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Introduction: Cerebral toxoplasmosis is one of the opportunistic diseases that present in patients with HIV/AIDS. One of the rare symptoms is unilateral papilledema due to cerebral toxoplasmosis. Case report: A 26-year-old male patient came with complaints blurred vision for 2 months. The patient had a history of pouting lips, and weakness face, arm, and legs on the left side of the body. The patient has been diagnosed with the observation of space occupying lesion Cerebri in November 2020. Patient with HIV stage IV (WHO) infection and CD4 14 cells/uL and viral load 5.43 x 105 copies /mL. Visual acuity left eye 6/18 PH 6/12, contrast sensitivity examination in both eyes 1.65, and the results of FD-15 are within normal limits, but the results of perimetry was enlargement of blind spot, relative afferent pupillary defect in the left eye, with optic nerve head swelling in the left eye. An MRI showed the presence of intracerebral neurotoxoplasmosis. Discussion: Papilledema is the manifestation of optic nerve abnormality due to an increase in intracranial pressure. Cerebral toxoplasmosis leads to asymmetric target lesion present with ring enhancement image on MRI with contrast which causes SOL and manifests as papilledema. Bilateral papilledema is a hallmark of increasing cerebrospinal fluid pressure, but unilateral papilledema is a rare case with a 2% of prevalence among papilledema cases. Two proposed mechanisms of atypical papilledema were anatomical nerve sheath anomalies and unilateral axoplasmic blockage of the lamina cribrosa. Conclusion: Early diagnosis and appropriate treatment have a very important role in determining the prognosis of patients with cerebral toxoplasmosis.

School myopia is a term that is used for the development of myopia at school age. The Child Heart and Health Study in England (CHASE) 2010, the prevalence of myopia in Southeast 25,2% at school age. The risk factor for school myopia more complex and one of the environmental factors were near activity. Accommodation, convergence, and miotic pupil are third signs when we look closely. Convergence and accommodation were measured with Near Point of Convergence (NPC) and Amplitude Accommodation (AA). This research aims to know the correlation between NPC and AA with school myopia progression. Research location at Sibang Gede 1st elementary school, Kuta 1st elementary school, Jimbaran 4th elementary school, and Kerobokan Kelod 2nd elementary school. The sample was obtained by Convenience sampling, Stratified Sampling, and Consecutive sampling techniques. Data were analyzed and searching for correlation Near Point of Convergence (NPC), Amplitude Accommodation (AA), and myopia progression was done by bivariate and multivariate analysis with age, gender, and myopic parent. This Research has 125 sample who mostly female 56 %, age at 7 yo 24.8%, median near activity 78 Dh/ week, myopic parent 27.2%. Correlation NPC showed inversely to progression of myopia (NPC Break r = -0.332, p

Background: Near Point of Convergence (NPC) is a nearest point where the image still properly fused and the patient do not experience double vision. However, there is still no study that evaluate the normative value of NPC in Indonesia. Therefore, the purpose of this study was to evaluate NPC break and recovery amongst school aged children with refractive error in Badung Regency, Bali.Methods: A cross-sectional study was conducted from July to September 2018. Data were collected prospectively from the examinations of school aged children in four elementary schools. Categorical data were described in frequency and percentage. The others were described in median. Kruskal Wallis test was used to statistically analyzed the data.Results: A total of 149 children were included in this study, which consisted of 56.4% women and 43.6% men. Most of the students were at 7years old age group (25.5%), while only minority who in the 12-years old age group (2%). Median NPC Break is 3,5 cm and 3,70 cm in male and female, respectively (p = 0,77). The median NPC break and recovery was greater in the 9 to 12 years old group compared to the other groups (p = 0.007 and p =0.00, respectively). Finally, hypermetropia had a greater NPC break and recovery than another groups (p = 0.05). Conclusion: There were significant differences between NPC break and recovery value according to the age group and underlying refractive error.

