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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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Terson Syndrome: A Rare, Treatable Visual Loss After Subarachnoid and Intraventricular Hemorrhage: Poster Presentation - Case Report - Resident DITA PERMATASARI; SYNTIA NUSANTI; MUHAMMAD SIDIK; SALMAREZKA DEWIPUTRI; SITA PARAMITA AYUNINGTYAS
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/af396t72

Abstract

Abstract Introduction : Intracranial pathologies commonly affect vision through optic neuropathy. However, visual loss could be due to vitreous hemorrhage as in Terson syndrome. This report warns us rare cases of visual loss after intracranial hemorrhage that requires totally different management than more commonly found optic neuropathies. Case Illustration : Female, 46 years old, had a severe headache and decreased consciousness two days later. CT angiography revealed wide subarachnoid hemorrhage and intraventricular hemorrhage causing hydrocephalus. She received emergency lumbar drainage followed by digital subtraction angiography and flow diverter device. Postoperative she regained consciousness, CT scan showed reduced ventricular size without residual hemorrhage, yet visual acuity of left eye reduced to hand movement and did not improve until one month later. Ophthalmologic examination showed vitreous hemorrhage of the left eye. Right eye was normal. Vitrectomy was planned to clear the vitreous hemorrhage. Discussion : Terson syndrome is intraocular hemorrhage associated with subarachnoid hemorrhage, cerebral hemorrhage, or traumatic brain injury. The proposed mechanisms were transmission of subarachnoid blood to the optic nerve sheath and rapid effusion of cerebrospinal fluid into the optic nerve sheath due to sudden increase of intracranial pressure. It compresses central retinal vein, causing vascular rupture. The manifestations could be vitreous, subhyaloid, subretinal, or intraretinal hemorrhage. Visual prognosis is good in those resolved spontaneously or receiving vitrectomy in nonresolving cases. Conclusion : Visual loss from intracranial hemorrhage or trauma could be caused by intraocular hemorrhage. It deserved different management than optic neuropathies. Prompt recognition should improve the management and the prognosis of rare cases such as Terson syndrome.
Orbital Tumor Misdiagnosed as Optic Neuritis in Rheumatoid Arthritis Patient: A Case Report: Poster Presentation - Case Report - General practitioner Marcellina; Maria L. Susyono
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: 10.35749/5amqaa95

Abstract

Abstract Introduction : Unilateral blurred vision and optic nerve swelling are the two most common signs of optic neuritis (ON). However, ON is rarely reported in patients with rheumatoid arthritis (RA), thus necessitating further diagnostic workup. Case Illustration : A 42-year-old woman visited our hospital with strabismus and progressive loss of vision in her left eye since three months ago. She had been treated with pulse dose steroid for suspected ON. She had been diagnosed with RA over five years and treated with immunomodulatory medication. Left eye examination revealed best corrected visual acuity of 20/50, proptosis, esotropia with painless limitation in temporal movement. Afferent pupillary defect (RAPD) and optic nerve swelling were present. OCT assessment revealed reduction in RNFL thickness. Further magnetic resonance imaging (MRI) investigation revealed a 2.35 x 2.6 x 1.8 cm mass in the left intraconal retrobulbar, in proximity to the medial optic nerve, which suggests a case of orbital Schwanoma. Excisional biopsy was performed and revealed a benign tumor. Discussion : Intraconal tumor may falsely be diagnosed as an optic neuritis in autoimmune patient. Neuro- ophthalmologic symptoms of systemic inflammatory in the optic nerve includes unilateral acute visual loss and pain in eye movement. Signs of ON includes RAPD, disc edema, and corresponding visual field defect. MRI of the optic nerve can assist diagnostic workup. Conclusion : The exact diagnosis of rheumatoid arthritis-associated ocular manifestations is challenging. Imaging using MRI might be needed to provide clarity in the diagnosis.
Neuromyelitis Optica Spectrum Disorder (NMOSD) or Chronic-Relapsing Inflammatory Optic Neuropathy (CRION)?: A Challenge in Diagnosis and Treatment: Poster Presentation - Case Report - Ophthalmologist Alia Arianti, MD
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: 10.35749/6e9r2j17

