Sriwijaya Journal of Ophthalmology (SJO) is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations.
Department of Ophthalmology, Faculty of Medicine, Universitas Sriwijaya
Machine Learning Prediction of Binocular Vision Recovery in Accommodative Esotropia: A Prospective Multicenter Study
Introduction: Accommodative esotropia is the most common childhood convergent strabismus, yet predicting binocular vision recovery after treatment remains challenging. This study developed and validated machine learning (ML) models to predict binocular vision recovery using baseline clinical parameters. Methods: This prospective multicenter study enrolled 156 patients (aged 2–12 years) with accommodative esotropia across three private hospitals in Indonesia. The unit of analysis was patients. Baseline binocular vision parameters were used to train four ML models (gradient boosting, random forest, neural network, logistic regression) with 5-fold stratified cross-validation. Treatment success was defined as stereoacuity ≤100 arc seconds at 12 months. Model performance was evaluated using AUC-ROC and SHAP feature importance. Results: Treatment success was achieved in 104 patients (66.7%). Gradient boosting achieved the highest AUC of 0.903 (95% CI: 0.854–0.952; sensitivity 0.875; specificity 0.827). The strongest predictors were baseline stereoacuity ≤400 arc seconds (OR = 4.15; p < 0.001), deviation angle ≤20 PD (OR = 3.42; p < 0.001), and Worth 4-dot fusion (OR = 3.21; p = 0.001). Conclusion: ML models accurately predicted binocular vision recovery in accommodative esotropia, identifying clinically interpretable predictors that may optimize treatment selection in pediatric strabismus management.
Sustained Anti-VEGF Delivery via Hydrogel Implant Achieves Non-Inferior Visual and Anatomical Outcomes in Neovascular AMD: A 24-Month Randomized Controlled Trial
Introduction: Neovascular age-related macular degeneration (nAMD) requires frequent anti-VEGF intravitreal injections, creating substantial treatment burden. This study compared the 24-month efficacy and safety of a sustained-release anti-VEGF hydrogel implant versus monthly ranibizumab in treatment-naive nAMD eyes. Methods: This prospective randomized controlled trial enrolled 126 eyes (96 patients; 30 bilateral) with treatment-naive nAMD at a private hospital in Palembang, Indonesia (January 2022–December 2024). Eyes were randomized 1:1 to a biodegradable anti-VEGF hydrogel implant (n=64) or monthly ranibizumab 0.5 mg (n=62). The primary outcome was non-inferiority of the mean best-corrected visual acuity (BCVA) change (LogMAR) at 24 months (margin: 0.10 LogMAR). Analyses used linear mixed-effects models with generalized estimating equations to account for inter-eye correlation. Results: Mean BCVA improved by −0.24±0.18 LogMAR (≈12 letters) in the hydrogel group and −0.22±0.20 LogMAR (≈11 letters) in the ranibizumab group (difference: −0.02; 95% CI: −0.09 to 0.05; p=0.578; non-inferiority confirmed). The hydrogel group required 77.8% fewer injections (4.8±1.2 vs 21.6±3.4; p<0.001). Safety profiles were comparable. Conclusion: The sustained-release anti-VEGF hydrogel implant achieved non-inferior visual and anatomical outcomes versus monthly ranibizumab while reducing injection burden by 77.8% over 24 months. Multicenter validation is warranted.
Safety and Efficacy of Subretinal AAV-CRISPR/Cas9 Gene Editing for Rhodopsin-Mutant Retinitis Pigmentosa: A Phase I/IIa Dose-Escalation Triall
Introduction: Autosomal dominant retinitis pigmentosa (adRP) from rhodopsin (RHO) mutations lacks an approved gene therapy. This Phase I/IIa trial evaluated subretinal AAV5-CRISPR/Cas9 for RHO-adRP. Methods: An open-label, 3+3 dose-escalation design with expansion at the recommended Phase II dose (RP2D) was used. Eighteen patients (18 study eyes; one eye per patient) received subretinal AAV5-CRISPR/Cas9 at low (1.5×1010 vg, n = 3), mid (5.0×1010 vg, n = 3), or high (1.5×1011 vg, n = 6) doses, plus an expansion cohort (n = 6) at RP2D, at a private hospital in Palembang, Indonesia. The primary endpoint was dose-limiting toxicities (DLTs); secondary endpoints were BCVA (LogMAR), SD-OCT ellipsoid zone (EZ) width, microperimetry, and ffERG. Results: No DLTs occurred. The high-dose cohort showed a BCVA improvement of −0.14 LogMAR (95% CI −0.22 to −0.06, p = 0.003; Cohen d = 1.82), an EZ width increase of +312 µm (95% CI +187 to +437, p < 0.001; d = 2.45), and a microperimetry gain of +3.8 dB (95% CI +2.1 to +5.5, p < 0.001; d = 1.94). Dose-response trends were significant (Jonckheere–Terpstra p-trend: BCVA 0.008, EZ 0.002). Conclusion: Subretinal AAV5-CRISPR/Cas9 demonstrated acceptable safety with dose-dependent structural and functional improvements at 12 months. Phase II/III trials are warranted.
