Eye Center Research Articles

The Effect of Bimatoprost Implant on Glaucoma Patients: An Observational Study.

In this retrospective study of glaucoma patients receiving the bimatoprost implant at Duke Eye Center, the number of topical intraocular pressure-lowering medications was significantly reduced through 12 months after the implant. To study the effects of the bimatoprost implant on intraocular pressure (IOP) and the need for topical IOP-lowering medications in glaucoma patients in the clinical practice setting. Patients who received the bimatoprost implant at Duke Eye Center from November 2020 to October 2021 were identified. Exclusion criteria included addition of other IOP-lowering medications concurrent with the implant and <1 month of follow-up. The change in IOP and number of topical IOP-lowering medications from baseline to months 1, 3, 6, 9, and 12 after the implant was calculated. Subgroup analysis was performed for different glaucoma severities. A total of 63 patients and 92 eyes were included (mean age 77.8 ± 10.1 years). Glaucoma severity ranged from mild (11%), moderate (30%), to severe (54%). There was a nonsignificant decrease in IOP at all timepoints. The mean number of topical IOP-lowering medications significantly decreased by 0.81, 0.75, 0.63, 0.70, and 0.67 at month 1, 3, 6, 9, and 12, respectively (all P < 0.001). There was no significant change in the total number of medications, including the bimatoprost implant. When divided by glaucoma severity, the reduction in the number of topical medications was significant at 1, 3, and 6 months for mild/moderate disease and at 1 month for severe disease. During the follow-up period, 19 eyes underwent additional laser or surgical procedures, 68% of which had a history of prior incisional glaucoma surgery. The bimatoprost implant may reduce the need for topical IOP-lowering agents over a 1-year period, especially in mild to moderate-stage glaucoma. The efficacy of the implant may be more limited in severe glaucoma, and further work is needed to characterize its long-term effects.

Cystic Bleb Management : A Case Report

ABSTRACT Cystic Bleb Is An Abnormal Bleb Morphology Following Trabeculectomy Procedure. This Type Of Bleb Characterized By An Elevated, Thin, And Avascular Bleb Surface. Post-Operative Bleb Evaluation Needed To Be Done Thoroughly To Recognize And Prevent Further Complication Which Can Be Sight Threatening. Several Options Of Management Include Medical Therapy And Surgical Repair. To Report The Management Of Cystic Bleb. The Study Design Is A Case Report Study, Which Was Conducted At Indonesia National Eye Centre, Cicendo Eye Hospital, Bandung, Indonesia. Subject Of The Study Was A-17-Years-Old Female That Presented With Discomfort Sensation In The Right Eye, Which Previously Has Undergone Trabeculectomy Procedure With Antifibrotic Agent Application. Ophthalmological Examination Revealed A Cystic Bleb On The Right Eye. After Medical Therapy Was Given, The Symptoms Persist, Then The Cystic Bleb Was Surgically Repaired. Follow-Up Examination Showed An Improvement Of The Patient’s Condition, Measured By No Further Complaint Of Discomfort Sensation, A Good Bleb Morphology, And A Stable Intraocular Pressure. Cystic Bleb Is One Of The Complication From Trabeculectomy Which Could Progress To Devastating Condition. Surgical Treatment Is Indicated If Symptoms Persist After Medical Management, Or In The Presence Of A Bleb Leakage. Keywords: Antifibrotic, Cystic Bleb, Trabeculectomy

Rotational stability of a new hydrophobic acrylic intraocular lens platform.

