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PUPIL CYCLE TIME AND PERIPAPILLARY PERFUSION IN ANGLE CLOSURE GLAUCOMA: Oral Presentation - Observational Study - Resident Muhammad Alfin Kamal; Fifin Luthfia Rahmi; Denti Puspasari; Maharani Cahyono
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: 10.35749/3hjtkn18

Introduction & ObjectivesOne of important roles in the pathogenesis of glaucoma is vascular condition. To enhance glaucomamanagement, the clinical assessment of ocular perfusion is required. The pupillary light reflex'safferent or efferent pathways may become impaired as a result of pupil cycle time (PCT) elongation.PCT is a simple objective method to measure the function of optic nerve, including glaucoma. Thepurpose of this study is to evaluate the connection between pupil PCT and peripapillary perfusion. MethodsA cross-sectional study from Kariadi Hospital included 26 eyes with angle closure glaucoma and 26eyes of healthy patients. Complete ophthalmologic examinations, PCT measurements, and OCTperipapillary angiography were performed on each patient. Patients with history of drugs use thatcan affect pupillary reflexes such as barbiturates, methyldopa, anaesthetics, and antidepressant, andpatients with history of glaucoma attack are excluded. The comparisons between the two groupswere examined, with a p<0.05 indicating statistical significance. ResultsThe mean PCT of normal subjects was 943,4ms (882,4ms – 993,4ms) and angle closure glaucomasubject was 1789,5ms (1060ms – 4600ms). There were statistically significant difference of PCTvalue in angle closure glaucoma compared to normal subjects (P<0,05). Peripapillary flow index andperipapillary vessel density in closed angle glaucomatous eyes were lower than normal eyes(P<0.05). There is a significant relationship between PCT with peripapillary flow index andperipapillary vessel density. (P<0,05). ConclusionIn angle closure glaucoma, prolonged PCT associated with decreased peripapillary perfusion asshown by decreases in peripapillary flow index and peripapillary vascular density.

EARLY POSTOPERATIVE COMPLICATION FOLLOWING FILTRATION SURGERY IN DR. KARIADI GENERAL HOSPITAL SEMARANG 2020-2022: Oral Presentation - Observational Study - Resident Mazidah Zulfa; Denti Puspasari; Maharani; Fifin L Rahmi
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: 10.35749/742jnq25

Introduction & ObjectivesFiltration surgery is the most frequent surgery in managing glaucoma. Although trabeculectomy isgenerally a safe and effective procedure, complications can occur. The purpose of the study was todescribe the early postoperative complications in patients who had undergone filtration surgery. MethodsThis study was a retrospective study that uses secondary data from electronic medical records ofpatients who had filtration surgery between January 1, 2020, and December 31, 2022, in KariadiHospital Semarang. Preoperative data include age, gender, visual acuity, intraocular pressure, andtype of glaucoma. The incidence of early postoperative complications was described up to 3 weeks offollow-up. Results287 eyes were obtained from 266 patients who underwent filtration surgery. 168 eyes (58.5%) hadphaco-trabeculectomy, 117 eyes (40.77%) had trabeculectomy and 2 eyes (0.7%) had ECCEtrabeculectomy.Primary angle closure glaucoma (126 eyes, 43.9%) was the most common type ofglaucoma treated with filtration surgery. During the 3-week follow-up period, 93 eyes (32.4%)experienced an early complication with trabeculectomy being more common (17.42%) thancombined surgery. The commonest complication found was hypotony in 69 eyes (24%). Othercomplications include hyphema (3.14%), transient intraocular pressure elevation (3.14%), blebleakage (2.09%), suprachoroidal haemorrhage (0.7%), subhyaloid haemorrhage (0.35%) and retinalhaemorrhage (0.35%). ConclusionThis study found the most common early postoperative complication of filtration surgery washypotony. This complication occurs frequently after trabeculectomy.

Successful Rate of Glaucoma Surgery in Secondary Glaucoma after Vitrectomy in Kariadi General Hospital Semarang 2020-2022: Oral Presentation - Observational Study - Resident Nur Azizah Intan Putri Ismail; Maharani; Fifin L. Rahmi; Denti Puspasari
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: 10.35749/01mhar90

Introduction & ObjectivesGlaucoma is one of the most frequent complications of vitrectomy surgery. It can cause a significantrise in intraocular pressure (IOP). Glaucoma surgery can be planned in medically uncontrolledglaucoma. Trabeculectomy and Glaucoma Drainage Device (GDD) implantation are the mostfrequent filtering surgeries used in these cases. This study aims to define the success rate ofglaucoma surgery in secondary glaucoma after vitrectomy. MethodsThis study is an analytical observational study with retrospective data collection held from medicalrecords of patients with secondary glaucoma after vitrectomy who underwent glaucoma surgery inKariadi General Hospital Semarang from 2020-2022. Surgical success defined by postoperative IOPreduced by>20% from baseline, with or without anti-glaucoma medication. ResultsThere were 16 eyes of trabeculectomy with 5-fluorouracil (5-FU), and 8 eyes of GDD implants. Themean preoperative IOP was 43.76+6.77 mmhg for trabeculectomy 5-FU, and 42.43+4.02 mmhg forGDD implant. IOP levels in both groups varied significantly after one day, one week, one month, andthree months after surgery (p<0.05). The success rate for the trabeculectomy 5-FU group was81.25% and the GDD implant group was 87.5% in 3 months. There was no statistically significantdifference in the success rate between the trabeculectomy 5-FU and GDD implant groups (p=0.839).The complication for the GDD implant group was 25%. No complications were found in thetrabeculectomy 5-FU group. ConclusionThere was no significant difference in the success rate between trabeculectomy 5-FU and the GDDimplant group. Both groups are viable for glaucoma surgery in secondary glaucoma after vitrectomysurgery.

