Eye Examination Research Articles

Sudden Ocular Complication after Snake Bite

Introduction : A snakebite constitutes a common acute medical emergency and has several systemic and even ocular consequences. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.
 Case Illustration : A 17 years old man came to emergency department with painful swelling on his left hand and sudden blurred vision right after his left hand were bitten by venomous snake in the rice field. Diplopia and ptosis were developed several hours after admission. On eye examination, visual acuity was 0,05 on right eye and 0,8 on left eye, abnormal pupillary reflects on both eyes were present, pupil dilatation, limited eye movement and ptosis were present, Intraocular pressure were 23,7 mmHg on right eye and 24,5 mmHg on left eye. Antivenom was administered immediately. He received cycloplegic, timolol eyedrop, and prednisolone eyedrop for ocular treatment
 Discussion : Ocular complications are rare and uncommon but they may lead to sight-threatening conditions. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Mild neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.
 Conclusion : This study presented a rare case of systemic ocular complication as a result of a snake bite. Ophthalmoplegia induced ocular discomfort for an extended period is a rare symptom of snake-bites. Combined treatment of steroid with antivenom may improve the recovery from sudden ocular manifestation in snake bite.

Phacodonesis in Angle-Closure Glaucoma: Phacomorphic or Other Lens- Induced?

Introduction : Glaucoma is defined as progressive optic neuropathies characterized by optic disk cupping, reduced visual field, and visual loss. As a “silent thief of sight”, glaucoma ranked second worldwide and third in Indonesia as the cause of blindness. The cause of glaucoma varies, one of which is lens-induced which presents as loss of vision and red eye.
 Case Illustration : A 53-year-old female complained about blurred and pained red eyes. Examination of the right eye revealed VOD 1/300, cloudy-milky lens, phacodonesis, and IOP 26.3 mmHg. She was diagnosed with angle-closure glaucoma suspected as phacomorphic or other lens-induced and was treated by topical hypotensive agents and phacoemulsification with IOL implantation procedure. Right eye examination on day one post operation showed VA 2/60 and IOP 13.6 mmHg. Improvement on two weeks follow- up revealed VA 6/15 with best VA of 6/6, IOP 15.7 mmHg, CD ratio 0.5, and negative glaucoma optic neuropathy (GON) finding.
 Discussion : When accompanied by phacodonesis, angle-closure glaucoma is mainly caused by a secondary process. It involves zonule of Zinn fragility, which usually occurs in subluxation but also appear in hypermature cataract. Dilated eye examination showed no sign of subluxation, therefore the final diagnosis was phacomorphic glaucoma and hypermature cataract. Cataract surgery as the definitive treatment must be done at an appropriate time as was done for this patient with a favorable outcome.
 Conclusion : The presence of phacodonesis in angle-closure glaucoma should be thoroughly evaluated. Meticulous decisions on definitive treatment can be planned afterward.

A Mystery Unsolved: A Spontaneous Lens and Uveal Prolapse in a New-born

Introduction : Corneal rupture in new-born, especially during the first week of life is rare. Some of these cases occur because of ocular trauma during deliveries, systemic infection, and congenital anomalies. We aim to deliver a rare case of spontaneous lens and uveal prolapse in new-born and management in treating the case.
 Case Illustration : A-2-day-old full-term-baby was referred due to bleeding of the right eye 6 hours post-partum by spontaneous vaginal delivery with no trauma. The mother, a 23-year-old, having the second born with no history of medical illness or vaginal discharged during pregnancy. Measurements of birth weight and length were normal. Eye examination of the right eye (RE) was uveal and lens prolapse and left eye (LE) cloudy cornea with leukoma and prominent neovascularization. Orbital CT-Scan revealed bilateral vitreous bleeding of both eyes. Laboratory examination showed reactive IgM for herpes simplex virus, reactive IgG for both toxoplasma and rubella. Corneal swab culture was sterile. Systemic and topical antibiotics were administered then switched to systemic antivirus. The 12-day-old-patient showed partial epithelization of cornea, less uveal volume with it partially shrank. Close observation was conducted and evisceration was postponed.
 Discussion : Although etiologic work-up has been addressed, exact etiology remains unknown with the possibility of congenital cause. It has been postulated that structurally malformed eyes are more prone to corneal perforations. Management should be personalized based on the patient’s need.
 Conclusion : Thorough examination is vital a rare case with undisclosed aetiology especially new-born. Patient monitoring is sufficient if no infections and bleedings found.

