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Screening Kesehatan Mata Anak pada Komunitas Kusta dalam Era Pandemi Covid-19 Yunia Irawati; Julie Dewi Barliana; Hindun Zakiyah; Hisar Daniel; Made Susiyanti
Media Karya Kesehatan Vol 5, No 1 (2022): Media Karya Kesehatan
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/mkk.v5i1.33560

Indonesia masih merupakan negara endemis kusta terbanyak ketiga didunia. Tim KATAMATAKU telah melakukan program kesehatan pada penderita kusta dan komunitasnya selama tiga tahun terakhir. Sebagai generasi penerus bangsa, kesehatan mata anak di lingkungan tersebut perlu diperhatikan. Deteksi gangguan mata anak dan tatalaksananya harus sedini mungkin dilakukan. Pandemi Covid-19 di Indonesia berdampak pada banyak aspek. Pembelajaran dengan system daring/online membuat anak menatap layar digital lebih lama sedangkan kegiatan diluar rumah dibatasi, hal ini meningkatkan gangguan penglihatan. Pemeriksaan kesehatan mata anak di Indonesia masih jarang dilakukan secara rutin. Tujuan dari pengabdian masyarakat ini adalah untuk mendeteksi gangguan mata pada anak di lingkungan sosio-ekonomi rendah, komunitas kusta, Tangerang saat pandemi covid 19. Metode pelaksanaan kegiatan dengan penelusuran riwayat kesehatan, pemeriksaan ketajaman visual dengan chart dan autorefraktometri, segmen anterior, dan segmen posterior. Pemeriksaan dilaksanakan 12-13 Desember 2020 melibatkan total 103 anak dengan median usia 11 (4 - 18) tahun. Rasio laki-laki dan perempuan adalah 1: 1,2. Mayoritas anak yang terpapar digital screen time lebih dari 2 jam perhari sebesar (80/103, 77.7%) dengan (11/103, 10.7%) anak mengalami gangguan refraksi. Waktu menatap layar gadget yang lama, seringnya melihat dalam jarak dekat dan kegiatan diluar ruangan yang kurang, dapat berpotensi meningkatkan progresivitas gangguan refraksi. Meskipun dengan banyak keterbatasan karena pandemi, screening kesehatan mata anak tetap perlu dilakukan dengan melakukan modifikasi kegiatan sesuai protokol kesehatan. Kegiatan ini diharapkan dapat meningkatkan pemahaman anak dan orang tua terkait pentingnya pemeriksaan mata pada anak secara rutin sejak dini dan dapat menjadi contoh pelaksanaan skrining kesehatan di masa pandemi. Kata kunci: COVID-19, daring, digital screen time, tajam penglihatan

Single Arterial Oxygen Tension Elevation Increases the Risk of Stage of Acute Disease Retinopathy of Prematurity Karina Satyani Pratiwi; Dian Estu Yulia; Julie Dewi Barliana; Rita Sita Sitorus
International Journal of Retina Vol 6 No 2 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss002.242

Introduction: Numerous studies have shown inconclusive results regarding ideal parameter for oxygen supplementation to balance the risk of mortality and retinopathy of prematurity (ROP) development. The purpose of this study is to compare mean partial oxygen tension (PaO2) level in ROP. Methods: This retrospective study was performed on premature infants undergoing ROP screening at our neonatal intensive care unit during 2021. All infants born at our hospital at ≤ 30 weeks, birth weight (BW) ≤ 1500 grams, or high-risk infants with prolonged ventilation were included. ROP screening was performed at chronological age four to six weeks, were followed and managed according to the severity. ROP severity was categorized by International Classification of ROP 3rd edition (ICROP3). We reviewed the characteristics of each group and compared mean PaO2 level in day 1, day 5, and day 10 between incomplete vascularization (IV) group, stage of acute disease (SAD) group, and Aggressive ROP (A-ROP) group. Result: We investigated 124 eyes from 62 eligible PI. The incidence of IV, stage 1, stage 2, stage 3, and A-ROP were 58.9%, 2.4%, 7.3%, 23.4%, and 8.1%, respectively. Mean PaO2 level in day 5 was higher in SAD group compared to IV group (p=0.002). For each level increase in PaO2, there was 1.042 times higher odds of developing SAD (p=0.004). Multivariate logistic regression analysis showed consistent results, simultaneously, each week increase in GA was associated with lower risk of SAD development (p=0.018) and each level increase in PaO2 was associated with higher risk for SAD development (p=0.005). Conclusion: A single elevation in PaO2 during early life of PI increases the risk of developing stage of acute disease ROP, particularly in younger infants. Careful monitoring for PaO2 is mandatory to prevent development of ROP.

