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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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Managing Periorbital Necrotizing Fasciitis: How Invasive Should We Go? Poster Presentation - Case Report - Resident Andi Marsa Nadhira; Lia Amanda; Muhammad Shafiq Advani; Lukman Edwar
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: 10.35749/0yb71086

Abstract

Introduction : Periorbital necrotizing fasciitis (PNF) is rapidly progressive and severe infection that may result in vision loss, serious facial disfigurement, and death. Primary management includes surgical debridement; however, here we report a case in which conservative approach resulted in favorable resolution. Case Illustration : A 24-year-old male presented with swollen right upper eyelid, with watery eye, pain, and blurry vision since 1 week prior. No history of trauma or known systemic diseases was reported. Restricted movement of the right eye (RE), slight nonaxial proptosis, and skin defect along the right superior palpebra with pus, blood, necrotic and granulation tissues were found. Visual acuity (VA) of RE decreased to 6/40 with normal intraocular pressure. No abnormalities on the left eye, fever, and other signs of systemic involvement were present. Contrast orbital computed tomography (CT) scan revealed right preseptal and postseptal tissue lesions, suggesting orbital cellulitis. Initial blood work showed leukocytosis, elevated neutrophil and lymphocyte counts, and high liver function markers. The diagnosis of right orbital cellulitis with PNF was established. Skin swabs and blood cultures were taken, while intravenous ampicillin-sulbactam, bedside wound debridement, and chloramphenicol ointment application were initiated. The swab culture later showed Acinetobactersp. The infection improved, VA was restored to 6/6, and wound closure was achieved without any surgery. Discussion : Management of necrotizing fasciitis localized in periorbita in an otherwise healthy patient may be successfully accomplished with a less invasive approach. Conclusion : Timely diagnosis and correct antibiotic therapy are mandatory to decrease morbidity and mortality related to PNF.
Recurrent Candida Parapsilopsis Corneal Ulcer cum Hypopion: A Case Report: Poster Presentation - Case Report - Resident Septian Dwi Prabowo; 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/pv392e57

Abstract

Introduction : Candida is common in tropical and subtropical climes estimated for 20-60% of all culture-positive corneal infection. Over the past two-decades, candida parapsilosis has become a common opportunistic fungal pathogen. Case Illustration : A-60-years-old-man, came with redness and pain in the left eye since one month ago after working at field. In the left eye, visual acuity was hand movement, palpebra was spasm and oedema, conjunctiva was hyperaemia, hazy, feathery edge and fluorescein test were positive in paracentral corneal 6x7 mm and hypopyon in anterior chamber. KOH staining revealed yeast, corneal scrapping revealed candida parapsilopsis, and antifungal sensitive to fluconazole. Fluconazole intravenous 200mg 2-times-a-day, moxifloxacin eyedrop loading dose, fluconazole eyedrop fortified every-one- hour, atropine 1% eyedrop 2-times-a-day, artificial tears eyedrop every-one-hour was administered.In the fifth-day, hypopyon was improved, and patient was discharged. Tenth-days after, patient felt pain and hypopyon raised 4mm. Debridement in the ulcer, and therapy was continued. Two weeks later, hypopyon was less than 1 mm, and pain was relieved. Discussion : There was clinically improvement using antifungal therapy. Recurrent hypopyon was happen, and mechanical debridement in the ulcer was administered. In four-times within two-weeks, hypopyon was improved. Although, initial treatment was antibiotics until microbiological confirmation, antifungal therapy, combined with mechanical eradication of fungal filaments could be administered for fungal corneal ulcer. Conclusion : In this case, combination of antifungal therapy with mechanical debridement could be the right choice to treat candida parapsilopsis corneal ulcer. Better outcomes can be achieved and complications can be avoided with appropriate diagnosis and efficient therapy.
Management of Recurrent Anterior Uveitis in Spondyloarthritis: A Case Report: Poster Presentation - Case Report - Resident nadida nurfadhila; 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: 10.35749/8hr2qj05