Amnion Membrane Transplantation: A Therapy for Persistent Epithelial Defect as A Result of Neurotrophic Keratitis

Introduction : A persistent epithelial defect (PED) is a failure of re-epithelialization and complete healing of the cornea. The primary goal of PED treatment is to create a favorable environment for corneal wound healing. Amniotic membrane transplants (AMT) become one of the refractory cases treated for PED. This study aims to report AMT as therapy for a PED.
 Case Illustration : A fifty-six-year-old male presents with a chief complaint of redness and pain in the left eye in the last2 weeks. The patient complained of blurred vision, tearing, and foreign body sensations. An ophthalmology examination of the left eye revealed that it was close to face finger counting in visual acuity and had a persistent epithelial defect, corneal edema, descemet fold, and a decrease in corneal sensation. The patient was diagnosed with PED and received autologous serum eye drops, levofloxacin eye drops, vitamin A palmitate eye gel, and acyclovir 400mg twice a day, but did not respond adequately. AMT was planned for the patient. The patient's pain level improved one week after surgery.
 Discussion : The most common symptom of PED is pain. There are various etiological factors for PED. Neurotropic keratitis has emerged as one of the causes of PED. Management for PED is carried out sequentially according to the protocol.
 Conclusion : Amniotic membrane transplantation has become an alternative therapy for PED. The amniotic membrane provides re-epithelialization of the cornea and anti-inflammatory properties. The prognosis for AMT as a therapy for PED is quite good.

Cicatricial Ectropion After Maxillofacial Surgery

Introduction : cicatricial ectropion is a malposition lower eyelid by shortening and/ or scarring of the anterior lamella of eyelid but it can occur in the upper eyelid. Ocular manifestations in cicatricial ectropion occurred epiphora, redness eyes, foreign body sensation, dry eyes due to direct exposure to the outside. In severe case may occur ulceration and loss of vision
 Case Illustration : A 33 year old male patient was being came to ophthalmologist department at Bali Mandara General Hospital with complaints that the right eye could not close completely, the felt dry eyes, foreign body sensation, and sometimes redness eyes after maxillofacial surgery one month ago before admitted to hospital. The physical examination the patient was normal. The ophthalmological examination visual acuity 6/6 for both eyes, intraocular pressure was normal for both eyes. The movement of the eyeballs was normal. The segment anterior examination was a scar on the lower right eyelid, inferior palpebral retraction, lagophthalmos 4 mm. The segment anterior examination of the left eye was normal.
 Discussion : The patient was treated to repair the cicatricial ectropion with surgery under general anesthesia with postauricular full thickness skin graft, antibiotic eye ointment, antibiotic oral, and lubricant eye drop.
 Conclusion : Cicatricial ectropion is a complication that occurs due to trauma or surgery. Reconstructive surgery to repair eyelid function, improve cosmetic appearance and minimize complications of further eye damage such as keratitis to blindness. Knowing the etiology along with the progression of the disease is necessary for early diagnosis and prompt treatment.

