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All Journal Ophthalmologica Indonesiana
Brigitta Marcia Budihardja
Faculty of Medicine, Udayana University
Health Professions Medicine & Pharmacology Public Health

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Prophylaxis Pharmacological Management for Patients with Intraoperative Floppy Iris Syndrome Risk Due to ?1-Adrenergic Receptor Antagonists Use Brigitta Marcia Budihardja; Ade Ajeng Cempakadewi
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.v48i2.100514

Abstract

Introduction: Intraoperative floppy iris syndrome (IFIS) remains a challenge that increases the risk of complications in patients undergoing cataract surgery who use ?1-adrenergic receptor antagonists. To date, no definite consensus on a preventive strategy for IFIS is available. The aim of this review is to assess various pharmacological managements to prevent IFIS in high-risk patients. Methods: This review was based on Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. A systematic search using PubMed, Science Direct, Cochrane Library, and WorldCat database was performed. Quality of each study was evaluated using Cochrane Risk of Bias 2.0 (RoB 2.0), Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I), or Newcastle- Ottawa Scale (NOS). Results: The search identified 1589 articles of which 7 met the eligibility criteria. Experimental and observational studies between 2010 and 2018 were included. Pharmacological managements included in this review are administered in varying routes. Phenylephrine, lidocaine, a combination of lidocaine and epinephrine are given intracamerally. Other pharmacological managements included are sub-tenon injection of lidocaine, topical atropine, a combination of topical atropine with intracameral epinephrine, combined irrigation solution of phenylephrine and ketorolac, and mydriatic cocktail- soaked wick sponges. Conclusion: Various pharmacological managements for IFIS prophylaxis have shown promising potential. However, studies that evaluate the efficacy of each agent and comparison between these strategies are still limited. Further research is needed to determine the best prophylaxis strategy to reduce the incidence of IFIS.
The Role of Optical Coherence Tomography Angiography in Non-Arteritic Ischemic Optic Neuropathy: A Case Report Syntia Nusanti; Brigitta Marcia Budihardja; Lazuardiah Anandi; Rona Ali Badjrai
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.v48i2.100597

Abstract

Introduction: Non-arteritic ischemic optic neuropathy (NAION) is the second most common optic neuropathy in adults. Since circulatory insufficiency is presumed to have a role in pathogenesis of NAION, optical coherence tomography angiography (OCTA) is suggested as a tool in assessing NAION patients, while optical coherence tomography (OCT) can detect structural changes. This case report aims to describe the congruity of visual field defect with OCT and OCTA result in a case of bilateral NAION, highlighting the role of both OCT and OCTA in NAION. Case Report: A 52-years-old male came due to painless, progressive blurry vision in both eyes, especially in lower visual field, for the past 7 months. Humphrey visual field examination revealed inferior visual field defects in both eyes. OCTA showed reduced retinal perfusion in the superior part bilaterally. OCT revealed ganglion cell loss in the superior part of his right eye and almost all parts of his left eye. Retinal nerve fiber layer (RNFL) thinning was found in the superior part bilaterally. Discussion: In this case, the congruity of visual field defect, reduced perfusion, ganglion cell-inner plexiform layer (GCIPL), and RNFL thinning portrayed the connection of hypoperfusion as the presumed underlying mechanism of NAION, neuron loss as the result of the hypoperfusion, and the visual field loss as the presenting symptom in NAION. Conclusion: This finding demonstrates the role of OCT-A and OCT in diagnosing and monitoring progression in patients with NAION.OCT-A is a useful tool to evaluate microvascular changes, while OCT can be used to evaluate RNFL and GCIPL thinning.
Co-Authors Ade Ajeng Cempakadewi Lazuardiah Anandi Rona Ali Badjrai Syntia Nusanti