Improvement In Visual Acuity Research Articles

Treatment of Corneal Perforation Using Periosteal Graft Technique With the Continuation of Penetrating Keratoplasty

Introduction : Corneal perforation occurs due to various conditions and management are based on the underlying cause. Modalities to treat corneal leaks is dependent on the size of corneal defect and include tissue adhesive, conjunctival flap, grafts and transplants. Penetrating Keratoplasty (PK) is effective to treat large corneal defect and to improve visual acuity (VA), but unfortunately PK is usually delayed due to availability.
 Case Illustration : A 17-years-old teenager was diagnosed with corneal perforation on his left eye, VA at initial visit was 1/300, positive seidel test, and shallow anterior chamber. Patient immediately underwent periosteal graft with subsequent PK surgery one month later. First until eight days postoperatively, VA improved from 3/60 to 6/30. Ten days after PK, a mechanical trauma caused the transplant to be detached, and VA greatly decreased to 1/300. Patient underwent immediate repair surgery. First day after surgery, VA was light perception. Eight days later, VA increased to 1/60 with concurrent iris prolapse. Iris repair was done immediately and eight days later VA increased to 6/60. At day sixteen, the final VA is 6/30.
 Discussion : Periosteal graft was performed to maintain ocular integrity. After waiting for a month, PK was performed to improve vision. This combination therapy was successful proven by VA improvement from 1/300 to 6/30.
 Conclusion : Periosteal graft is necessary to maintain ocular integrity while waiting for availability of donor cornea. Penetrating keratoplasty is an appropriate procedure for patients with large corneal leaks. It replaces all corneal structures, and it also improve visual function.

OPTICAL COHERENCE TOMOGRAPHY PREDICTS VISUAL RECOVERY OF PATIENTS WITH PITUITARY ADENOMA FOLLOWING SURGERY IN DR KARIADI HOSPITAL,SEMARANG

Introduction and Objective: The characteristics, symptoms, and clinical manifestations of pituitary adenoma in Indonesia have not been widely studied. In 26 patients undergoing pituitary surgery at Dr. Kariadi Hospital, we compared visual acuity pre-operative and post-operative from normal and thin optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell layer-internal plexiform layer (GCL-IPL). Method: A retrospective study of the medical record from January 2020 to December 2022 was done. 21 of the 26 patients had surgery by the transsphenoidal route and the rest by craniotomy. All patients had macroadenoma (tumor size >1cm) and were histologically confirmed. Visual acuity before and after surgery was evaluated along with the patient’s OCT value. Result: The thinner pre-operative RNFL thickness was associated with worse visual acuity (VA). Patients with normal RNFL had a median VA of 20/200 while those with thin RNFL had to count their fingers (CF). The patients with normal pre-operative RNFL had a significant improvement in median VA after surgery, from 20/200 to 20/32 (p=0.022), whereas the patients with thin RNFL did not improve (CF to CF, p=0.026). The patients with normal pre-operative GCL-IPL had non-significant improvement in median VA after surgery from CF to 20/20 (p=0.505), also the patients with thin GCL-IPL from CF to 20/200 (p=0.151). Conclusion: The visual recovery after pituitary adenoma surgery is likely to be predicted by pre-operative OCT RNFL. Patients with normal RNFL thickness show an increased tendency in visual recovery after surgery. Keywords: Optical coherence tomography , visual acuity, pituitary adenoma

OPTICAL COHERENCE TOMOGRAPHY PREDICTS VISUAL RECOVERY OF PATIENTS WITH PITUITARY ADENOMA FOLLOWING SURGERY IN DR KARIADI HOSPITAL SEMARANG