To evaluate rotational stability for ease of rotation of a new intraocular lens (IOL) platform with 4 haptics in an ex vivo model and compare it with a control single-piece lens with 2 open loops. Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. Experimental study. 10 human cadaver eyes were prepared as per the Miyake-Apple technique. After injection of the test or control lens, clockwise and counterclockwise rotations were attempted with a hook, with and without an ophthalmic viscosurgical device in place. Ease of rotation was scored as (1) very easy, (2) easy, (3) difficult, and (4) very difficult. Rotation of the entire eye containing test or control IOL was also performed with a multipurpose rotator (2 minutes; 220 revolutions per minute) to evaluate its effect on IOL alignment. There were statistically significant differences regarding ease of rotation between test and control lenses in all 4 scenarios, with rotation being more difficult with the test lens ( P < .05, Wilcoxon signed-rank test). No change in the alignment of test or control lenses was observed after eye rotation with the multipurpose rotator. The new IOL platform showed greater rotational stability than the control lens in this model, owing to design features such as 4 small arcs of contact between the haptics and the bag equator, a bulge at the distal end of each haptic, and arcuate haptics with curvatures oriented toward each other.

CLINICAL FEATURES AND SURGICAL OUTCOMES OF SCLERAL BUCKLE SURGERY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT: Moorfields Buckle Study.

Long-term study to evaluate the clinical and surgical outcomes of scleral buckle (SB) surgery for primary rhegmatogenous retinal detachment (RRD) at a large tertiary eye center. Noncomparative, retrospective case series of 589 eyes of 569 patients with primary RRD who underwent SB surgery between 2004 and 2022 with a median follow-up of 6 months. The main outcome measures were best-corrected visual acuity, surgical outcomes, complications, and classification of RRD. At baseline, 447/589 (76.1%) round hole RRD, and 133/589 (22.7%) retinal dialysis RRD. Overall primary SB success rate was 83.7% for all retinal detachment subtypes, with round hole retinal detachment 84.8% and dialysis RRD 81.2%. Overall, the baseline best-corrected visual acuity was 0.42 logarithm of the minimum angle of resolution (logMAR) and the final best-corrected visual acuity was 0.26 logMAR ( P < 0.0001). In macula-off RRD, the best-corrected visual acuity significantly improved from 0.79 to 0.48 logMAR ( P < 0.0001). In patients with macula-on RRD, it improved from 0.19 to 0.12 logMAR ( P = 0.014). Binary logistic regression showed registrar surgeon grade (odds ratio [OR] 0.09, 95% confidence interval [CI] 0.01-0.55), and partial or complete posterior vitreous detachment (OR 0.21, 95% CI 0.10-0.49) was associated with reduced odds of primary success. Higher surgical failure was associated with low pre-fellowship SB surgeon experience ( P = 0.024). Favorable visual and functional outcomes have been reported in a large series of SB for primary retinal detachment, mainly for patients with round hole RRD and retinal dialysis RRD.

Clinical Characteristics And Success Of Ptosis Surgery At Indonesia National Eye Center Cicendo Eye Hospital During January 2016 – December 2020

ABSTRACT Ptosis is defined as drooping of the upper eyelid. Unilateral or bilateral ptosis can affect appearance and visual function, both of which can negatively impact quality of life. It may be congenital or acquired, determined by the timing of onset. To describe clinical characteristics and surgical outcomse in ptosis correction surgery at Indonesia National Eye Centre, Cicendo Eye Hospital. This is a descriptive-retrospective study, medical records of patients who was admitted to Indonesia National Eye Centre, Cicendo Eye Hospital, from January 2016 to December 2020 with diagnosis of eyelid ptosis were included in this study. From total of 189 patients (209 eyes) in this study, there were 41,8% male and 58,2% female patients with median age 22 years at the first time of visit. Most of the patients had unilateral ptosis (89,5%), and 10,5% had unilateral ptosis. According to the etiology of ptosis, 34,2% eyes were neurogenic ptosis. Degree of ptosis were severe in 70,9% eyes and most patients had fair levator function. Success rate were more than 95% in ptosis patient who underwent surgery. Majority of ptosis patient in Indonesia National Eye Centre, Cicendo Eye Hospital were caused by neurogenic followed by mechanical, traumatic, aponeurotic, myogenic, and pseudoptosis. Female patients were more common than male patients and median age at the first time visit were during second decade of life. Surgical outcome in ptosis tend to have high clinical success rates. Keywords: Characteristic, Outcome, Ptosis, Surgery

Pediatric retinal detachment: Anatomical and visual outcomes from tertiary eye center in Nepal

