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All Journal Ophthalmologica Indonesiana
Lia Amanda
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Health Professions Medicine & Pharmacology Public Health

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A Watchful Eye: A Case Report on The Management of Hypotony Maculopathy after Non-Valved Glaucoma Drainage Device Implantation: Poster Presentation - Case Report - Resident Felicia Sesih Herdian; Lia Amanda; Regina Ivanovna; Triana Hardianti Gunardi; Ardiella Yunard; Astrianda Nadya Suryono
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/b6ewfv90

Abstract

Introduction : Low intraocular pressure (IOP) and reduced visual acuity following glaucoma surgery have been linked to a serious complication known as hypotony maculopathy. Here, we report a case of hypotony maculopathy following glaucoma drainage implant which was successfully managed by a conservative approach utilizing oral and topical steroids, resulting in favorable outcomes. Case Illustration : A 25-year-old female with juvenile glaucoma presented with low IOP in the right eye (RE) following glaucoma drainage surgery using non-valved implant four months prior. Ophthalmic examination revealed a decrease of IOP (9mmHg to 4mmHg) and visual acuity (6/6 to 6/24). Fundus examination and optical coherence tomography (OCT) of macula was indicating hypotony maculopathy. All glaucoma medications were discontinued and the patient was given oral methylprednisolone 3x8 mg and topical prednisolone acetate three hourly for two months. Subsequent follow-up revealed an increase in IOP to 37mmHg and visual acuity improvement to 6/6. The patient was then given oral and topical antiglaucoma medications to maintain IOP control. Discussion : Hypotony and its related sequelae are more common with the non-valved drainage devices. Prompt intervention is crucial for improving visual outcomes. Treatment options include surgical and conservative approach. Closely monitored conservative therapy may also give favorable outcomes similar to surgical approach. Conclusion : In advanced cases of glaucoma, extremely low IOP is just as risky as a high IOP. Conservative therapy, including topical and oral corticosteroids, can be employed to reverse hypotony, at the expense of transient IOP rise, in corticosteroid-responsive patients. Restoring normal IOP in a timely manner may improve retinal function.
Silent Progressive Glaucoma in Encephalofacial angiomatosis (Sturge-Weber Syndrome): A Vision-Preserving Trabeculectomy: Poster Presentation - Case Report - Resident Triana Hardianti Gunardi; Ferdy Iskandar; Felicia Sesi Herdian; Lia Amanda; Florentina Priscilla; Virna Dwi Oktariana
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/h8wd8052

Abstract

Introduction : Encephalofacial angiomatosis, also known as Sturge-Weber Syndrome (SWS), is a rare, non- hereditary condition affecting multiple organs. Glaucoma occurs in almost 70% SWS children, more commonly when the port-wine stain involves the upper eyelid skin. Secondary glaucoma was present due to elevated venous pressure. Case Illustration : An 8-year-old boy with typical port-wine stain involving eyelid, came with recurrent painful right eye (RE) and headache in the past 3 months. He was diagnosed with SWS at 1 year and was on daily doses of carbamazepine and valproic acid for seizure control. His best visual acuity and intraocular pressure were 0.5/60 RE, 6/38 LE, 38 mmHg RE, 28 mmHg LE, respectively. Examination revealed Cup-disc-ratio (CDR) 0.9-1.0 RE and 0.5-0.6 LE. During the first three months, he showed favourable outcome with timolol and latanoprost (controlled IOP with target of <12 mmHg and markedly similar Cup-Disc Ratio). However, at 4th and 5th month visit, his IOP significantly increased despite of additional regiments, thus underwent trabeculectomy on both eyes for preserving his sight. After procedure, his IOP remained stable <12mmHg with maintained bleb, deep anterior chamber, also attached posterior segment. Discussion : Treatments of secondary glaucoma of SWS typically involved surgery with significantly lower success rate compared to Primary Congenital Glaucoma. Trabeculectomy or tube shunt surgery should be performed with caution due to risks of choroidal effusion and hemorrhages. Conclusion : Secondary glaucoma in children with SWS is common and challenging. Trabeculectomy should be pursued when the benefit outweighs the risks, even with a slim chance, to preserve the vision.
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