Abstract
 Introduction & Objectives : The characteristics, symptoms, and clinical manifestations of pituitary adenoma in Indonesia have not been widely studied. In 26 patients undergoing pituitary surgery at Dr. Kariadi Hospital, we compared visual acuity pre-surgery and post-surgery from normal and thin optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell layer-internal plexiform layer (GCL-IPL).
 Methods : A retrospective study from medical record from Januari 2020 to December 2022 was done. 21 of the 26 patients had surgery by the transsphenoidal route and the rest by craniotomy. All patients had macroadenoma (tumor size >1cm) and histologically confirmed. Visual acuity before and after surgery was evaluated along with patient’s OCT value.
 Results : The thinner pre-surgery RNFL thickness was associated with worse visual acuity (VA). Patients with normal RNFL had a median VA of 20/200 while those with thin RNFL had to count their fingers (CF). The patients with normal pre-surgery RNFL had a significant improvement in median VA after surgery, from 20/200 to 20/32 (p=0.022), whereas the patients with thin RNFL did not improve (CF to CF, p=0.026). The patients with normal pre-surgery GCL-IPL had non-significant improvement in median VA after surgery from CF to 20/20 (p=0.505), also the patients with thin GCL-IPL from CF to 20/200 (p=0.151).
 Conclusion : Based on this study, the visual recovery after pituitary adenoma surgery is likely to be predicted by pre-surgery OCT RNFL. Patients with normal RNFL thickness show an increase propensity in visual recovery after surgery.

Management Strategies of Ocular Alkaline Chemical Injury

Introduction : Ocular chemical burns are true ophthalmic emergencies that can cause permanent corneal and intraocular damage leading to visual impairment or even blindness. When a case of chemical trauma occurs, immediate and appropriate management should be done.
 Case Illustration : A 24-year-old man came to Cicendo Eye Hospital with complaints of blurry eyes accompanied by burning and watery eyes after being doused with a bucket of cement mortar two weeks earlier. Ophthalmologic examination obtained visual acuity for the right eye 1/300 and left eye was 1/60. The anterior segment of both eyes showed corneal edema, conjunctivalization, persistent epithelial defects, limbal ischemia, and punctate epithelial erosion. There was an ulcer and thinning of the corneal layer in left eye. He was diagnosed with alkaline chemical injury Dua's classification grade VI on the right eye and grade V on the left eye (Figure 1). The patient then underwent a keratectomy, conjunctival resection, and amniotic membrane transplantation procedure. On the seventh day postoperatively, symptoms and clinical features improved with the visual acuity of both eyes improved to 1/60 (Figure 2).
 Discussion : Amniotic membrane graft was performed in late reparative phase which aims to preserve the surface of the corneal epithelium and prevent corneal perforation and inflammation. Conjunctival resection was performed to prevent neovascularization of the amniotic membrane.
 Conclusion : Management of ocular burn injury requires an immediate and comprehensive treatment to achieve good result. In this case successful treatment was achieved by improvement of visual acuity and no complication occured.

Blindness Management for Retinitis Pigmentosa with Cataract senile immature : A Case Report

Introduction : Retinitis Pigmentosa (RP), also called pigmentary retinal dystrophy, is the term of hereditary retinal diseases that feature degeneration of rod and cone photoreceptors. The most common complication of RP is cataract. Cataract formation is most likely the result of retinitis pigmentosa-related inflammation response. Cataract is an important secondary cause of visual impairment in RP.
 Case Illustration : A 39-year old female came to the Hospital with complaint of having blurred vision in both eyes since four years ago. Ophthalmologic examination revealed that visual acuity for her right and left eye was 1/300. Anterior segment examination was revealed lens opacification in right and left eye. Funduscopy examination was revealed bone spicula in right and left eye. Patient was diagnosed with retinitis pigmentosa with cataract senile immature in both eyes. Phacoemulsification with intraocular lens (IOL) implantation were done as surgical management for the right eye.
 Discussion : RP is one of the leading causes of irreversible blindness. The possible explanation of reduced vision in RP can be photoreceptor cell death and treatable complications of RP. Cataract is the most common anterior segment complication described in RP. Visual acuity in RP could be improved for the complications that receive effective treatment, especially with the improvement of the cataract surgery. However, the visual prognosis and surgical risk following cataract surgery is uncertain, the cataract surgery should still be considered in patients with RP. Phacoemulsification with IOL implantation remains the most preferred method to manage cataracts.
 Conclusion : Cataract surgery in patients with RP leads to significant improvements in visual acuity

REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY

Abstract
 Introduction & Objectives : Introduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.
 Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power >1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.
 Results : Day-1 follow-up keratometry shown that corneal astigmatism was still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism was better in 600um incision depth.
 Conclusion : When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.

Clinical Outcome in Lens Drop evacuation after a High-Risk Characteristics Proliferative Diabetic Retinopathy Post Pars Plana Vitrectomy Case

Introduction : Vitrectomy surgery affects zonular strength, which increases the risk of lens drop and can be sight- threatening if not managed correctly. Pars plana vitrectomy (PPV) and evacuation of dislocated lens fragments have to be done very carefully.
 Case Illustration : A 42-year-old female with blurred vision in the right eye for two months and a history of right-eye surgery three months ago due to proliferative diabetic retinopathy (PDR) was tamponed with SF6 gas. On examination was found visual acuity (VA) was 6/120, with cloudy lens and attached retina. The patient was diagnosed with a right-eye complicated cataract with advanced PDR post-PPV and planned to undergo phacoemulsification. While waiting for the surgery, the lens dropped into the posterior chamber, then planned to do the evacuation immediately. Dropped lens evacuation, PPV, retro-pupil IOL implantation, and silicone oil (SO) tamponing were done. Two months after the SO evacuation, the best corrected VA improved to 6/15.
 Discussion : Cataract progression after vitrectomy is common. In a vitrectomized eye, there is a lack of vitreous tamponade and a less stable lens. Peripheral zonules are attached to the pars plana, which can be disrupted during the vitrectomy surgery. Improvements in visual acuity and lower rates of complications were found if the lens fragment was evacuated soon.
 Conclusion : Cataract surgery is better done soon after PPV to prevent dropped lenses into the posterior chamber, whether the zonulisis sign is seen or not. The interval between the dropped lens incident and evacuation was associated with better final visual outcomes.

Non-Surgery Management of Globe Rupture in Rural Area

Introduction : Globe rupture is a vision-threatening emergency. The management of globe rupture must arrange immediate.
 Case Illustration : A 59-year-old woman presented with painful and sudden vision loss on her left eye after hit by wood an hour prior. From the examination, the palpebra was oedema, and spasm, the conjunctiva was chemosis and bleeding, the sclera was laceration. Visual acuity of the left eye was 1/~. We diagnosed as globe rupture of the left eye. We gave levofloxacin injection, methylprednisolone injection, tranexamic acid injection, prednisolone eyedrop every 3 hours, levofloxacin topical every hour, and oxytetracycline eye ointment once a day in night. After 10 days, clinical manifestation was improved, but the visual acuity. From the examination, we found retinal detachment on her left eye. Patient was referred to the primary health care.
 Discussion : In globe rupture, infection risk is high and requires immediate systemic empiric antibiotics and surgical management. The conservative treatment was administered since the patient rejected for the globe exploration and scleral suture surgery. The aim treatment for this case is to prevent the infection. We used combination systemic and topical levofloxacin antibiotics and corticosteroid. Systemic tranexamic acid was to control the bleeding. No improvement of visual acuity after 10 days, we suspected because of retinal detachment and need surgery management.
 Conclusion : Surgical exploration and infection prevention are needed for globe injury. The sooner management, the better prognosis it could be.