RECURRENT CONGENITAL PTOSIS MANAGEMENT BY SUPRAMAXIMAL LEVATOR RESECTION TECHNIQUE

Introduction : Congenital ptosis is an abnormal low position of the eyelid since birth. Levator resection technique is one of the surgery technique for ptosis corection. Recurrence could be occured even after ptosis correction
 Case Illustration : A 22 year old male presented with a chief complaint of droopy left eyelid since birth. Visual aquity were 0,08 pinhole 0,2 and 0,25 pinhole 0,63 respectively. Opthalmology examination revealed interpalpebral fissure (IPF) 4 mm, margin reflex distance (MRD)1 0 mm, MRD2 4 mm and levator function test (LFT) 6 mm on the left eye (Figure 1). Levator resection technique was conducted on his left eye with a good result, MRD1 2 mm, MRD2 5 mm, IPF 7 mm. But the lid dropped again after3 months (Figure 2). Opthalmology examination of the left eye showed IPF 5 mm, MRD1 0 mm, MRD2 5 mm, LFT 2 mm and lagophtalmos 1 mm. Second surgery was done with supramaximal levator resection technique. Good result was achieved after second surgery, MRD1 3 mm, MRD2 5 mm, IPF 8 mm (Figure 3).
 Discussion : Recurrent ptosis could occured after ptosis surgery and had challenges due to scar from previous surgery. Frontal suspension technique was recommended for congenital ptosis levator function less than 4 mm. Supramaximal levator resection was done for this patient, with resection of 30 mm levator muscle, which had result as good as of frontal suspension technique.
 Conclusion : Levator resection technique could be repeated to repair recurrent congenital ptosis. Supramaximal levator resection technique is one of the option.

A Case: The Strategy of Corneal Ulcers

Introduction : Corneal ulcers are considered an ophthalmologic emergency because of their potential to permanently impair vision or perforate the eye. Accurate and quick diagnosis and prompt treatmentis a key to improve clinical and visual outcomes in cases of corneal ulceration.
 Case Illustration : In this paper, we present the case of male 40-year-old presented with complaints of pain and defective vision in the right eye. Visual examination of the right eye is 1/~. It was found, palpebral edema, hyperemic tarsal conjunctiva. The bulbar conjunctiva showed conjunctival injection, ciliary injection. The cornea looks completely cloudy, the surface is not slippery, infiltrates and edema. The patient was treated with medical and surgical therapy, and then the patient’s have a good clinical response and was able to return to work.
 Discussion : The diagnosis of corneal ulcers was established based on history, physical examination and clinical examination using a slit lamp and laboratory examinations. Patient's examination revealed the presence of Candida albicans. This examination is important to distinguish the cause of the corneal ulcer so that it can help select an adequate therapy.
 Conclusion : Indonesian farmers have highrisk of fungal corneal ulcers. Fungal corneal ulcers is important cause of corneal blindness all over the world especially in develoving countries. Fungal corneal ulcers can diagnosis by slitlamp biomicroscopic examination and culture are essential for early specific diagnosis and must be taken consideratiaon to establish the most effective treatment and avoid severe complications

MANAGEMENT OF RECURRENT INTRAOCULAR LENS SUBLUXATION AFTER IOL REPOSITION IN APHAKIC PEDIATRIC PATIENT WITH SECONDARY GLAUCOMA AND DEPRIVATIVE AMBLYOPIA

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

Perforating Ocular Sickle Knife Trauma: a Case report

Introduction : Perforating ocular injury can lead to disability or even mortality. Most individuals sustaining eye injuries are male in young age. This is a report of an extreme case when a sickle knife stabbed in the right eye of a young male cause perforating of the eyeball.
 Case Illustration : Seventeen years old young male presented to Emergency Room of Sukabumi Regional Public Hospital with pain and bleeding in his right eye an hour before. He had been hacked during a brawls. There was a wound in the right supraorbita area and a big sickle knife stuck in the head and tear the eye ball. Visual acuity was no light perception in his right eye. Anterior segment examination of the right eye revealed perforated sclera and cornea. X-ray examination showed fracture of the roof of the right orbit and a metal object had stuck into the Orbits. The sickle knife extraction, enucleation and superior orbit reconstruction of the right eye was done.
 Discussion : Identification of wounds caused by sharp metal foreign body is very important for the subsequent treatment of injuries. If the eyeball cannot be preserved, then enucleation can't be avoided. In this case, hard impact of sharp object around of the eye are also cause fracture of superior orbital rim. Reconstruction of the orbital roof using titanium and micro screws given the most stable and effective results.
 Conclusion : Removing a metal foreign body and anatomical defect management is important for a good outcome.

