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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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Devastating Mooren Ulcer Halt by Timely Aggressive Treatment - A Case Report: Poster Presentation - Case Report - Resident Florentina Priscilia; Lily Raudah Putri; Annisa Windyani; Ferdy Iskandar; Triana Hardianti Gunardi; Yulia Aziza
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/bdmp6t90

Abstract

Introduction : Mooren ulcer is a progressive and painful peripheral ulcerative keratitis of unknown cause. Study aims to show effective aggressive treatment for Mooren ulcer. Case Illustration : A 43-year-old man was admitted with a marked clinical worsening of the white tissue covering the cornea, accompanied by pain, redness, and blurry vision of the left eye. Initial examination showed visual acuity of 6/21cc. Peripheral corneal ulcer was found from 6 to 2 clock hours with superficial vascularization and epithelial defect. Patient underwent ancillary examinations with unremarkable findings. Patient was diagnosed with Mooren Ulcer and treated with artificial tears and steroid topical. Patient had no significant improvement; therefore conjunctival resection with immunosuppressive therapy were performed. At follow up, no pain was reported, vision improved to 6/15cc, and the ocular surface inflammation resolved. Discussion : Mooren ulcer is usually misdiagnosed since the clinical signs are similar to other differential diagnoses. The examination must be performed carefully to rule out autoimmune and corneal infection. Treatment goals are to halt the destructive process and promote reepithelization. The stepwise aggressive approach of Mooren Ulcer treatments is crucial. It starts directly with topical steroid to control the progression of inflammation. However, when used alone, topical steroid usually cannot prevent the rapid progression so conjunctival resection is needed to remove the source of collagenase production by cutting the perilimbal blood vessels’ access to the area of the ulcer. Combination with an immunosuppressant will effectively maintain a stable condition. Conclusion : Early diagnosis and aggressive treatment for Mooren ulcer are needed to prevent the rapid progression.
BOTULINUM TOXIN A FOR BLEPHAROSPASM WITH DRY EYE: A SYSTEMATIC REVIEW: Poster Presentation - Observational Study - General practitioner dr. Muthia Despi Utami; Yulia Aziza; Lukman Edwar; Made Susiyanti; Rina La Distia Nora; Ratna Sitompul
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/d2xzdv11

Abstract

Introduction & Objectives : Essential blepharospasm is a neurological condition that is defined by uncontrolled and abnormal eyelid closure from a central cerebral disorder. Between 40%-85% of blepharospasm occurs in conjunction with dry eye symptoms. Botulinum neurotoxin (BoNT) injections are commonly used treatment for reducing spasms in blepharospasm. Furthermore, it is often suggested for dry eye therapy due to their ability to reduce lacrimal drainage. The purpose of this review is to assess the effectiveness of BoNT treatment for blepharospasm with dry eye symptoms. Methods : A literature research was conducted on online databases such as PubMed, Cochrane library and Google scholar. All studies of BoNT and dry eye with full-text journals published in English within the last 10 years were included. We assessed Tear Breakup Time (TBUT), Schirmer Test, and Blepharospasm Disability Index (BSDI). Results : 204 patients from 6 publications were analyzed. In five trials, the BoNT treatment statistically significant increased TBUT (p<0,5), with mean final TBUT 5,7 ±1.1 s. Furthermore, the Schirmer test also increased with the mean final score 6,29 ± 4,6 mm. The mean BSDI score dropped by 6,05 ± 3,7 in two studies. Conclusion : It is confirmed that BoNT injection is an effective treatment for essential blepharospasm with dry eye symptoms. Clinicians should be screened for dry eye in all blepharospasm patients prior to BoNT treatment.
THE RELATIONSHIP BETWEEN DRY EYE SYNDROME AND THE USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) IN HOSPITAL MEDICAL WORKERS): Poster Presentation - Observational Study - Ophthalmologist NUR SHANI MEIDA; Prifina Windy Aulia; Yunani Setyandriana
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: 10.35749/7fa62c83

