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CHALLENGES IN THE SURGICAL MANAGEMENT OF BILATERAL POSTERIOR LENTIGLOBUS: Poster Presentation - Case Report - Resident SYIFA RAHMANI; Feti Karfiati Memed; Sesy Caesarya; Primawita Oktarima Amiruddin; Irawati Irfani; Mayasari Wahyu Kuntorini
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/awdxnd05

Introduction : Lentiglobus is a lens deformation characterized by spherical bulging of the lens surface. The weakness of the posterior capsule in the lentiglobus makes the surgery challenging. We present a case of bilateral posterior lentiglobus and its management. Case Illustration : A 5-year-old boy was presented with the chief complaint of gradually blurred vision since 1 year ago. Visual acuity were 0.1 and closed face finger counting in the right and left eyes, respectively. An ophthalmology examination revealed lens opacities with partially reabsorbed lens material and protrusion of the lens surface posteriorly in both eyes (figure 1). The patient was diagnosed with developmental cataracts of the membranous type and posterior lentiglobus in both eyes. The patient underwent a surgical intervention for cataract extraction with aspiration technique. A spontaneous posterior capsule rupture was found with a shape like a lentiglobus. An anterior vitrectomy was performed. An intraocular lens was implanted. At one month after surgery, the best corrected visual acuities were 0.5 in both eyes (figure 2). Discussion : Several difficulties can be encountered during pediatric cataract surgery with the posterior lentiglobus morphology because of the thin or ruptured capsule. Previous studies have found preoperative and intraoperative posterior capsule rupture in 25% and 3.13% of lentiglobus cases, respectively. Hydrodissection should be avoided due to the weakness of the posterior capsule. ConclusionAppropriate surgical techniques to anticipate posterior capsule defects in the lentiglobus are required to produce a favorable outcome.

SUCESSFULL MANAGEMENT OF CHILDHOOD BASIC-TYPE ESOTROPIA IN ADULT PATIENT: Poster Presentation - Case Report - Resident ANISA VITRIANA; Feti Karfiati M.; Sesy Caesarya; Primawita O. Amiruddin; Mayasari Wahyu Kuntorini; Irawati Irfani
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/b62wcv21

Introduction : Strabismus in adults may indicate other pathological causes, such as neurological disorders or trauma. Diagnosis of esotropia in adult patients has to be made carefully to determine the right treatment. Management’s goal of strabismus in adult patients is mainly cosmetic by diminishing deviation. Case Illustration : A 46-year-old woman, complaint of inward deviation of both eyes since childhood. There were no complaints of double vision, headaches, nor trauma history. Visual acuity of right eye was 0.4 with BCVA and left eye was 0.8 with BCVA 0.8. Hirschberg test was 45o (Figure 2A). Prism cover test was 75 PD base out in near and distance. Patient was diagnosed with basic-type esotropia. The patient already given spectacles but the deviation persisted so she underwent bilateral medial rectus recess surgery (Figure 2B). Ocular alignment without spectacles 1 week after surgery showed orthotropia and small esophoria. (Figure 2C). Discussion : Each esotropia types has a different treatment approach. Basic-type esotropia with large deviation usually needs surgical treatment. Management of childhood onset strabismus in adult patients is challenging because those patients have lesser ability to maintain fusion. Older patients and large deviation are poor prognostic factors to achieve good functional and cosmetics outcome after strabismus surgery. Conclusion : Establishing a definite diagnosis in adult strabismus patients, including esotropia, is challenging. Careful diagnosis and management decision will determine the outcome of the patient’s condition.

Sympathetic Ophthalmia in Paediatric Post-Surgical Repair, A Case Report: Poster Presentation - Case Report - Resident Muhammad Akbar Wicaksana; Irawati Irfani; Mayasari Wahyu Kuntorini; Sesy Caesarya; Feti Karfiati; Primawita O. Amiruddin
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/z5apmh49

