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Natalia Christina Angsana,1 Firman Setya Wardhana,1 Supanji,1 Mohammad Eko Prayogo,2 Muhammad Bayu Sasongko1 1Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia; 2Department of Ophthalmology, Universitas Gadjah Mada Academic Hospital, Yogyakarta, IndonesiaCorrespondence: Muhammad Bayu Sasongko, Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Sardjito Eye Center, Dr. Sardjito General Hospital, Jalan Farmako Sekip Utara, Yogyakarta, Indonesia, Tel/Fax +62 274 552850, Email mb.sasongko@ugm.ac.idPurpose: To present a modified technique of 4-point scleral fixation using polymethyl methacrylate (PMMA) 2 eyelets intraocular lens (IOL) with 8-0 polypropylene sutures.Methods: A 270-degree conjunctival peritomy is done, and 4 sclerotomies (2 nasal and 2 temporal) are created. Lamellar scleral or clear corneal incision is made at superior site (6 mm wide for sclera or 5.5– 6 mm for corneal). A short segment of 8-0 polypropylene is inserted into each eyelet, each thread of the suture is externalized through the sclerotomy site, and the lens is inserted. The suture is tightened evenly, and the knot is rotated and internalized. Scleral incision and conjunctival peritomy are sutured with 8-0 vicryl.Results: We have performed this technique in 6 patients with excellent visual outcomes and no reported complications over 1 year of follow-up. This technique has practical advantages including rigid and stable PMMA IOL, high tensile, and slim 8-0 polypropylene suture which is easily internalized and less irritated, and affordable and widely available overall consumables.Conclusion: We present a modified 4-point scleral fixation technique for posterior chamber IOL placement using PMMA IOL with 2 eyelets and 8-0 polypropylene as compared to previous studies that used foldable IOL with 4 eyelets and 10-0 polypropylene or Gore-Tex sutures. This procedure has moderate technical complexity, comparable to previously reported techniques with good overall clinical outcomes and several practical advantages, particularly related to the affordability and availability of the consumables.Plain Language Summary: This paper presents a modification of currently existing 4-point sutured scleral fixation technique for posterior chamber intraocular lens implantation using PMMA IOL with 2 eyelets using 8-0 polypropylene. This technique has some practical advantages compared to previously reported techniques with potential applicability in low-resource setting.Keywords: sutured scleral fixation, four-point, polymethyl methacrylate, 2-eyelets, secondary intraocular lens implantation

Dhimas Hari Sakti,1,2 Aufar Tirta Firdaus,1 Tiara Putri Utami,1 Krisna Dwi Purnomo Jati,1,2 Indra Tri Mahayana,1,2 Firman Setya Wardhana,1,2 Novika Handayani3 1Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 2Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia; 3Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, IndonesiaCorrespondence: Dhimas Hari Sakti, Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, 55281, Indonesia, Tel +62 274 560300, Email Dhimas.hari.s@ugm.ac.idPurpose: To evaluate patients’ satisfaction with ophthalmology health services in a teaching clinic of a tertiary public hospital.Patients and Methods: This was a cross-sectional study in ophthalmology clinic of Dr. Sardjito teaching hospital, Yogyakarta, Indonesia conducted in 2019. Patients were surveyed using the Patient Satisfaction Questionnaire-18 (PSQ-18). PSQ-18 subscale score was analyzed based on patients’ characteristics. The main outcome was the odds of reaching top satisfaction score (TSS) of 4– 5 from a Likert scale 1 to 5.Results: Our study recorded 269 participants who consisted of 138 males (51.3%) and 131 females (48.7%) with median age of 52 (18– 87) years old. Variables with higher odds of reaching TSS on “patient overall satisfaction” was public health insurance (OR: 7.959 [95% CI: 1.989– 