Diagnostic Accuracy of a Federated Learning Algorithm for Proliferative Diabetic Retinopathy Detection: A Multicenter Indonesian Study
Introduction: Proliferative diabetic retinopathy (PDR) remains a leading cause of preventable blindness in resource-limited settings. Federated learning (FL) enables collaborative artificial intelligence (AI) model training without sharing patient data. This study evaluated the diagnostic accuracy of an FL-based algorithm for PDR detection across three Indonesian ophthalmology centers. Methods: This multicenter, prospective, diagnostic accuracy study enrolled 512 eyes from 289 patients with type 2 diabetes at three private hospital ophthalmology clinics in Palembang, Jakarta, and Surabaya, Indonesia (January 2023–December 2024). All eyes underwent standardized fundus photography, spectral-domain optical coherence tomography, and comprehensive ophthalmic examination. The FL-based deep learning algorithm was evaluated against two independent retinal specialists using the International Clinical Diabetic Retinopathy classification. Primary outcomes were sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Results: The FL-based AI achieved a sensitivity of 94.6% (95% CI 81.8–99.3), specificity of 91.2% (95% CI 88.2–93.6), and AUC of 0.962 (95% CI 0.943–0.981) for PDR detection. Agreement with retinal specialists was substantial (κ = 0.87). Performance was consistent across centers (AUC 0.955–0.968; p = 0.841). Media opacity was the strongest predictor of misclassification (OR 3.42; 95% CI 1.87–6.25; p < 0.001). Conclusion: The FL-based AI demonstrated high diagnostic accuracy for PDR detection comparable to retinal specialists across multiple Indonesian centers. This privacy-preserving approach may facilitate scalable diabetic retinopathy screening in resource-limited ophthalmology settings.
Continuous 24-Hour Intraocular Pressure Monitoring with a Smart Contact Lens Predicts Visual Field Progression in Normal-Tension Glaucoma
Introduction: Normal-tension glaucoma (NTG) may progress despite normal office intraocular pressure (IOP), suggesting that 24-hour IOP dynamics captured by a smart contact lens (SCL) sensor may improve risk stratification. This study evaluated whether SCL-derived nocturnal IOP parameters independently predict Humphrey 24-2 visual field (VF) progression in NTG. Methods: This prospective observational cohort enrolled 62 NTG eyes (62 patients; one eye per patient) who underwent 24-hour SCL monitoring and serial Humphrey 24-2 SITA-Standard VF testing over 24 months at a private hospital in Palembang, Indonesia. The primary outcome was VF mean deviation (MD) slope (dB/year). Multivariable linear regression and receiver operating characteristic (ROC) analysis were performed. Results: Eyes with a nocturnal IOP acrophase (n = 36) had a significantly faster MD decline (−1.24 ± 0.31 dB/year) than eyes without acrophase (n = 26; −0.42 ± 0.19 dB/year; mean difference −0.82 dB/year, 95% CI −0.97 to −0.67, p < 0.001; Cohen d = 3.20). Independent predictors of MD slope were nocturnal acrophase (β = −0.71, p < 0.001), number of long peaks (β = −0.18, p < 0.001), and baseline RNFL thickness (β = +0.034, p = 0.002); adjusted R² = 0.64. Nocturnal amplitude yielded an AUC of 0.83 (95% CI 0.74–0.91). Conclusion: SCL-derived nocturnal IOP parameters independently predict VF progression in NTG. Integration of 24-hour SCL monitoring may enhance risk stratification beyond office IOP measurement.
Retinal Microvascular Changes on OCT-Angiography in Preclinical Alzheimer’s Disease: A Prospective Indonesian Cohort Study
Introduction: Preclinical Alzheimer’s disease (AD) involves cerebral amyloid deposition in cognitively normal individuals 15–20 years before symptom onset. Optical coherence tomography angiography (OCT-A) may detect early retinal microvascular changes reflecting cerebral pathology. This study evaluated OCT-A parameters as biomarkers for preclinical AD in Indonesian elderly. Methods: This prospective cohort enrolled 180 cognitively normal participants aged ≥60 years (90 preclinical AD with amyloid-PET positivity, 90 controls) at two private hospital ophthalmology clinics in Palembang and Jakarta, Indonesia (January 2022–June 2024). OCT-A (RTVue XR Avanti) measured superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density, foveal avascular zone (FAZ) area, and perfusion density. SD-OCT assessed RNFL and GCL-IPL thickness. The unit of analysis was the individual eye (342 eyes after quality exclusion). Results: SCP vessel density was significantly reduced in preclinical AD (43.2 ± 3.1% vs 47.8 ± 2.9%; Bonferroni-adjusted p < 0.001; Cohen’s d = 1.53). FAZ area was enlarged (0.38 ± 0.08 vs 0.31 ± 0.06 mm²; p < 0.001). The combined model (SCP + FAZ + GCL-IPL) achieved a bootstrap-validated AUC of 0.898 (95% CI: 0.859–0.937). SCP vessel density was the strongest predictor (OR 0.72; 95% CI: 0.63–0.82; p < 0.001). Conclusion: OCT-A parameters, particularly SCP vessel density, demonstrated strong discriminative ability for preclinical AD. These findings support OCT-A as a potential non-invasive screening biomarker, warranting validation in community-based populations.
