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Introduction: The primary treatment in proliferative diabetic retinopathy (PDR) is vitrectomy; however, direct intervention to the dense proliferative fibrovascular membrane may lead to massive hemorrhage obscuring the surgery process. Purpose: to review the use of anti-vascular endothelial growth factor (VEGF) as an adjuvant therapy before pars plana vitrectomy in PDR cases. Review: Anti-VEGF has been proposed as an adjuvant preceding the vitrectomy to lower intraoperative and post-operative complications. On the other hand, it could increase fibrosis which triggers tractional retinal detachment (TRD) in PDR cases. Conclusion: Intervals of five to ten days are considered the most ideal between anti-VEGF injection and pars plana vitrectomy (PPV) surgery in which the adjuvant therapy has made neovascularization regression and before the occurrence of fibrovascular contractions.

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

Introduction: The prevalence of blindness in Bali based on Rapid Assessment of Avoidable Blindness (RAAB) survey in 2015 was 2%. This prevalence rate is still high according to WHO guidelines. Bali has challenges in providing eye care services. The aim of this study was to report situational analysis of the eye care in Bali.Method: This is a descriptive study with quantitative and qualitative approach. Data collection was carried out through interviews and questionnaires targeting respective stakeholders involved in the eye care services in Bali.Result: Bali consists of 9 districts with total 4,337 million people. Eye care in Bali consist of 43 hospitals, 120 primary health care (Puskesmas), 73 general ophthalmologist and subspecialists, 18 trained opthalmic nurses, and 12 refractionist. Bali has mobile eye care unit covering remotes area and a Non-Government Organization (NGO) actively contributing in community eye care service. Total number of cataract surgery in 2019 was 8.225 eyes with cataract surgical rate (CSR) was 1.896. Komite Mata Daerah (Komatda) dan health insurance for eye service and eye surgery is a form of support from the government.Conclusion: The implementation of eye care services in Bali is yet under evaluation. Things needed to consider to improve eye care services including providing better distribution of ophthalmologist to districts, and empowering voluntary local manpower as village health workers / cadres through regularly organized training. Education on blindness and preventable visual disturbances also must be carried out regularly.Pendahuluan: Prevalensi kebutaan di Bali berdasarkan survei Rapid Assessment of Avoidable Blindness (RAAB) tahun 2015 sebesar 2%. Angka prevalensi ini masih tinggi menurut pedoman WHO. Bali memiliki tantangan dalam memberikan pelayanan perawatan mata. Tujuan dari penelitian ini adalah untuk melaporkan analisis situasi perawatan mata di Bali.Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan kuantitatif dan kualitatif. Pengumpulan data dilakukan melalui wawancara dan kuesioner dengan sasaran masing-masing pemangku kepentingan yang terlibat dalam layanan perawatan mata di Bali.Hasil: Bali terdiri dari 9 kabupaten dengan jumlah penduduk 4.337 juta jiwa. Perawatan mata di Bali terdiri dari 43 rumah sakit, 120 Puskesmas, 73 dokter spesialis mata umum dan subspesialis, 18 perawat mata terlatih, dan 12 dokter spesialis mata. Bali memiliki unit perawatan mata keliling yang mencakup daerah terpencil dan Lembaga Swadaya Masyarakat (LSM) yang aktif berkontribusi dalam layanan perawatan mata masyarakat. Jumlah operasi katarak pada tahun 2019 sebanyak 8.225 mata dengan angka bedah katarak (CSR) sebanyak 1.896. Komite Mata Daerah (Komatda) dan jaminan kesehatan untuk pelayanan mata dan operasi mata merupakan bentuk dukungan dari pemerintah.Simpulan: Pelaksanaan pelayanan kesehatan mata di Bali masih dalam tahap evaluasi. Hal-hal yang perlu diperhatikan untuk meningkatkan pelayanan kesehatan mata antara lain penyediaan dokter spesialis mata yang lebih merata ke kabupaten, dan pemberdayaan tenaga sukarelawan lokal sebagai kader/petugas kesehatan desa melalui pelatihan yang diselenggarakan secara rutin. Edukasi tentang kebutaan dan gangguan penglihatan yang dapat dicegah juga harus dilakukan secara berkala.

