Ophthalmologica Indonesiana (OI) is the official peer-reviewed scientific journal of the Indonesian Ophthalmologist Association (Perhimpunan Dokter Spesialis Mata Indonesia; PERDAMI). This journal publishes high-quality scholarly work that advances clinical practice, research, and education in the field of ophthalmology. Published biannually in February and August, Ophthalmologica Indonesiana disseminates original research articles, review articles, case reports, and other scientific contributions relevant to ophthalmology and visual science. This journal serves as a platform for clinicians, researchers, and academicians to share evidence-based findings and clinical insights. Ophthalmologica Indonesiana is available in both print (ISSN 0216-1193) and online (e-ISSN 2460-545X) formats. As an official publication of PERDAMI, the journal is published in collaboration with the Faculty of Medicine Publishing Unit, Universitas Indonesia (Balai Penerbit FKUI), Jakarta, and upholds high standards of scientific integrity and publication ethics.
The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))
Editor's Introduction: Paradigm Shift in Optic Neuropathy: Early Insights into Precise Etiological Differentiation
Due of its heterogeneity in etiology, including inflammatory, vascular, and traumatic causes rather than as a singular condition and individual disease, the global prevalence of non-glaucomatous optic neuropathy (NGON) continues to be a challenging scientific difficulty.1,2,3 A retrospective study was performed at a tertiary eye‑care center in Yogyakarta, Indonesia, covering the period between January 2019 to December 2023 (4 years investigation period, including in the COVID-19 era). Read more >>>
Copyright (c) 2026 Indra Tri Mahayana, MD, PhD https://creativecommons.org/licenses/by-nc-sa/4.0
Clinicopathological Characteristics and Predictive Clinical Features of Lacrimal Gland Lesions
Introduction: Lacrimal gland tumors encompass a wide spectrum of benign, malignant and inflammatory conditions. Understanding the clinico-demographic profile and histopathological findings is crucial for early detection, determining appropriate treatment strategies and improving patient outcomes. Methods: This was a retrospective observational study of patient with lacrimal gland lesions diagnosed at the Reconstructive Oculoplastic and Oncology department at a tertiary care hospital in Central Java. Thirty-nine patients with biopsy-proven lesions between January 2021 and December 2024 were included. Clinical characteristics including age, sex, laterality, symptom duration, proptosis, lagophthalmos, and ocular motility restriction were evaluated. Histopathological diagnoses were categorized into benign, malignant, and inflammatory lesions. Statistical analyses were performed to assess associations between clinical variables, sex, and tumor classification. Results: A total 47 eyes of 39 patients were retrospectively reviewed. The mean age of patients was 46.15 ± 20.27 years (range 2–76), with 48.7% male and 51.3% female. Malignant tumors were more frequent in patients older than 60 years (69.2%), while benign tumors were more common in patients aged 40–59 years (60.0%). Histopathological analysis demonstrated that lymphoid and inflammatory disorders were the most common lesions. Inflammatory disorders consisted of dacryoadenitis and systemic inflammatory disease (sarcoidosis). Proptosis and shorter symptom duration were significantly associated with malignancy, whereas bilateral involvement was significantly associated with inflammatory disorders. No statistically significant difference in tumor classification was observed between male and female patients. Conclusion: Lymphoid and inflammatory disorders were the most prevalent lacrimal gland lesions. Identifying clinical markers such as proptosis, symptom duration, laterality can assist in early malignancy detection and guide management decisions effectively. This study is limited by its retrospective design, single-center setting, and small sample size, which may introduce selection bias and limit generaizability.
Copyright (c) 2026 Yossi Eriska, Raja Erinda, Trilaksana Nugroho https://creativecommons.org/licenses/by-nc-sa/4.0
Comparing Predictability of SRK/T, Barrett Universal II, and Kane Formulas on High Myopia Phacoemulsification
Introduction: The refractive outcomes of phacoemulsification surgery have improved significantly in recent years, but it is still challenging to obtain good outcomes in eyes with long axial lengths. This study compares the difference between the predicted and manifest refraction outcomes between Sanders Retzlaff Kraff theoretical (SRK/T), Barrett Universal II (BU-II), and Kane formula in high myopia patients undergoing uncomplicated phacoemulsification surgery. Methods: This cross-sectional design study includes eyes with high myopia (axial length ≥26.0 mm) that undergo uncomplicated phacoemulsification surgery with intraocular lens implantation between January 2024 and January 2025 at Semarang Tertiary Hospital. The one-month post-surgery mean absolute prediction errors (MAE) difference between SRK/T, BU-II, and Kane formula are calculated and analyzed using the Wilcoxon Sign Rank Test. Result: Thirty-seven eyes meeting the criteria were analyzed, with a mean axial length of 29.07±2.42 mm. The MAE and percentages of eyes within 0.50 diopters (D) refractive prediction errors of the three formulas are as follows: SRK/T (0.68 D, 60%), BU-II (0.41 D, 73%), and Kane (0.37 D, 76%). There is a statistically significant difference in MAE between SRK/T vs BU-II (p < 0.05) and SRK/T vs Kane (p < 0.05). Conclusion: The Kane and BU-II formula has better accuracy in predicting refractive outcome (lower MAE and higher percentages of eyes within 0.5 D refractive prediction errors) than the SRK/T formula in patients with high myopia who undergo uncomplicated phacoemulsification surgery.
Copyright (c) 2026 Rizal Ryamizard, Wisnu Sadasih, A. Rizal Fanany, Fatimah Dyah Nur Astuti https://creativecommons.org/licenses/by-nc-sa/4.0
Affordable HLA-B27 Detection in Resource-Limited Settings: Evaluating Conventional PCR for Uveitis and Spondyloarthropathy in Indonesia
Introduction: HLA-B27 is a genetic marker strongly associated with spondyloarthropathy (SpA) and acute anterior uveitis (AAU). Detection of this allele can support earlier diagnosis and targeted management. However, commercially available HLA-B27 tests are costly and often inaccessible in low- and middle-income countries, including Indonesia. Methods: A cross-sectional study was conducted involving 42 subjects: 14 with SpA, 19 with AAU, and 9 healthy controls. DNA was extracted from peripheral blood samples and analyzed using both conventional PCR (targeting exon 3 of HLA-B27) and a commercial HLA-B27 strip assay. Sensitivity, specificity, and diagnostic accuracy of conventional PCR were calculated against the commercial kit as the reference standard. Results: Conventional PCR showed high sensitivity (100%) and accuracy (85.71%) in SpA patients, indicating its potential as a reliable screening tool in this group. However, its performance in AAU patients was suboptimal, with lower sensitivity (40%) and specificity (55.56%). False positives and false negatives were observed, likely due to limitations in allele coverage by conventional primers. Conclusion: Conventional PCR is a promising, affordable alternative for HLA-B27 detection in SpA patients, particularly in resource-limited settings. However, its lower reliability in AAU cases highlights the need for careful clinical application and further optimization. Larger studies and local allele mapping are recommended to enhance diagnostic precision in diverse populations.