Abstract

Introduction & Objectives : Background: The need to wear personal protective equipment (PPE) during a pandemic can cause dry eye syndrome. It will increase sweating so reduce tear production and the use of masks increase air flow to the eye area so that tear evaporation increases. Objective: To determine the relationship between the incidence of dry eye syndrome and the use of PPE in hospital medical personnel. Methods : Methods: This was an analytic observational study with a cross-sectional design using the OSDI (Ocular Surface Disease Index) questionnaire. The research was carried out at the Cilacap Hospital in 2021. There were 49 samples (51% male and 49% female), with an age range of 20-50 years. The data was analyzed by using the Spearmans test. Results : Results: The incidence of dry eye syndrome was 69.5% (mild 18.4%, moderate 18.4%, severe 32.7%). As many as 53.1% of the incidence of dry eye syndrome occurred in wearing PPE for more than 4 hours and was more common in the use of PPE level 1 (40.8%), followed by level 3 (36.7%) and level 2 (22.5%). In the Spearman's test, it was found that there was a significant association between the incidence of dry eyes syndrome and the use of PPE (duration and level of PPE) (p<0.05) but had a weak relationship strength (r=0.3). Conclusion : Conclusion: There is a significant relationship between the incidence of dry eyes syndrome and the use of PPE (duration and level of PPE use) but has a weak relationship strength.
Treatment of Corneal Perforation Using Periosteal Graft Technique With the Continuation of Penetrating Keratoplasty: Poster Presentation - Case Report - Resident ADRIAN PRATAMA; Petty Purwanita; Anang Tribowo
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: 10.35749/0d3pap92

Abstract

Introduction : Corneal perforation occurs due to various conditions and management are based on the underlying cause. Modalities to treat corneal leaks is dependent on the size of corneal defect and include tissue adhesive, conjunctival flap, grafts and transplants. Penetrating Keratoplasty (PK) is effective to treat large corneal defect and to improve visual acuity (VA), but unfortunately PK is usually delayed due to availability. Case Illustration : A 17-years-old teenager was diagnosed with corneal perforation on his left eye, VA at initial visit was 1/300, positive seidel test, and shallow anterior chamber. Patient immediately underwent periosteal graft with subsequent PK surgery one month later. First until eight days postoperatively, VA improved from 3/60 to 6/30. Ten days after PK, a mechanical trauma caused the transplant to be detached, and VA greatly decreased to 1/300. Patient underwent immediate repair surgery. First day after surgery, VA was light perception. Eight days later, VA increased to 1/60 with concurrent iris prolapse. Iris repair was done immediately and eight days later VA increased to 6/60. At day sixteen, the final VA is 6/30. Discussion : Periosteal graft was performed to maintain ocular integrity. After waiting for a month, PK was performed to improve vision. This combination therapy was successful proven by VA improvement from 1/300 to 6/30. Conclusion : Periosteal graft is necessary to maintain ocular integrity while waiting for availability of donor cornea. Penetrating keratoplasty is an appropriate procedure for patients with large corneal leaks. It replaces all corneal structures, and it also improve visual function.
Penetrating Fishhook Ocular Injury: Challenging management in low- resource country: Poster Presentation - Case Report - General practitioner Nafisa Naaz Nisha; Andronico Ly
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/rg0j6y58

Abstract

Introduction : Fishing is a common income source in rural areas, but fishhook eye injuries are rare. This report describes a case of a rare penetrating fishhook ocular injury, which resulted in endophthalmitis and eye evisceration, and highlights the challenges caused by delayed referral and limited options for intravitreal antibiotics due to inadequate consumable availability. Case Illustration : A 13-year-old boy from Vanuatu had a fishhook in his right eye and was referred to an Ophthalmologist one day later due to unavailability of flights. Upon arrival, endophthalmitis signs were noted, with the left eye having a visual acuity of 6/7.5 and the right eye showing only hand movement. The right eye showed corneal edema and a blood stain around the fishhook, fresh keratic precipitates, discharge and conjunctival edema. The fishhook was removed, and the cornea repaired under local anesthesia. On Day 1 post-operation, Intravitreal vancomycin and moxifloxacin were administered after procuring privately from pharmacies outside the hospital. However, the patient's condition worsened, requiring evisceration of the right eye. Discussion : Prompt management of penetrating eye injuries is crucial, with patients requiring broad spectrum antibiotics, tetanus shots, and an eye shield during referral. However, challenges such as lack of an eye shield and transportation delays worsened the patient's condition before arrival. This case also highlights the challenges faced in treating the patient effectively by the ophthalmologist due to limited options intravitreal antibiotics. Conclusion Timely management and urgent referral are crucial in low-resource areas to prevent complications. Essential consumables are necessary for effective treatment by an ophthalmologist.
Recurrent Orbital Subperiosteal Abscess in Patient with Nasopharyngeal Carcinoma: Poster Presentation - Case Report - Resident Mefina Aulia Mufidah; Lukman Edwar; Mutmainah; Rwtno Sulistyo Wardani
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/b5jry486