Introduction : Sympathetic Ophthalmia (SO) is a rare and devastating complication of ocular trauma. Incidence reached 0.26% among cohort in paediatric open globe injury. We present a case report of pediatric Sympathetic Ophthalmia. Case Illustration : An 8-year-old boy is present in an outpatient clinic with a history of corneal lacerating injury on LE 1 month ago and had surgical repair 7 days after the injury. The patient complained of redness and blurry vision in both eyes. VA RE 0.5 and LE 0.05. RE revealed ciliary injection, flare/cell (f/s) +2/+2, and vitreous cell +1. LE revealed ciliary injection, corneal scars, f/s +2/+2, and vitreous cell +2 (Fig. 1). Fundus and OCT revealed macular oedema with exudative retinal detachment RE and bilateral optic nerve head swelling (Fig. 2). Patient was diagnosed with sympathetic ophthalmia and treated with prednisolone acetate 8x per day for RLE with high-dose oral steroid methylprednisolone 1 mg/kg body weight (32 mg). One week after treatment, clinical findings were improved, and the steroid was tapered. After 2 months f/s, macular oedema, exudative retinal detachment and optic nerve head swelling were resolved with VA RE 1.0 and LE 0.4. Discussion : Although the etiology of SO is currently unknown, it is believed that hypersensitivity following trauma to the fellow eye may be the trigger. The severity of SO's clinical presentation might range from mild to severe. Conclusion : Sympathetic ophthalmia is a serious complication that rarely occurs after trauma, especially in the pediatric population. Prompt treatment of oral and topical corticosteroids may lower the inflammatory response.

MANAGEMENT OF RECURRENT INTRAOCULAR LENS SUBLUXATION AFTER IOL REPOSITION IN APHAKIC PEDIATRIC PATIENT WITH SECONDARY GLAUCOMA AND DEPRIVATIVE AMBLYOPIA: Poster Presentation - Case Report - Resident INDRIYANI; Primawita O. Amiruddin; Sesy Caesarya; Irawati Irfani; Mayasari Wahyu Kuntorini; Feti Karfiati M
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: 10.35749/12mdey33

Introduction : Malposition of the intraocular lens (IOL) can be in the form of decentration, subluxation, dislocation, or luxation. Conservative management and surgery are used to treat IOL subluxation. Case Illustration : A 14-year-old boy came to clinic with chief complaint of diplopia since 1 month ago. There were histories of cataract surgery of both eyes in 2014 and 2015 at a secondary hospital, secondary IOL implantation and membranectomy of right eye in December 2017, and IOL reposition of right eye in February 2022. Ophthalmologist examination revealed BCVA of right eye is 0.5 with S+10.00 C-2.25 x180 and left eye is 1/300. The right eye's intraocular pressure was 23 mmHg and the left eye's was 16 mmHg. Anterior segment examination of the right eye showed aphakia with subluxation of the IOL to the inferotemporal (Figure 1) and PC IOL of the left eye. Patient diagnosed with aphakia ODS with IOL subluxation OD, secondary glaucoma OD, astigmatisma Hypermetropia composite OD, astigmatism Myopia Compositus OS, Hypermetropia OD, Myopia Gravior OS, Deprivative Amblyopia ODS, and Last Eye OD. Patient given monofocal spectacles, prednisolone asetat eye drop tapering dose, and timolol maleate eye drop, with observation of IOL position Discussion : Recurrent IOL subluxation without clear signs of zonular or capsular instability in this patient was managed with conservative management using spectacles and medication due to secondary glaucoma. Long-term observation needed to evaluate possibility of repositioning or explanting the IOL in the future. Conclusion : Management of IOL subluxation could temporarily undergo conservative treatment. A surgical approach is considered in cases of recurrent dislocation

SUCCESSFUL DIFFERENT TREATMENT IN INTERMITTENT EXOTROPIA: CASE SERIES: Poster Presentation - Case Series - Resident NASIKA CELIA DENDY; Sesy Caesarya; Primawita O. Amiruddin; Mayasari Wahyu Kuntorini; Feti Karfiati
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/axxkqs12