Abstract Objective: The aim is to evaluate the anatomical and functional outcomes of retinal detachment (RD) surgery in the pediatric population in a tertiary eye hospital in Nepal. Methods: This study is a hospital-based, retrospective cross-sectional study, including patients under 18 years of age, diagnosed with rhegmatogenous RD (RRD) for 5 years from January 2015 to December 2019, who underwent RD surgery. Results: Twenty patients were included in the study (mean age of 10.75 ± 2.63). Male patients were 19 (95%). A history of trauma was seen in 13 (65%) patients. Phakic RRD was observed in 18 (90%) patients and the rest 2 (10%) patients were pseudophakic. Type B proliferative vitreoretinopathy changes were observed in 3 (15%) patients, type C was observed in single patient (5%). Scleral buckling was performed in 7 (35%) patients, while 12 (60%) patients underwent three-port pars plana vitrectomy (PPV) and silicon oil instillation and the remaining single patient (5%) underwent PPV with gas exchange. Lensectomy was performed in 8 (40%) patients. Retinal attachment with a single surgical procedure was seen in 8 (40%) patients, while 12 (60%) patients required multiple surgeries. The mean duration of silicon oil removal was 5 ± 2.78 months (1–11 months). At the end of 6 months, 11 (55%) patients had improved visual acuity of 6/60. Six months postoperatively, 18 (90%) patients had attached retina. Conclusion: Visual improvement and retinal reattachment could be achieved with early diagnosis and intervention in pediatric RRD.

Uveal melanoma in the Iranian population: two decades of patient management in a tertiary eye center

BackgroundTo assess the characteristics and outcomes of uveal melanoma management at a tertiary center in the Middle East.MethodsA study on 164 patients with uveal melanoma was conducted by reviewing the available medical records, ultrasound, and pathology report results. Age at diagnosis, tumor location and size, treatment mode, visual outcome, metastasis, mortality, and survival were studied.ResultsThe mean age of patients was 52.0 ± 15.0 years, and 52.5% were male. Choroidal melanoma was the most common uveal melanoma, followed by the ciliary body and iris melanoma. The mean thickness of tumors was 8.29 ± 3.29. The majority of patients (n = 111, 67.9%) were managed by brachytherapy with ruthenium-106 plaques. Enucleation was performed primarily in 46 (28%) patients and secondarily in nine (5.5%) patients. The sexual disparity was detected as the proximity of uveal melanoma to the fovea in males. For a 61-month mean follow-up period, mortality occurred in eight of our cases, six of which were due to metastasis. The most common site for distance metastasis was the liver (5/6), followed by the lung (1/6). The five-year and eight-year overall survival (OS) rate was 0.947%± 0.019. The 5-year survival rate reached zero in metastatic patients. OS was not statistically different depending on the age, tumor diameters, the primary treatment received, or the histopathologic findings (p > 0.50 for all).ConclusionIn this study, individuals diagnosed with UM exhibited an OS rate of around 94% at the five-year mark, which remained consistent up to eight years. Notably, the presence of distance metastasis emerged as the sole statistically significant factor influencing overall survival.

Ethnic Differences in the Rates of Posterior Capsule Rupture and Long-Term Sequelae in Phacoemulsification Cataract Surgery.

Purpose The purpose of this study is to investigate the rates of posterior capsular rupture (PCR) and its sequelae during phacoemulsification across different ethnicities. Methods This is a retrospective cohort study of all consecutive phacoemulsification cases complicated by PCR that met the inclusion criteria over a four-year period at a single tertiary eye centre in the United Kingdom (UK). Results PCR occurred in 0.85% of cases overall (157/18,481). PCR rates were 1.8% (26/1485), 1.2% (51/4350), and 0.7% (75/10,927) in African-Caribbean, Indian subcontinent, and Caucasian patients, respectively (p < 0.001). Mean final corrected distance visual acuity improved (p < 0.05) in all ethnic groups(0.40 ± 0.57 logMAR) compared to pre-op (0.78 ± 0.61 logMAR). Post-operative cystoid macular oedema and unstable intraocular pressure rates following PCR did not statistically differ amongst ethnicities (p = 0.37 and p = 0.75, respectively). However, post-operative uveitis rates significantly differed at 11.5%, 15.7%, and 1.3% amongst the three ethnic groups, respectively (p = 0.01). Conclusion This is the first study to highlight a possible link between patient ethnicity and the risk of PCR during phacoemulsification cataract surgery. We observed significantly greater numbers of PCR cases amongst certain ethnic groups (highest in African-Caribbean eyes, then Indian subcontinental eyes, and lowest in Caucasian eyes) within the same multi-cultural urban population. Ethnicity may therefore be a contributing factor for PCR and should potentially be taken into consideration during preoperative risk stratification.