Abstract

Abstract Introduction : Neuromyelitis optica spectrum disorder (NMOSD) is a chronic inflammatory, immune-mediated central nervous system disease targeting the AQP4-water channel membrane protein of the optic nerve and the spinal cord. This case report aims to present a case of seroconverting NMOSD which was initially diagnosed as chronic relapsing inflammatory optic neuropathy (CRION). Case Illustration : 15-year-old female with recurrent, steroid-dependent optic neuritis of the LE. During the first attack, brain MRI showed optic nerve inflammation with normal brain findings. Initial test for AQP4-IgG, MOG-Ab and ANA profile were negative. The diagnosis of CRION was made. Treatment with corticosteroid and immunosuppressant agent was maintained for one year. After treatment cessation, however, LE optic neuritis recurred with bilateral lower limb weakness. Spinal MRI showed signs of longitudinal extensive transverse myelitis. Re-testing for AQP4-IgG showed positive result. Diagnosis of NMOSD was made, and the patient was treated with high-dose intravenous corticosteroid followed by oral dose, and immunosuppressant. Final visual acuity of the LE was 1.0, with minimal residual visual field defect and good motor function. Discussion : During the initial attack, the patient did not meet the 2015 NMOSD international consensus diagnostic criteria. The AQP4-IgG was negative and no other corresponding signs and symptoms. The criteria was met one year after: optic neuritis, LETM and positive seroconversion of AQP4-IgG. Conclusion : Diagnosing NMOSD is at times challenging especially during initial attack. Retesting of the AQP4- IgG is at times necessary in seronegative patients, especially in children showing ADEM-like event with optic neuritis and LETM to achieve diagnosis and proper treatment strategy.
Reversible visual recovery in Optic Neuritis patient with No Light Perception VA: Poster Presentation - Case Report - Ophthalmologist DEVI PUTRI SWADAYANI; Irwan sanjaya
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: 10.35749/60drdr90

Abstract

Abstract Introduction : Optic neuritis is characterized by an inflammation and demyelination of the optic nerve and is traditionally treated with corticosteroids. The findings of the ONTT, reported in more than 50 publications during the past 20 years, have numerous implications Case Illustration : A 48-year-old woman presented to the ophthalmology outpatient clinic with a 12-day history of blurred vision. The best-corrected visual acuities and Ishihara colour vision was unilaterally reduced with a non light perception on left eye. There were also relative afferent pupillary defect with slow respons of pupillary reflect. Slit-lamp examination was otherwise normal. Funduscopy was Papillary edema on left eye, with all quadrant blurry edge. Optic neuritis (ON) was presumed as she had suffered with this previously. She was hospitalized and undergone (optic neuritis treatment trial) ONTT . Thereafter, a trial of pulsed methylprednisolone was commenced, resulting in near complete resolution of the Visual acuity that become 6/40 UCVA from NLP. Discussion : The original ONTT, along with three follow-up studies at five-year intervals, generated more than three dozen papers in scientific journals. Collectively they show what happens to an individual over the course of 15 years following about of optic neuritis. Conclusion : Prior to the ONTT well-established guidelines for treating optic neuritis did not exist, this case were demonstrates the importance of keep starting ONTT with a point valuable to patient with NLP.
Challenges in Diagnosing Functional Visual Loss and Malingering: a Case Report: Poster Presentation - Case Report - General practitioner Rona Ali Badjrai; Sarah Shabrina; Subandono Bambang Indrasto; Arlin Chyntia Dewi
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: 10.35749/01gvwf45

Abstract

Abstract Introduction : Functional Visual Loss (FVL) is decreased visual acuity and/or altered visual fields without any associated organic pathology and is considered within the spectrum of malingering. It manifests as either simulating an ophthalmic disease or denying ophthalmic disease. Thorough history-taking and careful examination of the patient are essential in reaching the diagnosis. Case Illustration : A 17-year-old female came with complaints of a spinning headache, sudden and painless blurry vision in both eyes, double vision, and a history of syncope for the last two days. Ophthalmology examination revealed UCVA was 0.5/60 for both eyes with inconsistent answers from the patient. The confrontation test, light reflex, funduscopy, Humphrey visual test, OCT, and MRI were normal. Malingering was suspected and a psychiatric consultation was made. The patient was found to be a victim of bullying and had a history of visual hallucinations. The patient was then diagnosed with severe depression with psychotic signs. Discussion : Conclusion : FVL can be suspected when there is inconsistency in the results of some clinical basic tests. Despite the association between FVL and psychological problems like depression is complicated, this condition may occur in a bidirectional relationship in which depression leads to disability or contrarily. In conclusion, diagnosing visual problems in malingering patients can be challenging. Subjective and objective tests are needed to help practitioners confirm the malingering state of the patient. Practitioners also should be aware of the underlying risk of psychological problems among persons reporting visual function loss.
A peculiar case of idiopathic orbital myositis in adolescence: Poster Presentation - Case Report - Resident NABILA ALJUFRI; Agung Nugroho; Sita Paramita; Salmarezka Dewiputri; M. Sidik; Syntia Nusanti
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: 10.35749/837snw43