Introduction. Keratoconus is a vision disorder that occurs when the cornea becomes thin and irregularly (cone) shaped. Instead of being focused correctly on the retina, this abnormal shape causes the light entering the eye to improperly refracted and manifested as a distortion of vision. Refractive Lens Exchange is one type of Invasive therapy in Keratoconus. Here we describe a case of Keratoconus managed by the Refractive Lens Exchange procedure in our Center.Case Description. A male, 25 years old, visited the clinic due to blurry vision since ten years ago. Every six months or a year, he needs to adjust his lens power. Ophthalmology examination found visual acuity in the right eye was 2/60 PH 6/60, and if using S-9.00, visual acuity improved to 6/30. Meanwhile, visual acuity in the left eye was 1/60 PH 6/60 and if using S–11.75, visual acuity improved to 6/48. Corneal topography supports the finding of Keratoconus. Management for this patient was Refractive Lens Exchange + Intraocular Lens + Capsular Tension Ring. Initially, This advised was differ from the patient expectation, as he wanted a LASIK procedure. An important reminder was given, that Keratoconus is contraindicated for LASIK and any corneal surface ablation procedure. After series of procedure, the VA of the right eye was 6/15 PH 6/6, with C - 4.00 x 1800 VA became 6/6. VA left eye was 6/18 PH 6/9, with C - 4,00 x 1800 VA became 6/9. Binocular vision was 6/6. For near vision, S +3.00 was added for both eyes.Conclusions. Refractive Lens Exchange + Intraocular lens implantation is effective and safe procedures to treat high myopia in keratoconus cornea.

Introduction: Ocular complication associated with Dengue Haemorrhagic Fever (DHF) is a rare condition with varied manifestations, ranging from subconjunctival hemorrhage to optic neuropathy. This condition's pathophysiological mechanism is not well understood, with several unpredictable conditions resulting in permanent visual loss. In this case series, three patients with severe ocular complications associated with DHF are presented. Case Report: Case 1: a 16 years old girl presented with proptosis after diagnosed with DHF with no light perception. All findings were consistent with pan-ophthalmitis and retrobulbar hemorrhage. Unfortunately, the right eye turned into phthisis and spontaneous prolapse even with canthotomy with lateral cantholysis and steroid administration. Case 2: 10 years old boy presented with bilateral visual blurring within a month after being diagnosed with DHF with hand movement perception on both eyes and optic disc swelling. The visual acuity recovered to 20/20 in a month of steroid therapy with no optic disc swelling. Case 3: 52 years old man presented with proptosis and dengue shock syndrome with counting finger perception, swelled optic disc, and limited eye movement to all directions. The patient was diagnosed with optic neuritis and retrobulbar hemorrhage. Canthotomy with lateral cantholysis lateral and steroid therapy were planned, but the patient died before treatment was done.Conclusions: Severe ocular complications should be anticipated and monitored in DHF patients. Although visual recovery is possible, permanent ocular complications can be severe and cause permanent visual loss.

Background: Amplitude of Accommodation (AA) is the maximum amount of accommodation of a person's response when looking closely. Decreased accommodation capability indicates functional abnormalities, including refractive disorders. This study aims to determine the characteristics of accommodative amplitude in elementary school children with refractive abnormalities in Badung Regency, Bali.Methods: This study was an analytic cross-sectional observational research. Data were collected prospectively based on the results of examinations and observational records of students in four elementary schools. Data were presented in frequency, percentage, and bivariate tests. Data were analyzed by SPSS version 20 for Windows.Results: Most of the study respondents were 7 years old (25.7%), female (52.7%), not wearing glasses (91.2%), bilateral myopia correction (43.2%), and having sharp vision before correction of 0.3 (0.2-0.5) diopters. There was a significant difference in binocular eye accommodation based on the comparison of Subject AA with the Expected Value (p = 0.001). However, there was no significant difference in the comparison of students' refractive errors with the amplitude of monocular accommodation (p> 0.05).Conclusion: The measurement of monocular AA decreased with age and in this study, there was no AA result that was lower than the expected value or the minimum value according to the Hofstetteer formula. AA measurement results are not affected by refractive errors. It is necessary to screen for refractive errors early in children to reduce the number of amblyopia. Latar Belakang: Amplitudo akomodasi (AA) adalah jumlah maksimum akomodasi dari respon seseorang saat melihat dekat. Penurunan kemampuan akomodasi menunjukkan adanya kelainan fungsional antara lain berupa kelainan refraksi. Tujuan penelitian ini untuk mengetahui karakteristik amplitudo akomodatif pada anak sekolah dasar dengan kelainan refraksi di Kabupaten Badung, Bali.Metode: Penelitian ini merupakan observasional dengan pendekatan studi potong lintang analitik. Data dikumpulkan secara prospektif berdasarkan hasil pemeriksaan dan pencatatan hasil observasi pada anak-anak di empat sekolah dasar. Data ditampilkan dalam bentuk frekuensi, persentase, dan analisis bivariat. Data dianalisis dengan SPSS versi 20 untuk Windows.Hasil: Sebagian besar responden penelitian berusia 7 tahun (25,7%), berjenis kelamin perempuan (52,7%), tidak menggunakan kacamata (91,2%), koreksi kacamata myopia bilateral (43,2%), dan memiliki tajam pengelihatan sebelum koreksi sebesar 0,3 (0,2-0,5) dioptri. Terdapat perbedaan yang bermakna akomodasi mata binokular berdasarkan perbandingan AA Subjek dengan Expected Value (p=0,001). Akan tetapi tidak terdapat perbedaan bermakna pada perbandingan kelainan refraksi siswa dengan amplitudo akomodasi monokular (p>0,05).Kesimpulan: Pengukuran AA monokular menurun sesuai usia dan pada penelitian ini, tidak terdapat hasil AA yang lebih rendah dibandingkan dengan expected value maupun nilai minimal menurut formula Hofstetteer. Hasil pengukuran AA tidak dipengaruhi oleh kelainan refraksi. Perlu dilakukan skrining kelainan refraksi lebih awal pada anak-anak untuk mengurangi jumlah ambliopia.