Copyright (c) 2026 Rina La Distia Nora, Lukman Edwar, Made Susiyanti, Yulia Aziza, Ikhwanuliman Putera, Ulifna Alfiya Sifyana, Mei Riasanti, M Zakiy Waliyuddin, Maria Valentina Wibawa, Rachel Ethelind, Erica Widodo, Ratna Sitompul https://creativecommons.org/licenses/by-nc-sa/4.0
Identifying the Burden of Digital Eye Strain: Prevalence, Clinical Manifestations, and Risk Factors in Indonesian Medical Students
Introduction: The increasing use of digital devices among university students, particularly in medical education, has raised concerns regarding Digital Eye Strain (DES). This study aimed to assess the prevalence, symptom profile, and risk factors of DES among Indonesian medical students. Methods: A cross-sectional study was conducted among 356 medical students using the validated Computer Vision Syndrome Questionnaire (CVS-Q). Data on demographic characteristics, ocular history, digital device usage habits, and DES symptoms were collected. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with DES, with a significance level set at p < 0.05. Results: The prevalence of DES was 62.9%. Common symptoms included itchy eyes (76.8%), blurred vision (70.1%), and headaches (76.33%). Bivariate analysis revealed associations between DES and refractive errors (OR 1.889, p = 0.004), poor posture (OR 0.467, p = 0.001), and the use of more than two digital devices daily (OR 1.610, p = 0.030). Multivariate analysis identified refractive errors (OR 2.049, 95% CI: 1.300–3.227, p = 0.002), poor posture (OR 0.413, 95% CI: 0.258–0.663, p < 0.001), and the use of more than two devices (OR 1.879, 95% CI: 1.171–3.015, p = 0.009) as independent risk factors for DES. Conclusion: DES is highly prevalent among Indonesian medical students. Refractive errors, poor posture, and the concurrent use of multiple digital devices were significant risk factors. Vision screening, ergonomic education, and digital health awareness are recommended to reduce DES and support ocular health.
Copyright (c) 2026 Elwande Hagasaro Zega, Selly Azmeila, Yetty Machrina, Kamal Basri Siregar https://creativecommons.org/licenses/by-nc-sa/4.0
Treatment Strategies of an Iris Implantation Cyst: A Case Report
Introduction: Iris cyst can be divided into primary and secondary, both originating from epithelial cells. Although rare, the entity has a high recurrence rate. This clinical case report highlights the treatment strategies to treat and prevent the recurrency of iris cyst. Case Report: We report a rare presentation of a secondary iris cyst in a 20-year-old male with a history of cataract surgery 17 years prior. The patient underwent fine-needle aspiration and intracystic alcohol injection. However, the iris cyst recurred eight months after the procedure. Afterward, the invasive strategy of iris cyst excision was conducted. Eight months after the secondary iris cyst surgery, the patient showed no signs of recurrence. Discussion: Iris cyst is known to have a high recurrence rate, however, a minimally invasive treatment is still preferred, supported by previous studies showing no recurrence in treatment with fine-needle aspiration and intracystic alcohol injection. In our case, the iris cyst relapsed eight months after this procedure, warranting for surgical excision. Eight months after the excision, the patient showed no signs of recurrence. Conclusion: Although the recurrency of iris cyst is high, the authors suggest starting with non-invasive treatment with follow-up ensuring no recurrence before opting for a more invasive treatment.
Copyright (c) 2025 Jessica Zarwan, Ayang Rashelda Maulidinia, Astrid Mariam Khairani Siregar, Syska Widyawati, Faraby Martha, Rio Rhendy https://creativecommons.org/licenses/by-nc-sa/4.0
3-Snip Punctoplasty with Silicone Tube Implantation: A Simple Procedure For Punctal Disorders
Introduction: Punctal or canalicular atresia is a rare disorder in which an intact epithelial layer covers the punctum, impairing tear drainage and causing epiphora, especially in lower punctal atresia. Less frequently, canalicular atresia occurs. Standard management involves probing, irrigation, and silicone tube insertion. Case Report: In two cases, an 8-year-old and a 30-year-old female presented with lifelong tearing and discharge from the left eye. Ophthalmic examination revealed imperforate superior and inferior lacrimal puncta, and the Dye Disappearance Test (DDT) confirmed reduced tear drainage, leading to a diagnosis of punctal atresia. In a third case, a 40-year-old female experienced a painful, red lump on the right medial lower eyelid over a three-month period. Palpation produced yellowish discharge, and examination revealed a hyperemic mass with granulomas around the punctum, consistent with chronic canaliculitis. All three patients underwent a 3-snip punctoplasty with silicone tube implantation using a round-tip pigtail probe. Discussion: The 3-snip procedure is a minimally invasive and effective treatment for punctal disorders. It involves one basal cut and two vertical incisions along the canaliculus. Although canaliculotomy with curettage can lead to fistula formation, the use of a silicone tube helps prevent this complication. At the three-month follow-up, all patients demonstrated functional tear drainage and normal DDT results. Conclusion: The 3-snip procedure with silicone tube implantation offers favorable functional and cosmetic outcomes. It is a simple and viable option for ophthalmologists in resource-limited settings, ensuring improvement in tear drainage without symptom recurrence.
