
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/svdapm67

Abstract

Introduction : Ocular chemical burns are true ophthalmic emergencies that can cause permanent corneal and intraocular damage leading to visual impairment or even blindness. When a case of chemical trauma occurs, immediate and appropriate management should be done. Case Illustration : A 24-year-old man came to Cicendo Eye Hospital with complaints of blurry eyes accompanied by burning and watery eyes after being doused with a bucket of cement mortar two weeks earlier. Ophthalmologic examination obtained visual acuity for the right eye 1/300 and left eye was 1/60. The anterior segment of both eyes showed corneal edema, conjunctivalization, persistent epithelial defects, limbal ischemia, and punctate epithelial erosion. There was an ulcer and thinning of the corneal layer in left eye. He was diagnosed with alkaline chemical injury Dua's classification grade VI on the right eye and grade V on the left eye (Figure 1). The patient then underwent a keratectomy, conjunctival resection, and amniotic membrane transplantation procedure. On the seventh day postoperatively, symptoms and clinical features improved with the visual acuity of both eyes improved to 1/60 (Figure 2). Discussion : Amniotic membrane graft was performed in late reparative phase which aims to preserve the surface of the corneal epithelium and prevent corneal perforation and inflammation. Conjunctival resection was performed to prevent neovascularization of the amniotic membrane. Conclusion : Management of ocular burn injury requires an immediate and comprehensive treatment to achieve good result. In this case successful treatment was achieved by improvement of visual acuity and no complication occured.
A Rare Case of Congenital Corneal Keloids: Poster Presentation - Case Report - Resident Nurul Hikmah; Elfa Ali Idrus; Patriotika Muslima; Arief Akhdestira Mustaram; Angga Fajriansyah
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/xxq7gk11

Abstract

Introduction : A corneal keloid is a uncommon ophthalmic condition that manifest as proliferation of fibrous tissue in the cornea and presents as an enlarging, white, elevated, well circumscribed corneal lesion. It is a relatively uncommon lesion that typically appears after surgery, injury, or corneal perforation. Pathological examination of the resected specimen leading to a diagnosis of corneal keloid. Case Illustration : A 6-year-old girl came with chief complaint was blurry vision in both eyes accompanied with a white opacity in her left eye that was gradually growing. The patient has been diagnosed with congenital glaucoma ever since birth. Nobody of her parents acknowledged having a history of inflammatory, infection, or ocular damage. At first glance, her visual acuity appeared to be light reflex in both eyes. Slit lamp biomicroscopy revealed a pearly white, enhanced opacity with sharp edges and smooth surface in the left eye (figure 1). New vessels were present in the lesion adjacent to the limbus. The patient is undergoing keloids excision, multilayer amnion membrane transplant and fine needle diathermy (figure2). Discussion : Corneal keloid can present at any age, present as a glistening white enlarging mass on the cornea and well demarcated from the adjacent normal tissue. Histopathologic examination demonstrates a thickened corneal epithelium overlying stroma and hyalinized collagen (figure 3). Conclusion : A corneal keloid should be suspected in cases of enlarging white glistening avascular corneal scars. Biopsy and histopathology confirmed the diagnosis.
Adherent leukoma with iris prolapse and cataract in old farmer patient : a case report: Poster Presentation - Case Report - General practitioner Lulu Hasna Ulfadila; Hilman Hitam
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/wctxf845

Abstract

Introduction : Adherent leukoma is a condition of the formation of white scars with the involvement of iris incarceration on the cornea, scar which has fibrous tissue adherent to its deeper surface. Case Illustration : a 70 year old grandfather with complaints of blurry right and left eyes, especially in the left eye there are white spots that increasingly interfere with discomfort vision in 5 months ago. The patient works as a rice farmer every day and is likely due to frequent trauma from being exposed to rice seeds since he was young. There is no history of disease and he likely to used insto eye drops. General physical examination is normal. VODS 6/15. IOP OD 11 and OS 7. There is adherens leukoma at 11 o'clock and iris prolapse and there are cataracts as well as the right and left eyes which are still thin. fundoscopy within normal limits. Discussion : Corneal opacity such as adherent leukoma generally results from incidental or iatrogenic trauma. In this case, the patient was traumatized showed post-traumatic cases to be the most common cause of corneal opacity (47.2%), followed by post-ulceration cases (37.7%), glaucoma (7.5%), and other unknown causes (4%). A few rare cases of non-traumatic bilateral adherent leukoma have been described to occur in association with protein energy malnutrition, vitamin A deficiency, herpetic infections and measles. Corneal tattoos and corneal transplantation have been used in treating corneal opacities with varying results. Conclusion : White corneal scar on leucoma represents fibrosis secondary to a previous corneal insult, most frequently trauma or infection.

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