Impact of removing soft contact lenses 1day versus 1month before surgery on the outcomes of microkeratome laser in situ keratomileusis.

To compare the outcomes, safety, efficacy, and predictability of microkeratome laser in situ keratomileusis (LASIK) 24h and one month or more after removing soft contact lenses. ULTRALASIK Eye Center, Dubai, United Arab Emirates. The patients were divided based on the time of discontinuation of the soft contact lenses before LASIK (Group 1 at 24h and Group 2 at one month or longer), and the two groups were well matched. Schirmer's testing, tear break-up time, corrected distance visual acuity, uncorrected distance visual acuity, manifest refraction spherical equivalent, and infection rate were evaluated preoperatively and at one week, one month, and six months after treatment. Group 1 (G1) comprised 1025 eyes, and group 2 (G2) had 1052 eyes. The groups were comparable preoperatively. The overall-mentioned outcomes were comparable between groups with uncorrected distance visual acuity of - 0.084 ± 0.12 logMAR in G1 and - 0.078 ± 0.17 logMAR in the G2 at 6months (P = 0.322). Tear break-up time as well as Schirmer's testing results was also comparable with no evidence of increased risk of dry eyes or non-inflammatory complications in any of the groups on follow-up visits at 1week (P = 0.421), 1month (P = 0.101), and 6months (P = 0.399) postoperatively. Finally, no infectious complications were recorded in either of the groups. With the absence of corneal warpage, no statistical or clinical difference in microkeratome LASIK outcomes and safety was spotted between the groups despite the difference in SCL discontinuation time before the procedure.

Impact of Bariatric Surgery on Treatment Burden and Progression of Diabetic Retinopathy.

Purpose: To assess the severity, progression, and treatment burden of diabetic retinopathy (DR) in patients after bariatric surgery compared with controls. Methods: A retrospective cohort study was performed of patients with type 2 diabetes and DR seen at the Duke Eye Center between 2014 and 2023. Clinical data included hemoglobin A1c (HbA1c), diagnostic stage of DR, diabetic macular edema (DME) or vitreous hemorrhage (VH), visual acuity (VA), and treatment burden at baseline and follow-up. Generalized estimating equation analysis was used to account for the correlation between 2 eyes of the same patient. Results: Sixteen patients who had bariatric surgery were matched by age, sex, and duration of diabetes with 60 control patients managed medically during the same time period. The HbA1c level, severity of DR, presence of DME or VH, VA, and treatment burden were not significantly different (all P > .05) at the baseline examination. On average, patients were followed for 6 years. The HbA1c level at the follow-up was significantly lower in the bariatric surgery group (6.4% vs 8.5%; P < .001). At the follow-up, the treatment burden was reduced in the bariatric surgery group compared with the control group (P = .04). There was a clear trend toward reduced progression of DR and treatment burden in the bariatric surgery group over the follow-up. Conclusions: Bariatric surgery may improve glycemic control, stabilize DR progression, and reduce the treatment burden, which may have a significant impact on quality of life for patients with DR.

