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Diagnostic Approach and Successful Treatment of Ocular Tuberculosis Siti Chadijah; Ovi Sofia; Herwindo Putranto
Majalah Oftalmologi Indonesia Vol 47 No 1 (2021): 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.v47i1.100151

Introduction: The prevalence of ocular tuberculosis (TB) are 1% in patients with pulmonary TB and 20% in patients with extrapulmonary TB. The definitive diagnosis and its management are still challenging. This case highlights the diagnostic approach and successful management of ocular tuberculosis Purpose: To report the diagnostic approach and successful management of ocular tuberculosis.Case Presentation: A-15-Years-old-Girl, presented to outpatient clinic due to blurred vision on both eyes since 6 month ago. She was suffered from fever and solitaire mass along the neck lymph node 2 weeks before. The best corrected visual acuity (BCVA) of the right eye was 0.2 and the left eye 0.3. The ophthalmology examination of both eyes revealed mutton fat, 2+ flare, and 1+ cell, posterior synechia, koeppe and bussaca nodule, 4+ vitreous cells. Funduscopy were unremarkable due to vitritis. There was an elevation of erythrocyte sedimentation rate, positive mantoux test and Quantiferon-TB Gold. Chest radiograph showed fibrosis of the right lung. Fine needle aspiration biopsy of neck mass showed fibrotic tissue. Patient was diagnosed with tuberculous granulomatous panuveitis. She received anti-tuberculous therapy (ATT) along with high dose methylprednisolone 0.5 mg/BW/days on tapered dose. At 3 weeks follow up, vitritis was subsided and we revealed snowball, snowbanking, and optic disc swelling of both eyes that showed improvement at 11 weeks follow up. The BCVA become 1.0 at week-17 of therapy and remains stable until 8 months follow up. Conclusion: Diagnosis of ocular tuberculosis diagnose was made based on symptoms and signs of granulomatous panuveitis and supporting evidence of pulmonary TB ancillary tests. Significant clinical improvement was achieved after administration of ATT along with high dose oral steroid.

Management of Bilateral Complicated Cataract in Convalescent Stage of Vogt- Koyanagi-Harada Syndrome Faradina R. Quamila; Ovi Sofia; T. Budi Sulistya
Majalah Oftalmologi Indonesia Vol 47 No 2 (2021): 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.v47i2.100292

Introduction: The incidence of complicated cataract in VKH syndrome in Japan is 35% and 40% in US. Cataract extraction surgery is advisable for evaluating posterior segment and improving visual acuity. This study is reporting management of bilateral complicated cataract in Vogt-Koyanagi- Harada syndrome convalescent stage under corticosteroid coverage. Purpose: To report the diagnostic approach and successful management of bilateral complicated cataract in convalescent stage of Vogt-Koyanagi-Harada syndrome Case Presentation: A 24-year old woman came to the outpatient clinic of Dr. Saiful Anwar Hospital Malang complaining of blurred vision on both eyes which worsen 2 months prior to visit. It was accompanied with headache, nausea, fever, hair loss, and facial hair whitening started 1 month afterwards. General examination showed alopecia and poliosis. The visual acuity of both eyes were hand motion. Anterior segment examination showed polymorphic old KPs, 4+ flare and 4+ cells, secluded pupil, and cataract in both eyes. Vitritis and choroidal thickening were noted from ultrasound examination. Laboratory examination results were within normal limit. She was diagnosed with Vogt- Koyanagi-Harada syndrome convalescent stage with complicated cataract and had been treated with combination of oral corticosteroid and azathioprine. Synechiolysis and cataract extraction of left eye were performed under oral corticosteroid and posterior subtenon triamcinolone injection coverage. There was improvement of visual acuity and controlled inflammation postoperatively. Conclusion: Significant visual improvement of left eye was shown after cataract extraction surgery under adequate inflammation control preoperatively. There was no relaps of uveitis during 6 months follow up.

CLINICAL MANIFESTATIONS AND CD4 COUNT CHARACTERISTICS OF PATIENTS WITH CYTOMEGALOVIRUS (CMV) RETINITIS Yunneke Renna Xaverina; Ovi Sofia
International Journal of Retina Vol 5 No 2 (2022): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2022.vol005.iss002.201