Abstract

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.
Managing Periorbital Necrotizing Fasciitis: How Invasive Should We Go? Poster Presentation - Case Report - Resident Andi Marsa Nadhira; Lia Amanda; Muhammad Shafiq Advani; Lukman Edwar
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: 10.35749/0yb71086

Abstract

Introduction : Periorbital necrotizing fasciitis (PNF) is rapidly progressive and severe infection that may result in vision loss, serious facial disfigurement, and death. Primary management includes surgical debridement; however, here we report a case in which conservative approach resulted in favorable resolution. Case Illustration : A 24-year-old male presented with swollen right upper eyelid, with watery eye, pain, and blurry vision since 1 week prior. No history of trauma or known systemic diseases was reported. Restricted movement of the right eye (RE), slight nonaxial proptosis, and skin defect along the right superior palpebra with pus, blood, necrotic and granulation tissues were found. Visual acuity (VA) of RE decreased to 6/40 with normal intraocular pressure. No abnormalities on the left eye, fever, and other signs of systemic involvement were present. Contrast orbital computed tomography (CT) scan revealed right preseptal and postseptal tissue lesions, suggesting orbital cellulitis. Initial blood work showed leukocytosis, elevated neutrophil and lymphocyte counts, and high liver function markers. The diagnosis of right orbital cellulitis with PNF was established. Skin swabs and blood cultures were taken, while intravenous ampicillin-sulbactam, bedside wound debridement, and chloramphenicol ointment application were initiated. The swab culture later showed Acinetobactersp. The infection improved, VA was restored to 6/6, and wound closure was achieved without any surgery. Discussion : Management of necrotizing fasciitis localized in periorbita in an otherwise healthy patient may be successfully accomplished with a less invasive approach. Conclusion : Timely diagnosis and correct antibiotic therapy are mandatory to decrease morbidity and mortality related to PNF.
When Retinal Vasculitis Wears a Mask: Unveiling Retinal Vasculitis Presented as Branch Retinal Vein Occlusion in a Young Male Patient: Poster Presentation - Case Report - Resident Lia Amanda; Andi Marsa Nadhira; Yulia Aziza; Rina La Distia Nora
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: 10.35749/982cvw55

Abstract

Introduction : Retinal vasculitis can present with a range of clinical features. Correct diagnosis and prompt treatment are essential to prevent permanent visual loss. We describe a case of retinal vasculitis with branch retinal vein occlusion (BRVO) as initial diagnosis, which is a rare manifestation in a young individual without any vascular risk factors. Case Illustration : A 24-year-old male was referred to our center with a sudden onset of blurry vision of his left eye. He was previously diagnosed with BRVO. The patient denied having any chronic diseases, fever, or sore throat. Visual acuity was 6/18 on the left eye and 6/6 on the right eye, respectively. The anterior segment showed no abnormalities. However, fundus examination revealed prominent retinal sheathing, retinal whitening at the inferior quadrant, and macular star. Systemic diseases, such as Bechet disease, sarcoidosis, and systemic lupus erythematosus were excluded by ancillary tests. One month after the initial examination, the patient reported worsening of vision. Funduscopic examination revealed preretinal hemorrhages and macular star. The patient then received intravitreal injection of anti-vascular endothelial growth factor (VEGF), which helped to resolve the hemorrhage and improve vision. Discussion : Further investigations, such as fundus fluorescein angiogram, may aid in the diagnosis and management of this condition. Anti-VEGF therapy may be a useful treatment option for retinal vasculitis-associated hemorrhages. Conclusion : Our case highlights the importance of considering retinal vasculitis as a differential diagnosis in young patients presenting with BRVO, even in the absence of traditional risk factors.
Co-Authors Andi Marsa Nadhira Ardiella Yunard Astrianda Nadya Suryono Faraby Martha Felicia Sesi Herdian Felicia Sesih Herdian Ferdy Iskandar Florentina Priscilla Jessica Zarwan Lukman Edwar Muhammad Shafiq Advani Regina Ivanovna Rina La Distia Nora Syska Widyawati Triana Hardianti Gunardi Virna Dwi Oktariana Yulia Aziza