The Effect of Ethambutol Therapy in terms of Visual Evoked Potential, Color Vision Test, and Contrast Sensitivity Test at the Subclinical Level

Abstract
 Introduction & Objectives : Ethambutol is one of the first-line drugs in the treatment of tuberculosis and known to induce optic neuropathy. However, there are unknown protocols for detecting subclinical level of toxicity. The aim of this study was to assess the difference in amplitude and latency of visual evoked potential (VEP), color vision, and contrast sensitivity in tuberculosis patients before and after taking ethambutol for 1 and 2 months.
 Methods : This was a prospective observational cohort study of 38 eyes of 19 newly diagnosed patients with category-1 tuberculosis being treated with ethambutol. All patients were given ethambutol for 2 months at a dose of 15 - 20 mg/kg body weight/day. The participants underwent complete eye and visual function examination including pattern-reversal VEP, color vision with Farnsworth Munsell D-15 test, and contrast sensitivity with LEA Low Contrast Flip Chart before and after 1 and 2 months of treatment. Wilcoxon test was employed for data analysis.
 Results : During the study, no changes in visual acuity was observed. The results showed that the latencies of VEP after 1 month (p = 0.000) and 2 months (p = 0.000) of treatment were significantly delayed. There was a significant difference in contrast sensitivity after 2 months (p = 0.014) of treatment. However, no significant difference was found in color vision and amplitude of VEP.
 Conclusion : Latency of VEP and contrast sensitivity test could prove useful in detecting subclinical and hence very useful for monitoring patients under ethambutol therapy for ocular toxicity.

INTRAOCULAR LENS EXCHANGE PROCEDURE AS A MANAGEMENT FOR INTRAOCULAR LENS DISCOLORATION

Introduction : Intraocular lens (IOL) discoloration is a rare complication of cataract surgery. It may result in severe visual function impairment and potentially lower the patient's quality of life. IOL exchange is an unusual procedure as the incidence rate was 2 per 1000 surgeries over 8 years. It is the surgical procedure of choice for symptomatic IOL discoloration.
 Case Illustration : A 50-year-old man came to the hospital complaining of a right eye blurry vision for the previous two months. His right eye had undergone cataract surgery seven years earlier. After having cataract surgery, the patient's vision was clear, but five years later, it began to feel blurry and glare. The patient has a history of well-controlled type II diabetes and hypertension. An intraocular lens discoloration was discovered after a careful examination of the eye (figure 1). For his right eye, the patient underwent an IOL exchange procedure (figure 2). A square-edge single-piece foldable IOL was obtained from the surgery. Follow-up examinations after surgery revealed an improved visual function and a clear intraocular lens (figure 3).
 Discussion : IOL discoloration may occur years after surgery. It is related to the type of IOL, local ocular factors, and the patient's systemic condition. The IOL exchange procedure consists of IOL extraction and secondary IOL implantation. The extraction can be done by cutting, splitting (bisecting), or folding the IOL. Different methods of fixation can be used for secondary IOL implantation.
 Conclusion : The IOL exchange procedure can optimally restore visual functions after a severe decline caused by IOL discoloration.

Changes in Ocular Surface Parameter After Intense Pulsed Light Therapy in Ocular Demodicosis: A Case Report

Introduction : Demodex infestation may manifest as blepharitis and dry eye syndrome. Intense Pulsed Light (IPL) therapy is an emerging option for managing ocular demodicosis.
 Case Illustration : A 77-years-old woman complained of itch and watery eyes since four years ago. Meibomian pouting, telangiectasias, foamy secretions, and sleeves were identified in both eyelids. Right eye examination showed 52% and 42% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer test 6 mm, lipid layer thickness (LLT) 43 nm, tear meniscus height (TMH) 0.36 mm, and non-invasive tear break-up time (NIBUT) 9.6 seconds. Left eye examination showed 65% and 56% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer test 5 mm, LLT 66 nm, TMH 0.16 mm, and NIBUT 5.8 seconds. Demodex mites were identified during eyelash wet mount examination. She underwent four sessions of IPL. At the two-month follow-up, complaints were alleviated. Signs of blepharitis were subsided. Right eye examination showed 36% and 34% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer's test 9 mm, LLT 68 nm, TMH 0.49 mm, and NIBUT 10.7 seconds. Left eye examination showed 25% and 35% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer's test 9 mm, LLT >100 nm, TMH 0.9 mm, and NIBUT 6.2 seconds.
 Discussion : IPL has a role in managing ocular demodicosis by local inflammation control, meibum liquefaction, and meibomian glands photomodulation. IPL is also thought to directly eradicate Demodex mites.
 Conclusion : Improvement of ocular surface parameters was observed after IPL therapy in ocular demodicosis.