Dissociated Therapeutic Regimen: Systemic Corticosteroids and Topical Natamycin in Traumatic Fungal Keratitis
Introduction: Penetrating ocular trauma complicated by secondary fungal keratitis presents a fundamental inflammatory paradox in ophthalmology. While corticosteroids are clinically imperative to suppress trauma-induced fibrinoid syndrome and prevent phthisis bulbi, they are traditionally contraindicated in active mycotic infections due to the risk of potentiating fungal proliferation. This report evaluates a dissociated therapeutic protocol utilizing systemic corticosteroids alongside topical antifungals to navigate this therapeutic impasse. Case presentation: We present the case of a 26-year-old male sustaining a penetrating corneal injury from a metallic nail. Following primary repair, the patient developed a severe anterior chamber reaction with Standardization of Uveitis Nomenclature (SUN) Grade 3+ cells and a corneal infiltrate exhibiting feathery margins. Potassium Hydroxide 10% wet mount confirmed the presence of fungal hyphae. A dissociated therapeutic regimen was initiated: intensive topical Natamycin 5% administered hourly to target the ocular surface infection, synchronized with oral Methylprednisolone (24 mg/day; 0.4 mg/kg) to control intraocular inflammation via the systemic circulation. The regimen successfully decoupled the immune response. Intraocular inflammation resolved within 14 days, preventing the formation of permanent synechiae or cyclitic membranes. The fungal infection was eradicated, confirmed by negative serial corneal smears and the clinical resolution of the infiltrate into a stable leucoma. Visual acuity improved from Hand Motion (LogMAR 2.30) at presentation to 6/45 (LogMAR 0.88) at Day 35. No fungal recurrence was observed during the follow-up period. Conclusion: A dissociated strategy using intermediate-dose systemic corticosteroids to manage internal inflammation, while reserving the ocular surface for aggressive topical antifungal therapy, may offer a viable strategy for globe salvage in complex traumatic fungal keratitis cases where standard protocols are undefined.
Navigating Therapeutic Challenges in Adult-Onset Coats' Disease: Successful Vitrectomy for Tractional Retinal Detachment Following Laser Photocoagulation
Introduction: Adult-onset Coats' disease, an infrequent variant of idiopathic exudative retinopathy, presents a unique management paradigm. While laser photocoagulation is a primary treatment for the characteristic retinal telangiectasia, it can paradoxically trigger a severe inflammatory and fibrotic cascade, leading to vision-threatening complications. This report addresses a critical clinical question: What is the optimal management strategy when first-line ablative therapy not only fails but leads to iatrogenic tractional retinal detachment? Case presentation: A 35-year-old male presented with a 15-day history of metamorphopsia in his right eye. Best-corrected visual acuity (BCVA) was 20/20. Multimodal imaging confirmed Stage 2B Coats' disease. Following sectoral argon laser photocoagulation, his BCVA declined to a nadir of 20/60. Within two months of laser, optical coherence tomography (OCT) documented the rapid development of an epiretinal membrane and a subsequent superior macular tractional retinal detachment (TRD). A 23-gauge pars plana vitrectomy (PPV) with membrane peeling was performed. Anatomical success was achieved, and at the six-month follow-up, the retina remained attached, and BCVA improved to 20/40. Conclusion: This case demonstrates that laser-induced inflammation can rapidly convert an exudative process into a complex fibro-proliferative state in adult-onset Coats' disease. When confronted with iatrogenic fibrosis, medical management is insufficient. This report validates that timely and definitive surgical intervention with PPV is not merely an option but an essential strategy for reversing the disease trajectory, achieving anatomical restoration, and salvaging vision.
Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Retinopathy of Prematurity: A Systematic Review
Introduction: Retinopathy of prematurity (ROP) remains a leading cause of childhood blindness, with its pathogenesis linked to aberrant vascular development and systemic inflammation. There is a critical need for accessible biomarkers to improve risk stratification beyond current screening standards. This systematic review critically appraises the evidence for the neutrophil-to-lymphocyte ratio (NLR), a widely available inflammatory marker, as a predictor of ROP. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, ScienceDirect, ProQuest, and SpringerLink for observational studies published between January 1st, 2015, and December 31st, 2024. Studies assessing the association between NLR and ROP in preterm infants were included. Two reviewers independently performed study selection, data extraction, and a formal risk-of-bias assessment using the Newcastle-Ottawa Scale (NOS). A narrative synthesis was performed due to significant heterogeneity. Results: The search identified 32 records, with 6 retrospective studies ultimately meeting the inclusion criteria, encompassing a total reported sample of 1,065 infants. The methodological quality of the included studies was low to moderate, with NOS scores ranging from 5 to 7 out of a possible 9. The evidence base was defined by profound methodological heterogeneity, particularly in the timing of blood sample collection, which was unspecified in half of the studies, and inconsistent reporting of core population data. A narrative synthesis of the findings showed that several studies reported a statistical association between an elevated NLR or related inflammatory markers and ROP. However, one study reported no significant association, and the interpretation of others was complicated by a focus on different biomarkers or a lack of statistical significance. Conclusion: The available evidence, derived exclusively from retrospective studies of varying quality, suggests a possible association between elevated NLR and ROP, a link supported by strong biological plausibility. However, the current evidence base is severely limited by methodological flaws and profound heterogeneity, making it insufficient to support the adoption of NLR into clinical practice. NLR is not a standalone diagnostic or predictive tool for ROP. Its potential utility can only be realized through large-scale, methodologically rigorous prospective studies designed to overcome the limitations identified in this review.
