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Perbandingan Efisiensi dan Keamanan Fakoemulsifikasi Transversal-Longitudinal Sistem Peristaltik dengan Sistem Venturi pada Katarak Derajat Sedang-Keras Maulia Fitra Purnama; Bondan Harmani; Syska Widyawati; Amir Shidik; Aria Kekalih
Majalah Oftalmologi Indonesia Vol 45 No 2 (2019): Ophthalmologica Indonesiana
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Tujuan: Untuk membandingkan tingkat efisiensi dan keamanan antara teknologi Ellips FX-sistem Peristaltik dan Ellips FX-sistem Venturi pada fakoemulsifkasi katarak derajat sedang keras. Metode: terdapat 48 pasien yang terseleksi untuk dilakukan randomisasi di RSCM pada periode January 2016 â€“ Juni 2016. Dilakukan pengukuran densitas sel endotel dan ketebalan kornea sentral. Efisiensi dinilai dari effective phaco time (EFX). Mesin fakoemulsifikasi yang digunakan adalah Signature Ellips FXÂ®. Hasil :nilai median phaco time kedua grup tidak berbeda signifikan (190 vs 184 detik, p>0.05). Penurunan densitas sel endotel dan peningkatan ketebalan kornea sentral tidak berbeda signifikan. Tidak ada komplikasi yang terjadi pada penelitian ini. Kesimpulan: tingkat efisiensi dan keamanan pada Ellips FX-Peristaltik and Ellips FX-Venturi adalah sama. Kata kunci: densitas sel endotel, ketebalan kornea sentral, transversal, ellips FX, peristaltik, venturi.

Virna Glaucoma Implant (VGI) as the Management of Secondary Glaucoma following TASS : A Case Report: Poster Presentation - Case Report - General practitioner Athira Presialia; Anissa Nindhyatriayu Witjaksono; Gisela Haza Anissa; Syska Widyawati
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: 10.35749/4sepeq10

Introduction : Secondary glaucoma may occur in severe TASS. The inflammatory cell and debris can clog trabecular meshwork causing IOP to rise. In this case, we describe the successful management of secondary glaucoma due to TASS using Virna Glaucoma Implant (VGI). Case Illustration : A 66-year-old woman presented with decreased vision in the left eye one week after anterior vitrectomy and anterior segment lavage due to TASS. She had a history of phacoemulsification and intraocular lens placement with complication of PCR. On ocular examination, the visual acuity was 1/60 in the left eye with intraocular pressure (IOP) 55 mmHg. After maximum glaucoma medication using timolol, latanoprost, brinzolamide eye-drops and oral acetazolamide IOP was 22mmHg. Glaucoma Drainage Device (GDD) surgery using VGI was performed. After 2.5 weeks, IOP in the left eye was reduced to 19 mmHg without anti-glaucoma medication and visual acuity has improved to 6/60, showing a favourable outcome. Discussion : TASS may cause significant damage to the trabecular meshwork, which leads to secondary glaucoma. Although medical therapy is often used to control elevated IOP, surgical therapy may be required to treat refractor IOP elevation. GDD surgery has been reported to have effective outcomein secondary glaucoma and pseudophakic eyes. Conclusion : Secondary glaucoma is considered as one of the characteristics in the late stages of TASS, and required prompt treatment. VGI implantation is a promising choice of treatment in managing secondary glaucoma following TASS when medication is not effective.

Did the metal object hit the cornea? A case report of penetrating ocular injury with embedded foreign body: Poster Presentation - Case Report - Resident AGUNG NUGROHO; Dearaini; Annisa Windyani; Diannisa Paramitha Susantono; Rishka Pangestika; Yulinda Arty Laksmita; Syska Widyawati; Gitalisa Andayani Adriono
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: 10.35749/7fy1ce37