3-Snip Procedure, Punctoplasty, Punctal Disorder, Punctal Atresia, Canaliculitis
Copyright (c) 2026 Aisyah Amelia Zulkarnaen R Wattimena, Andi Pratiwi, Halimah Pagarra, Suliati P Amir, Syukriah Sofyan https://creativecommons.org/licenses/by-nc-sa/4.0
UNUSUAL CASE OF A METAL FOREIGN OBJECT IN ORBITOCRANIAL INJURY: UNLOCKING THE MACCARTY KEYHOLE
Introduction. Penetrating orbitocranial injuries are quite rare but very fatal if left untreated. Various metal objects have been reported as foreign bodies that have penetrated the orbit. However, unusual objects such as motorcycle locks have never been reported before. Case Illustration. A 14-year-old boy was brought to the emergency room with a motorcycle lock embedded in his left temporal region. Examination of the left eye showed decreased vision, clear serous ciliary secretions, conjunctival hyperemia, chemosis, and relative afferent pupillary defect. Investigations using a 3D Head MSCT Scan revealed the presence of a metal object that penetrates the left optic nerve, the rectus lateralis muscle, and the frontal process of the left zygoma bone in the left temporal region, which is located around the MacCarty keyhole. The operation in the form of exploration and foreign object removal was then carried out in collaboration with the neurosurgeon. No postoperative complications were reported, but the patient had restricted movement of the left eye. Discussion. Penetrating orbitocranial injury should be treated as an emergency. Diagnosis should include comprehensive ophthalmological and neurological examinations. CT Scan continues to be the best cranial imaging technique. In this case, the motorcycle lock penetration was around the MacCarty keyhole, a structure that is frequently used to enter both the orbit and the frontal fossa, which located 7 mm superior and 5 mm posterior to the frontozygomatic suture. An appropriate surgical strategy is mandatory for removing the object because it may lead to serious consequences, including cerebral, infectious, vascular complications, and even death. Conclusion. Metal foreign objects such as motorcycle lock was considered unusual, particulary when it unlock an important landmark such as MacCarty keyhole. This case emphasizes the significance of a surgical strategy based on accurate anatomical tracking.
Copyright (c) 2025 Fadiah Gazzani Rahman, Andi Pratiwi, Halimah Pagarra, Suliati P. Amir https://creativecommons.org/licenses/by-nc-sa/4.0
COMBINATION OF DEXAMETHASONE IMPLANT AND ANTI-VEGF IN THE MANAGEMENT OF DIABETIC MACULAR EDEMA: A SYSTEMATIC REVIEW
Background: Anti Vascular Endothelial Growth Factor (anti-VEGF) and dexamethasone implant (DEX) are suggested as the first and second-line therapy for Diabetic Macular Edema (DME). However, persistent DME were found after six months of routine anti-VEGF injection. Intravitreal steroids have the advantage to control the inflammatory component of DME. Combining intravitreal anti-VEGF and DEX may reduce macular edema more effectively and more quickly theoretically. Hence, we aim to review the efficacy of adding DEX to anti-VEGF in treating DME. Methods: Literatures were obtained using comprehensive searching on PubMed and Proquest using the keywords “Dexamethasone implant”, “anti-VEGF therapy”, and “Diabetic Macular Edema” including their synonyms between 2018 to 2023. Non-English studies, animal studies, review articles, case studies, and editorial letters were excluded. This result was presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Results: A total of 3 studies with 265 eyes were included. All of the studies had Central Foveal Thickness (CFT) and Best Corrected Visual Acuity (BCVA) as the main outcomes. Improved CFT was seen in all of the studies (all p<0.05) with ∆CFT (200,40 μm in 6 months and 413 μm in 12 months). Most studies showed improved visual acuity after 8 months of injections which were shown by ∆BCVA (8,84 letters in 6 months and 21,6 letters in 12 months) and increased intraocular pressure as an adverse effect of steroids. Conclusion: Combination of DEX and anti-VEGF showed improvement in CFT and BCVA. Further studies are required due to the controversial intravitreal steroids’ ocular adverse effect.
Copyright (c) 2024 Ursula Natasya Pradnya Paramita, Tania Tania, Clarissa Clarissa, Salma Salsabila https://creativecommons.org/licenses/by-nc-sa/4.0
Determining The Etiology of Uveitis in Indonesia: The Role of Clinical Manifestation and Serological Test in Infectious Uveitis
Introduction: Uveitis is a heterogeneous group of intraocular diseases that significantly causes vision disabilities in patients worldwide. Establishing an etiological diagnosis can be challenging because of the extensive and varied clinical patterns and differential diagnoses across regions. Knowledge of these patterns is crucial in aiding physicians with diagnosis, reducing the need for costly ancillary tests, and facilitating timely management. Methods: We conducted a retrospective descriptive study using medical records data from a tertiary referral hospital in Indonesia over two years (2016-2017), involving 299 patients with uveitis. Discussion: Among the 299 patients, 152 were men (152/299, 50.8%) with a median age of 36. Panuveitis was the most frequent anatomical entity (152/199, 53.2%). Infectious etiology, primarily toxoplasmosis and tuberculosis, remained prevalent. Despite various final diagnoses, serological tests for IgG Toxoplasma and CMV were predominantly reactive in 192/251 (76.5%) and 228/236 (96.6%) of tested patients. At presentation, 106/299 (35%) of patients were categorized as blind, and 64/106 (60%) were without improvement. Complications were observed in 167/299 (55%) of patients, including cataracts (133/299, 44%) and glaucoma (32/299, 10%), contributing to 70/106 (66%) of blindness in our series. Conclusion: Panuveitis and infectious etiology, particularly toxoplasmosis and tuberculosis, were the most common causes of uveitis. Clinical patterns were better able to distinguish them than laboratory results. Understanding these uveitis patterns can guide physicians in diagnosing before performing expensive ancillary tests. Ocular complications were related to severe visual function; thus, timely referral in severe cases is essential. Keywords: Uveitis, Indonesia, epidemiology
Copyright (c) 2025 Gisela Haza Anissa, Rina La Distia Nora https://creativecommons.org/licenses/by-nc-sa/4.0
THE MULTIPLE OCULAR MANIFESTATIONS OF A NEGLECTED NEWLY DIAGNOSED MULTIBACILLARY LEPROSY WITH GRADE II DISABILITY
Introduction: Leprosy is a chronic granulomatous infection cause by Mycobacterium leprae that could involving the eye with prevalence within 51,6% to 85%. Despite the high prevalence of leprosy and ocular manifestation, ophthalmologist consultation is not routinely performed, thus leads to unrecognized ocular complications. This case report aims to portrays the ocular manifestation of multibacillary leprosy with grade II disability. Case report: A 71-year-old woman presented with severe corneal ulcer with perforation leading to the iris-lens prolapse resulted in total blindness of the left eye; peripheral ulcerative keratitis and neurotropic ulcer of the right eye; lagophthalmos, corneal hypoesthesia, and madarosis of both eye. The Dermatovenereology Department consultation revealed claw hand, ulnar nerve thickening on both upper extremity, and hypoesthesia on both upper and lower limb. The acid fast bacteria were identified from auricula skin scraping specimens with +3 bacterial index (BI) and 75% morphological index (MI). The patient was diagnosed with LE severe corneal ulcer with iris-lens prolapse, RE peripheral ulcerative keratitis (PUK) and neurotropic ulcer, RLE lagophthalmos, and multibacillary leprosy with grade II disability newly diagnosed. Left eye evisceration was performed after initiated the multidrug therapy (MDT) regiment. Conclusion: The ocular manifestation found in this case are corneal hypoesthesia, madarosis, corneal ulcer with perforation, iris-lens prolapse, peripheral ulcerative keratitis, and neurotropic ulcer. The management is directed to pathogen eradication and specific management on ocular manifestation. The collaboration with Dermatovenereology Department is required for comprehensive screening and management.