Anterior Orbitotomy with Transcutaneous Approach as Management of Orbital Cavernous Hemangioma

Introduction : Orbital cavernous hemangioma is the most common benign orbital lesion in adults. Management of cavernous hemangioma depends on the presented symptoms. Visual impairment is indication of surgical management. Anterior orbitotomy is the preferred surgical technique for cavernous hemangioma.
 Case Illustration : A 34-years-old male came with chief complaint of mass in the inferior palpebra left eye (LE) accompanied with double vision for three years. Visual acuity of the right eye (RE) was 1.0 and LE was 0.8. Ophthalmology examination revealed hypertropia, non-axial proptosis, mass lesion sized 4 x2 cm in the left inferior palpebra and RAPD grade I in the LE (Figure 1). Funduscopy examination in both eyes was within normal limit. CT-Scan examination showed intraconal and extraconal inhomogen mass lobulated in the left inferomedial which obliterate inferior and medial rectus muscle (Figure 2). Patient was diagnosed with proptosis and compressive optic neuropathy in LE caused by suspected orbital cavernous hemangioma. Anterior orbitotomy with transcutaneous approach was done (Figure 3). Histopathological examination showed proliferation of large blood vessels lined with endothelial cells as characteristic of cavernous hemangioma (Figure 4). There was improvement of visual acuity and no RAPD after surgery (Figure 5).
 Discussion : Orbital cavernous hemangioma can compress optic nerve which will cause visual disturbances. Anterior orbitotomy with transcutaneous approach provides wider space when surgeon take out hemangioma completely. It will reduce bleeding caused by truncated mass of hemangioma and increase successful rate of surgery.
 Conclusion : Anterior orbitotomy with transcutaneous approach can correct globe displacement and visual disturbances caused by orbital cavernous hemangioma.

Non-Surgery Management of Globe Rupture in Rural Area

Introduction : Globe rupture is a vision-threatening emergency. The management of globe rupture must arrange immediate.
 Case Illustration : A 59-year-old woman presented with painful and sudden vision loss on her left eye after hit by wood an hour prior. From the examination, the palpebra was oedema, and spasm, the conjunctiva was chemosis and bleeding, the sclera was laceration. Visual acuity of the left eye was 1/~. We diagnosed as globe rupture of the left eye. We gave levofloxacin injection, methylprednisolone injection, tranexamic acid injection, prednisolone eyedrop every 3 hours, levofloxacin topical every hour, and oxytetracycline eye ointment once a day in night. After 10 days, clinical manifestation was improved, but the visual acuity. From the examination, we found retinal detachment on her left eye. Patient was referred to the primary health care.
 Discussion : In globe rupture, infection risk is high and requires immediate systemic empiric antibiotics and surgical management. The conservative treatment was administered since the patient rejected for the globe exploration and scleral suture surgery. The aim treatment for this case is to prevent the infection. We used combination systemic and topical levofloxacin antibiotics and corticosteroid. Systemic tranexamic acid was to control the bleeding. No improvement of visual acuity after 10 days, we suspected because of retinal detachment and need surgery management.
 Conclusion : Surgical exploration and infection prevention are needed for globe injury. The sooner management, the better prognosis it could be.

REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY

Introduction & ObjectivesIntroduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.
 Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power >1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.
 Results : Day-1 follow-up keratometry shown that corneal astigmatism was still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism was better in 600um incision depth.
 Conclusion : When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.