31.852], p=0.003) while examination time (OR: 0.955 [95% CI: 0.923– 0.988], p=0.008) had lower odds. Examination waiting time (OR: 0.992 [95% CI: 0.985– 0.999], p=0.027) and examination time (OR: 0.941 [95% CI: 0.908– 0.976], p=0.001) had lower odds of reaching TSS in “general satisfaction”. Family monthly income (OR: 1.829 [95% CI: 1.038– 3.223], p=0.037) had higher odds of reaching TSS in “technical quality” while examination time (OR: 0.961 [95% CI: 0.931– 0.993], p=0.017) and education (OR: 0.549 [95% CI: 0.322– 0.934], p=0.027) had lower odds. Comorbidities (OR: 0.533 [95% CI: 0.301– 0.944], p=0.031) had lower odds of reaching TSS in “financial aspects”. Retina subspecialty clinic (OR: 3.436 [95% CI: 1.154– 10.232], p=0.027) had higher odds of reaching TSS in “time spent with doctor”. Registrar as attending physician (OR: 0.427 [95% CI: 0.205– 0.89], p=0.0230) and examination time (OR: 0.957 [95% CI: 0.924– 0.991], p=0.013) had lower odds of reaching TSS in “accessibility-convenience”.Conclusion: Examination time and examination waiting time should be shortened, specialist doctors should always see the patients whenever possible, and registrars’ technical and communication skill should be improved. Alternative funding for patients without health insurance also should be provided to increase satisfaction.Keywords: Patient Satisfaction Questionnaire-18, PSQ-18, health service quality, examination time, health survey

Supanji Supanji,1– 4 Dewi Fathin Romdhoniyyah,1,2 Muhammad Bayu Sasongko,1,2,4 Angela Nurini Agni,1,2,4 Firman Setya Wardhana,1,2,4 Tri Wahyu Widayanti,1,2,4 Muhammad Eko Prayogo,1,2,4 Ayudha Bahana Ilham Perdamaian,1,2 Aninditta Dianratri,1,2 Masashi Kawaichi,5 Chio Oka5 1Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 2Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia; 3Ophthalmology Clinic, Military Air Force Central Hospital Dr. Suhardi Hardjolukito, Yogyakarta, Indonesia; 4Ophthalmology Clinic, Dr YAP Eye Hospital, Yogyakarta, Indonesia; 5Laboratory of Gene Function in Animals, Nara Institute of Science and Technology, Ikoma, Nara, JapanCorrespondence: Supanji SupanjiDepartment of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Farmako Sekip Utara, Yogyakarta, 55281, IndonesiaTel +62 274 560300Fax +62 274 581 876Email supanji@ugm.ac.idPurpose: This study aimed to determine the association of ARMS2 A69S, ARMS2 del443ins54, and CFH Y402H polymorphisms with neovascular age-related macular degeneration (nAMD) for the first time in an Indonesian population.Patients and Methods: Our case–control study involved 104 nAMD and 100 control subjects. AMD diagnosis was evaluated by retinal specialists based on color fundus photography and optical coherence tomography. The polymorphisms on CFH Y402H and ARMS2 A69S were analyzed by PCR-restriction fragment length polymorphism (PCR-RFLP), whereas ARMS2 del443ins54 was evaluated by PCR-based assay.Results: Significant allelic associations with nAMD were detected on all polymorphisms (P< 0.05), with stronger association with the ARMS2 A69S (OR 3.13; 95% CI 2.08– 4.71; P< 0.001) and ARMS2 del443ins54 (OR 3.28; 95% CI 2.17– 4.95; P< 0.001) polymorphisms than with CFH Y402H (OR 2.08; 95% CI 1.08– 3.99; P=0.028). Genotype analysis showed a statistical difference between nAMD and the control group for all polymorphisms (P< 0.05). However, the association with nAMD was weaker for CFH Y402H (P=0.043) than for ARMS2 A69S and ARMS2 del443ins54 (P< 0.001). A significant interaction between ARMS2 A69S and hypertension was documented (OR 9.53; 95% CI 3.61– 25.1; P< 0.001).Conclusion: Our findings indicate that ARMS2 A69S and ARMS2 del443ins54 polymorphisms are strongly associated with the risk of nAMD for the first time in an Indonesian population. The risk of nAMD increased when the presence of risk alleles from ARMS2 A69S was combined with the presence of hypertension.Keywords: age-related macular degeneration, ARMS2, CFH, polymorphism