Abstract

Abstract Introduction : Idiopathic orbital myositis, an inflammation localized at the extraocular muscles, is rarely reported in pediatrics. Until now, the prevalence and incidence of orbital myositis remain unknown. This paper aims to report a case of idiopathic orbital myositis in a young girl with headache. Case Illustration : A-16-year-old presented with a droopy eyelid of the left eye (LE) and double vision since 1 week before admission. She also experienced swollen eyelid and cluster headache for 5 months with no neurological abnormalities. Ophthalmic examinations showed exotropia with limited eye movement of LE. Ptosis of LE was noted with margin reflex distance 1 (MRD-1) +2 mm, while MRD-1 +6 mm for the right eye. Other examinations were unremarkable with normal funduscopy and negative RAPD. Non-contrast orbital sinus CT-Scan revealed an enlargement of the superior rectus and lateral rectus muscle. The laboratory result showed slight leucocytosis and normal ESR. High-dose intravenous corticosteroid was administered and tapered with oral steroid. The orbital clinical findings showed improvements, better ocular movements, and diminished headache complaints. Discussion : As a rare case, the diagnosis of orbital myositis in adolescence can be challenging and requires detailed examination, and proper imaging to exclude other diagnosis such as ophthalmoplegic migraine, infections, malignancies, or congenital lesions (hemangioma). The first-line therapy is a systemic corticosteroid, which well responded in this patient. Conclusion : In this patient, intravenous corticosteroid represent an effective treatment. Close monitoring of the disease progression is required after switching to oral therapy to prevent relapse.
A Continuous Red Eye: Case Report of Indirect Carotid Cavernous Fistula: Poster Presentation - Case Report - Resident Nurul Qalbi Ramadhani; dr. Andi Muhammad Ichsan, Ph.D, Sp.M(K); Dr. dr. Yunita Mansyur, Sp.M(K), M.Kes; dr. Ashari Bahar, M.Kes, Sp.S(K); FINS; FINA
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/hpg2kp06

Abstract

Abstract Introduction : Carotid cavernous fistula (CCF) is a type of arteriovenous shunt in the cavernous sinus. Indirect CCF symptoms are not typical that can outwit us. Ocular manifestations occur because of venous and arterial stasis around the eye and orbit. The aim of this report is to increase awareness of the existence of other causes if there is no improvement after treatment. Case Illustration : A 59-year-old male presented with prolong conjunctival hyperemia on both eyes for two months that been diagnosed and treated as conjunctivitis. The ophthalmologic examination showed dilated episcleral vessels on both eyes with no evidence of infection and inflammation, this became a suspicion about the existence of a suppression from retro orbital region. The magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) brain examination were performed anda right CCF was diagnosed. The patient was referred to interventional neurology, digital subtraction angiography (DSA) examination showed a fistula in the right cavernous sinus and embolization was conducted. Discussion : The patient categorized as spontaneous, low flow, indirect CCF Barrow type D. On this type of CCF conjunctival injection is often the most prominent feature, and patients are commonly treated for other conditions, such as conjunctivitis, before a correct diagnosis is made. Conclusion : Carotid cavernous fistula can be characterized by the insidious onset of symptoms, diagnosis is based on the angiographic examination. When a sign suggestive of orbital or cavernous sinus pathology is present, a more thorough examination is crucial. Early diagnosis and appropriate management are essential to avoid vision and life threatening complications.
Terson Syndrome: what an ophthalmologist should know? Poster Presentation - Case Report - Ophthalmologist ANINDITA WICITRA; Muhammad Firdaus
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/akj2zx20