Eyelid Squamous Cell Carcinoma in Palembang, Indonesia: A 5-Year Retrospective Study
Introduction: Eyelid squamous cell carcinoma (SCC) is a prevalent malignancy with potentially severe consequences if not detected and managed early. This study aimed to investigate the prevalence, clinical characteristics, and histopathological features of eyelid SCC patients at Dr. Mohammad Hoesin General Hospital Palembang, Indonesia, over a 5-year period. Methods: A retrospective analysis of medical records was conducted on 20 patients diagnosed with eyelid SCC between 2020 and 2024. Data on demographics, clinical presentation, tumor characteristics, and histopathological findings were collected and analyzed. Univariate analysis was performed to describe the characteristics of the study population. Correlation tests were conducted to explore the relationships between various factors and eyelid SCC. Results: The prevalence of eyelid SCC was 16.67%, with the highest incidence in 2024 (25%). The majority of patients were ≥ 50 years old (60%), with an equal distribution between males and females. Outdoor occupations (45%) and lower education levels (60% with primary education) were common characteristics. Lesions were mostly multiple (45%), >3cm in size (55%), and located on the right side (60%). Histopathological analysis revealed well-differentiated (25%) and poorly differentiated (25%) SCC as the most common subtypes. Correlation analysis revealed significant associations between age and tumor size, occupation and tumor size, education level and tumor size, smoking status and differentiation, tumor size and lymphovascular invasion, and perineural invasion and differentiation. Conclusion: Eyelid SCC in Palembang predominantly affects older individuals with outdoor occupations and lower education levels. Multiple, large, and right-sided lesions are frequent findings. Emphasis on sun protection and early detection is crucial, particularly for outdoor workers.
Predicting Glaucoma Progression with Artificial Intelligence: A Meta-Analysis of Machine Learning Models
Introduction: Glaucoma, a leading cause of irreversible blindness, requires early detection and prediction of progression to preserve vision. Artificial intelligence (AI) offers promising tools for analyzing complex ophthalmic data and identifying high-risk individuals. This meta-analysis evaluates the performance of machine learning (ML) models in predicting glaucoma progression. Methods: A systematic search of PubMed, Scopus, and Web of Science databases was conducted for studies published between 2013 and 2024 that investigated the use of ML models to predict glaucoma progression. Studies reporting performance metrics like sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and accuracy were included. Results: Six studies met the inclusion criteria, encompassing 1,250 participants. The pooled sensitivity and specificity of ML models for predicting glaucoma progression were 0.81 (95% CI: 0.78-0.84) and 0.77 (95% CI: 0.73-0.81), respectively. The pooled AUC was 0.88 (95% CI: 0.86-0.90), indicating excellent discriminatory ability. Conclusion: ML models hold significant potential for predicting glaucoma progression with high accuracy. Further research with larger, more diverse datasets is needed to validate these findings and develop clinically applicable tools.
Shifting Patterns of Ocular Emergencies: A Comparative Study in Basrah, Iraq
Introduction: Ocular emergencies present a significant public health concern, potentially leading to vision loss if not addressed promptly. Understanding the dynamics of these emergencies is essential for effective healthcare planning and resource allocation. This study aimed to analyze the trends and characteristics of ocular emergencies in Basrah, Iraq, and compare them with historical data. Methods: A retrospective study was conducted at Al-Sayab Teaching Hospital in Basrah, involving 250 patients presenting to the ophthalmology emergency department between January 1st, 2023, and December 31st, 2023. Data regarding demographics, presentation time, causes of emergencies, and visual acuity were analyzed. Results: The leading causes of ocular emergencies were inflammatory diseases (32%), trauma (28%), and foreign bodies (33.2%). A significant proportion of patients (20%) presented with severe visual impairment (less than 20/200). Most emergencies occurred in males (72.4%), primarily in the 20-40 year age group. Conclusion: The study highlights a high prevalence of inflammatory diseases and trauma among ocular emergencies in Basrah. Public health interventions should focus on preventing ocular trauma and improving access to eye care services. Continuous monitoring of these patterns is crucial for effective public health planning.
Refractive Error Correction in Bali, Indonesia: A Retrospective Cohort Study of ReLEx SMILE and Femto-LASIK Outcomes
Introduction: Technological advances have driven progress in surgical techniques for refractive problems, including the use of laser-assisted in situ keratomileusis (LASIK) through the ReLEx SMILE and Femto-LASIK methods. While Bali Mandara Eye Hospital pioneered LASIK procedures in Bali Province, there has been no research to date evaluating the outcomes of these procedures. Methods: This retrospective cohort study analyzed medical record data from patients with refractive disorders who underwent LASIK surgery at Bali Mandara Eye Hospital between January and December 2023. The data collected included patient demographics, pre-and post-operative visual acuity, and the type of LASIK surgery performed. Results: The study included 151 eyes. The majority of patients were male (52.3%), aged 17-29 years, had a college education (60.3%), worked in the private sector (38%), resided in Bali (86%), and underwent the ReLEx SMILE procedure (60.3%). Both Femto-LASIK and ReLEx SMILE procedures yielded excellent visual outcomes and were considered safe. Post-operative uncorrected visual acuity (UCVA) improved to the level of pre-operative best-corrected visual acuity (BCVA) in 137 eyes (90.73%). Conclusion: The ReLEx SMILE and Femto-LASIK methods are both safe and effective procedures for correcting refractive errors, particularly mild myopia. There was no significant difference in visual outcomes between the two methods.
Computer Vision Syndrome in High School Students: The Role of Gadget Use Intensity
Introduction: The ubiquity of digital devices in the lives of high school students has raised concerns about the potential impact on their visual health. Computer vision syndrome (CVS), a constellation of eye and vision-related problems, has been linked to prolonged digital screen use. This study aimed to investigate the relationship between gadget use intensity and the prevalence and severity of CVS in high school students. Methods: A cross-sectional study was conducted involving a sample of high school students. Data on gadget use intensity (hours per day) and CVS symptoms were collected through validated questionnaires. The Computer Vision Symptom Scale (CVSS) was used to assess the severity of CVS. Statistical analyses were performed to examine the association between gadget use intensity and CVS prevalence and severity. Results: The study found a significant positive correlation between gadget use intensity and the prevalence and severity of CVS in high school students. Students who reported higher levels of gadget use were more likely to experience CVS symptoms and exhibit greater symptom severity. Conclusion: The findings underscore the importance of promoting healthy gadget use habits among high school students. Interventions aimed at reducing screen time and encouraging regular breaks may be crucial in mitigating the risk of CVS and its associated visual discomfort.