Introduction : In intermittent exotropia, management's goals are to diminish deviation by improving fusion control. Case Illustration : Case 1: A 19-year-old woman has complained of squinting and blurred vision since the age of 3 years. The visual acuity of both eyes (OU) was 0.05, with a BCVA of 0.63. Hirschberg's test was exotropia 15o . The exotropia after the cover test (Figure 1A) improved without blinking. The prism cover test was 35 D in near and distance. Patient was diagnosed with exotropia, an intermittent basic type with good control, astigmatism, and myopia compositus OU. Three months after, with refraction correction and occlusion, the Hirschberg test revealed orthotropia (Figure 1B). Case 2: A 7-year-old boy has suffered of squinting and blurred vision from the age of 6 years. The visual acuity of both eyes was 0.63 with a BCVA of 1.0. Hirschberg's test was exotropia 30° (Figure 2A). The prism cover test was 50 D in near and distance. Exotropia intermittent basic type, poor control, and bilateral astigmatism were diagnosed in the patients. The patient had surgery for bilateral lateral rectus recession. Hirschberg test 1 day Postoperatively, orthotropia was present (Figure 2B). Discussion : In exodeviation, control mechanisms relate to therapy compliance and different deviation angles. Intermittent exotropia can be progressive due to loss of fusion control and cause persistent deviation. Conclusion : For patients with exotropia with intermittent good control, non-surgical management can give good results. Surgical management is considered for large angle deviations in patients with poor control.

QUALITY OF LIFE PERSPECTIVE CORRELATION IN CHILDREN UNDERGOING AMBLYOPIA OCCLUSION THERAPY AND THEIR PARENTS AS PROXY: Oral Presentation - Experimental Study - Resident ANDIVAN RAHMAN; MAYASARI WAHYU KUNTORINI; NINA RATNANINGSIH; FETI KARFIATI MEMED; IRAWATI IRFANI; PRIMAWITA OKTARIMA AMIRUDDIN; SESY CAESARYA
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: 10.35749/9bxcj564

Abstract Introduction & Objectives : One of the main therapies used to treat amblyopia in the dominant eye is occlusion therapy. When used on the dominant eye during activities, eye patches can lead to quality of life issues include visual, cosmetic, and psychosocial disorders. To improve visual acuity in the suppressed eye and stop a progressive loss of visual acuity, therapy must be followed. An important factor affecting a child's compliance with occlusion therapy is parental support. Parental negativity affects children's level of support, and as a result, a decreased compliance. This research aimed to determine the relationship between quality of life and the perspectives of parents and children receiving occlusion therapy. Methods : This is a correlation study with a cross-sectional design. Fifty-one subjects were addressed in the amblyopia children's group and fifty-one subjects in the parents’ group. Every participant was directly interviewed. Correlation analysis was used to assess the relationship between the results of interviews with children and their parents. Results : There is a decrease in the quality of life in children undergoing therapy, both from the perspective of the child and their parents. The decline in the quality of life that occurs in children is not as low as parents think. The results of the questionnaires for the children and their parents in total demonstrated a significant correlation (p = 0.0001) and a moderately positive correlation (R = 0.598). Conclusion : There is a positive correlation between children and parents in assessing the quality of life due to occlusion therapy.

RETINOPATHY OF PREMATURITY IN TERTIARY REFERRAL EYE HOSPITAL IN INDONESIA: CHARACTERISTICS AND MANAGEMENT: Oral Presentation - Observational Study - Resident RAISHA PRATIWI INDRAWATI; Mayasari Wahyu Kuntorini; Sesy Caesarya; Primawita O. Amiruddin; Irawati Irfani; Feti Karfiati Memed
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/b067yy70

Abstract Introduction & Objectives : Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina that occurs in premature infants. Incidence of ROP is higher in middle- and lower-income countries, including Indonesia; hence information about the characteristics of the patients is essential to make strategies regarding its management. The aim of this study is to describe the characteristics and managementof patients with retinopathy of prematurity at the National Eye Center, Cicendo Eye Hospital. Methods : Data were obtained retrospectively from medical records from January 2018 until December 2020 using ICD-10 coding for retinopathy of prematurity. Variables include demographic data, clinical characteristics, and management. Results : In total, 177 patients (340 eyes) were included in this study. Demographically, 53.7% of the patients were boys; 67.8% came from West Java; 93.2% were referred; and 85.9% were health coverage users. The mean gestational age was 29.9±2.6 weeks and the mean birth weight was 1415.6±393.1 grams. Most of the patients have bilateral conditions and already have stage 5 ROP, regardless of their gestational age and birth weight. Conservative management was given to 95.5% of stage 5 ROP patients. As many as 50% of stage 4 patients underwent pars plana vitrectomy, and 85.4% stage 3 patients were managed by laser photocoagulation. Those in earlier stages were mainly observed first. Conclusion : Patients with ROP at Cicendo Eye Hospital mostly came in the advanced stage of the disease with conservative management. Early screening, timely referral, and prompt treatment are recommended in order to prevent blindness in premature infants.

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