Krisna Dwi Purnomo Jati
Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/dr. Sardjito General Hospital, Yogyakarta

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Hasil Tindakan Bedah Implantasi Glaucoma Drainage Device pada Pasien Glaukoma Refrakter di RSUP dr Sardjito Yuandani Saputra; Krisna Dwi Purnomo Jati; Tatang Talka Gani; Retno Ekantini
Majalah Oftalmologi Indonesia Vol 49 No S1 (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/ak6fah94

Abstract

Introduction: Glaucoma drainage device (GDD) implantation was an effective surgical procedure in treating uncontrolled intraocular pressure (IOP) of glaucoma patients in certain complicated conditions. GDD implants were classified into valved and non-valved in which its surgical outcomes in different types of device and various etiologies were not similar. This study aimed to evaluate the surgery outcomes of GDD implantation in patients with refractory glaucoma at Sardjito General Hospital. Methods: All 12 eyes of 11 patient’s medical records who underwent GDD implantation during 2022 at Sardjito General Hospital was reviewed. Baseline data include age, gender, eye laterality, type of glaucoma, IOP and visual acuity. The IOP and visual acuity (LogMAR) were measured at week 1, month 1, 2 and 3. Type of GDD implants, postoperative glaucoma medications, complications and need for further glaucoma surgery were documented. Results: The mean IOP at baseline was 44 ± 14.2 mmHg with 3.4 ± 0.6 glaucoma medications. It decreased after surgery into 19.1 ± 11.2 mmHg (p=0.003) at 3 months follow up with 0.7 ± 1.7 (p=0.002) glaucoma medications. The mean initial visual acuity was 1.9 ± 0.6 and changed insignificantly to 1.7 ± 0.8 (p=0.624) at last follow up. Six eyes (50%) were implanted with valved implant. The most common early postoperative complications were recurrent high IOP (4 eyes, 33.3%) associated to ripcord of non-valved implant (p=0.025). Five eyes (41.7%) needed additional surgery related to non-valved implant type (p=0.003). Conclusion: GDD implantation especially valved type appears to be safe and effective surgical option in treating refractory glaucoma patients Keywords: Glaucoma drainage device, refractory glaucoma, glaucoma surgery, intraocular pressure
INTRAOPERATIVE MITOMYCIN-C, 5-FLUOROURACIL, RETROBULBAR TRIAMCINOLON ACETONIDE, IS IT EQUALLY EFFECTIVE TO DECREASE INTRAOCULAR PRESSURE AFTER TRABECULECTOMY? Yessi Primanda Sari; Retno Ekantini; Tatang Talka Gani; Krisna Dwi Purnomo Jati
Majalah Oftalmologi Indonesia Vol 49 No S1 (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: 10.35749/8f22f839

Abstract

Objectives: To evaluate the effect of mitomycin-C (MMC), 5-fluorouracil (5-FU), and retrobulbar triamcinolone acetonide (TA) on the surgical result of trabeculectomy Materials and Methods: All consecutive trabeculectomies with releasable sutures performed in Sardjito General Hospital between January 2022 and December 2022 were retrospectively reviewed from medical records. Patients without any intraoperative metabolite (control group, n=5) were compared to those with retrobulbar TA (n=5), MMC group (n=19), and 5-FU group (n=11) in terms of surgical success. Successful surgery results were defined as IOP between 5 - 21 mm Hg without any further medications or surgical intervention and fewer complications. Results: 40 eyes of 35 patients (15 male, 25 female, mean age 52.4 years) were included in the study. The IOP pre operative in TCA group was 47.12 ±12.16 mmHg, in MMC group was 35.53 ± 17.05 mmHg, in 5-FU group was 34.54 ± 17.77 mmHg, and 43.80 ± 15.79 mmHg in group without any metabolite. The patient was observed until the post-operation day (POD) 90. There were no significant differences in intraocular pressure at POD 1, 7, 30, 60, and 90 between the control group compared to TCA, MMC, and 5-FU group. In TCA group, pre operative IOP was 47.12 ±12.16 mmHg then decreases to 15.60 ± 4.61 mmHg at POD 90. In MMC group, pre operative IOP was 35.53 ± 17.05 mmHg, 90 days later became 14.42 ± 5.71 mmHg. In 5-FU group, pre operative IOP was 34.54 ± 17.77 mmHg then decrease to 13.64 ± 4.08 mmHg. In group without metabolite, pre operative IOP was 43.80 ± 15.79 mmHg, then became 21.00 ± 6.81 mmHg at POD 90. The lowest mean intraocular pressure of POD 90 was in the 5-FU group (13.64 ± 4.08 mmHg). Complication after trabeculectomy in the TCA group was 21%, the MMC group was 27%, the 5-FU group was 10%, and the control group was 42%. Conclusion: MMC, 5-FU, and TCA in this study are equally effective to decrease IOP after trabeculectomy.