Abstract

Abstract Introduction : Terson syndrome is the occurrence of any intraocular hemorrhage in patients with intracranial hemorrhage or traumatic brain injury. In this article we present a case of patient with Terson Syndrome after craniotomy. Case Illustration : Forty-six yo female patient consulted from neurosurgery department with chief complain of blurry vision in both eyes since 1 day before. Pain or red eyes were denied. There was no history of visual field defect. She had history of breast cancer and she underwent craniotomy four days before because of her brain metastases. Her Glasgow Coma Scale was 15. In ophthalmology examination, her visual acuity is 6/6 with correction in both eyes with good ocular motility. RAPD was positive in her left eye, and posterior segment showed bilateral optic disc edema with intrapapillary and peripapillary hemorrhage. Humphrey examination revealed enlargement of blind spot in the right eye. Brain CT Scan demonstrated hemorrhagic lesion with pneumoencephal within post operative defect area in right parietal lobe. Laboratory examination showed normal fibrinogen and thrombocyte aggregation with elevation of d-dimer. After two weeks observation, visual acuity still 6/6 in both eyes with decreasing intrapapillary and peripapillary hemorrhage. Discussion : The exact pathophysiology of Terson Syndrome is still unknown. Even though, it has association with high intracranial pressure. Patient with Terson Syndrome will develop 5 times higher mortality rate compare to subarachnoid hemorrhage without Terson Syndrome. Conclusion : Terson Syndrome needs to be recognized early since it will bring significant prognostic effect and cause permanent vision loss if left untreated
Can Optical Coherence Tomography Angiography be a Useful Adjunctive Diagnostic Tool in Patient with Non Arteritic Ischaemic Optic Neuropathy? Poster Presentation - Case Series - Resident Laura Agnestasia Djunaedi; Syntia Nusanti; M. Sidik; Salmarezka Dewiputri; Sita Paramita
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: 10.35749/3zzp0093

Abstract

Abstract Introduction : Perfusion deficiency of the optic nerve head is presumed to have an immense role in the pathogenesis of non-arteritic ischaemic optic neuropathy (NAION). Optical coherence tomography angiography (OCTA) is a non-invasive method that can assess posterior pole vasculature at multiple levels. Thus, these case series want to compare the OCTA in the acute (before four weeks) and chronic phases (after six weeks) of NAION with their fellow unaffected eyes to give an overview of vasculature changes in NAION. Case Illustration : This case series consists of four patients with NAION. Half of them came with a sudden painless blurry vision, and the remaining presented with an abrupt visual field defect. All of them have diabetes mellitus and hypertension. None of them have superimposed vascular pathology. The first OCTA was taken within seven days of the first symptoms, and the second OCTA was taken more than six weeks after. Discussion : The high percentage of systemic vascular risk factors and the acute onset supported the vascular occlusive hypothesis in the pathogenesis of NAION. Meanwhile, the OCTA provides an actual overview of the vasculature changes. Microvasculature is more likely to expand in the acute phase, and a more significant expansion was found in greater optic disc edema. On the other hand, microvascular tend to attenuate in the chronic phase, representing the pruning of capillaries. A swept-source OCTA with deeper penetration might give a better peripapillary choriocapillaris image in the acute phase. Conclusion : OCTA is a promising adjunctive tool for diagnosing and monitoring progression in patients with NAION.
Progressive Bilateral Ptosis in Adduction Deficit: True Internuclear Ophthalmoplegia (INO) or Pseudo-INO? Poster Presentation - Case Report - Resident MARSHA RAYFA PINTARY; Salmarezka Dewiputri; Annisa Nindiana Pertiwi; Syntia Nusanti; Sita Paramita Ayuningtyas; Mohamad Sidik
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/stqqd995

Abstract

Abstract Introduction : Bilateral INO is a rare disease caused by a lesion in the medial longitudinal fasciculus (MLF) in the pons, resulting in adduction deficit. Progression to ptosis is rare and may confuse with pseudo-INO as in ocular myasthenia gravis (OMG). This case aims to report progressive ptosis in bilateral INO that mimics pseudo-INO. Case Illustration : A 36-year-old woman complained sudden binocular diplopia 4 days before admission. Bilateral adduction deficits (-3 and -2 of right and left eye, respectively) with nystagmus were seen. There was no ptosis. The patient was diagnosed with bilateral INO. One month later, the patient returned with bilateral ptosis. The marginal reflex distance 1 (MRD1) were 0 on both eyes. Post fatigue and ice pack test showed 2mm difference of MRD1. The single fiber electromyography (EMG) result came out negative with jitter <10%. Brain MRI revealed lesions in the posterior pons and periaqueductal on the level of midbrain. Discussion : The MLF controls 6th and contralateral 3rd cranial nerve nucleus for horizontal gaze. Ptosis in INO can occurred due to central caudal subnucleus involvement in midbrain that innervates levator palpebra. The result of fatigue and ice pack test may be misleading, as those are not pathognomonic for OMG. The single-fiber EMG are valuable modalities to exclude pseudo-INO in this case. Conclusion : Progressive bilateral ptosis may occur in bilateral INO. Fatigue and ice pack test may give false- positive results leading to confusion with pseudo-INO, rather than true INO. Supporting examinations are needed to confirm the diagnosis.

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