Risk Factors and Management Strategies for Dry Eye Syndrome: A Comparative Study
Introduction: Dry eye syndrome (DES) is a prevalent multifactorial ocular surface disorder characterized by discomfort, visual disturbances, and tear film instability. This study aimed to investigate the risk factors associated with DES and compare the effectiveness of various management strategies. Methods: A cross-sectional comparative study was conducted at an ophthalmic consultant clinic from March 2023 to October 2023. One hundred patients diagnosed with DES were enrolled. Demographic data, including age, gender, and body mass index (BMI), were collected. Ophthalmological examinations, including slit-lamp examination, non-contact tonometry, fundus examination, tear break-up time (TBUT) measurement, and ocular surface disease index (OSDI) questionnaire assessment, were performed. The management strategies employed were categorized as medical, surgical, or a combination of both. Results: The study population predominantly consisted of females (70%) with a mean age of 49.65 years. The majority of patients (57%) fell within the overweight BMI category (25-29 kg/m2). TBUT values of 7 seconds and 8 seconds were most prevalent (35% and 37%, respectively), and the majority of patients (65%) reported an OSDI score of 2. Notably, two-thirds of patients received medical treatment, one-third underwent a combination of medical and surgical treatment, and a small proportion (5%) underwent surgery alone. Conclusion: Female gender, increased BMI, and older age were identified as significant risk factors for DES. Patients with DES symptoms exhibited shorter TBUT values and higher OSDI scores, indicating tear film instability and increased disease severity. Medical treatment was the most common management strategy, followed by a combination of medical and surgical interventions. These findings underscore the importance of early diagnosis and individualized treatment plans for effective DES management.
An Investigation of Keratoplasty Procedures and Their Outcomes in Iraq
Introduction: The treatment of corneal disorders involves the use of various forms of keratoplasty. The objective of this study was to provide a detailed description of the various types of keratoplasty procedures performed in Iraq, as well as their corresponding outcomes. Methods: An observational study was conducted at Al-Zahraa Teaching Hospital to document cases of keratoplasty. The collected data included age, gender, types of keratoplasty, indications, previous surgical or medical history, and postoperative outcomes. The types of keratoplasty included penetrating keratoplasty (PKP), deep anterior lamellar keratoplasty (DALK), and Descemet's stripping endothelial keratoplasty (DSEK). Additionally, we performed cataract surgery and intraocular lens (IOL) insertion for those with cataracts, using either IOLs with scleral fixation or IOLs with iris fixation. We complete the task on the first day following the purchase order, then the first week, the first month, and every six months thereafter. Prior to surgery, patients with corneal vascularization had laser photocoagulation of the blood vessels in the cornea. Results: Ages range from 4 to 90. People over 40 (60.8%) were the most common age group. The female prevalence was 52.9%. Right-eye illness was diagnosed 51.6% of the time. 60% of patients underwent PKP. 26.8% had DALK, 12.4% had DSEK. Post keratoplasty, the statistically-significant improvement-ratio was 68.5% as eyes best corrected visual acuity (BCVA) improvement, while 12.2% of eyes showed a decline in BCVA and 19.3% discharged with no changes in BCVA. Postoperatively, BCVA was significantly lower in cases with a duration below 1 year (1.5), and better among the duration > 3 years (0.5). The greatest improvements were seen in cases with infective keratitis (-0.7), corneal dystrophies (-0.6), and advanced keratoconus (-0.7) whereas the lowest rates were documented in cases with a graft rejection (-0.3), and bullous keratopathy (-0.3) Conclusion: Keratoplasty is associated with a substantial enhancement of visual acuity in the younger population. Infective keratitis, keratoconus, and corneal dystrophy produce the most optimal and superior results. The PKP method is the most frequently performed.
Impact of COVID-19 on Preventable Blindness Detection in Bali, Indonesia
Introduction: WHO, and the Indonesian government, have agreed to a plan to eradicate preventable blindness by 2020 in VISION 2020. However, the COVID-19 pandemic has caused a strain on the healthcare system. It is difficult to assess the impact of the pandemic on preventable blindness. Here we approach the issue by evaluating hospital visits for visual impairments in one regency in Bali, Indonesia. Methods: We collected outpatient visit records from three hospitals providing ophthalmologic clinics in Tabanan, Bali, Indonesia, a regency of 445 thousand people. We then conducted a descriptive analysis of the general changes in outpatient visits to these clinics and changes observed in different diagnoses identified as causes for preventable blindness. Results: The result showed a 35% downtrend in outpatient visits to the ophthalmologic clinic throughout the provinces. A more pronounced downtrend (45.22%) was observed for one public hospital that also serves as a COVID-19 referral hospital compared to private hospitals (around 30% each). By diagnoses, visits for cataracts were shown with a less severe downtrend compared to glaucoma, pterygium, and refractive disorders. Conclusion: Our study found a downtrend in outpatient visits for visual impairment in ophthalmologic clinics, which may be attributed to COVID-19 preventive measures by the hospital as well as patient reluctance due to fear of COVID-19 transmission. Public health communication needs to address this fear to recover patient confidence while maintaining vigilance in practicing COVID-19 preventive behavior.