Abstract

Introduction : Non-infectious anterior uveitis is caused by underlying diseases, one of which is spondyloarthritis. Spondyloarthritis is a part of chronic rheumatic disease. The main goals of uveitis therapy are to prevent blindness, permanent organ damage, and recurrence. Case Illustration : A 19-years old woman came to Cicendo Eye Hospital with blurry vision for one week. The complaint was accompanied by redness, photosensitivity, and pain in her right eye. She had similar complaints in her right eye one month ago and in her left eye one year ago. She also had a history of morning stiffness in her knee joint and lower back pain. For those symptoms, the rheumatologist diagnosed her with spondyloarthritis. The uncorrected visual acuity examination for both eyes were 0,16. Anterior segment examination on right eye were blepharospasm, ciliary injection, corneal oedema, flare and cells while the left eye within normal limit. She was diagnosed with anterior uveitis and was treated with topical corticosteroid, oral corticosteroid, and immunomodulator. Knowing the treatment was not responding, the rheumatologist added biologic agents to the therapy. As a result, the patient’s conditions improved. Discussion : Topical steroid therapy was used as the first line of treatment, but for the recurrence of anterior uveitis, systemic medication, including biologic agents, is needed. Conclusion : Multidiscipline and stepwise approach to treat anterior uveitis with underlying disease is necessary.
Sympathetic ophthalmia following corneal patch graft for corneal perforation: Poster Presentation - Case Report - Ophthalmologist RENI ANGRAINI; Havriza Vitresia
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/vgy9vv80

Abstract

Introduction : Sympathetic ophthalmia (SO) is a rare, bilateral, diffuse granulomatous uveitis that usually occurs after open globe injury or intraocular surgery. We report a rare case of SO after the closure of corneal perforation using a corneal patch graft. Case Illustration : A 12 year old boy diagnosed as corneal perforation in the right eye, with visual acuity (VA) 20/100, underwent a corneal patch graft. He presented with redness and decreased vision in both eyes 2 weeks after surgery. The patient had VA of hand movements in the RE and 20/200 in the LE. Anterior segment examination showed a corneal patch graft with iris adherent to the graft posteriorly in RE, endothelial dusting, 2+ cells in both eye. Fundus examination showed optic disc oedema in both eye and inferior retinal detachment with macular involvement in RE. The patient was managed with pulse steroids for three days followed by oral steroids in tapering doses along with continued topical steroids. Three months follow-up showed improvement of VA to 20/60 in RE and 20/25 in LE Discussion : SO is thought to be an autoimmune response to uveal injury. The incarceration of uveal tissue in the wound is a major risk factor. SO has been reported 5 days to 66 years after penetrating insult to the eye. In this case, incarceration of uvea in corneal pacth resulted in SO 2 weeks after surgery. Conclusion : In a case of a perforated cornea, the possibility of iris incarceration in the wound is high and hence SO can develop
Spontaneous Ocular Haemorrhage: Poster Presentation - Case Report - General practitioner Klarissa Chrishalim; Cisca Kuswidyati
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/nmkbwr34

Abstract

Introduction : Hemorrhagic complications are one of the major complications encountered with reperfusion therapies but rarely involve the ocular, especially hyphema. Case Illustration : a 61-year-old woman presented with blurred vision, discomfort, and red eye in her right eye. She had been treated for hypertension, diabetes mellitus, and coronary artery disease with antiplatelet and other oral medication for 5 years. There was no history of eye trauma or Valsalva-like maneuver effort. The best corrected visual acuity was 20/40 in both eyes and there was no relative afferent pupillary defect. Both eyes had normal IOP. A slit lamp examination revealed pool blood in the anterior chamber as hyphema grade 1. Fundus examination showed dot and blot hemorrhage with cupping discs 0.6 and 0.7. USG examination showed no mass and clear vitreous. The antiplatelet was stopped and evaluated by the internal department. The patient was observed and treated with topical medication, and the hyphema resolved within less than 7 days. Discussion : Although it is still not clear if there is any increase in intraocular bleeding has been recognized with antiplatelet agents, the concern would be greatest amongst those at high baseline risk due to predisposing conditions, such as elderly with diabetes, hypertension, and usage of antiplatelet agents to maintain cardiovascular disease. Conclusion : This case emphasizes that though the most common cause of hyphema is a traumatic injury, it can be a rare complication of antiplatelet therapy. Patients on antiplatelet therapy should be carefully monitored for ocular bleeding, especially if they have associated systemic or ocular comorbidity.
Incidence Of Photokeratitis In Factory Workers After Ultraviolet C Exposure and Its Management : A Case Series: Poster Presentation - Case Series - Ophthalmologist dr. ANDREAS SURYA ANUGRAH, Sp.M; dr. Rima Melati, M.KK, SpAk(K), Sp.Ok(K)
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/pj540m50