Trabeculectomy Versus Tube Outcome in Neovascular Glaucoma: Oral Presentation - Observational Study - Resident Daisy Syakhsiatusy Syahiqoh; Fifin Luthfia Rahmi; Denti Puspasari; Maharani
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: 10.35749/73qxtp82

Introduction & ObjectivesNeovascular glaucoma (NVG) is known to be a refractory form of glaucoma, which frequentlyrequires the integrated use of medical, laser and incisional surgery. Tube-shunt implantation andtrabeculectomy with antifibrotic agent are the two most-popular incisional procedures for managingrefractory glaucoma. This study aims to compare surgical outcome between patients who underwenttrabeculectomy versus tube-shunt implantation for the treatment of NVG. MethodsA retrospective study was held of NVG patients that underwent trabeculectomy and tube-shuntimplantation between January 2020 - December 2022 at Dr. Kariadi Hospital, Semarang. IOPoutcome and success rate was measured at 3 months post operatively. Statistical analysis was usedto compare the outcome between groups, p<0.05 was considered significant. ResultsThere were no significant differences in characteristics between groups at baseline. Mean IOPmeasured at 3 months post operatively was 18.58 ± 5.53 and 15.94 ± 10.79 in trabeculectomy andtube group respectively (p=0.04), complete success rate was 18.8% in trabeculectomy and 25% intube group, qualified success rate was 37.5% in trabeculectomy and 56.3% in tube group. Greaterfailure rate was observed in trabeculectomy group (43.8%). ConclusionCompared to trabeculectomy, tube-shunt implantation has lower IOP at 3 months post operatively inNVG. Greater failure rate was observed in trabeculectomy.

Success Rate of Glaucoma Drainage Device Implantation in Kariadi General Hospital Semarang 2020-2022: Oral Presentation - Observational Study - Resident Rina Apriliana; Fifin L Rachmi; Denti Puspasari; Maharani
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: 10.35749/270xg831

Introduction & ObjectivesGlaucoma is a leading cause of irreversible blindness, and implantation of drainage devices is aneffective treatment option for patients with advanced glaucoma. The purpose of this study was toinvestigate success rate of glaucoma drainage devices implantation in Kariadi Hospital MethodsThis study was an observational analytic study with a retrospective design. All patients who receivedVirna implantation between January 2020 and December 2022 were included. Intraocular pressure(IOP) examination was performed at baseline and at the first day, seventh day, first month, and thirdmonth following surgery. The success rate was divided into three groups: complete success if IOPwas <21mmHg without medication, qualified success if IOP was <21mmHg with medication, andfailure if IOP was >21mmHg with medication. ResultsThis study included 42 patients (42 eyes) with an average age of 43.3 years. There were 16 male(38%) and 26 female (62%) patients in the group. Of these patients, 11 (26.2%) had primaryglaucoma and 31 (73.8%) had secondary glaucoma. There was significant decrease in IOP frompreoperative measurement (37.1±10.1mmHg) compared to IOP on first day (13.0±6.0mmHg),seventh day (15.4±3.8mmHg), first month (18.2±4.4mmHg), and third month (23.4±8.9mmHg) aftersurgery (p<0.05). At three-month follow-up, complete success was 14.29%, qualified success was50%, and failure was 35.71%. ConclusionGlaucoma drainage device implantation was found to successfully reduce IOP in patients withadvanced glaucoma. The qualified success rate was higher than complete success rate, suggestingthat some patients may require medication to achieve target IOP levels.

Recurrence of Malignant Glaucoma After Vitrectomy Intervention: A Challenging Case Series: Poster Presentation - Case Series - Resident Mazidah Zulfa; Satya Hutama P; Arief Wildan; Fifin L Rahmi; Denti Puspasari; Maharani
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: 10.35749/571xr814

Introduction : Malignant glaucoma most commonly occurs after glaucoma filtration surgery. Most cases require surgical intervention such as vitrectomy. However, even after successful treatment, it can reoccur in some cases. We present two cases of recurrent malignant glaucoma. Case Illustration : The first case involved a 48-year-old female with primary angle closure glaucoma who developed malignant glaucoma 1-week after undergoing combined glaucoma surgery. The second case involved a 70-year-old man with primary angle closure glaucoma and pseudophakia who developed malignant glaucoma 4-month after trabeculectomy. They received total vitrectomy treatment. We observed anterior chamber deepening in these 2 cases, but intraocular pressure remained increased 2-week after intervention. Discussion : We found improvement in anatomy by deepening the anterior chamber, but the intraocular pressure increased in the 2 weeks. Although the problem of releasing aqueous accumulations from the vitreous has been resolved after vitrectomy, but there is no permanent passage between the anterior chamber and the vitreous cavity. So, recurrences can occur. It is possible to manage this condition by restoring aqueous flow from the anterior vitreous to the anterior chamber. YAG laser capsulo- hyaloidotomy or vitrectomy combined with hyaloido-zonula-iridectomy are frequently effective in treating underlying causes. Conclusion : Vitrectomy can help to improve the deepening anterior chamber, but intraocular pressure may remain increased after 2-week follow-up. The recurrence of malignant glaucoma may be related to incomplete resolution of the underlying condition.

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