Introduction : Penetrating ocular injury with IOFBs may cause severe ocular damage. We demonstrate the diagnostic and treatment approach in a case of scleral laceration with a large IOFB. Case Illustration : A-24-year-old male presented with a rusty segment of fence wire, sized 15x11 mm, embedded near the nasal corneal margin of the right eye. Upon initial examination the vision was 6/9 with normal IOP. The object obstructed the view of the entry site, therefore corneal wound was suspected. CT scan showed penetrating metal object without posterior segment involvement. Anti-tetanus injection, topical and oral levofloxacin were given. He underwent exploration, foreign body removal and repair surgery. During surgery, the wound was revealed as a scleral laceration, 4 mm from nasal limbus. One day post-operative, vision was 6/20. A 0.1 mm hypopyon was found, along with fibrin at nasal vitreous. Oral and topical corticosteroids were given, and hypopyon disappeared the next day. One week after surgery, vision improved to 6/7.5, with clear vitreous and normal retina. Discussion : Ocular injuries with large IOFBs can hinder clinical examination. Corneal entry wound should be ruled out, due to potential permanent damage to visual axis. CT scan was helpful in assessing the depth of object penetration. The object was removed successfully, with no damage to the cornea and retina. Anti-tetanus, antibiotics and corticosteroids were able to control infection and inflammation. Conclusion : Large IOFBs which do not affect the visual axis, can be managed with successful outcome, by prompt removal and repair of the entry wound, and control of infection and inflammation.

Cataract Surgery After Keratoplasty: How Should We Prepare? Poster Presentation - Case Series - Resident Irma Suwandi Sadikin; Syska Widyawati
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: 10.35749/5xx1gd17

Introduction : Cataract surgery following corneal transplantation demands special attention to corneal graft stability and optimization to allow for excellent IOL selection, as well as corneal graft preservation since lens removal damages the corneal endothelium. This study aimed to determine how we should prepare for cataract surgery after keratoplasty. Case Illustration : Case 1: A 34-year-old male has phacoemulsification in his right eye (last eye). He had a history of eye surgery, including, keratoplasty for RE in 2019, and vitrectomy for RE because of endophthalmitis. The pre-operative visual acuity is 0.5/60 with PAS and an irregular pupil. Post-operative VA 3/60 with BCVA 6/40. Last follow-up, the grafted cornea was still clear with normal IOP. Case 2: A 50- year-old female underwent phacoemulsification for both eyes (BE). She had histories of keratoplasty in 1986, 1989, and 1997 for BE. She also had extreme myopia for BE (RE S -17.00, LE S-14.00). Pre- operative VA was 1/60 of BE, and BCVA was 6/20 a month after surgery. During the last check-up, both transplant corneas were clear with normal IOP. Last visit, her both grafts remained clear. Discussion : Conclusion : IOL calculations are challenging due to inaccuracy in corneal measurements, astigmatism, or corneal pathology. The best time to perform surgery is at least 2 years after keratoplasty. We suggest using total keratometry in the K-6 formula or Haigis for the IOL formula. Good dispersive viscoelastic, operating away from the corneal endothelium, and employing low phaco-energy/fluids will help to deliver a clear cornea after surgery. Last, steroid treatment will enhance graft survival rate.

A Challenging Case of Simple Limbal Epithelial Transplantation (SLET) in Limbal Stem Cell Deficiency Following Chemical Injury: A Case Report: Poster Presentation - Case Report - Resident Lia Amanda; Syska Widyawati; Faraby Martha; Jessica Zarwan
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/ahx7p888

Introduction : Limbal stem cell deficiency (LSCD) often arises following trauma or inflammation that hinders corneal epithelium healing, commonly caused by chemical or thermal injuries. Despite significant advancements, treating LSCD remains challenging. This case highlights a challenging case of simple limbal epithelial transplantation (SLET) in LSCD following chemical injury. Case Illustration : A 20-year-old male presented with reduced vision in left eye following an alkaline chemical injury (grade III) was diagnosed with unilateral LSCD. Upon examination, conjunctivalization of the peripheral cornea, a central corneal cicatrix, and stromal neovascularization present after previous necrotomy, tenoplasty, and amniotic membrane transplantation (AMT). The patient then underwent SLET, with limbal biopsies from the collateral eye. Four months after surgery the visual acuity improved from 3/60 to 6/15 with spectacles. However, the cornea conjunctivalization still developed despite improved visual acuity. Discussion : To effectively manage the recurrence of stem cell deficiency, other stem cell transplantation techniques are needed to manage the problem. Combining different limbal stem cell transplantation approaches can be customised to address the problem and achieve lasting results. Conclusion : Prompt diagnosis and treatment of LSCD is crucial to prevent complications and blindness. SLET is a surgical option for LSCD after chemical injury, but this report highlights a challenging case and the need for the alternatives approaches.