COMPARISON OF TEAR FILM BREAKUP PATTERN IN ACTIVE AND INACTIVE THYROID EYE DISEASE PATIENTS

Abstract&#x0D; Introduction &amp; Objectives : Thyroid Eye Disease (TED) is an autoimmune inflammatory disease of the orbit that affects orbital fat, extraocular muscles, periocular tissue and lacrimal glands. TED activity can be assessed with a Clinical Activity Score (CAS) to identify active or inactive TED conditions. Dry Eye Diseases (DED) is one of the manifestations in patients with TED with a prevalence that varies from 27%-96%. The Asia Dry Eye Society (ADES) 2017 proposed a new concept for DED diagnosis and therapy, namely Tear Film Oriented Diagnosis (TFOD) and Tear Film Oriented Diagnosis Therapy (TFOT) with Tear Film Breakup Pattern (TBUP) examination. TBUP examination help in determine specific management of DED. The aim of this study is to determine the differences in TBUP in TED patients based on active and inactive.&#x0D; Methods : This is an analytical observational study with a cross-sectional design. The subjects were TED patients who came to the Cicendo Eye Hospital and met the inclusion criteria. The study was conducted at the National Eye Center of Cicendo Eye Hospital in April - June 2022. The data were analyzed with the Chi-Square Test.&#x0D; Results : This study was conducted on 23 patients or 46 eyes. This study found a statistically significant differences in TBUP features in active and inactive TED patients (p=0.0001). The most common features of TBUP was found in active TEDs was dimples (55%).&#x0D; Conclusion : There are differences of TBUP features in active and inactive TED patient.

SECONDARY GLAUCOMA AFTER VITREORETINAL SURGERY: A RETROSPECTIVE OBSERVASIONAL STUDY

Introduction &amp; ObjectivesSecondary glaucoma is the most common complication after vitreoretinal surgery. Pars PlanaVitrectomy (PPV) is a common surgical procedure aimed at removing vitreous gel and replacing itwith variety of substances denominated tamponades. Vitreous removal and replacement may causeincreased intraocular pressure (IOP). The IOP can be reduced with medical treatment or surgery.The purpose of this study is to describe the characteristics of secondary glaucoma after vitreoretinalsurgery in National Eye Center Cicendo Hospital from January 2019 - December 2020.&#x0D; MethodsThis study was a retrospective descriptive study which data were obtained from medical records.Data such as age, gender, vitrectomy tamponades, IOP, onset of glaucoma, and glaucoma treatmentwere collected.&#x0D; ResultsOne hundred fifty-three eyes were referred to Glaucoma Unit with increasing IOP after vitreoretinalsurgery. PPV with tamponade was done in 141 eyes (92.16%) and silicone oil (SO) 1000 centistokes(cSt) was the most used tamponade in 101 eyes (66.07%). Secondary glaucoma with open angle wasthe most common type in 124 eyes (81.04%). Secondary glaucoma developed in 4-7 weeks aftersurgery, with the highest IOP recorded at 31-40 mmHg. The IOP decreased after SO evacuation withinitial glaucoma treatment in 121 eyes (79.09%), and glaucoma surgery was performed in 32 eyes(20.91%).&#x0D; ConclusionSilicon oil as a tamponade agent after PPV may cause rise IOP in the post-operative period.Evacuation SO needs to be done after retinal adhesion to prevent secondary glaucoma. Therefore,timely detection and anti-glaucoma treatment are important to decreased IOP, or filtration surgerycan be performed.

COMPARISON OF VISUAL ACUITY AFTER A COMBINATION OF CITICHOLINE AND METHYLPREDNISOLONE WITH A SINGLE CITICHOLINE TREATMENT IN NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY PATIENTS