Management Strategies of Ocular Alkaline Chemical Injury

Introduction : Ocular chemical burns are true ophthalmic emergencies that can cause permanent corneal and intraocular damage leading to visual impairment or even blindness. When a case of chemical trauma occurs, immediate and appropriate management should be done.
 Case Illustration : A 24-year-old man came to Cicendo Eye Hospital with complaints of blurry eyes accompanied by burning and watery eyes after being doused with a bucket of cement mortar two weeks earlier. Ophthalmologic examination obtained visual acuity for the right eye 1/300 and left eye was 1/60. The anterior segment of both eyes showed corneal edema, conjunctivalization, persistent epithelial defects, limbal ischemia, and punctate epithelial erosion. There was an ulcer and thinning of the corneal layer in left eye. He was diagnosed with alkaline chemical injury Dua's classification grade VI on the right eye and grade V on the left eye (Figure 1). The patient then underwent a keratectomy, conjunctival resection, and amniotic membrane transplantation procedure. On the seventh day postoperatively, symptoms and clinical features improved with the visual acuity of both eyes improved to 1/60 (Figure 2).
 Discussion : Amniotic membrane graft was performed in late reparative phase which aims to preserve the surface of the corneal epithelium and prevent corneal perforation and inflammation. Conjunctival resection was performed to prevent neovascularization of the amniotic membrane.
 Conclusion : Management of ocular burn injury requires an immediate and comprehensive treatment to achieve good result. In this case successful treatment was achieved by improvement of visual acuity and no complication occured.

Diagnosis of Ocular Toxocariasis: a case report

Introduction : Ocular toxocariasis (OT) is an eye parasitosis due to incidental ingestion of Toxocara cati or canis larvae. Although mostly affects young children, it can also occur in older individuals. It is usually uniocular with various presentations.
 Case Illustration : A 69-year-old woman came with a chief complaint of deteriorating vision and pain in her left eye (LE)2 weeks prior to the visit, accompanied by floaters, redness, itchiness, and glare. She had a contact history with neighborhood dogs. Her best corrected visual acuity (VA) was 6/12 in the right eye (RE) and 3/60 in the LE. The intraocular pressure of LE was 27mmHg. Examinations of the LE found corneal edema, keratic precipitates, worm-like foreign bodies that moved in the anterior chamber, lens and vitreous opacity, and obscured fundus. The ultrasound showed a membrane-like lesion and no vitreomacular traction. The examination of the RE was unremarkable. We performed prompt foreign body extraction with local anesthesia and prescribed oral albendazole, topical and oral antibiotics, and steroids afterward. The investigation of the specimen revealed Toxocara larvae. There was no VA improvement after 1 month of close observation.
 Discussion : The OT diagnosis is based on clinical findings and a history of exposure to dogs or cats, soil, and consuming raw or undercooked meat. The gold standard for diagnosis is specimen biopsy. While no acceptable treatment regimen exists, the combination of anthelmintics and corticosteroids appears useful in some cases.
 Conclusion : Clinical presentation, parasitologic confirmation, and close contact with pets may be key elements to making the diagnosis.

Quality of Life After Cataract Surgery in Patients with Age-Related Macular Degeneration: A Literature Review

Abstract
 Introduction & Objectives : Age-related macular degeneration (AMD) is a common ocular disease that affects millions of people worldwide. Cataract surgery is one of the most performed surgical procedures in the world and is effective to improve visual function and quality of life (QoL) in individuals with cataracts. Both cataract and AMD are conditions that occur in late age. However, the presence of AMD may complicate the postoperative outcomes and QoL of these patients. This review aims to examine the impact of cataract surgery on the QoL of patients with AMD.
 Methods : A search of the literature was conducted using electronic databases. Studies were included if they evaluated QoL outcomes in patients with AMD who underwent cataract surgery.
 Results : The results of the review suggest that cataract surgery can improve visual acuity and QoL in patients with AMD. However, the degree of improvement is influenced by the severity of AMD. Patients with mild to moderate AMD tended to have greater improvements in QoL and visual acuity compared to those with advanced AMD. Incidentally, it is still cost effective to perform cataract surgery in patients with advanced AMD.
 Conclusion : Overall, patients with AMD who underwent cataract surgery experienced improvements in their QoL. Nevertheless, individual characteristics including severity of AMD must be considered to optimize the procedure outcomes. Further research, particularly with longer follow up times, is needed to determine the long-term effects of cataract surgery on QoL in patients with AMD.