Copyright (c) 2025 Suci Purnamasari, Ovi Sofia https://creativecommons.org/licenses/by-nc-sa/4.0
Copyright (c) 2024 Widya Artini Wiyogo https://creativecommons.org/licenses/by-nc-sa/4.0
Refractive and Visual Outcomes of Pediatric Cataract Surgery in Indonesian Tertiary Eye Center
Introduction: Cataract remains as a leading cause of visual impairment in children. Surgical intervention and post-operative refractive correction remain fundamental. This study aims to describe the refractive and visual outcome of pediatric cataract surgery in a tertiary eye center in Indonesia. Methods: This retrospective study was conducted utilizing medical records of all congenital and developmental cataracts patients undergoing cataract extraction procedures with or without primary IOL implantation between January and December 2022. Exclusion criteria included patients who did not undergo visual acuity and objective refraction examination 1-month post-cataract surgery and those with incomplete medical records data. Results: A total of 118 eyes from 65 patients was included in this study. Most patients had bilateral cataracts (93.80%) and operated at the median age of 18 (0.96-212.64) months. Post-operatively, there were 71 (60.19%) aphakic and 47 (39.81%) pseudophakic patients with a respective refractive status of +18.00 (12.00 – 21.13) D and +0.60 (±2.37) D. Prediction error (PE) and absolute prediction error (APE) were obtained within 1.00 D. Most aphakic patients had unquantifiable visual acuity both before (91.50%) and after (83%) surgery. Among pseudophakic patients, nine (19.16%) had visual acuity of ≥ 6/12 and seven (14.89%) had visual acuity of <6/12 - 6/18 post-operatively. No patients had visual acuity ≥ 6/12 and <6/12 - 6/18 before surgery. Conclusion: Post-operative refractive status of both aphakic and pseudophakic patients were well within correctable range. There was an improvement of vision after surgery. Limited visual potential may be attributed to the presence of amblyopia.
Pediatric cataract, axial length, corneal curvature, BCVA, Biometric
Copyright (c) 2025 Feti Karfiati Memed, Rizki Adi Santosa, Irawati Irfani, Sesy Caesarya, Primawita Oktarima Amiruddin, Mayasari Wahyu Kuntorini https://creativecommons.org/licenses/by-nc-sa/4.0
COMPARISON OF VISUAL ACUITY RESULTS AFTER FEMTOSECOND LASER-ASSISTED IN SITU KERATOMILEUSIS (FS-LASIK) AND SMALL INCISION LENTICULE EXTRACTION (SMILE)
Introduction: Two of the most popular refractive surgery methods currently used are Femtosecond Laser-Assisted In Situ Keratomileusis (FS-LASIK) which creates a flap using femtosecond laser and stromal ablation using excimer laser, and Small Incision Lenticule Extraction (SMILE), a flapless procedure in which a lenticule is extracted through a small incision. The aim of this study is to compare the visual acuity results of FS-LASIK and SMILE. Methods: This is a descriptive cross-sectional study. Data were collected from the medical record of patients who underwent FS-LASIK or SMILE procedure at Cicendo Eye Hospital, the national eye centre, in 2022. Patients were followed up at 1 day, 1 week, and 1 month postoperatively and visual acuity outcomes between the two procedures were compared. Results: A slightly higher percentage of eyes in FS-LASIK (46.6%) achieved a UCVA of 1.0 at 1 day postoperatively compared to SMILE (45.5%). At 1 week and 1 month, SMILE showed superior results with 83% and 94.6% of eyes achieving a UCVA of 1.0, meanwhile FS-LASIK had 72.2% and 86.2%. Residual refractive error at 1 month had a median of -0.6146 and -0.3125 in the FS-LASIK and SMILE groups. Conclusion: This study found better UCVA results in the FS-LASIK group compared to the SMILE group at 1 day postoperatively. Meanwhile, UCVA at 1 week and 1 month postoperatively, showed superior results in the SMILE group. Residual refractive error at 1 month postoperatively also showed better results in SMILE than FS-LASIK.
Copyright (c) 2024 Nafisa Mardhiyya, Andrew M. H. Knoch, Emmy D. Sugiarti, Ludwig M. Tjokrovonco, Budiman https://creativecommons.org/licenses/by-nc-sa/4.0
INTERNUCLEAR OPHTHALMOPLEGIA IN MULTIPLE SCLEROSIS PATIENT
Introduction: Internuclear ophthalmoplegia (INO) characterized by impaired adduction of the affected eye caused by a lesion in the medial longitudinal fasciculus (MLF). The common cause of INO is demyelinating disease including multiple sclerosis. INO arguably the most discrete localizing sign in medicine, has considerable value in predicting multiple sclerosis. Due to its high spatial resolution, MRI has allowed us to depict in vivo the anatomic organization of the human oculomotor nerve complex, the MLF, and related structures in the brainstem. Case Report: A 48-year-old female presented with blurred vision of both eyes for 2 weeks, but then slowly resolved. Best corrected visual acuity presentation on both eyes were 20/20 with normal intraocular pressure (IOP). Adduction deficit observed on the left eye with no nystagmus. Convergence are not impaired in both eyes. Anterior segments was normal except minimal lens cloudiness in both eyes. Funduscopic examination result also within normal limit. Patient had undergone Computerised Tomography (CT-Scan) and the result was normal, no ischemic area or Space occupied lesion (SOL) or intracranial bleeding were found. Brain MRI showed bilateral optic perineuritis and multiple lesion in bilateral frontoparietalis and in the left side of the pons suggested multiple sclerosis. Discussion: Impairment of adduction movement on the patient’s left eye caused by demyelinating plaque related multiple sclerosis on the left side of the pons as shown MRI imaging. Management in this patient is based on the underlying condition. Conclusion: Internuclear ophthalmoplegia in this cases maybe caused by lesion in the medial longitudinal fasciculus could be related with multiple sclerosis.