Efficacy of Intravitreal Anti Vascular Endothelial Growth Factor Injection Compared to Focal Therapy in Pediatric Patients with Coats Disease Alia Nesa Utami; Julie Dewi Barliana
Majalah Oftalmologi Indonesia Vol 48 No 2 (2022): Ophthalmologica Indonesiana
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/journal.v48i2.100602

Introduction: Coats disease is a retinal vascular disorder that may lead to progressive exudative retinal detachment. The standard regiment of treatment is focal therapy. However, its effectiveness may decrease when more than two quadrants of the retina exhibit vascular abnormalities. Thus, recent studies tried to use anti vascular endothelial growth factor (anti-VEGF) as therapy for the vascular problems. Aims: Comparing the efficacy between anti-VEGF injection and standard therapy regiment such as focal laser therapy. Methods: Literature searching was conducted through PubMed, ScienceDirect, Google Scholar, ProQuest, and SpringerLink. Search terms included "Coats’ Disease" and mesh terms of “Anti- VEGF". The efficacy is assessed based on Best-Corrected Visual Acuity (BCVA) and improvement in fundus manifestations. Results: All of the studies that conducted primary intravitreal anti-VEGF treatment were followed by necessary ablative treatment. These studies, such as by Yang Q and Zheng XX, et al. showed remarkable improvements in both visual acuity and anatomical outcomes. Laser therapy also gained satisfactory result in upgrading clinical stages, even though some complications including subretinal fibrosis, cataract, and vitreous hemorrhage were reported. A comparative study by Ray R, et al. noted that group undergoing anti-VEGF might require longer treatment sessions despite possible benefits. Conclusion: Anti-VEGF agents can be used as neoadjuvant in standard therapy. It did not reduce the time for full treatment, but the resolution of disease was seen in the most severe cases treated with combination therapy.

Scleral Buckling for Retinopathy of Prematurity: A Case Report: Presentation - Case Report - Resident Gustiandari Fidhya Permanik; Julie Dewi Barliana; Anggun Rama Yudantha
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/esqh6d30

Introduction : Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease that affects premature infants. Patients with advanced ROP require surgery to minimize retinal distortion and prevent total retinal detachment. This case reports the efficacy of scleral buckling (SB) in a patient with stage 4B ROP in both eyes within 3 months. Case Illustration : A 4-month-old female baby presented to the Pediatric Ophthalmology Division in Cipto Mangunkusumo Hospital with the chief complaint of no eye contact in both eyes. Her eyes moved by themselves since the age of 3.5 months and sometimes looked crossed. The patient presented to the pediatrician and was referred to the pediatric ophthalmology division for further management. There was a history of premature delivery at 30 weeks with oxygen therapy for 3 weeks. Pediatric Ophthalmology Division performed ultrasonography and Retcam and diagnosed ROP stage 4B in both eyes. Scleral buckling was performed by vitreoretinal division in the right and left eyes at 49 and 52 weeks postmenstrual age, respectively. Discussion : Vitrectomy and scleral buckling are the surgical options in advanced ROP. Vitrectomy is ideally performed in stage 4A without macular involvement. We considered performing SB because vitrectomy seems to be ineffective in this patient and the patient is more prone to intraocular complications. Conclusion : Scleral buckling is effective in preventing further progression of retinal detachment, reducing vitreoretinal traction and preventing ischemia in the retinal detachment. In short-term follow-up, we found no worsening of progression. However, further follow-up is needed to demonstrate the long- term efficacy of SB in advanced ROP.

OVERVIEW OF PATIENTS SCREENED FOR AND DIAGNOSED WITH ROP IN PEDIATRIC OPHTHALMOLOGY OUTPATIENT CLINIC BEFORE, DURING, AND AFTER THE COVID-19 PANDEMIC: Poster Presentation - Observational Study - Ophthalmologist JULIE DEWI BARLIANA; Rita Rita Sitorus; Dian Estu Yulia; Anthea Casey; Raihanny Andrea Zahra
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/hwpgv162

Introduction & Objectives : The COVID-19 pandemic has profoundly impacted healthcare systems worldwide, leading to significant changes in the delivery of medical services. Non-urgent ophthalmology visits were canceled. However, premature infants at risk of retinopathy of prematurity (ROP) require timely and in-person care to prevent vision loss. This study aims to report on the high-risk babies screened and diagnosed with ROP before, during, and after the COVID-19 pandemic Methods : This is a descriptive study conducted on premature infants who visited the pediatric ophthalmology outpatient clinic at Cipto Mangunkusumo Hospital Jakarta between January 2019 and December 2022. Data was collected using medical records and presented using tables and charts Results : A total of 368 babies were screened for ROP in 2019, and 75% were diagnosed with ROP. During the lockdown in 2020, the number of babies screened for ROP decreased to 286, and the incidence of ROP was 38.5%. In 2021 and 2022, ROP screening increased to 458 and 515 babies per year, respectively. After the COVID-19 pandemic subsided, ROP screenings increased significantly from 2020 to 2021. The number of babies screened in 2021 and 2022 was similar, but the incidence of ROP decreased from 45.4% in 2021 to 20.3% in 2022 Conclusion : This study highlights the impact of the COVID-19 pandemic on ROP screening and diagnosis in a pediatric ophthalmology outpatient clinic. After the COVID-19 pandemic, the number of babies screened for ROP increased due to the end of the lockdown