Introduction: To describe the clinical manifestations and CD4 count characteristics of patients with cytomegalovirus (CMV) retinitis. Methods: This is a retrospective study of patients diagnosed with CMV retinitis at the Ophthalmology Outpatient Clinic at Dr. Saiful Anwar General Hospital, Malang, between January 2016 to December 2019. The patients’ characteristics and clinical data including gender, age, visual acuity, slit lamp biomicroscopy, indirect ophthalmoscope, and laboratory findings were collected from medical records. Result: Twenty-one eyes from thirteen patients with CMV retinitis were enrolled. The mean age was 30.9 ± 7.12 years, with 54% of them male. Bilateral lesions were observed in 62% of the patients, and the mean visual acuity during the initial visit was 1.50 ±1.07 log MAR. All patients presented with the classic form of CMV retinitis. Mean CD4 count when commencing treatment was 62.23 ±11.82 cells/µL with 77% below 50 cells/µL. Patients with CD4 count < 50 cells/µL mostly presented with posterior uveitis, bilateral lesion, and visual acuity ≤1.00 logMAR. Ten patients were given oral valganciclovir and antiretroviral therapy. Retinal detachment condition was noted at seven eyes. Candidiasis was the most presenting opportunistic infection. Conclusion: Cytomegalovirus retinitis was found in patients infected with AIDS with low CD4 counts. In this study, patients with CD4 counts of below 50 cells/µL tend to have more severe clinical presentations.

Diagnostic Approach and Successful Treatment of Ocular Tuberculosis Siti Chadijah; Ovi Sofia; Herwindo Putranto
Majalah Oftalmologi Indonesia Vol 47 No 1 (2021): 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.v47i1.100151

Introduction: The prevalence of ocular tuberculosis (TB) are 1% in patients with pulmonary TB and 20% in patients with extrapulmonary TB. The definitive diagnosis and its management are still challenging. This case highlights the diagnostic approach and successful management of ocular tuberculosis Purpose: To report the diagnostic approach and successful management of ocular tuberculosis.Case Presentation: A-15-Years-old-Girl, presented to outpatient clinic due to blurred vision on both eyes since 6 month ago. She was suffered from fever and solitaire mass along the neck lymph node 2 weeks before. The best corrected visual acuity (BCVA) of the right eye was 0.2 and the left eye 0.3. The ophthalmology examination of both eyes revealed mutton fat, 2+ flare, and 1+ cell, posterior synechia, koeppe and bussaca nodule, 4+ vitreous cells. Funduscopy were unremarkable due to vitritis. There was an elevation of erythrocyte sedimentation rate, positive mantoux test and Quantiferon-TB Gold. Chest radiograph showed fibrosis of the right lung. Fine needle aspiration biopsy of neck mass showed fibrotic tissue. Patient was diagnosed with tuberculous granulomatous panuveitis. She received anti-tuberculous therapy (ATT) along with high dose methylprednisolone 0.5 mg/BW/days on tapered dose. At 3 weeks follow up, vitritis was subsided and we revealed snowball, snowbanking, and optic disc swelling of both eyes that showed improvement at 11 weeks follow up. The BCVA become 1.0 at week-17 of therapy and remains stable until 8 months follow up. Conclusion: Diagnosis of ocular tuberculosis diagnose was made based on symptoms and signs of granulomatous panuveitis and supporting evidence of pulmonary TB ancillary tests. Significant clinical improvement was achieved after administration of ATT along with high dose oral steroid.

Management of Bilateral Complicated Cataract in Convalescent Stage of Vogt- Koyanagi-Harada Syndrome Faradina R. Quamila; Ovi Sofia; T. Budi Sulistya
Majalah Oftalmologi Indonesia Vol 47 No 2 (2021): 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.v47i2.100292

Introduction: The incidence of complicated cataract in VKH syndrome in Japan is 35% and 40% in US. Cataract extraction surgery is advisable for evaluating posterior segment and improving visual acuity. This study is reporting management of bilateral complicated cataract in Vogt-Koyanagi- Harada syndrome convalescent stage under corticosteroid coverage. Purpose: To report the diagnostic approach and successful management of bilateral complicated cataract in convalescent stage of Vogt-Koyanagi-Harada syndrome Case Presentation: A 24-year old woman came to the outpatient clinic of Dr. Saiful Anwar Hospital Malang complaining of blurred vision on both eyes which worsen 2 months prior to visit. It was accompanied with headache, nausea, fever, hair loss, and facial hair whitening started 1 month afterwards. General examination showed alopecia and poliosis. The visual acuity of both eyes were hand motion. Anterior segment examination showed polymorphic old KPs, 4+ flare and 4+ cells, secluded pupil, and cataract in both eyes. Vitritis and choroidal thickening were noted from ultrasound examination. Laboratory examination results were within normal limit. She was diagnosed with Vogt- Koyanagi-Harada syndrome convalescent stage with complicated cataract and had been treated with combination of oral corticosteroid and azathioprine. Synechiolysis and cataract extraction of left eye were performed under oral corticosteroid and posterior subtenon triamcinolone injection coverage. There was improvement of visual acuity and controlled inflammation postoperatively. Conclusion: Significant visual improvement of left eye was shown after cataract extraction surgery under adequate inflammation control preoperatively. There was no relaps of uveitis during 6 months follow up.

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