Copyright (c) 2024 Fahrian Tirkal, Yunita Mansyur, Batari Todja Umar, Junus Baan, Yudy Goysal, Junus Baan https://creativecommons.org/licenses/by-nc-sa/4.0
Defeating Mooren Ulcer: Timely Diagnosis and Strategic Interventions for Swift Recovery
Introduction: Mooren ulcer is a unique and rare manifestation of peripheral ulcerative keratitis of idiopathic origin, triggered by immunological abnormalities, genetic predispositions, and environmental factors. Case Report: We report the successful treatment of a rare case involving a 43-year-old man who presented with a significant worsening of white tissue covering cornea, severe pain, redness, and blurred vision in the left eye. An examination revealed a peripheral ulcer extending centrally with scleral sparing. Ancillary examinations yielded unremarkable findings. The patient was diagnosed with Mooren ulcer and initially treated with topical steroid, which showed no improvement. Therefore, a simultaneous conjunctival resection combined with immunosuppressive therapy was performed. At 1-year follow-up, no pain was reported, vision improved (6/21 to 6/12), and resolved ocular surface inflammation. Discussion: Mooren ulcer is often prone to misdiagnosis due to clinical signs that resemble other differential diagnoses. A meticulous examination is essential to carefully exclude autoimmune and corneal infection. The treatment goals are to arrest the destructive process and facilitate re-epithelization. A stepwise aggressive approach is crucial, starting with topical steroids to control inflammation. However, this single treatment modality may not prevent rapid progression, making conjunctival resection imperative to eliminate the source of collagenase production by cutting off the perilimbal blood vessels’ access to ulcer cites. Combining this with an immunosuppressant effectively maintains a stable condition. Conclusion: This case underscores the importance of timely diagnosis and aggressive treatment in preventing the swift progression of Mooren ulcer.
Mooren Ulcer, Steroid, Conjunctival Resection, Immunosuppressant Therapy
Copyright (c) 2026 Florentina Priscilia, Dewa Ayu Anggi Paramitha, Yulia Aziza https://creativecommons.org/licenses/by-nc-sa/4.0
Development and Application of Targeted Multi-plex Polymerase Chain Reaction to Help Diagnose Infectious Uveitis
Introduction: Clinical pattern recognition is paramount in uveitis diagnosis. Pathogen detection from ocular fluid samples is often necessary to support infectious uveitis diagnosis, particularly in cases presenting with atypical clinical appearance. This study aims to present the process of developing targeted multiplex PCR and evaluate its application in infectious uveitis diagnosis. Methods: This was a cross-sectional study to evaluate the diagnostic performance of targeted multiplex PCR in infectious uveitis. We obtained ocular fluid samples and reviewed medical records of uveitis patients who underwent ocular fluid analysis at Cipto Mangunkusumo Hospital from February 2022 to March 2023. PCR detection threshold values (DNA copies/mL) were 10.9 for Mycobacterium tuberculosis (Mtb), 672 for Epstein-Barr virus (EBV), 4.77 for Cytomegalovirus (CMV), 6.37 for Toxoplasma gondii (T. gondii), and 5.53 for Herpes simplex virus (HSV). With multiple pathogen selection, this method requires a lower volume of samples than single-plex PCR, as the latter will increase the sample volume linearly with each additional pathogen tested. Discussion: Forty-seven aqueous or vitreous samples were analyzed. The positivity rate was 23.4% (11/47) with Mtb yielding the highest positivity (7/41; 17.1%). With final diagnosis as a reference, targeted multiplex PCR resulted in 32.3% (95% CI: 16.7 – 51.4%) sensitivity, 93.8% (95% CI: 69.8 – 99.8%) specificity, 90.9% (95% CI: 58.4 – 98.6%) positive predictive value, and 41.7% (95% CI: 35.2 – 48.4%) negative predictive value. Conclusion: With its high specificity, targeted multiplex PCR is useful as a confirmatory but not screening tool in uveitis diagnosis. Ocular fluid analysis is an important part of the stepwise diagnostic approach in uveitis.
Copyright (c) 2025 Rachel Ethelind, Rina La Distia Nora https://creativecommons.org/licenses/by-nc-sa/4.0
Refractive Status Characteristic in School-Aged Children: Cicendo National Eye Hospital Vision Screening Program
Introduction: Refractive error is a major cause of visual impairment in school-age children and can be detected early through vision screening programs. This study aimed to describe the characteristics of refractive errors among school-age children participating in a vision screening program at the Community Ophthalmology Unit, National Eye Center Cicendo Eye Hospital. Methods: A retrospective cross-sectional study was conducted using vision screening data from January–December 2023. Visual acuity and non-cycloplegic refraction were examined by trained personnel. Data were analyzed descriptively using Microsoft® Excel. Results: A total of 1,411 children were included, with 488 (17%) experiencing visual impairment. Myopia was the most common refractive error, mainly mild myopia and moderate astigmatism. Severe visual impairment (1.02%) was still found despite best corrected visual acuity. Refractive errors were most frequent among 11-year-old students (26%). Conclusion: The prevalence of refractive errors in school-age children remains high, with myopia as the most common type. Routine vision screening programs are still necessary for early detection and management.
Copyright (c) 2026 Nathasya Maharani Susilo, Nina Ratnaningsih, Mayang Rini https://creativecommons.org/licenses/by-nc-sa/4.0
The Relationship Between Tumor Necrosis Factor-Alpha (TNF-α) with Retinal Nerve Fiber Layer (RNFL) Thickness in Diabetic Retinopathy Patients at Prof. CPL Universitas Sumatera Utara General Hospital and Affiliated Hospital
Introduction: Retinal neurodegeneration may be an early indicator of diabetic retinopathy, the second most common complication after nephropathy. Tumor Necrosis Factor-Alpha (TNF-α) plays a role in the pathogenesis of inflammatory and neovascular eye disorders and is associated with intraocular inflammatory diseases like macular edema and proliferative diabetic retinopathy. This study aims to find the relationship between TNF-α levels and Retinal Nerve Fiber Layer (RNFL) thickness in diabetic retinopathy patients at Prof. CPL Universitas Sumatera Utara General Hospital and affiliated hospital. Methods: This cross-sectional study included 45 patients with type 2 DM and diabetic retinopathy at Prof. CPL Universitas Sumatera Utara General Hospital and affiliated hospital from March to June 2024. RNFL and posterior segment examinations were conducted. TNF-α levels were measured from blood samples.Blood sugar data were taken from medical records. Results: Of the 45 participants, 24 were men (53.3%) and 21 women (46.7%). 32 (71.1%) had DM for >5 years, and 27 (60%) experienced PDR. Highest location for RNFL thickness examination was superior (19, 42.2%). Average TNF-α with thin RNFL was 65.67 ng/L, and with thick RNFL was 64.78 ng/L. Mean TNF-α with thin superior RNFL was 65.74 ng/L, and thick was 63.70 ng/L. Mean TNF-α with thin inferior RNFL was 65.73 ng/L, and thick was 63.9 ng/L. Mean TNF-α with thin temporal RNFL was 68.73 ng/L, and thick was 67.19 ng/L. Mean TNF-α with thick nasal RNFL was 67.06 ng/L. Conclusion: There was no statistically significant relationship between TNF-α and RNFL thickness in diabetic retinopathy patients.