PANUVEITIS AS A MANIFESTATION OF OCULAR SYPHILIS IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS : A CASE SERIES

Introduction : Syphilis is a sexually transmitted disease caused by the spirochete bacterium Treponema pallidum. Syphilis can result in multiple organ involvement, including the eyes, and demonstrates various clinical findings. Ocular syphilis is an important cause of uveitis in the new era of co-infection with the human immunodeficiency virus (HIV).
 Case Illustration : Case 1: A 29-year-old male HIV-positive with 5 months of blurred vision, pain, and redness in left eye (LE) with skin rashes on the palms and foots (Figure 1). The visual acuity was 1/300 in LE, anterior segment showed flare cell (Figure 2). Fundus examination (Figure 3) revealed multiple exudative lesion of right eye (RE) and vitreus opacity of LE due to inflammation. VDRL and TPHA tests were positive. Case 2: 38-year-old male, HIV-positive and tuberculosis-positive, with 2 months of blurred vision,pain and redness in both eyes with skin rashes on the palms and foots (Figure 1). The visual acuity of the RE was 1/60 and 1,5/60 in the LE on the initial visit. Anterior segment eye examination revealed flare and cell (Figure 2). Fundus examination revealed (Figure 3) preretinal hemorrhage and exudate of both eyes. VDRL and TPHA testing were positive, CD4 count showed severe immunodeficiency.
 Discussion : This study depicts clinical features and outcomes of two cases of ocular syphilis with HIV co- infection. Poor visual outcome was associated with posterior segment-involving uveitis at presentation.
 Conclusion : An accurate diagnosis is crucial, treatment is adjusted according to the clinical stage. Comprehensive education is needed for patients and their families.

Chemical Eye Burn Injury Due to Polyester in Industrial Worker: A case report

Introduction : Chemical eye burns are common causes of work-related eye injuries. Prompt and appropriate emergency management may be the most important factor in determining the visual outcome.
 Case Illustration : A 50-year-old man who works in a plastic factory immediately went to the emergency room after being exposed to melted polyester in his right eye. He complained of hurt and hotness in his eye. The emergency primary survey was stable. Triage of ophthalmology was an emergency. Initial Uncorrected Visual Acuity (UCVA) was light perception with correct projections. Physical examination revealed 2nd-degree combutio on the forehead and left cheek. Anterior right eye examination revealed palpebral edema, polyester debris on the eyelid, conjunctival mixed injection, ischemia of less than 1/3 of the limbus, corneal edema, corneal opacity, and polyester sticking to the cornea. The damage was determined as Roper-Hall grade II. In the Emergency room, Eye was immediately irrigated with 1 L of normal saline. A referral was made to the ophthalmologist and Immediate debridement was carried out. Wide corneal erosion was found after the procedure. Treatment was continued with antibiotic eye drops, lubricant eye drops, oral vitamin, and oral analgetic. The patient had improved visual acuity to 20/20 f2 with corneal scar and opacity 1 month after surgery.
 Discussion : The combined management of this case consisted of ocular lavage, surgery, and medication. A Chemical Eye Burn requires immediate management to prevent extensive damage leading to visual impairment.
 Conclusion : Initial treatment in the emergency department and referral to the ophthalmologist can improve patient outcomes.

CORRELATION BETWEEN COMPLIANCE OF SPECTACLE WEAR AND MYOPIA PROGRESSIVITY RATE IN MEDICAL STUDENTS OF DIPONEGORO UNIVERSITY