Introduction: Prolonged computer use will lead to a group of symptoms such as dryness of eyes, tired, headache and others called Computer Vision Syndrome (CVS). The decrease of Mucin 5 AC (MUC5AC) level could be one of the signs of dry eye disease on persons with CVS.Objective: The purpose of this study is to describe the Mucin 5AC level in medical faculty students of Udayana University, Bali, Indonesia with CVS.Method: It is an observational cross-sectional analytic study at Medical Faculty Udayana University on October 2018. Thirty four subject selected by purposive sampling and examined with Schirmer I test, Tear Break Up time (TBUT) test, and Mucin 5AC test. All of the subject then divided into CVS group and non-CVS group. Mucin 5AC level which less than 186.33 ng/mL categorized as low mucin, while more than 186.33 ng/mL categorized as normal mucin level. Data was analyzed by crosstabulation table and chi-square test with significant value p < 0.05.Result: Most of the students who diagnosed with CVS had lower mucin 5AC levels as much as 77,3% and 33,3% students with CVS had normal mucin 5AC level. This study analyses found there is significant association between level of mucin 5AC with CVS. The students with low level of mucin 5AC had 6,8 higher risk tend to be CVS (OR=6,8; CI 95%= 1,42-32,37; p=0,012).Conclusion: Low level of mucin 5AC has association with the risk of CVS in the medical students with prolonged computer use.

Background: Conjunctival goblet cells could be impaired and resulted in unstable tear film after small incision cataract surgery (SICS). The purpose of this study was to describe the effects of topical vitamin A on the conjunctival goblet cell density after SICS. Methods: This is a randomized clinical trial with pre-and post-control group design conducted in Bali Mandara Hospital on September 2015 until January 2016. A total of 38 patients were divided into two groups; 19 patients were given topical vitamin A and 19 patients were given placebo. Impression cytology specimen was obtained before SICS, after SICS and 4 weeks after intervention. Impression cytology was examined in Pathological Anatomy Laboratory of Sanglah General Hospital. Mean density of goblet cells before and after SICS were calculated using paired t-test. The difference of before and after intervention in each group were calculated using independent t-test. Results: Mean density of conjunctival goblet cells before SICS was 15.5 ± 13.4 cells/10 HPF and after SICS was 15.7 ± 12.7 cells/10 HPF (p = 0.938). Mean difference in conjunctival goblet cells density before and after SICS in the intervention group was 0.2 ± 11.7 cells/10 HPF and in the control group was -10.2 ± 8.1 cells/10 HPF (p = 0.003). The mean difference between the two groups was 10.4 ± 3.2 cells/10 HPF. Conclusions: The mean difference of conjunctival goblet cells density between two groups after intervention was found to be statistically significant.