Diabetes mellitus, diabetic retinopathy, TNF-α, RNFL layer
Copyright (c) 2025 Wahyu Medsa Yeltas Putra, Delfi, Taufik Ashar https://creativecommons.org/licenses/by-nc-sa/4.0
Scleral Buckling for Retinopathy of Prematurity: A Case Report
Introduction The selection of management for advanced retinopathy of prematurity (ROP) requires careful consideration. The purpose of this study is to report the effectiveness of scleral buckling in patient with retinopathy of prematurity stage 4B of both eyes within 3 months. Case Description A 4-month-old female baby came to the Pediatric Ophthalmology Unit in Cipto Mangunkusumo General Hospital (RSCM) Kirana with chief complain did not make eye contact of both eyes. Her eyes were moving on their own since she was 3.5 months old, and sometimes squint. The patient came to the pediatrician and was referred to pediatric ophthalmology for further treatment. There was a history of premature delivery at 30 weeks with oxygen therapy for 3 weeks. The Pediatric ophthalmology division performed ultrasonography and retcam, and the diagnosis of retinopathy of prematurity stage 4B of both eyes was made. Scleral buckling was performed in the right and left eyes at the postmenstrual age of 49 weeks, and 52 weeks respectively by vitreoretinal division. Conclusion The management of ROP depends on the type ROP. For advanced ROP, surgery is indicated. The scleral buckle is a treatment option for advanced retinopathy of prematurity patients with retinal detachment if it is assumed that intraocular surgery presents a greater risk. In short-term period, for the right eye, the scleral buckling is effective. Further time to follow up is needed to show the long-term period effectiveness of scleral buckling in patients with advanced ROP.
Copyright (c) 2025 Gustiandari Fidhya Permanik, Julie Dewi Barliana, Anggun Rama Yudantha https://creativecommons.org/licenses/by-nc-sa/4.0
OCULAR GNATHOSTOMIASIS IN A FARMER FROM SOUTH SULAWESI, INDONESIA
Introduction: Ocular Gnathostomiasis is a rare parasitic infection caused by the third-stage larvae of the spiruroid nematode. Gnathostome species are mostly seen in tropical and subtropical areas. It is a food-borne zoonosis caused by the consumption of raw or undercooked freshwater of fish, amphibians, reptiles, birds, and mammals, all of which are known to harbor the larval stages of Gnathostome species. Case Report: A 37-year-old farmer complained of seeing moving objects in his left eye accompanied by blurred vision. At the previous visit, the patient had a history of red left eye with increased intraocular pressure, a visual acuity (VA) of 20/30 with the best corrected visual acuity (BCVA) of 20/20 and normal intraocular pressure. Slit lamp examination showed slight hyperemia of the conjunctiva and a live worm moving in the anterior chamber (AC). The worm was immediately removed using corneal clear incision and sent for parasitological examination. Discussion: Ocular Gnathostomiasis by third-stage larvae of spiruroid nematode was found at the eye of a man from Siwa, South Sulawesi. Patients with complaints of recurrent redness of the eyes accompanied by increased intraocular pressure and a history of living in an area with a habit of eating raw freshwater fish should be considered the possibility of harboring helminth in the eye. Conclusion: Patients with complaints of recurrent eye redness increased intraocular pressure, and a history of living in an area with a habit of eating raw freshwater fish should be considered the possibility of harboring helminth in the eye especially Gnathostome.
Gnathostomiasis, human, ocular, Indonesia
Copyright (c) 2025 Dian Trisnawaty, Batari Todja Umar https://creativecommons.org/licenses/by-nc-sa/4.0
ISOLATED UNILATERAL PTOSIS DUE TO JUVENILE OCULAR MYASTHENIA GRAVIS, CASE REPORT
Introduction: Ocular myasthenia gravis in children is an uncommon autoimmune condition impacting the neuromuscular junction. Typical manifestations include weakness in the levator palpebrae, orbicularis oculi, or extraocular muscles, leading to symptoms such as ptosis and binocular diplopia. Case Report: a 5-year-old girl was brought in with the primary concern of her right eyelid drooping for the last 11 days. The weakness of the eyelid is more pronounced during daytime and nighttime but improves upon waking up in the morning. The patient did not experience difficulties in speaking, swallowing, or breathing. There was no extremity weakness. Ophthalmologic examination reveals orthophoric eye position without restriction of eye movement. The patient exhibited drooping of the right eyelid. Repetitive Nerve Stimulation (RNS) confirmed the presence of a lesion at the neuromuscular junction. Consequently, the diagnosis was made of myasthenia gravis causing the right eye ptosis. Seven months after beginning treatment with oral pyridostigmine, there was a noticeable improvement in the patient's condition during a follow-up examination. Discussion: Juvenile ocular myasthenia gravis, can present with isolated unilateral ptosis. Diagnosis of mechanical/congenital ptosis, external ophthalmoplegia, and Horner syndrome has ptosis as a manifestation was ruled out. Conclusion: The diagnosis and initial management of juvenile ocular myasthenia gravis play a crucial role in preventing disease progression. First-line therapy with oral pyridostigmine is safe and effective. The prognosis for ocular myasthenia gravis in prepubertal patients is generally favorable.
