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IMPROVEMENT OF LEUKEMIC RETINOPATHY AFTER LEUKAPHERESIS IN CHRONIC MYELOGENOUS LEUKEMIA WITH LEUKOSTASIS Ruchyta Ranti; Sauli Ari Widjaja; Wimbo Sasono; Muhammad Firmansjah; Ima Yustiarini; Ady Dwi Prakosa; Moestidjab Moestidjab; Gatut Suhendro
International Journal of Retina Vol 3 No 1 (2020): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2020.vol003.iss001.87

ABSTRACT Introduction: to report a case of bilateral leukemic retinopathy due to leukostasis that was successfully managed by leukapheresis. Case Presentation: 31-year-old male with mild visual disturbance was referred to ophthalmology department. He suffered from Chronic Myelogenous Leukemia (CML) with white blood cell (WBC) count 533.900/microL. He was started on hydroxyurea, allopurinol, and once leukapheresis. Ophthalmologic evaluation revealed visual acuity of 4/4 in the right eye and 4/6,3 in the left eye. Funduscopy examination showed the presence of bilateral papilledema, venous engorgement, tortuosity, and retinal hemorrhages. Then this patient continued with second leukapheresis. Result: Visual acuity, laboratory examination, and funduscopic finding was evaluated. His visual acuity was improved, papilledema and retinal blood vessels abnormality had markedly reduced concurring with the patient’s hematological remission. Decreasing WBC count after leukapheresis has improved blood flow that reflected from the retinal findings and visual acuity improvement. Conclusion: Leukapheresis treatment is sufficient to improved clinical condition for leukemic retinopathy caused by CML with leukostasis. Keywords: chronic myelogenous leukemia (CML), hyperleukocytosis, leukostasis, leukemic retinopathy

ASSOCIATION BETWEEN CENTRAL RETINAL THICKNESS AND VISUAL OUTCOME POST INTRAVITREAL RANIBIZUMAB INJECTION LOADING DOSES IN EXUDATIVE AGE RELATED MACULAR DEGENERATION Ferdian Ramadhan; Ima Yustiarini; Ady Dwi Prakosa; Sauli Ari Widjaja; Wimbo Sasono; Muhammad Firmansjah
International Journal of Retina Vol 4 No 2 (2021): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2021.vol004.iss002.169

Introduction : Age Related Macular Degeneration (AMD) stills the leading cause of blindness in developing countries for age 50 and above, increasing along higher life expectations.Anti- VEGF is the mainstay management for exudative AMD and able to reduce the central retinal thickness (CRT) and to increase the visual outcome. The aim of this study is to correlate between CRT and visual outcome in exudative AMD post intravitreal ranibizumab injection loading doses in Soetomo general academic hospital, Surabaya Methods : This was a retrospective, cross sectional study. Fourty two eyes who met inclusion criterias were received monthly loading doses of 0.5 mg Ranibizumab intravitreal injection for three consequtives months. Baseline visual acuity (BCVA) was measured with Snellen Chart converted to LogMAR, CRT was measured by SD-OCT. Parameters was measured before the first injection and after completed three months injections. Result : Fourty two eyes were composed by 59.5% male and 40.5% female with higher incidence in 61-70 years old (47.6%). Mean BCVA were 0.831 before and 0.624 after injection of serial Ranibizumab. Mean CRT were 346.9 and 254.2 µm before and after injection respectively. There was significant comparison between CRT and BCVA (p=0.00) & no correlation between CRT and BCVA before and after injection of Ranibizumab loading doses (p=0.418 & p=0.275) Conclusion : There were no correlation statistically between CRT and BCVA before and after injection of loading doses Ranibizumab intravitreal in exudative AMD. Further studies may be needed to prove the etiology of this tendencies.

UNILATERAL CMV RETINITIS IN HIV/AIDS PATIENT WITH MULTIPLE OPPORTUNISTIC INFECTIONS: Poster Presentation - Case Report - Resident Daya Banyu Bening; Muhammad Firmansjah; Ismi Zuhria
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/n3kv9x42