QUALITY OF LIFE AFTER CATARACT SURGERY IN PATIENTS WITH AGE-RELATED MACULAR DEGENERATION: A LITERATURE REVIEW

Objective: Age-related macular degeneration (AMD) is a common ocular disease that affects millions of people worldwide. Cataract surgery is one of the most performed surgical procedures in the world and is effective to improve visual function and quality of life (QOL) in individuals with cataracts. Both cataract and AMD are conditions that occur in late age. However, the presence of AMD may complicate the postoperative outcomes and quality of life (QOL) of these patients. This review aims to examine the impact of cataract surgery on the QOL of patients with AMD. Methods: A search of the literature was conducted using electronic databases. Studies were included if they evaluated QOL outcomes in patients with AMD who underwent cataract surgery. Result: The results of the review suggest that cataract surgery can improve visual acuity and QOL in patients with AMD. However, the degree of improvement is influenced by the severity of AMD. Patients with mild to moderate AMD tended to have greater improvements in QOL and visual acuity compared to those with advanced AMD. Incidentally, it is still cost effective to perform cataract surgery in patients with advanced AMD. Conclusion: Overall, cataract surgery is found to be able to improve QOL and visual acuity in patients with AMD. Nevertheless, individual characteristics including severity of AMD must be considered to optimize the outcomes. Further research, particularly with longer follow up times, is needed to determine the long-term effects of cataract surgery on QOL in patients with AMD.

Corneal Rigid Gas Permeable Contact Lens in Corneal Scarring: a Case Report

Introduction : Corneal scarring is part of corneal wound healing response to injury, surgery, or infection to the cornea. Corneal scarring causes significant visual reduction. This case report highlights visual acuity (VA) improvement in patient with corneal scarring following rigid glass permeable contact lens (RGP-CL)
 Case Illustration : A 25 year-old male presented blurry vision in right eye (RE) due to trauma. His VA was 3/60 on RE and 6/6 on left eye (LE). The best corrected visual acuity (BCVA) of RE was 6/45 (S-1.25 C-5.00 X 180°). Slit lamp examination of RE showed corneal scarring in central area and deep neovascularization. Keratometry readings obtained 39.50D (8.48mm) at 170 degree and vertical curvature of 44.00D (7.68mm) at 80 degree, with markedly irregular mires of RE. A trial fitting was performed for RE by using tisilfocon A lens with base curve of 8.30 mm, power S-4.00D and diameter 9.20 mm. The over-refraction with trial lens obtained a total refractive error of S-6.00 with cylindrical correction neutralize with RGP. The achieved BCVA by over-refraction was 6/45 with comfortable fit.
 Discussion : Rigid permeable lens (RGP) is an option in dealing with irregular astigmatism due to corneal scarring. The RGP fitting works best especially when the corneal scarring is not in the center of visual pathway. Rigid lens works by providing tear-lens power and creating smooth surface to neutralize the irregular cornea. Good RGP-CL fitting could help patient with corneal carring gain better VA.
 Conclusion : Good rigid permeable contact lens fitting could help patients with corneal scarring gain better VA.

Treatment of Vitreous Hemorrhage due to Proliferative Diabetic Retinopathy in Cipto Mangunkusumo Hospital During Pandemic Era (March 2020 - March 2022)