Copyright (c) 2025 Adji Pramanto, Eka Sutyawan https://creativecommons.org/licenses/by-nc-sa/4.0
Emerging Challenges of Acute Bilateral Diabetic Cataract in Pediatric: Insight to Early Detection and Management– A Case Report
Purpose: To report rare case of acute bilateral cataract in pediatric with Type 1 Diabetes Mellitus as ocular complication despite of good glycaemic controls and its management. Methods: A 17-year-old male patient complained of blurry vision and glare in both eyes(BE) since 3 months in newly diagnosed T1DM (HbA1c 10% --> now 6.3%). Visual Acuity (VA) was 6/45PH6/21f2, with correction S-1.50 advancing to 6/18 in BE. Slitlamp examination of BE revealed lens opacity (P3),central position, 3mm in diameter, retinometri 0.32. Posterior segment evaluation and intraocular pressure (IOP) were within normal limits. Right eye (RE) was underwent lensectomy and IOL insertion under GA. Results: Postoperative RE with final VA of 6/18 PHNI and IOP of 43 mmHg. Patient was given antiinflammation eyedrops, oral and topical antiglaucoma, and received controlled final IOP of 8mmHg within 3 days and remain stable until now without antiglaucoma. Result was satisfying despite of uncomplicated secondary glaucoma as short-term complication that resolved with therapy. Evaluation and close monitoring postoperatively is needed and play significant role in visual outcome. Conclusions: Early detection for ocular complication in DM is needed as cataract genesis process still progressing despite of good glycaemic control. Ocular manifestation may present as early sign of undiagnosed T1DM or as its complications. Comprehensive and holistic multidicipline treatment, glycaemic control, and routine evaluation is essential and play significant role in the success of metabolic cataract therapy and progression of microvascular complications due to DM. Lensectomy + IOL implantation still the mainstay therapy in pediatric cataract. Awareness play vital role as it possibly cause decreased vision and or amblyopia, leading to blindness.
Copyright (c) 2025 Clara Valentina, MD, I Wayan Eka Sutyawan, MD, Ni Made Ayu Surasmiati, MD, I Made Agus Kusumadjadja, MD, I Wayan Gede Jayanegara https://creativecommons.org/licenses/by-nc-sa/4.0
Secondary Glaucoma due to Mucopolysaccharodis: a Case Report
Introduction: Mucopolysaccharidosis (MPS) is a rare, autosomal recessive inherited lysosomal storage disorder involved in glycosaminoglycans (GAG) degradation. Glaucoma, as a leading cause of irreversible blindness, in MPS patients has a very low occurrence rate, indicating that this condition needs attention and more research to improve MPS patients’ quality of life. Case Report: A 15-year-old boy came with a chief complaint of progressive onset of blurred vision in both eyes 4 years prior to admission. He was being treated as hypermetropia since then. Opacity was noticed in both eyes in addition to deteriorating vision for the last 3 months. Genetic test supported the possibility of MPS type VI. Hence this patient was diagnosed as secondary glaucoma due to MPS. Glaucoma medications were unable to control the intraocular pressure, thus trabeculectomy was planned. After the surgery, the patient was given antibiotic, analgetic, steroid, and anti-glaucoma medications. Releasable suture was removed on the 14th day post-surgery due to elevated IOP. Unfortunately, the patient did not make any visit afterward for further follow-up. Discussion: Our case faces several difficulties with anterior and posterior ophthalmological examinations. Corneal opacity with corneal thickening often occurs in MPS type VI. The exact mechanisms underlying corneal opacities remain elusive. IOP measurements can be helpful for the diagnosis and monitoring of glaucoma. Changes in corneal thickness can affect IOP measurements, and corneal opacity can prevent accurate visualization of the optic nerve and cornea-sclera angle, as well as supportive diagnostic devices such as Funduscopy, Ultrasound Biomicroscopy (UBM), and Optical Coherence Tomography (OCT), are difficult to perform. Conclusion: The underlying syndrome was suspected only after glaucoma occurred. Early detection and regular assessment play an important role in MPS. Routine follow-up is needed to ensure IOP control and determine the long-term outcome of IOP after trabeculectomy. Keywords: Glaucoma, Mucopolysaccharidosis, trabeculectomy
Copyright (c) 2025 Irene Carolin Mulyadi, Franky Richard Kasih https://creativecommons.org/licenses/by-nc-sa/4.0
Outcomes of GDD Implantation in NVG Patients at Cipto Mangunkusumo Hospital: A 3-Year Study
Introduction: Neovascular glaucoma is a challenging type of glaucoma to manage, due to its progressive nature. Achieving good intraocular pressure (IOP) in neovascular glaucoma cases often requires the aid of filtering surgery, preferably with a glaucoma implant/drainage device. This study aims to evaluate the outcomes of glaucoma drainage device (GDD) implantation for neovascular glaucoma patients in Cipto Mangunkusumo Hospital. Methods: A total of 77 eyes with neovascular glaucoma were included in this study, which underwent GDD implantation in Cipto Mangunkusumo Hospital between 2020 to 2022. Baseline data include age, gender, laterality, implant type used, underlying ocular condition, systemic comorbid, visual acuity (VA), IOP, and prescribed glaucoma medications. The postoperative VA and IOP were measured at 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, and 18 months or above. Complications and additional surgical interventions were noted. Success criteria based on the IOP and amount of glaucoma medications were evaluated at least 6 months postoperatively. Results: The mean IOP at baseline was 45.91 ± 13.9 mmHg with 3.42 ± 0.77 glaucoma medications. At 6 months postoperative, mean IOP was decreased to 13.84 ± 8.6 mmHg with 1.21 ± 1.18 glaucoma medications. At 6 months follow-up, 32.0% patients achieved complete success and 48.0% patients achieved qualified success. At 1 year postoperative, the Kaplan-Meier analysis for GDD success in neovascular glaucoma cases was estimated to be 79.2%. Conclusion: GDD implantation is an effective surgical option in treating neovascular glaucoma cases.