Introduction Myopia is a refractive error that causes images of distant objects to be focused in front of the retina by the non-accommodating eye. Myopia is one of the most common visual disturbances in the world. It is believed that the use of spectacle can reduce the progressivity rate of myopia. Spectacle can help light fall on the retina and prevent axial elongation of the eye. This theory needs to be investigated further so that it can be used as a reference. This study aimed to know the correlation between compliance of spectacle wear and myopia progressivity rate in medical students of Diponegoro University (UNDIP). Methods This research was an observational analytical study with cross-sectional design on 54 subjects ranging from 18 to 22 years old. Data are primary data obtained from questionnaires and objective eye examinations using an autorefractometer. The research was conducted from October to November 2021. Data were analyzed using Spearman Rank test which p<0,05 was considered significant. Results The mean of compliance of spectacle wear and myopia progressivity rate in medical students of UNDIP are (1,57±0,108) and (0,259±0,515) dioptres respectively. The correlation between compliance of spectacle wear and myopia progressivity rate are p=0,082 and r=0,239. Conclusion There are no correlation between compliance of spectacle wear and myopia progressivity rate in medical students of UNDIP. Keywords : Compliance, Spectacle, Myopia progressivity rate, Student

Lower Eyelid Laceration in Children: A Case Report

Introduction : Eyelid lacerations may be associated with serious ocular injury and are often accompanied by other ocular injuries. Most injuries occur in children. Eyelids have an important role in protecting the globe. Effective management of eyelid lacerations requires an understanding of the basic anatomical features of the eyelids.
 Case Illustration : A two-year-old boy was brought to our emergency department after getting scratched in the eyelid by the family dog. The patient has received first aid and a tetanus shot at another hospital. Eye examination shows a lower eyelid laceration on the right eye, extending from the medial downwards around 3 cm. Visual examination was central+, steady+, maintenance+, and eye movement was within normal limits. The patient was admitted to undergo eyelid repair in the operating room.
 Discussion : The first step in eyelid repair is wound irrigation and removal of foreign particles to avoid infection and inflammation, and primary repair of eyelids should be performed within 12 to 24 hours of the injury to reduce subsequent complications. The recommended method for best wound closure and healing is gently handling tissue edges, slight eversion, and using the smallest diameter sutures. A proper pre-operative assessment and surgical planning include evaluation of the thickness of the defect, the size, the location, and the involvement of canthus and lacrimal drainage. The goals are to provide adequate eye closure, preservation of tear film, maintenance of visual field, and aesthetics.
 Conclusion : A thorough knowledge of the eyelid anatomy and suture technique is important to successfully repair the defect while maintaining eyelid function.

CORRELATION BETWEEN COMPLIANCE OF SPECTACLE WEAR AND MYOPIA PROGRESSIVITY RATE IN MEDICAL STUDENTS OF DIPONEGORO UNIVERSITY

Introduction and Objective
 Myopia is a refractive error that causes images of distant objects to be focused in front of the retina by the non-accommodating eye. Myopia is one of the most common visual disturbances in the world. It is believed that the use of spectacle can reduce the progressivity rate of myopia. Spectacle can help light fall on the retina and prevent axial elongation of the eye. This theory needs to be investigated further so that it can be used as a reference. This study aimed to know the correlation between compliance of spectacle wear and myopia progressivity rate in medical students of Diponegoro University (UNDIP).
 Methods
 This research was an observational analytical study with cross-sectional design on 54 subjects ranging from 18 to 22 years old. Data are primary data obtained from questionnaires and objective eye examinations using an autorefractometer. The research was conducted from October to November 2021. Data were analyzed using Spearman Rank test which p<0,05 was considered significant.
 Results
 The mean of compliance of spectacle wear and myopia progressivity rate in medical students of UNDIP are (1,57±0,108) and (0,259±0,515) dioptres respectively. The correlation between compliance of spectacle wear and myopia progressivity rate are p=0,082 and r=0,239.
 Conclusion
 There are no correlation between compliance of spectacle wear and myopia progressivity rate in medical students of UNDIP.