Prevalence and Analysis of Risk Factors for Cataracts in Jember Regency, Indonesia
Introduction: Cataracts are the leading cause of preventable blindness. This study aims to determine the prevalence of cataracts and analyze the risk factors for cataracts in Jember Regency. Methods: The research design is observational research with a cross-sectional approach. The study carried out eye examinations on 1000 adults (≥50 years) who were randomly selected in Jember Regency. Risk factors analyzed included age, gender, education, occupation, smoking, and history of diabetes mellitus and hypertension. Results: The prevalence of cataracts in Jember Regency is 25.3%. Risk factors associated with the incidence of cataracts are age (OR=1.35; 95%CI: 1.02-1.98), female gender (OR=1.54; 95%CI: 1.12-2.13), low education (OR=1.83; 95%CI: 1.22-2.73), outdoor work (OR=3.72; 95%CI: 1.14-5.58), smoking (OR=1.42; 95%CI: 1.01-2.00), and history of diabetes mellitus (OR=2.15; 95%CI: 1.43-3.24). Conclusion: The prevalence of cataracts at ages ≥ 50 years in Jember Regency is quite high. Age, female gender, low education, outdoor work, smoking, and a history of diabetes mellitus are risk factors for cataracts.
Management of Wet Age-Related Macular Degeneration: A Case Report
Introduction: Age-related macular degeneration (AMD) is a progressive neurodegenerative disease of the photoreceptors and retinal pigment epithelium (RPE). It is a leading cause of blindness and visual impairment in the elderly population, despite recent advances in treatment. We reported a case of wet AMD and its management. Case Presentation: A 69 years old woman complained of blurred vision, especially in the left eye, which she had experienced since 3 years ago, progressively worsen since the last 3 months. Fundoscopy and OCT examination was done. Fundoscopy found no foveal reflex with a drusen and perifoveal haemorrhage found on left eye. She was diagnosed with wet age-related macular degeneration type II of left eye. She had done intravitreal anti-VEGF injection with local anaesthesia. Conclusion: AMD management relies heavily on observation, lifestyle changes, frequent follow-up evaluations, early recognition of visual impairment and detection of CNV. Meanwhile, the current modality for wet AMD therapy is intravitreal anti-VEGF injection to preserve patient’s visual acuity and improve quality of life.
A 39-Year-Old Woman with Oculodermal Melanocytosis: A Case Report
Introduction: Nevus of Ota, also known as oculodermal melanocytosis (ODM), is characterized by macular pigmentation which localized to the forehead and periocular area. It usually shows a dermatomal distribution from the first two branches of the trigeminal nerve. We reported a case of oculodermal melanocytosis (ODM). Case presentation: A 39-year-old woman, came with complaints of her left eye rolling inwards for the past 5 years accompanied by a flat black spot on her forehead that spread to her left cheek. She was done macular OCT and orbital ultrasonography of the left eye. She was diagnosed with oculodermal melanocytosis in the left eye, moderate NPDR in both eyes, juvenile cataracts in both eyes, and esotropia in the left eye due to left-eye cranial nerve VI paralysis. Follow-up at 6 months was advised to the patient. Conclusion: Although this is a benign condition, patients are at risk of developing complications such as increased intraocular pressure and melanoma of the skin and/or uvea, ongoing evaluation with imaging methods is highly recommended even if only skin lesions may be repaired using laser for cosmetic reasons.
Epiretinal Membrane Management for Young Adult Patient: A Case Report
Introduction: Epiretinal membrane (ERM) is a condition where a thin fibrotic tissue layer appears on the surface of the macula, which causes a decrease in visual acuity. There are still limited data about the management of ERM due to its low incidence. We reported a case of epiretinal membranes in young adult patients. Case presentation: A 40-year-old male complained of blurry vision on the left eye since 6 months ago. His visual acuity was reduced, and a fundus photograph and macula OCT examination were performed. He was diagnosed with left eye epiretinal membrane and planned for left eye membrane peeling. The retinal break was found intraoperatively as a suspected predisposing factor. Conclusion: Management of severe ERM focuses on reducing metamorphopsia, improving visual acuity, and improving binocularity with pars plana vitrectomy combined with membrane peeling. At a young age, the predisposing factors for secondary development must be further identified.
The Relationship between Eyestrain and the Occurrence of Floaters in Kalam Kudus Senior High School
Introduction: Floaters, or particles that appear to float in the visual field, are often subjective complaints that cause disruptive sensations in vision. Eye strain, which is a common symptom associated with prolonged use of digital screens, can lead to other visual disorders. However, there is limited research examining the relationship between eye strain and floaters. This study aimed to evaluate the relationship between eyestrain and the occurrence of floaters in Kalam Kudus Senior High School. Methods: The study was conducted using a cross-sectional method with 62 respondents who extensively use electronic devices. Data on eye strain symptoms and the occurrence of floaters were collected using a standard questionnaire. Statistical analysis was performed to evaluate the relationship between eye strain and floaters. Results: The results of the study showed a significant relationship between eyestrain and the occurrence of floaters (p-value = 0.022). Students who reported eyestrain had a higher risk of experiencing floaters. Conclusion: Excessive use of digital screens and eye strain can contribute to the development of floaters in the high school student population.