Pseudopterygium After Limbal Dermoid Cyst Excision in a Child with Goldenhar Syndrome: Poster Presentation - Case Report - Ophthalmologist DEA PRITA CAESARITA; Julie Dewi Barliana
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: 10.35749/0e622333

Introduction : Goldenhar syndrome is a rare congenital disorder also known as oculoauricularvertebral dysplasia. Limbal dermoid associated with this syndrome. This case report aims to present an reccurent pseudopterygium after three times limbal dermoid cyst excision in patient with Goldenhar syndrome. Case Illustration : Patient 13 years old male with pseudopterygium in right eye. Visual acuity both eyes 6/6 snellen chart. Fibrovascular tissue from tarsal conjunctival inferotemporal to 2 mm limbal cornea in right eye. Patient had limbal dermoid cyst in right eye since birth and underwent limbal dermoid cyst excision for three times. First time surgery used amniotic membrane transplantation, then second and third surgery used conjunctival limbal graft. Goldenhar syndrome have been diagnosed since the age of 2 years old. External examination noticed asymmetrical hemifacial microsmia, grade III microtia right ear, conduction deafness, and laryngomalacia. Discussion : Limbal dermoid cyst is one of characteristic of Goldenhar syndrome. In this case pseudopterygium grade II in right eye developed after limbal dermoid cyst excision for three times. Limbal dermoid simple excision may lead to corneal vascularization persistent epithelial defect, scar, and pseudopterygium. Various surgical include superficial keratectomy, amniotic membrane transplantation and lamellar or penetrating keratoplasty. Pseudopterygium still occurs in this case, even though recurrence has been prevented by administration of amniotic membrane transplantation and conjunctival limbal graft. Conclusion : We should be concerned about management of limbal dermoid cyst with Goldenhar syndrome to prevent recurrent pseudopterygium.

Nocturnal Lagophthalmos in Pediatric Patient with Hydrocephalus: Poster Presentation - Case Report - Resident IZZA ZUKHRUFIA; Yunia Irawati; Julie Dewi Barliana
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/egvmc937

Introduction : Nocturnal lagophthalmos is a physiologic and asymptomatic condition observed in 1.4-5% of the population. In unconscious patients, using mechanical ventilation and neuromuscular blocker medication can worsen the lagophthalmos, causing the patient to have exposure keratopathy. This report aims to emphasize the importance of eye care in unconscious patients. Case Illustration : A 5-year-old girl came with a chief complaint of a whitish lesion on the right eye. She got the lesion when hospitalized in Pediatric Intensive Care Unit for two weeks due to seizure attacks. A red and watery eye accompanied the whitish lesion. The patient had history of nocturnal lagophthalmos and Dandy-Walker syndrome, a complex malformation characterized by agenesis or hypoplasia of the vermis and cystic enlargement of the fourth ventricle. The corneal ulcer was treated with antibiotic treatment. After several visits, her infection had subsided but left a corneal cicatrix on her right eye. Discussion : In unconscious patients, it’s important to pay attention to the eyelid. Lagophthalmos can be divided into three groups; where grade 1 has complete eyelid closure; grade 2 has conjunctival exposure; and grade 3 has corneal exposure. It’s important to lubricate the eye in each grade and keep it closed using eyelid tape or cover in grades 2 and 3 to prevent exposure keratopathy. Surgical intervention can be considered when there is a risk of corneal ulcer. Conclusion : Prevention is always better than cure. Establishing standardized eye care in the intensive care unit is crucial to prevent ocular complications and preserve visual acuity.