Abstract

Introduction : Subperiosteal abscess (SPA) is a rare finding in cancer patients with orbital cellulitis. Severe complications associated with this condition are permanent visual loss, intracranial extension, and death. Case Illustration : A 38-year-old male with history of nasopharyngeal carcinoma (NPC) came with progressive right eyelid swelling, non-axial proptosis, and visual acuity was NLP. CT scan revealed right SPA associated with frontal sinusitis. NPC staging was T3N2M0. Despite the treatment of intravenous antibiotics and drainage incision of SPA, there was recurrence of right SPA two weeks after procedure and re-staging revealed T4N3M0. A joint operation with otolaryngology department to do debulking of the mass, frontal sinus surgery, and drainage incision was held. Culture resulted in Talaromyces marneffei. Patient was assessed with talaromycosis and given itraconazole for ten weeks. Moreover, patient came again with proptosis seven weeks postoperatively. Re-drainage incision was performed and clinical presentation was improved. Discussion : This case describes rare biological nature of NPC where extensive blockage of paranasal sinuses allows microorganism overgrowth and infection. The anatomical changes and cancer-related immunosuppression contribute to recurrent SPA. Chemotherapy and radiotherapy are ideal treatments for our patient, however, infection must be treated adequately first. Surgical interventionis needed to manage the infection by SPA drainage where antimicrobial has poor penetration into the abscess and debulking of tumor to clear the blockage of drainage pathway. Conclusion : Recurrent orbital SPA could happen in patients with NPC, therefore appropriate medical treatment and timely surgical intervention are essential in managing orbital SPA. Multidisciplinary management is required to optimize patient outcomes.
Changes in Ocular Surface Parameter After Intense Pulsed Light Therapy in Ocular Demodicosis: A Case Report: Poster Presentation - Case Report - Resident Rizki Adi Santosa; Angga Fajriansyah; Elfa Ali Idrus; Patriotika Muslima; Arief Akhdestira Mustaram
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/rhpqnd96

Abstract

Introduction : Demodex infestation may manifest as blepharitis and dry eye syndrome. Intense Pulsed Light (IPL) therapy is an emerging option for managing ocular demodicosis. Case Illustration : A 77-years-old woman complained of itch and watery eyes since four years ago. Meibomian pouting, telangiectasias, foamy secretions, and sleeves were identified in both eyelids. Right eye examination showed 52% and 42% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer test 6 mm, lipid layer thickness (LLT) 43 nm, tear meniscus height (TMH) 0.36 mm, and non-invasive tear break-up time (NIBUT) 9.6 seconds. Left eye examination showed 65% and 56% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer test 5 mm, LLT 66 nm, TMH 0.16 mm, and NIBUT 5.8 seconds. Demodex mites were identified during eyelash wet mount examination. She underwent four sessions of IPL. At the two-month follow-up, complaints were alleviated. Signs of blepharitis were subsided. Right eye examination showed 36% and 34% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer's test 9 mm, LLT 68 nm, TMH 0.49 mm, and NIBUT 10.7 seconds. Left eye examination showed 25% and 35% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer's test 9 mm, LLT >100 nm, TMH 0.9 mm, and NIBUT 6.2 seconds. Discussion : IPL has a role in managing ocular demodicosis by local inflammation control, meibum liquefaction, and meibomian glands photomodulation. IPL is also thought to directly eradicate Demodex mites. Conclusion : Improvement of ocular surface parameters was observed after IPL therapy in ocular demodicosis.
Temporary Partial Periosteal Graft for Emergency Management in Peripheral Corneal Perforation: Poster Presentation - Case Report - Resident Indah Saraswati; Ridho Ranovian; Yulia Aziza; Astrianda Nadya Suryono
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: 10.35749/706qex60