Purpose Corneal erosion is common in eye emergency cases. Extensive corneal erosions result in severe pain and prolonged healing time. This study aimed to compare bandage contact lenses with pressure patching in terms of reducing the size of the erosion area, pain scale in patients with corneal erosion and its complications. Design A randomized open-label clinical trial was conducted. Methods Subjects with mechanical corneal erosion were selected to use either bandage contact lenses or pressure patching. All subjects received antibiotic eye drops and 0.5% tropicamide eye drops. Evaluations were done 24 and 72 hours after treatment. The size of the corneal erosion area, pain scale, and complications were assessed. Results A total of 32 eyes (16 eyes in each group) were studied. The change in the size of the corneal erosion area was greater in the bandage contact lens group than in the pressure patching group, although there was no significant difference. In the bandage contact lens group, 56.25% of the eyes were healed at 24 hours and 43.75% were healed at 72 hours. In the pressure patching group, 62.50% were healed at 24 hours and 12.50% were healed at 72 hours. The change in pain scale was significantly greater in the bandage contact lens group than in the pressure patching group. No complications were found in both groups. Conclusions Bandage contact lenses are an effective alternative to treating mechanical corneal erosion because of their effect in reducing pain without causing any complications.

Glaukoma adalah penyebab kebutaan permanen di seluruh dunia. Data WHO tahun 2007 menyebutkan bahwa glaukoma merupakan penyebab sekitar 15% kebutaan di dunia. Penelitian ini bertujuan untuk mengetahui apakah kadar 8-hydroxyl-2’-deoxyguanosine (8-OHdG) serum pada pasien glaukoma primer sudut terbuka lebih tinggi dibandingkan kontrol. Penelitian ini merupakan penelitian potong-lintang yang dilaksanakan di Poliklinik Mata RSUP Sanglah dan RS Bali Mandara Denpasar Bali, pada bulan Agustus sampai November 2015. Setiap sampel dilakukan pemeriksaan menggunakan slit lamp, applanasi goldmann, dan funduskopi dengan lensa 78 untuk menegakkan diagnosis glaukoma primer dan presbiopia serta pengambilan sampel darah vena untuk pemeriksaan kadar 8-OHdG serum. Perbedaan kadar 8-OHdG serum dianalisis dengan uji t tidak berpasangan. Besar sampel yang memenuhi kriteria penelitian sebanyak 60 pasien yang terbagi menjadi 29 pasien glaukoma primer sudut terbuka dan 31 pasien kontrol. Rerata kadar 8-OHdG serum pada pasien glaukoma primer sudut terbuka didapatkan lebih besar dibanding kontrol [15,57 (SB 0,83) vs 8,87 (SB 0,87) ng/mL, beda rerata 6,70 (IK95% 6,25 sampai 7,13) ng/mL, P=

Introduction and Aims. Refractive errors such as miopia, hyperopia and astigmatism in teenagers are common in Asian country nowadays. Gadget usage also influence the prevalence and incidence of refractive errors specially for miopia and astigmatism. Outdoor activities have positive impact to prevent miopia. The aim of this study is to report the role of outdoor activities as unique school program that could prevent refractive errors in Junior High School in rural area of Bali Method. This is analytic descriptive study with cross sectional approach of 231 Pekutatan II Junior High School students taken in December 2016. This school located in rural area; 35,3 km from Jembarana and 60,5 km from Denpasar, the capital city of Bali. The area of the school is about 1500 m2, where 70% of the land are still vacant to natural habitat and this school had their own garden area that being organized by the students themselves after school hours. This school do not have computer extra curriculum as well. Result. From 231 students there were only 14 students that have refractive errors consist of 5 boys and 9 girls, mostly aged 15 years. Six students (2%) were diagnosed as myopia and 8 students (3.4%) were diagnosed as compound astigmatism myopia. The length of gadget usage in this school were 1.66 hours and outdoor activities time were 4.78 hours per day. The hereditary factors of refractive errors were noted in 12 students (5 %). Outdoor activities associated with refractive errors in this study (p = 0.03). While time using gadget does not have an association with the refractive errors (p = 0.38). Conclusion. Rural area where the outdoor activities are still common have protective effect to prevalence of refractive errors in teenager.