Abstract

Introduction : Ultraviolet C lamps have been used in industry and healthcare to disinfect rooms, air, water, and surfaces. However, exposure to UV-C may cause serious damage to human eyes. Case Illustration : This were photokeratitis case series of 4 factory workers that occurred simultaneously after 4 hours exposure to UV-C lamp about one meter away without any protective eyewear. Several hours after exposure, they complained swollen, red and watery eyes, photophobia, sandy sensation, and blurry vision. One day after, they were taken to the Emergency Unit. Diagnosis of photokeratitis was established by using biomicroscopic examination. All subjects were treated with antibiotic eye drops, lubricants, oral anti-inflammatory drugs, and cold compress. Evaluation after 1 week showed clinical improvement and all subjects were able to return to work normally. Discussion : Photokeratitis or ultraviolet keratitis is an inflammatory condition of the cornea after ultraviolet exposure for 30 minutes to 12 hours. The corneal epithelial layer functions as protector for corneal stroma and endothelium. However, the longer corneal epithelium is exposed to ultraviolet light, the more damaged it is. This caused subepithelial nerve plexus exposed, resulting in severe pain, photophobia, and bilateral epiphora. Injection and chemosis of bulbar conjunctiva, epiphora, and punctate keratopathy of cornea were found in examination. The management given is supportive therapy, and should be immediately given until corneal epithelium healed. Conclusion : Photokeratitis may occurred in daily work. Regulation, warning, training and appropriate protective eyewear for workers in workplaces using UV-C lamps are mandatory. Immediate and adequate treatment can save the sight of workers exposed to UV-C.
Ocular Syphilis in an Immunocompetent Young Man: Poster Presentation - Case Report - General practitioner Vincentius Handy Suria, dr; Halida Wibawaty
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/jarsjn40

Abstract

Introduction : Syphilis is called the great imitator because its clinical presentations vary widely and overlap with many other etiologies. We present a case of ocular syphilis in an immunocompetent young man with negative HIV test and history of unprotected sexual activities. Case Illustration : A 27 year-old male initially presented to an outpatient Solo Eye Hospital with complain of blurred vision and sudden visual impairment in the right eye and acute onset left eye redness, pain, clear discharge. His right eye VA was counting finger and 0,2 in his left eye. The patient diagnosed with acute posterior uveitis in the RE and acute iridocyclitis in the LE. A detailed sexual history, he endorsed having unprotected sex with numerous men in the past. Patient was subsequently started on P-Pred ED/2 hourly, atropine ED and testing to evaluate cause of iridocyclitis was sent. Fundus RE : clouded fundus view, vascular occlusion, vitreous opacification. Fundus LE : within normal limit. Rheumatoid factor negative, HIV antigen antibody screen non-reactive, syphilis IgG reactive, RPR screen reactive, RPR quantitative titer 1:128. ANA screen negative. The patient was started on intravenous penicillin G, and both his genital lesion and bilateral visual acuity improved. He was discharged to complete 14 fays of iv penicillin G. Discussion : HIV-positive patients may often present with ocular syphilis before the HIV status is known. Ocular syphilis is considered to be neurosyphilis for treatment purposes. Conclusion : Ocular syphilis should be kept in the differential diagnosis in immunocompetent/HIV negative patient, and the importance of obtaining a detailed sexual history should not be forgotten.
Topical Immunosuppressant Agent Cyclosporine (CsA) as Therapy for Ocular Alkali Chemical Injury: Is It Really Beneficial? Poster Presentation - Case Report - General practitioner Rijena Karina Abigael F .K. Bangun; Balgis Desy Sulistyowati
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/fbrdx179