Pars Plana Vitrectomy in Tuberculous Endophthalmitis: A Case Report
Introduction: Ocular tuberculosis (TB) is an extrapulmonary mycobacterial disease with varied manifestations. Endophthalmitis is a severe manifestation with a rapid progression that may lead to intraocular tissue destruction and panophthalmitis. This study aimed to report a case of tuberculous endophthalmitis treated with pars plana vitrectomy (PPV). Case presentation: A 57-year-old male patient with TB endophthalmitis. The follow-up period was 6 months. The diagnosis was made on a clinical basis, and the specific etiology was confirmed by TST and IGRA tests. The diagnosis of ocular TB was delayed by one year. He had bilateral endophthalmitis with severe inflammation. The right eye (OD) was blind, and the left (OS) had best-corrected visual acuity (BCVA) of hand motion. Intraocular pressure (IOP) was elevated in both eyes. B-scan disclosed hyperreflective exudate, filling 1/3 of the vitreous cavity in OD, and vitritis and intravitreal hemorrhage in OS. We commenced triple antitubercular therapy. 23G PPV with silicone oil and phacoemulsification with IOL implantation were done. The intraocular inflammation in OS decreased postsurgically, and in one month, BCVA was 20/200 and IOP was within normal limits. Conclusion: Eendophthalmitis is an indication for therapeutic vitrectomy. The risks of surgery seem to be lower than the benefits, including a decent chance for visual improvement and avoidance of enucleation. In our case, 23G PPV with phacoemulsification seemed to be beneficial in decreasing the level of inflammation, improvement of visual acuity, reduction of IOP, and preservation of the eye.
Traumatic Macular Hole and Uveitis: A Case Report
Introduction: Blunt ocular trauma may be associated with a variety of complications, including traumatic macular holes (TMH) and uveitis. Concerning the TMH, there is no standard treatment protocol. There have been reports of spontaneous closure and of the use of certain medications and surgical techniques. Our purpose is to present a case of bilateral blunt ocular trauma with TMH in the right (OD) and uveitis in the left eye (OS) in a 24-year-old Caucasian man. Case presentation: The patient had complaints of decreased vision in OD and redness and discomfort in OS. Three days previously, he had sustained trauma to both eyes with an exercise resistance band. The diagnosis was made with a thorough ophthalmic exam and optical coherence tomography (OCT). The best-corrected visual acuity (BCVA) of OD was 20/40 and of OS – 20/20. The intraocular pressure was within normal limits. There was a TMH in OD and iridocyclitis in OS. The therapy included prednisolone with an initial dose of 60 mg q.d. PO, a lutein/zeaxanthin supplement, and additional topical treatment for OS – dexamethasone and cyclopentolate. The TMH in OD had improved significantly within 6 days. BCVA of OD recovered to 20/20 in a month. Conclusion: We observed closure of the TMH with complete recovery of vision in the affected eye, most likely spontaneous, and with full resolution of the uveitis in the other, in the setting of short-term prednisolone therapy. The uveitis in OS was also treated with topical dexamethasone and cyclopentolate.
Helicobacter pylori and Uveitis: A Brief Narrative Literature Review
Helicobacter pylori (H. pylori) is a gram-negative bacterium that typically infects the mucosa of the stomach. H. pylori is the most frequent causative infectious agent of chronic gastritis and peptic ulcer disease. It has also been associated with a number of extra-gastric diseases-neurological, ocular, hematologic, cardiovascular, rheumatologic, metabolic, and allergic. The possible role of H. pylori in the pathogenesis of uveitis is still unclear. High H. pylori seroprevalence has been found in some studies in patients with other ocular diseases like blepharitis, central serous chorioretinopathy, ocular adnexal lymphoma, and glaucoma. Its seroprevalence in uveitis has been investigated in very few studies. In all of them, however, it was increased. Antibodies have also been found in the anterior chamber of patients with anterior uveitis. Besides, seropositivity was also increased in studies with hypertensive uveitis. Eradication of the bacterium has anecdotally led to the subsidence of anterior uveitis in one patient. In any case, a causal relationship, either infectious or autoimmune, cannot be made at this time due to the scarcity of available research on the problem.
Retinal Detachment Following Vaccination against COVID-19: A Narrative Literature Review
Retinal detachment (RD) refers to the anatomical separation of the neurosensory retina from the Retinal pigment epithelium, which, if untreated, ultimately leads to a loss of visual function and blindness. Three main types are recognised based on the pathogenesis: rhegmatogenous, associated with retinal tears/holes; tractional, where there is pulling on the retina from preretinal and/or vitreal fibrotic changes; and exudative or serous, in which the subretinal fluid is due to transudation, exudation, or impaired outer blood-retina barrier. The infection with SARS-CoV-2 has not been directly associated with any type of RD, except in cases of secondary infections or autoimmune conditions. Serous retinal detachment has very rarely been observed following the application of various vaccines against COVID-19, but only in the setting of central serous chorioretinopathy and uveitis. The single case of purported rhegmatogenous detachment has a highly improbable connection with the vaccination. All in all, the described complications have been extremely uncommon, more frequently treatable or self-resolving, and should not discourage COVID-19 vaccination.