Abstract

Introduction : Corneal perforation occurs secondary to a number of corneal abnormalities and leads to further complications if left untreated. Varies options for managing corneal perforation had been conducted, yet the data of periosteal graft in ophthalmology was still limited. This case report aims to evaluate the efficacy of periosteal graft in peripheral corneal perforation. Case Illustration : A 77-year-old female patient came with a chief complain 14-day history of severe ocular pain and blurry vision of left eye. Initially, there were recurrent ocular redness with foreign body sensation since 6 month before admission, yet denied any history of systemic and autoimmune diseases. She was assessed as corneal infection by some hospitals and treated with some medications, yet the symptoms were not improved. The ophthalmological examination revealed a 360 degrees corneal thinning with uveal prolapse on the infero-temporal on limbus part. The perforation was treated with partial periosteal graft and conjunctival resection, as the corneal donor for tectonic keratoplasty was not available. A few months after surgery, the grafts remained in place after the surgery, even though the visual acuity was still the same. Discussion : Because of its ease in harvesting, avascularity, strength and lack of immune reaction, autogenous periosteum is a potential grafting tissue for corneal covering in the case of corneal perforation, although it was not the gold standard treatment. This technique presented satisfactory results with low complication rates and minimum number of complications. Conclusion : Temporary partial periosteal graft could be considered as emergency surgical options in peripheral corneal perforation.
How to Quickly and Affordably Reduce Corneal Neovascularization: Poster Presentation - Case Report - Resident Surya Atmaja; Elfa Ali Idrus; Feti Karfiati; 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/rtcz3738

Abstract

Abstract Introduction : Fine needle diathermy (FND) is one of the treatment modalities for corneal neovascularization (CoNV). Occlusion of the CoNV will reduce vascular leakage, thus preserving visual acuity. This case report presents FND as a treatment for CoNV due to ocular rosacea. Case Illustration : A 25-year-old volleyball athlete came to Cicendo Eye Hospital after experiencing blurry vision for a week, followed by flushing on the face. A general examination revealed telangiectasia and pustules on the central face (Figure 1). Visual acuity was 0.2 RE. A slit-lamp examination revealed hyperemiain the lid margins, oedema, and superficial-stromal neovascularization on the cornea (Figure 2). The patient was diagnosed with blepharo-kerato-conjunctivitis on RE due to ocular rosacea. The patient then underwent FND (Figure 3). The procedure was performed by using a 10.0-gauge needle inserted in the corneal stroma along the CoNV. The vessels were occluded by conducting monophasic diathermy at a power of 1 mA (Figure 4). On the 5th day, corneal oedema and neovascularization were reduced, and visual acuity improved to 0.4 ph 0.5 (Figure 5). Discussion : Corneal neovascularization may affect corneal transparency and thus reduce visual acuity. FND is relatively affordable and widely available. Compared to another modality, FND has not been widely performed to treat CoNV. A literature search using PubMed or Google Scholar found few case reports or reviews regarding successful cases of FND. Conclusion : Fine needle diathermy is a safe and effective treatment for CoNV due to ocular rosacea. Further studies should be conducted to evaluate the safety and long-term efficacy of FND.
Neuroretinitis et causa Ocular Syphillis Vision Recovery after Multidisciplinary Management: Case Report: Poster Presentation - Case Report - Resident RANDY VINCENT SUHARTONO KINDANGEN; Dr. dr. Made Susiyanti, SpM(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: 10.35749/7y9a8220

Abstract

Abstract Introduction : Ocular syphilis is a sight-threatening condition caused by spirochete infection, Treponema pallidum, with varied clinical presentations. Although uncommon, human immunodeficiency virus (HIV) infection increases the risk of ocular syphilis. If left untreated, it may lead to blindness. The disease can be treated effectively with appropriate antibiotic therapy from a multidisciplinary department. Therefore, early investigation and timely management can prevent infection progression and save patients’ eyesight. Case Illustration : A 29-year-old man complained of blurry vision with visual acuity light perception in both eyes one month before admission. The patient underwent examination and laboratory workup and was later diagnosed with HIV and ocular syphilis. A multidisciplinary approach was carried out with dermato- venerology, neurology, and internal medicine departments to treat the ocular and systemic infection. The patient was medicated with the antibiotic regimens Benzathine Penicillin 7.2 million IU and Ceftriaxone 1 g for 14 days. Visual acuity was later examined three weeks with a significant result for best corrected visual acuity (BCVA) in decimal 0.8 for the right eye and 0.67 for the left eye. Discussion : The patient was in poor eyesight condition when initially examined. According to reports, syphilis could be cured if it was diagnosed early and completely treated. Therefore, an immediately established diagnosis helped the patient get suitable therapy thus improving visual acuity. Conclusion : Early investigation and proper treatment are critical to managing systemic and ocular infections of HIV and syphilis. A multidisciplinary approach is required to achieve optimal results.

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