Imaging Mismatch of Nail in the Eyeball: What’s next? Poster Presentation - Case Report - Resident Christella Caroline; Gladys Kusumowidagdo; Burhana Mawarasti; Michael Hartono; Julie Dewi Barliana; Rio Rhendy; Yunia Irawati; Ari Djatikusumo
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: 10.35749/2payky76

Introduction : A retained foreign body (FB) can lead to severe complications, the most devastating of which is eye loss. We present a discrepancy of imaging that resulted in a dilemma in the approach management of a mixed global-adnexal FB case. Case Illustration : A 31-year-old man came to the emergency room with blurry vision for 1.5 hours after a nail hit his right eye (RE). The visual acuity of RE is light perception. Ophthalmological examination revealed a central Y-shaped full-thickness corneal laceration with iris and vitreous prolapse. The lens appeared cloudy, and the posterior segment was difficult to assess. Imaging showed a foreign metal object asa nail in the oculi to intraconal without penetration to the orbital wall. He was planned to undergo FB extraction with corneal laceration repair and aspiration of lens mass irrigation. However, the nail was hard to find intraoperatively because the vitreous and choroid kept coming out. Hence evisceration with DFG was performed. The nail was found more posteriorly and attached to the bone. Discussion : While primary repair is the standard practice for open globe injury, managing retained intraocular metallic foreign bodies is controversial. Imaging such as CT scans can help determine the location of FB and approach management. In this case, imaging showed the FB was in the iris plane and not penetrating the orbital wall, so primary repair and FB extraction were planned. Conclusion : The imaging may not always be accurate in determining the exact location of FB, and the surgical approach may need to be adjusted accordingly.

Effectiveness and Timing of Congenital Nasolacrimal Duct Obstruction Probing: a Systematic Review: Oral Presentation - Observational Study - General practitioner Kharisma Zatalini Giyani; Dewi Alya Winarto; Julie Dewi Barliana
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: 10.35749/5t0yhc19

Abstract Introduction & Objectives : Most congenital nasolacrimal duct obstruction (NLDO) cases could resolve spontaneously or only require minimal conservative treatment. In unresolved cases, lacrimal probing is considered a primary treatment; however, no consensus on the best timing to perform probing is available. Therefore, this study aims to compare the effectiveness of immediate probing with deferred probing and to assess the best time to perform primary probing. Methods : A search for relevant literature was performed on four electronic databases: PubMed, Cochrane Library, EMBASE, and Scopus with predetermined keywords. The inclusion criteria consist of systematic reviews, RCTs, and prospective/retrospective studies published between 2013-2023 regarding lacrimal probing as an intervention for congenital NLDO. Results : We included seven studies. Three studies compared immediate and deferred probing, while four focused on the success rate of probing for NLDO at various age groups. Studies suggest immediate and deferred probing had a comparable effectivity in treating NLDO; however, one systematic review suggests immediate probing was superior to deferred probing. Studies also demonstrate that the success rate of probing declines with age. Lacrimal probing performed on NLDO patients under 12 months old had a success rate of more than 80%. Conclusion : Despite findings of comparable effectiveness between immediate and deferred probing, probing performed at a younger age yielded a higher success rate. This suggests that doctors should consider the patient's age at diagnosis to decide between immediate and deferred probing. Further evidence is needed to determine cut-offs for the best time to perform primary probing.

Binocular therapy for amblyopia in children: a systematic review and meta- analysis of randomized controlled trials: Oral Presentation - Observational Study - General practitioner Diajeng Ayesha Soeharto; Abritho Zaifar; Natassha Priscillia Wibowo; Julie Dewi Barliana
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: 10.35749/374nnd84

Abstract Introduction & Objectives : Concerns for low compliance and mixed outcomes with conventional deprivation therapy prompt the need to explore new modes of amblyopia treatment. Novel binocular therapy using movies or games may offer comparable outcomes with better compliance, theoretically strengthening the amblyopic eye by enhancing stereopsis. This study aims to elucidate current evidence regarding binocular therapy in comparison to conventional therapy in treating amblyopia in children. Methods : Comprehensive literature search across five electronic databases was conducted using keywords selected a priori. Randomized controlled trials (RCTs) on binocular therapy in children with amblyopia were included and critically appraised using Cochrane risk of bias tool by three reviewers. Primary outcome was improvement of amblyopic eye VA, and a meta-analysis was conducted for quantitative data analysis. Results : We included 16 RCTs eligible for inclusion with a total sample size of 1,520 patients. In comparing binocular therapy to either patching or spectacles, there was no overall significant difference in terms of VA change from baseline. Subgroup analysis suggests binocular therapy may be favorable within 2-4 weeks, although not statistically significant. Albeit subgroup analysis of video-based binocular therapy revealed significant improvement in VA compared to patching (0.39 logMAR, [0.03, 0.74], p = 0.03), yet the same was not found for game-based binocular therapy. Conclusion : Efficacy of binocular therapy as a substitute for conventional therapy in treating amblyopia is not yet substantiated. Further exploration to determine most effective treatment protocol is needed, including strategies to increase adherence. Video-based therapy shows potential for improving outcomes and warrants further investigation.

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