The Color Vision Disorder in Diabetic Patients
Introduction: The visible spectrum (about 400 to 700 nm) with a mosaic of three classes of photoreceptors compose the human visual system. They are sensitive to different wavelength ranges with overlapping. The receivers have high sensitivities at short wavelengths (~440 nm), medium (~535 nm), or longer (~565 nm), which are S, M, and L cones, respectively. The study aimed to determine blue color vision defects in diabetes mellitus. Methods: A cross-sectional study was done at an ophthalmology clinic on 200 eyes (right and left) of patients with DM for a period of 5 one years (2021). Ishihara plates were used initially for screening. The D-15 test was performed for the evaluation of color vision. Results: The mean age of the sample was 45.66±15.65 years. The most frequent disorder visualized was tritanomaly in 63%, followed by trichromate in 27%, and the least disorder was deuteranomaly in 2%. In addition, mixed disorder is seen in 8% of cases. In relation to laterality, right eye tritanomaly was found in 34%, while the left eye was recorded in 29%. The right eye trichromate was observed in 12%, whereas the left eye was reported in 15%. The left eye deuteranomaly was reported more than the right (1.5% vs. 0.5%). Conclusion: Color vision evaluation with good screening color vision test can be detected even before clinically visible diabetic retinopathy. Early detection was helpful in the prevention of vascular changes in the retina. All diabetic patients should be given proper awareness and health education regarding color vision deficiency. Timely assessment of color vision may detect tritanomaly earlier in diabetics.
Evaluation of Chronic Central Serous Chorioretinopathy Treatment at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Introduction: Central serous chorioretinopathy (CSC) is a condition characterized by the accumulation of transparent fluid in the posterior pole of the fundus. Currently, there are several therapeutic options that can be used to treat chronic CSC. This study aimed to describe the clinical characteristics and results of the management of chronic CSC. Methods: The design of this study was a descriptive study. This research was conducted at the division of vitreoretina, department of ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital (RSCM), Jakarta, Indonesia, from April to June 2022. The inclusion criteria were newly diagnosed patients with chronic CSC in the specified period. Data analysis in this study was carried out using descriptive statistics. Snellen vision in patients is converted into logMar vision with the formula-log (decimal vision). Results: There were 17 patients who were included in this study. Among them, 76.4% were men, 52.94% were in the left eye, and there were risk factors for hypertension, as much as 29.41%. Five patients received non-steroidal anti-inflammatory drugs (NSAID) therapy, with 2 of them experiencing increased visual acuity and 3 of them complete resolution. Five patients received anti-VEGF therapy, with 3 of them experiencing increased visual acuity and also complete resolution. Seven patients received subthreshold laser therapy, with all experiencing increased visual acuity, and 4 of them complete resolution. There were 15 patients with subretinal fluid and 2 patients with subretinal fluid combined with retinal pigment epithelial detachment. Conclusion: Most of the patients were male, with an average age of 45.8 years. Most CSC patients affect one eye and still have fairly good vision. The treatments received by patients consisted of non-steroidal anti-inflammatory drugs (NSAID) therapy, anti-VEGF therapy, and subthreshold laser therapy.
Post-Streptococcal Uveitis: A Narrative Literature Review
Streptococcus spp. are gram-positive bacteria and common human pathogens and commensals, causing diseases of various organs in children and adults. They are etiological factors of scarlet fever, pharyngitis, tonsillitis, pneumonia, endocarditis, erysipelas, impetigo, meningitis, necrotising fasciitis, and sepsis, among others. The post-streptococcal syndrome is a presumed autoimmune condition that has been associated with rheumatism, reactive arthritis, glomerulonephritis, and erythema nodosum. This literature review aimed to describe post-streptococcal uveitis in clinical practice. The onset of the immune-mediated complications has varied from 7 to 35 days post-infection. The ocular complications present mainly in the form of blepharoconjunctivitis. There are anecdotal case reports of episcleritis. Keratitis is another possible complication. Preseptal or orbital cellulitis has also been described. Uveitis has been a much rarer finding, and it is hypothesized that the pathogenesis is immune-mediated rather than due to intraocular bacterial infection. Post-streptococcal uveitis has been described in cases of both group A and group B infections. The onset of uveitis has been from 1 week to 36 months after the infection. Post-streptococcal presents mostly as nongranulomatous, bilateral anterior uveitis with a good prognosis and affects mostly young people. Nevertheless, all anatomic types of intraocular inflammation have been observed. The common denominators between the varying clinical pictures appear to be the history of streptococcal infection, most frequently pharyngitis, an elevated anti-streptolysin O titer, and in the more recent studies-the raised anti-deoxyribonuclease antibodies. Furthermore, there has been a generally good therapeutic response to corticosteroids. Few cases have required immunomodulation with methotrexate, mycophenolate, and adalimumab.
Prolonged Face Mask Use During COVID-19 Pandemic Contributes to Increased Symptoms and Signs of Dry Eye: A Systematic Literature Review
Introduction: Face mask has been a vital protective equipment against COVID-19 in this pandemic era. Several ophthalmic complaints have been associated with face mask use, leading to the term "mask-associated dry eye". There's still a question that arises whether the duration of use contributes to the condition. This review aimed to assess the correlation between prolonged face mask use on dry eyes. Methods: A thorough systematic search was performed through PubMed, Science Direct, and Google Scholar, following the PRISMA 2020 Guideline. Keywords were "mask associated dry eye," OR "dry eye AND face mask" OR "OSDI" OR "tear break up time" AND "COVID-19 pandemic". Results: A total of 1130 articles were identified, and only six cross-sectional studies met the eligibility criteria. Prolonged face mask use is correlated with decreased TBUT in four studies, decreased Schirmer score in two studies, and lower TM parameter in one study. Increased duration of wearing mask is correlated with more frequent symptoms and severity of dry eye according to either OSDI, SPEED Questionnaire or another unspecified questionnaire found in five studies. Conclusion: Prolonged face mask use during the COVID-19 pandemic contributes to increased symptoms and signs of dry eye.