BILATERAL CONGENITAL MYDRIASIS WITH ACCOMPANYING MIXED DEVELOPMENTAL DELAY

Introduction: Congenital bilateral mydriasis is a rare condition characterized by fixed dilated pupils unresponsive to light. It may occur associated with cardiovascular syndrome, gastrointestinal malformation, or developmental delay. Referred causes in comprehensive differential diagnosis for congenital mydriasis include alterations in ocular structures, ocular innervation alterations and others secondary to trauma, infection, or topical medication. Case Illustration: A 10 months-old boy presented to the hospital with large pupils in both eyes since birth. He has a persistent pupillary membrane with 9 mm diameter of pupil and unable to respond to light in both eyes. The pupillary response test using pilocarpine solution 0.1% showed no difference in diameter of pupils. Comprehensive pediatric examination revealed developmental delay. Computed tomography and laboratory result (laboratory blood count, toxoplasmosis, and cytomegalovirus) within normal limit. After eight months follow up, no significant change in pupil size or light responsiveness was found. Discussion: Comprehensive examination of anterior to posterior segments of the eyes is imperative on the lookout for underdiagnosed diseases. Clinical assessment remains vital for guiding investigations. Observation is required to detect the presence of certain systemic abnormalities that frequently do not manifest at birth. Conclusion: Congenital mydriasis can be diagnosed quickly in ordinary conditions, but it can be quite challenging when it presents as a coincidental finding of other spectrum diseases. It is important to perform a comprehensive general and eye examination to rule out any serious condition related to it. Keyword: Bilateral congenital mydriasis, dilated pupil, mixed developmental delay, pediatric ophthalmology

Orbital Tumor Misdiagnosed as Optic Neuritis in Rheumatoid Arthritis Patient: A Case Report

Abstract
 Introduction : Unilateral blurred vision and optic nerve swelling are the two most common signs of optic neuritis (ON). However, ON is rarely reported in patients with rheumatoid arthritis (RA), thus necessitating further diagnostic workup.
 Case Illustration : A 42-year-old woman visited our hospital with strabismus and progressive loss of vision in her left eye since three months ago. She had been treated with pulse dose steroid for suspected ON. She had been diagnosed with RA over five years and treated with immunomodulatory medication. Left eye examination revealed best corrected visual acuity of 20/50, proptosis, esotropia with painless limitation in temporal movement. Afferent pupillary defect (RAPD) and optic nerve swelling were present. OCT assessment revealed reduction in RNFL thickness. Further magnetic resonance imaging (MRI) investigation revealed a 2.35 x 2.6 x 1.8 cm mass in the left intraconal retrobulbar, in proximity to the medial optic nerve, which suggests a case of orbital Schwanoma. Excisional biopsy was performed and revealed a benign tumor.
 Discussion : Intraconal tumor may falsely be diagnosed as an optic neuritis in autoimmune patient. Neuro- ophthalmologic symptoms of systemic inflammatory in the optic nerve includes unilateral acute visual loss and pain in eye movement. Signs of ON includes RAPD, disc edema, and corresponding visual field defect. MRI of the optic nerve can assist diagnostic workup.
 Conclusion : The exact diagnosis of rheumatoid arthritis-associated ocular manifestations is challenging. Imaging using MRI might be needed to provide clarity in the diagnosis.

Severe Case Of Delayed Diagnosed Of >10 Years Untreated Newborn Congenital Glaucoma

Introduction : Though cases of newborn primary congenital glaucoma (PCG) had poor prognosis, we couldn’t simply ignore that early proper diagnostic and treatment can still improves quality of one’s sight, which’s absent in this case. Presented with delayed diagnosed highly suspected case of newborn PCG, physician was compelled to make the best in condition of the already given poor prognosis to begin with.
 Case Illustration : A 13 years old female patient came to eye clinic with a very disturbing chronic condition of visual loss. Accompanied by her family, who also claimed had witnessed both the patient’s eyes appeared whitish since birth. Eye examination revealed visual acuity of 1/~ for right eye and no light perception for left eye, along with significant signs of buphthalmos, epiphora, nystagmus, megalocornea (diameter of 9x14mm right eye and 9x13.3mm left eye), cloudy cornea, leukocoria, and Schiotz tonometry of 60-100mmHg in both eyes. Patient then received oral Acetazolamide, Levofloxacin eye drop, and Timolol Maleate 0,5% eye drop; then advised to return for one week evaluation also to bring her siblings to be subjected to glaucoma screening.
 Discussion : The decision to perform surgical intervention in cases of newborn PCG commonly require further thoughts. This case immediately shifted our focus towards palliative care of the patient whilst continuing monitoring IOP, as glaucoma surgery possessed a more menacing risk to be performed this patient.
 Conclusion : All cases of pediatric glaucoma require a life time of comprehensive management that requires heedfulness especially from caregivers as it is a very challenging disease.