Introduction & ObjectivesProliferative diabetic retinopathy (PDR) is the most common etiology for vitreous hemorrhage (VH)and can be sight-threatening. Current treatment modalities for VH in PDR included anti-VEGFinjection, panretinal photocoagulation (PRP) laser, and vitrectomy. We conducted study to evaluatetreatment modalities and outcomes of VH in PDR during the pandemic era.
 MethodsA retrospective study of VH in PDR was conducted at Cipto Mangunkusumo Hospital, Indonesia,from March 2020 to March 2022. Primary treatment was the therapy planned at the initial visit,while secondary treatment was subsequent treatment after follow-ups. Good anatomical outcomewas defined as vitreous clearing at last follow-up, while functional outcome was visual acuity (VA)improvement in LogMAR.
 ResultsThis study included 83 patients (97 eyes), which is smaller than the previous study in our centerbefore the pandemic. Mean age was 54,28±8,57 years, with almost equal males and females. InitialVA was LogMAR 2,48 (0,15 – 2,80). The most frequent treatment for VH in PDR was vitrectomy(53,5%), followed by anti-VEGF injection, PRP laser, and observation. Glaucoma after vitrectomy wasthe most common complication (5,2%). Vitreous clearing was achieved in 85,5% of cases, which wassignificantly associated with vitrectomy surgery (p=0,013) and initial treatment time (p=0,023). TheVA improvement was LogMAR -0,48(-2,48–2,40) which was related to initial VA (p<0.05), yet therewas no significant association with treatment modality.
 ConclusionVitrectomy is essential to achieve vitreous clearing in VH caused by PDR. Initial visual acuity, notthe type of treatment modality, is a significant factor in vision improvement.

Sympathetic ophthalmia following corneal patch graft for corneal perforation

Introduction : Sympathetic ophthalmia (SO) is a rare, bilateral, diffuse granulomatous uveitis that usually occurs after open globe injury or intraocular surgery. We report a rare case of SO after the closure of corneal perforation using a corneal patch graft.
 Case Illustration : A 12 year old boy diagnosed as corneal perforation in the right eye, with visual acuity (VA) 20/100, underwent a corneal patch graft. He presented with redness and decreased vision in both eyes 2 weeks after surgery. The patient had VA of hand movements in the RE and 20/200 in the LE. Anterior segment examination showed a corneal patch graft with iris adherent to the graft posteriorly in RE, endothelial dusting, 2+ cells in both eye. Fundus examination showed optic disc oedema in both eye and inferior retinal detachment with macular involvement in RE. The patient was managed with pulse steroids for three days followed by oral steroids in tapering doses along with continued topical steroids. Three months follow-up showed improvement of VA to 20/60 in RE and 20/25 in LE
 Discussion : SO is thought to be an autoimmune response to uveal injury. The incarceration of uveal tissue in the wound is a major risk factor. SO has been reported 5 days to 66 years after penetrating insult to the eye. In this case, incarceration of uvea in corneal pacth resulted in SO 2 weeks after surgery.
 Conclusion : In a case of a perforated cornea, the possibility of iris incarceration in the wound is high and hence SO can develop

The Comparison of Visual Acuity between Spectacles and Rigid Gas Permeable (RGP) Group in Myopia Patients

Introduction & Objectives : The prevalence of myopia has approximately doubled in the past three decades, with rates of 70–87% among populations of school children and young adults in Asia. Approaches to treating myopia include spectacles and Rigid Gas Permeable (RGP) contact lenses. RGP has become a new "preference" because it is more comfortable and provides a more aesthetic look. This study aims to determine which method is better for correcting visual acuity in myopia patients.
 Methods : This cross-sectional study analyzed the outcomes and exposures measured at the same time. The sample included myopia patients (based on spherical equivalent) who underwent RGP contact lens fitting in the refraction outpatient clinic of M Djamil Hospital from January 2021 to December 2022. The samples were selected based on inclusion and exclusion criteria. The collected data included gender, age, and best-corrected visual acuity using spectacles and RGP.
 Results : Forty-three patients were eligible as the sample in this study. Most of the subjects were women (62.8%), and the mean age was 23.58 years old. The median LogMAR for the RGP group was lower than the spectacles group (0.00:0.10 on both eyes). Statistical analyses found a significant visual acuity improvement in the RGP group compared to the spectacles group in both the right and left eyes (p = 0.014 and p = 0.005, respectively (p < 0.05)).
 Conclusion : The use of RGP provides significantly better visual acuity in correcting myopia than spectacles. Myopia is more frequently found in young women.

A Watchful Eye: A Case Report on The Management of Hypotony Maculopathy after Non-Valved Glaucoma Drainage Device Implantation

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.