A snake venom ophthalmia: A case – report: Poster Presentation - Case Report - Resident Nabila Aljufri; Irma Suwandi Sadikin; Dany Petra; Diannisa Susantono; Virna Dwi Oktariani; Syska Widyawati
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/vm6dv861

Introduction : Snake venom ophthalmia is caused by venoms of spitting snakes. Delayed treatment may result in corneal ulcer, corneal perforation and blindness. We aim to report a fortunate snake venom ophthalmia case. Case Illustration : A-54-year-old male complained of burning eye pain, watery, and redness of the right eye (RE) after being spat by a snake 3 hours before admission. The snake was identified as a cobra-snake, spitted at a distance of 1 meter without body bite. He rinsed his eyes with tap water and irrigated at a nearby hospital before referred. During the admission, the pH of both eyes (BE) was 8. The patient was irrigated with normal-saline. The visual acuity (VA) of the right eye was 6/12 and left eye 6/6. There was RE conjunctival and ciliary injection. Other examinations were unremarkable. The patient was discharged and treated with levofloxacin eye-drop, sulfas-atropine 1%, EDTA 1%, artificial tears, and vitamin C. He did self-eye irrigation. Two days later, he presented with VA of 6/6 for BE with normal ocular examinations and pH of 7 for BE. Discussion : The general principle is prompt and copious irrigation of the eyes in chemical contact. The snake venom mixture of chemicals was washed out, which local necrosis can be prevented. Managing snake venom as a chemical splash injury with considerable irrigation, lubricants, and topical antibiotics, resulted a good outcome and prevented sequelae in this patient. Conclusion : Urgent irrigation of the affected eyes and other mucous membranes is the key in treating snake venom ophthalmia

Successful Management of Cataract in Patient With Long Anterior Zonules and Small Pupil :A Rare Case: Poster Presentation - Case Report - Ophthalmologist Riskha Pangestika; Rio Rhendy; Syska Widyawati
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/e9shxj46

Introduction : Long anterior zonules (LAZ) are rare disease with prevalence was 1–2%, characterized by zonular fibers that extend centrally leading to a small zonule-free zone (ZFZ), which raises the risk of complications during zonular cutting while continuous curvilinear capsulorhexis (CCC). This leads to two options whether to perform phacoemulsification through a small CCC within the small ZFZ or an adequately sized CCC. The objective of this study was to report challenging management of phacoemulsification surgery with LAZ eyes with small pupil Case Illustration : A 62 y.o female had visual acuity(VA) 0.7(logMAR) due to corticonuclear cataract in left eye. She had history complicated cataract surgery with secondary sulcus fixated IOL in her fellow eye. The IOP was normal, no phacodenesis and pseudoexfoliative material observed in left eye. The posterior segment was normal. The left eye observed otherwise normal in initial examination. Intraoperatively, after viscomidriasis technique the ZFZ identified in the area of 2.0-2.5 mm from central. Five millimeter CCC can be achieved in the central area and phacoemulsification with the help of CTR (Capsular Tension Ring) safely performed and one piece IOL was implanted in the bag. Discussion : On the first postoperative day, VA was improves to 0.4(logMAR), IOL central and clear corneal with minimal inflammation. One week after surgery, the VA 0.3(logMAR) and no sign of IOL decenteration. Conclusion : Phacoemulsification in eyes with LAZs can be safely performed with CTR through an adequately sized CCC without significant complications. A combination of early recognising high-risk eye, proficient skills, and surgical instruments can improve outcome.