Copyright (c) 2025 Andrew John Widya Sieman, Virna Dwi Oktariana https://creativecommons.org/licenses/by-nc-sa/4.0
Role of Optical Coherence Tomography Angiography (OCTA) in Anterior Ischemic Optic Neuropathy
Introduction: Anterior ischemic optic neuropathy (AION) is the most common type of optic neuropathy with symptoms of sudden and painless visual field defect and vision loss. Although evaluating the nonperfusion areas of the vascular ischemia have traditionally been visualized through fluorescein angiography, OCTA has proven to be effective in noninvasively representing the retinal vascular network. This literature review aims to evaluate the quantitaive OCTA assessment of peripapillary vessel density (VD) changes in AION. Methods: Literature search was performed in four databases (PubMed, ScienceDirect, ProQuest, and Cochrane Library) from 2018 to 2022 to identify relevant articles. Five studies were included in this review. Results: All five studies on OCTA findings of NAION eyes reported a reduction in the vessel density of peripapillary capillary plexus when compared to either the healthy control eyes or the fellow unaffected eyes. OCTA reveals vascular changes in both forms, aiding prognosis and treatment. One study comparing NAION and AAION indicates reduced vessel density in NAION and AAION, with more severe abnormalities and reduction of vessel density in AAION. Conclusion: OCTA can visualize alterations in vascular density in both types of AION, AAION and NAION, with a notably more pronounced reduction in peripapillary vessel density observed in AAION. Keywords: anterior ischemic optic neuropathy, optical coherence tomography angiography, peripapillary vessel density
optical coherence tomography angiography
Copyright (c) 2025 Calista Nathasya Gunawan, Syntia Nusanti https://creativecommons.org/licenses/by-nc-sa/4.0
Giant Intracranial Aneurysm Presenting as Temporal Hemianopia: When the Eyes Reveal a Hidden Danger
Introduction: Giant intracranial aneurysms (GIA) are rare and deadly diseases due to the high risk of rupture. The purpose of this report is to describe a case of GIA presenting as temporal hemianopia. Case Report: A 52-year-old male presented with worsening blurry vision three weeks before admission. Visual acuity was light perception in the right eye and 6/18 in the left eye. Neuro-ophthalmic examination revealed a relative afferent pupillary defect in the right eye and bilateral optic atrophy. At the next visit, the visual acuity of the right eye recovered to 6/18. Visual field testing showed temporal hemianopia in the left eye and generalized depression in the right eye. Magnetic resonance imaging demonstrated a 0,4 cm x 2,5 cm x 1,9 cm saccular aneurysm, on the medial side of the left internal carotid artery (ICA). Discussion: A giant (diameter ≥2.5 cm) ICA aneurysm may compress the optic chiasm, leading to various stages of visual loss. Several factors are known to delicate balance between thrombogenesis and thrombolysis within the aneurysmal sac. Spontaneous intra-saccular thrombosis in an unruptured GIA may be induced by calcification within the atherosclerotic wall of the aneurysm and loss of elastic lamina. It is prone to occur in a narrow aneurysm neck (<0.4 cm). Thrombosis reduces the size of the aneurysm sac, in which the accumulated fluid is reabsorbed. This may explain the decompression effect on optic chiasm and spontaneous visual recovery. Conclusion: Intracranial aneurysms are a rare cause of optic chiasm compression but can still be considered in cases of temporal hemianopia.
Copyright (c) 2025 Annisa Nindiana Pertiwi, Syntia Nusanti, Marsha Rayfa Pintary, Salmarezka Dewiputri, Sita Paramita Ayuningtyas, Muhammad Sidik https://creativecommons.org/licenses/by-nc-sa/4.0
MINIMIZING PROLIFERATIVE VITREORETINOPATHY REACTION IN RHEGMATOGENOUS RETINAL DETACHMENT: IS THERE A ROLE OF PREOPERATIVE ANTI-INFLAMMATORY?
Copyright (c) 2024 Ari Djatikusumo, Widya Artini Wiyogo https://creativecommons.org/licenses/by-nc-sa/4.0
CORRELATION OF CENTRAL CORNEAL THICKNESS TO ACTUAL INTRAOCULAR PRESSURE IN MYOPIA PATIENTS
Background : Central Corneal Thickness (CCT) is promote in the diagnosis and management of glaucoma, especially in myopic patients. Understanding the correlation between CCT and IOP (Intraocular Pressure) aids in glaucoma detection and control. The objective of this study is to determine the correlation between CCT and actual IOP in myopic patients. Methods : This research is an observational study with ethical committee approval, involving medical students from the Faculty of Medicine at Andalas University undergoing clinical clerkships at Dr. M Djamil Padang General Hospital. They were grouped into emmetropia, mild myopia, and moderate myopia. Data included visual acuity measurements, autorefraction, CCT measurements using OCT, and IOP with CCT correction. Samples with eye abnormalities, systemic conditions, myopia > 6D, a history of eye surgery, contact lens wear, and IOP > 21 mmHg were excluded. All data were analyzed statistically. Results : The study involved 78 eyes from 78 individuals, consisting of 26 eyes per group. The actual CCT and IOP values in mild myopia, moderate myopia and emmetropia are 506.31 ± 11,263 μm with 15.81 ± 1,234 mmHg, 533.96 ± 21,342 μm with 16.12 ± 1,336 mmHg, and 487.81 ± 28,272 μm with 15.35 ± 1.056 mmHg. There was a strong positive correlation between CCT and IOP (r=0.737, p=0.000), as well as a moderate negative correlation between CCT and actual IOP (r=-0.492, p=0.000). Conclusion : This research reveals a negative correlation between CCT and actual IOP in myopic patients, highlighting the importance of glaucoma screening for myopic patients due to their thinner corneas.
CCT, central corneal thickness, IOP, intraocular pressure, actual IOP, myopia, glaucoma
Copyright (c) 2025 Hadwer Wicaksono Pandjaitan, Andrini Ariesti https://creativecommons.org/licenses/by-nc-sa/4.0
Diagnostic Challenges in Retinoblastoma with Panophthalmitis-Like Manifestation: A Case Report
Purpose: To highlight the importance and challenges of diagnostic examination and modalities to diagnose retinoblastoma with varieties of manifestation such as panophthalmitis-like. Case Report: A 4-year-old boy presented with red and swollen right eye since two days prior to admission. The position of the right eye was hypotrophy with restricted eye movement towards all directions and there was a presence of proptosis with edema, spasm, hyperemia with yellowish crust. Ultrasonography result came with severe anterior-posterior vitreous haziness with calcified mass suggesting an intraocular tumor of the right eye. Orbital CT-scan was performed and suggestive of panophthalmitis with superior palpebra abscess of the right eye. The inflammation was proposed due to prior intraocular surgery of cataract extraction and trabeculectomy that led to progression and worsening of the retinoblastoma, such invasive surgery led to atypical presentation of panopthalmitis-like. Patient initial visit was due to symptoms of leukocoria and squinting, but even though ocular ultrasonography was performed, the patient had failed to be diagnosed with retinoblastoma. Patient had CT scan and was confirmed of an intraocular mass with calcification inside the right eye with some palpebral abscess. MRI was performed to confirm the extension of the mass, which fortunately did not extend outside the eye. The patient then underwent chemo reduction therapy, before finally got enucleation with dermatofat graft surgery. Histologic examination confirmed the diagnosis of retinoblastoma. This case was an example of how sometimes clinical misdiagnosis among retinoblastoma can happen which can be due to inadequate diagnostic examination or atypical presentation. Preventing clinical misdiagnosis of retinoblastoma can improve the treatment and likelihood of survival of patients with retinoblastoma. Conclusion: Clinical misdiagnosis of retinoblastoma can happen without adequate diagnostic tools and prowess which may result in mismanagement and/or delayed treatment leading to poorer prognosis of patient with retinoblastoma.
Copyright (c) 2025 Rino Nugrahaputra, Julie Dewi Barliana https://creativecommons.org/licenses/by-nc-sa/4.0