Introduction : CMV Retinitis is the most common opportunistic infection in HIV/AIDS patient. Ocular manifestations in HIV/AIDS have similar clinical features though the management therapies are different. Case Illustration : A 47-year-old man was presented with blurred vision on LE since 4 months. Patient was diagnosed with HIV/AIDS since 2 years. Patient only had light perception on LE, and 5/10 on RE. The LE anterior segment showed flare and cell indicating active anterior uveitis. The LE posterior segment revealed extensive hemorrhage and exudate known as ‘pizza pie’ appearance, and cotton wool spot with multiple ischemic areas on RE. Laboratory tests revealed reactive IgG CMV and very low CD4 count (4 cell/?l). Patient was also diagnosed with Tinea Corporis, Scabies, and Pneumocystis carinii pneumonia. Oral Valganciclovir 900 mg was administered twice a day for 3 weeks, along with anti- retroviral therapy. Discussion : The anterior uveitis and ‘pizza pie’ appearance with positive CMV IgG indicate CMV Retinitis in fulminant form. Cotton wool spot found in the RE leads to retinal microvasculopathy due to HIV invading the vascular endothelium and causing increased plasma viscosity. This patient only had 4 cell/?l CD4 which indicates severe immune deficiency. If not treated immediately, patients with CD4 count <50 are at higher risk of contralateral eye involvement. Oral Valganciclovir was chosen considering the multiple opportunistic infections the patient had. Conclusion : It is important to distinguish CMV retinitis with other HIV/AIDS ocular manifestations. The choice of therapy needs be considered with the overall condition of patient.

Neglected Coats Disease: Determining the Most Appropriate Treatment: Poster Presentation - Case Report - Resident Ruth Anastasia; Ima Yustiarini; Ady Dwi Prakosa; Sauli Ari Widjaja; Muhammad Firmansjah; Wimbo Sasono
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/bjhhjr84

Introduction : Coats disease is defined as retinal telangiectasia and aneurysm with retinal exudation that typically found in unilateral eyes of young male. This condition remains a diagnostic challenge because of its varied presentation. Case Illustration : A 12-years-old boy presented with a chief complaints of vision loss and pain in the right eye in the last 3 months and gradually blurred vision for a year. Visual acuity was positive light perception in the right eye and 5/5 in the left eye. Intraocular pressure of the right eye was 43.4 mmHg and 15mmHg of the left eye. Slit lamp examination of the right eye revealed conjunctival hyperemia, slightly corneal oedema, iris neovascularization, xantocoria, dilated pupil. Bullous total exudative retinal detachment with telangiectasia in all quadrants was found in the ophthalmoscopy examination of the right eye and left eye is within normal limit. The patient was diagnosed with stage IV coats disease and antiglaucoma agents was given as initial treatment. Discussion : Coats disease is a clinical diagnosis that can be assessed by clinical triad of exudative retinal detachment, irregularly-dilated telangiectatic vessel, and peripheral nonperfusion and can be supported by the diagnostic tools such as Ultrasonography, OCT, CT-Scan and MRI. Treatment of coats disease varies depend on the stage. In stage IV coats disease, external drainage is the most appropriate treatment. The more advanced stages demonstrating poor visual acuity both at presentation and at the time of final visit Conclusion : Majority of coats disease cases present with advanced stage therefore cause limited treatment option and poorer prognosis.

UNILATERAL CMV RETINITIS IN HIV/AIDS PATIENT WITH MULTIPLE OPPORTUNISTIC INFECTIONS: Poster Presentation - Case Report - Resident Daya Banyu Bening; Muhammad Firmansjah; Ismi Zuhria; Ima Yustiarini; Sauli Ari Widjaja
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: 10.35749/4fdqtz59

Introduction : CMV Retinitis is the most common opportunistic infection in HIV/AIDS patient. Ocular manifestations in HIV/AIDS have similar clinical features though the management therapies are different. Case Illustration : A 47-year-old man was presented with blurred vision on LE since 4 months. Patient was diagnosed with HIV/AIDS since 2 years. Patient only had light perception on LE, and 5/10 on RE. The LE anterior segment showed flare and cell indicating active anterior uveitis. The LE posterior segment revealed extensive hemorrhage and exudate known as ‘pizza pie’ appearance, and cotton wool spot with multiple ischemic areas on RE. Laboratory tests revealed reactive IgG CMV and very low CD4 count (4 cell/?l). Patient was also diagnosed with Tinea Corporis, Scabies, and Pneumocystis carinii pneumonia. Oral Valganciclovir 900 mg was administered twice a day for 3 weeks, along with anti- retroviral therapy. Discussion : The anterior uveitis and ‘pizza pie’ appearance with positive CMV IgG indicate CMV Retinitis in fulminant form. Cotton wool spot found in the RE leads to retinal microvasculopathy due to HIV invading the vascular endothelium and causing increased plasma viscosity. This patient only had 4 cell/?l CD4 which indicates severe immune deficiency. If not treated immediately, patients with CD4 count <50 are at higher risk of contralateral eye involvement. Oral Valganciclovir was chosen considering the multiple opportunistic infections the patient had. Conclusion : It is important to distinguish CMV retinitis with other HIV/AIDS ocular manifestations. The choice of therapy needs be considered with the overall condition of patient.

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