Abstract&#x0D; Introduction &amp; Objectives : Non-arteritic anterior ischemic optic neuropathy (NAION) accounts for 90-95% of optic neuropathy in the elderly with symptoms of decreased visual acuity. Posterior ciliary brevis hypoperfusion results in ischemia, triggers oxidative stress, axonal edema as well as compartment syndrome leading to retinal ganglion cell death via apoptosis. There is no gold standard therapy for NAION. Citicholine as a neuroprotector agent has shown satisfactory results in the acute and chronic phases. Methylprednisolone is also a therapeutic consideration that decreases capillary permeability thereby promoting faster resolution of disc edema. This study aimed to compare visual acuity in NAION patients with combination therapy of citicholine and methylprednisolone with single citicholine therapy.&#x0D; Methods : An analytical observational study with retrospective data collection at the National Eye Center of Cicendo Hospital for the period January 2021–February 2022. A total of 59 NAION patients who met the inclusion criteria were then divided into 2 groups, namely receiving a combination of citicholine with corticosteroids and single citicholine treatment.&#x0D; Results : The mean age in the combination group was 52.57±9.035 and the single group was 57.52±10.319. The number of men and women in the combination group were the same while in the single group women was higher. The risk factors obtained were hypertension, diabetes mellitus (DM), dyslipidemia, and smoking. There was a significant mean difference between initial visual acuity and3 months after therapy in the combination therapy group (p=0.0001) and in the single group. (p=0.002)&#x0D; Conclusion : Visual acuity in NAION patients with combination therapy of citicholine and methylprednisolone is better than citicholine alone.

Risk Factors of Occipital Stroke in Tertiary Eye Center in Yogyakarta, Indonesia

Abstract&#x0D; Introduction &amp; Objectives : Occipital stroke is a stroke involving occipital lobe of the brain which can impair the visual acuity in patient. Several risk factors have been identified as a predisposing conditions. Objectives The aim of this study is to investigate the risk factors for occipital stroke.&#x0D; Methods : It is a cross sectional research by analyzing secondary data from medical record of patients with occipital stroke hospitalized in Dr. Yap Eye Hospital in Yogyakarta from January 2021 to December 2022 were included in this study. Demographyy, clinical data, and risk factors associated with occipital stroke was recorded. The descriptive statistic was performed to evaluate risk factors for occipital stroke.&#x0D; Results : Subjects were analyzed 61, comprised of 44 males (72%) and 17 females (28%). Majority of subjects age ≥45 years old (93%). Attack occurred during activity (n=54, 89%), during wake up (n=7, 11%). The involvement right eye (n=8, 13%), left eye (n=9, 15%), &amp; bilateral (n=44, 72%). From 122 eyes, 74 hemianopia (61%), 34 quadranopia (28%) and 14 bilateral hemianopia (11%). 29 subjects had right occipital stroke (48%), 25 subjects hadleft occipital stroke (41%) and 7 subjects had bilateral occipital stroke (11%). Most subjects had one risk factor (n=29, 48%) and two risk factors (n=23, 38%). Eight subjects had three risk factor (13%) and only one subject had four risk factors (2%).&#x0D; Conclusion : The majority of risk factors of occipital stroke involved only single risk factors and double risk factors. Only minority of subjects had multiple risk factors.

Temporal trend of anisometropia incidence in Chinese school-aged children before and during the COVID-19 pandemic.

To analyze and compare the temporal trends in the incidence of anisometropia among Chinese school-aged children both before and during the COVID-19 pandemic, and to investigate the impact of the pandemic on the incidence of anisometropia. We conducted a retrospective study comprising six distinct and independent longitudinal cohorts, each including children aged 6 to 13 years who visited the Joint Shantou International Eye Center between January 2010 and December 2021. Children were grouped into cohorts based on the year of their first eye clinic visit: 2010, 2012, 2014, 2016, 2018, or 2020. Only children without anisometropia at initial visits, followed for 18 ± 6 months, were included. The cumulative incidence and risk factors of anisometropia were analyzed using Kaplan-Meier estimation and Cox proportional hazards regression models. Subgroup analyses were performed based on sex, age groups, initial refractive error status, and initial interocular SE difference. Anisometropic children were further categorized into myopic and non-myopic, with subsequent subgroup analyses conducted. Of 11,235 children were recruited from six cohorts (2010: n = 1,366; 2012: n = 1,708; 2014: n = 1,896; 2016: n = 2,354; 2018: n = 2,514; 2020: n = 1,397), 869 children developed anisometropia during a mean follow-up of 17.5 ± 3.7 months. After adjustment of confounding factors, we found that the risk of anisometropia remained relatively stable before 2020 but significantly increased in the 2020 cohort (adjusted HR 2.93, 95% CI 2.23 to 3.86; p < 0.001). This trend persisted in studies of spherical anisometropia (adjusted HR 2.52, 95% CI 1.60 to 3.97; p < 0.001) and cylindrical anisometropia (adjusted HR 2.91, 95% CI 1.69 to 3.62; p < 0.001). Older age and a greater initial difference in SE between the two eyes were also significantly associated with a higher risk of developing anisometropia (p < 0.001). Subgroup analyses consistently showed increased risk in the 2020 cohort. This study reveals a concerning rise in anisometropia incidence among Chinese school-aged children during the period of the COVID-19 pandemic. These findings highlight the worrisome rise in anisometropia risk during the COVID-19 pandemic and emphasize the importance of early detection and management to safeguard children's visual health.