Abstract

Introduction : Alkali chemicals can cause more severe ocular injury than acidic chemicals, because the alkali can rapidly penetrate the cornea into the anterior chamber of the eye and damage the iris, ciliary body, lens and trabecular meshwork, which can cause significant visual impairment. A topical immunosuppressant Cyclosporine (which also known as Cyclosporin A or CsA) was used in the treatments. Case Illustration : A 3-year-old male patient presented painful eyes 3 days after an accidental ocular injury with Calcium Hydroxide. The ophthalmic examination revealed based on Roper-Hall grading, the injuries indicated grade III-IV ODS. The patient's BCVA OD 2/60, and OS 20/200. The patient was hospitalized and underwent intensive conservative pharmacological therapy, including topical CsA. Corneal healing was examined by serial corneal Optical coherence tomography (OCT) and showed improvement of the corneal haze throughout the follow-ups. From the last follow-up, the BCVA OD 20/70, OS 20/40. Discussion : Topical CsA reduces the number of CD3-positive cells (T lymphocytes) and the production of pro- inflammatory cytokines, which was associated with the decreased expression of matrix metalloproteinase-9, inducible nitric oxide synthase, VEGF and active caspase-3. Corneal neovascularization is a clinical condition caused by alkali burn that, when left untreated, leads to significant visual impairment. VEGF-A is one of the most important mediators of angiogenesis, leading to neovascularization. Hence, topical CsA 0.1% eye drops may play a role in the treatment of alkali corneal injury. Conclusion : This case report showed that topical CsA gave a significant corneal wound healing, combined with the mainstay of alkali chemical injury.
AN UNILATERAL SCLEROMALACIA PERFORANS IN YOUNG PATIENT MANAGED BY MYOCONJUNCTIVAL ENUCLEATION AND DERMIS FAT GRAFT: Poster Presentation - Case Report - Resident ANNISA KARIMA; DELEFITRI LUTFI
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/g35mcs17

Abstract

Introduction : Scleromalacia perforans is a disease that might compromise vision and globe integrity. The possible associations of systemic disease are autoimmune diseases such as rheumatoid arthritis, lupus, and Wegener's granulomatosis. Determining the underlying etiology in such cases also possess a great challenge to treat disease, especially in this case. Case Illustration : A 19-year-old female with a progressed protrusion of the left eye since she was 1 year old. Six years ago, she had redness, worsen protrusion, photophobia, tearing, and pain, but resolved without treatment. Her cousin had the same condition but refused to continue the examination. Visual acuityof the left eye was no light perception with 4x4 mm of corneal leukoma, and 360 degrees of anterior scleral ectasia covered with conjunctival neovascularization. USG showed posterior vitreous detachment and 28,9 mm axial length. Systemic examination found ANA test and HLA B27 were normal, positive hypermobility joint, and Rheumatologists ruled out the possibility of autoimmune disease. Myoconjuctival enucleation was performed with a dermis fat graft for cosmesis, and pathological examination showed nonspecific chronic inflammation. Discussion : A childhood-onset scleromalacia perforans with positive family history and hypermobility joints might be a sign of connective tissue disorder. Possible autoimmune diseases were ruled out by a rheumatologist. The genetic examinations may be necessary to establish the diagnosis. Conclusion : Scleromalacia perforans is rare yet it is strongly believed to have an association with systemic disease. Collaboration between ophthalmologists, rheumatologists, and geneticist is essential to manage this kind of case.
Amnion Membrane Transplantation: A Therapy for Persistent Epithelial Defect as A Result of Neurotrophic Keratitis: Poster Presentation - Case Report - Resident Nathasya Maharani Susilo; 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/e3c8d366

Abstract

Introduction : A persistent epithelial defect (PED) is a failure of re-epithelialization and complete healing of the cornea. The primary goal of PED treatment is to create a favorable environment for corneal wound healing. Amniotic membrane transplants (AMT) become one of the refractory cases treated for PED. This study aims to report AMT as therapy for a PED. Case Illustration : A fifty-six-year-old male presents with a chief complaint of redness and pain in the left eye in the last2 weeks. The patient complained of blurred vision, tearing, and foreign body sensations. An ophthalmology examination of the left eye revealed that it was close to face finger counting in visual acuity and had a persistent epithelial defect, corneal edema, descemet fold, and a decrease in corneal sensation. The patient was diagnosed with PED and received autologous serum eye drops, levofloxacin eye drops, vitamin A palmitate eye gel, and acyclovir 400mg twice a day, but did not respond adequately. AMT was planned for the patient. The patient's pain level improved one week after surgery. Discussion : The most common symptom of PED is pain. There are various etiological factors for PED. Neurotropic keratitis has emerged as one of the causes of PED. Management for PED is carried out sequentially according to the protocol. Conclusion : Amniotic membrane transplantation has become an alternative therapy for PED. The amniotic membrane provides re-epithelialization of the cornea and anti-inflammatory properties. The prognosis for AMT as a therapy for PED is quite good.

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