Quality of Life After Cataract Surgery in Patients with Age-Related Macular Degeneration: A Literature Review: Oral Presentation - Observational Study - General practitioner Rosa Syahruzad; Syska Widyawati
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/bmrkac33

Abstract Introduction & Objectives : Age-related macular degeneration (AMD) is a common ocular disease that affects millions of people worldwide. Cataract surgery is one of the most performed surgical procedures in the world and is effective to improve visual function and quality of life (QoL) in individuals with cataracts. Both cataract and AMD are conditions that occur in late age. However, the presence of AMD may complicate the postoperative outcomes and QoL of these patients. This review aims to examine the impact of cataract surgery on the QoL of patients with AMD. Methods : A search of the literature was conducted using electronic databases. Studies were included if they evaluated QoL outcomes in patients with AMD who underwent cataract surgery. Results : The results of the review suggest that cataract surgery can improve visual acuity and QoL in patients with AMD. However, the degree of improvement is influenced by the severity of AMD. Patients with mild to moderate AMD tended to have greater improvements in QoL and visual acuity compared to those with advanced AMD. Incidentally, it is still cost effective to perform cataract surgery in patients with advanced AMD. Conclusion : Overall, patients with AMD who underwent cataract surgery experienced improvements in their QoL. Nevertheless, individual characteristics including severity of AMD must be considered to optimize the procedure outcomes. Further research, particularly with longer follow up times, is needed to determine the long-term effects of cataract surgery on QoL in patients with AMD.

Monovision versus multifocal intraocular lens implantation in cataract patients: a systematic review and meta-analysis: Oral Presentation - Observational Study - General practitioner Fadhli Waznan; Yosilia Nursakina; Aydan Jalil Rancakbudi; Syska Widyawati
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: 10.35749/5ma22y90

Abstract Introduction & Objectives : Modern cataract surgery technique entails replacing the crystalline lens with an artificial intraocular lens (IOL). While the standard monofocal IOL implantation with monovision technique has been cost- effective and provided patients with good visual acuity, multifocal IOLs present the prospect of spectacle-free vision despite various adverse outcomes. It remained contentious whether multifocal IOLs were superior to monovision. Our review provide an up-to-date assessment of monovision vs. multifocal IOL implantation's visual acuity and spectacle independence following cataract surgery. Methods : A systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacle independence, and visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data. Results : Ten studies were identified. Pooling analysis for uncorrected binocular distance visual acuity and binocular uncorrected near visual acuity showed no difference between monovision vs. multifocal IOL (SMD 0,31; 95% CI -0,21 to 0,82 and SMD 0,41; 95% CI -0,58 to 1,40, respectively). Spectacle independence showed monovision was inferior to multifocal IOL (OR 0,22; 95% CI 0,08 to 0,61; heterogeneity I2=75%). Conclusion : Current evidence showed that multifocal IOL had comparable visual acuity to monovision with slightly higher likelihood of being spectacle-free. Despite that, monovision can be an efficacious and affordable option to be implemented in countries with high cataract burden.

The use of Visual Function Index-14 (VF-14) questionnaire in determining cataract patients’ quality of life in Jonggol subdistrict, Indonesia: Oral Presentation - Observational Study - General practitioner Nadya Safira; Muhammad Keyvan Fermitaliansyah; Syska Widyawati; Mutmainah Mahyuddin
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/h07pbw45

Abstract Introduction & Objectives : Unresolved cataract primarily has caused patients to have disturbance in carrying out daily activities, thus lowering their quality of life (QoL). We aim to use the Visual Function Index-14 (VF-14) questionnaire, one of the most frequently used tools, to discover the extent of daily activities disturbance in patients with cataract. Methods : In this observational study, we conducted eye screening to 47 subjects in Jonggol subdistrict, Bogor, Indonesia. Patients were asked several questions based on the translated VF-14 questionnaire into Bahasa and also tested to find out their best-corrected visual acuities. Lens examination was carried on using handheld slit lamp. Results : Out of all 47 subjects, 34 (72,3%) patients had cataract that was marked by lens opacities in either one or both eyes. According to distant vision impairment categories by International Classification of Diseases 11, 8,8% of cataract patients had normal vision from the better eye, 20,6% had mild, 64,7% had moderate, 0% had severe impairment, and 5,9% had blindness. From the assessment using VF-14 translated questionnaire, 14,7% subjects had no disruption in doing daily activities, 82,3% had disruption, and 2,9% could not do the mentioned activities at all. From the Spearman correlation test, there was a significant association with moderate correlation between the degree of vision impairment and QoL (p = 0.006, rs = 0.459). Conclusion : The majority of cataract patients in Jonggol subdistrict had moderate vision impairment and had disruption in doing daily activities, therefore lowering their QoL.

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