Comparison of Pain and Anxiety Scales in The First and Second Cataract Surgeries in Patient with Bilateral Cataract

Abstract : Introduction &amp; ObjectivesPain and anxiety in cataract surgery can be investigated as subjective experiences and satisfaction. This study was to evaluate and compare pain and anxiety scale reported by patients with bilateral cataract in the first and second surgery.&#x0D; Methods : This prospective study was based on patients in Jakarta Eye Centre Orbita Makassar between August-October 2022. Consecutive patients undergoing bilateral cataract surgery with the first and second surgery separated by minimum of two weeks with phacoemulsification method and used topical anaesthesia, by three surgeons. Patients with traumatic cataract, secondary cataract, and other ocular abnormality, also patients with intraoperative complications were excluded. Patients completed questionnaires of Numerical Rating Scale to evaluate pain and Amsterdam Preoperative Anxiety and Information Scale (APAIS) to evaluate anxiety divided into no, mild, moderate, severe, and very severe anxiety.&#x0D; Results : A total of 42 patients with an average of 64,5 years old were included. There were 2 (4.7%) patients reported more pain in the first surgery, 30 (71%) patients reported more pain in the second surgery, and 10 (23%) patients reported same pain between the first and second surgeries (p=0,000). Most patients reported mild anxiety in the first surgery and no anxiety in second surgery.&#x0D; Conclusion : Patients with bilateral cataracts reported more pain on the second surgery than the first surgery. The anxiety was reported more severe before and during the first surgery than the second surgery. This report can be used in giving informed concern and in the management of bilateral cataract surgeries consecutively.

INTRAVENOUS METHYLPREDNISOLONE EFFECTS ON RECTUS MUSCLES IN THYROID EYE DISEASE

Introduction &amp; Objective: Intravenous methylprednisolone has been used in management of Thyroid Eye Diseases (TED) which was an autoimmune inflammatory disease of the orbital tissues and the eyes. Previous study has shown benefits of intravenous methylprednisolone therapy on TED but there was need of quantitative measure to assess the effect of intravenous methylprednisolone therapy on extraocular rectus muscles. This study aimed to report the effect of high-dose intravenous methylprednisolone pulse therapy on inferior, medial, superior, and lateral rectus muscles and providing data distribution of active TED before and after therapy. Methods: Retrospective analyses were used in the data collection of patients with active Thyroid Eye Disease (TED) underwent high-dose intravenous methylprednisolone pulse therapy regiment 500mg every week for six consecutive weeks at Sardjito Eye Centre between January 2022 and December 2022. Ophthalmological investigation and quantitative computed tomography (CT) scan of the orbit were performed before and after methylprednisolone pulse therapy and demographics data were presented in tables and graphs. Results: This study included 62 eyes of 31 patients (61,3% female) with mean age of 37.8±13.47 years old. The mean thickness of Superior Rectus (SR) muscle before therapy were 4.12±2.20 mm and significantly decreased to 3.70±1.54 mm post therapy. There was no significant difference in delta mean Inferior Rectus (?IR) -0.18±1.69 (p=0.381), Medial Rectus (?MR) -0.34±1.68 (p=0.116), and Lateral Rectus (?LR) -0.33±1.94 (p=0.188) Conclusion: The treatment of Thyroid Eye Disease (TED) with high dose intravenous corticosteroid is safe and effective in reducing extraocular muscle tissue thickness with minimal side effects. Keywords: Thyroid Eye Disease, Extraocular Muscle, Intravenous Methylprednisolone Therapy.

INTRAVENOUS CORTICOSTEROID EFFECTS ON SUPERIOR AND INFERIOR RECTUS MUSCLE IN THYROID EYE DISEASE

Abstract&#x0D; Introduction &amp; Objectives : Intravenous corticosteroid has been used in management of Thyroid Eye Diseases (TED) which was an autoimmune inflammatory disease of the orbital tissues and the eyes. Previous study has shown benefits of intravenous corticosteroid therapy on TED but there was need of quantitative measure to assess the effect of intravenous corticosteroid therapy on extraocular muscle. This study aimed to report the effect of high-dose intravenous corticosteroid pulse therapy on superior and inferior rectus muscle and providing data distribution of active TED before and after therapy&#x0D; Methods : Retrospective analyses were used in the data collection of patients with active TED underwent high- dose intravenous methylprednisolone pulse therapy regiment 500mg every week for six consecutive weeks at Sardjito Eye Centre between January and December 2022. Ophthalmological investigation and quantitative computed tomography (CT) scan of the orbit were performed before and after corticosteroid pulse therapy and demographics data were presented in tables and graphs&#x0D; Results : This study included 62 eyes of 31 patients (61,3% female) with mean age of 37.8±13.47 years old. The mean thickness of Superior Rectus (SR) muscle before therapy were 4.12±2.20 mm and decreased to 3.64±1.50 mm post therapy. The mean thickness of Inferior Rectus (IR) muscle before therapy were 4.45±1.80 mm and decreased to 4.26±1.63 mm post therapy. There was significant difference in mean ΔSR -0.47±1.84 mm (p=0.046) but not in ΔIR -0.18±1.69 (p=0.381)&#x0D; Conclusion : The treatment of Thyroid Eye Disease (TED) with high dose intravenous corticosteroid is safe and effective in reducing extraocular muscle tissue thickness with minimal side effects.

COMPARISON OF TEAR FILM BREAKUP PATTERN IN ACTIVE AND INACTIVE THYROID EYE DISEASE PATIENTS

Introduction: Thyroid Eye Disease (TED) is an autoimmune inflammatory disease of the orbit that affects orbital fat, extraocular muscles, periocular tissue and lacrimal glands. TED activity can be assessed with a Clinical Activity Score (CAS) to identify active or inactive TED conditions. Dry Eye Diseases (DED) is one of the manifestations in patients with TED with a prevalence that varies from 27%-96%. The Asia Dry Eye Society (ADES) 2017 proposed a new concept for DED diagnosis and therapy, namely Tear Film Oriented Diagnosis (TFOD) and Tear Film Oriented Diagnosis Therapy (TFOT) with Tear Film Breakup Pattern (TBUP) examination. TBUP examination help in determine specific management of DED. The aim of this study is to determine the differences in TBUP in TED patients based on active and inactive. Methods: This is an analytical observational study with a cross-sectional design. The subjects were TED patients who came to the Cicendo Eye Hospital and met the inclusion criteria. The study was conducted at the National Eye Center of Cicendo Eye Hospital in April - June 2022. The data were analysed with the Chi-Square Test. Result: This study was conducted on 23 patients or 46 eyes. This study found a statistically significant differences in TBUP features in active and inactive TED patients (p=0.0001). The most common features of TBUP was found in active TEDs was dimples (55%). Conclusion: There are differences of TBUP features in active and inactive TED patient.

RETINOPATHY OF PREMATURITY IN TERTIARY REFERRAL EYE HOSPITAL IN INDONESIA: CHARACTERISTICS AND MANAGEMENT

Abstract&#x0D; Introduction &amp; 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.&#x0D; 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.&#x0D; 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.&#x0D; 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.