Background: Visual impairment in children affects growth and development, psychological, social, daily activities, which reduce the quality of life. Children often don't realize that they see "lack of" and do not complain of any difficulty in seeing. Collaboration between medical and non-medical personnel could be developed as a tiered health service team. Teachers as educators could help the health service team through health education and eye screening. The purpose of this study was to find out the consistency of visual acuity measurements by trained teachers using PPEK acuity and Snellen-E.Methods: This study is an analytic cross sectional study conducted on 178 samples in elementary school. Visual acuity was measured by trained teachers using PEEK Acuity and Snellen-E cards and ETDRS by an ophthalmologist. Data analysis using Bland Altman and Rank-Spearman correlation test.Results : Mean difference in visual acuity measurement with PEEK Acuity by trained teacher and ETDRS by ophthalmologist are 0,0028 logMAR (p = 0,543; 95% CI -0,0063 – 0,0119; 95% limit of agreement -0,11766 - 0,12326). Mean difference in visual acuity measurement with Snellen-E by trained teacher and ETDRS by ophthalmologist shows 0,0090 logMAR (p = 0,103; 95% CI -0.0018 – 0.0198; 95% limit of agreement -0.13426 – 0.15225). Mean difference in visual acuity measurement with PEEK Acuity and Snellen-E by trained teacher shows -0,0062 logMAR (p = 0.248; 95% CI -0,0175– 0,0052; 95% limit of agreement -0,15667 – 0,144269).Conclusion: Visual acuity measurement using PEEK Acuity and Snellen-E by trained teachers and ETDRS by an ophthalmologist are consistent and could replace each other.

Introduction: Sclera buckle is one of the operative management of rhegmatogenous retinal detachment. Sclera buckle can combine with vitrectomy in young people, phakic, myopia more than 6 dioptri, axial length more than 26mm, proliferative vitreoretinopathy stage C, multiple inferior break and recurrent break. Complications from the installation of sclera buckle is one of them the occurrence of strabismus after the installation of sclera buckle. Treatment can be done to remove the sclera buckle and further surgery for extraocular muscle.Case Description: Male patients aged 31 years, patients present with complaints right eyes rolling inward since 8 months ago. The patient had a history of surgical sclera buckle and tamponade with silicone oil. Patient also complain blurry vision since 1 month ago after removing silicone oil. The patient has a history of -5.00 glasses in both eyes. In examination obtained Hirschberg esotropia 15 degrees and retinal detachment on right eyes. Patient was diagnosed with right eye Detached Retina post evacuation of silicone oil (16 days), acquired esotropia Suspect et cause sclera buckle installation. Patients are planned to undergo Re-Vitrectomy Pars Plana (VPP), Release Sclera Buckle , Endolaser, Silicon Oil tamponade, and evaluation of extraocular muscle at surgery. During evaluation of extraocular muscle there was fibrosis cover four rectus muscle and no tear was found. Then we removed of fibrosis and released sclera buckle. Strabismus complaint did not feel better after removed of fibrosis so we planned for further action was medial rectus recess with adjustable sutureConclusion: Sclera buckle can combine with vitrectomy on young people, phakic, myopia more than 6 dioptri, axial length more than 26mm, proliferative vitreoretinopathy, multiple inferior break and recurrent break. Installation of sclera buckle can cause complications in the form of postoperative strabismus. One of the causes of this complication is fibrosis of the extraocular muscles, so there is an attachment called fat adherent syndrome. Treatment that can be taken to treat strabismus after sclera buckle surgery is one of them with the release of sclera buckle, but if strabismus complaints did not improve, surgery can be done on extraocular muscles to improve the position of the ball Pendahuluan: Sclera buckle merupakan salah satu tindakan operatif dalam menangani ablasio retina regmatogen. Tindakan sclera buckle dapat dikombinasikan dengan vitrektomi pada orang muda, phakia, riwayat miopia lebih dari 6 dioptri, panjang bola mata lebih dari 26 milimeter, ditemukan adanya proliferatif vitreoretinopati stadium C, robekan multiple pada bagian inferior retina dan robekan berulang. Komplikasi dari pemasangan sclera buckle ini adalah salah satunya terjadinya strabismus pasca pemasangan sclera buckle. Penanganan yang dapat dilakukan berupa pelepasan sclera buckle, dan operasi strabismus jika kondisi otot ekstraokular tidak membaik.Deskripsi Kasus: Pasien laki-laki, usia 31 tahun, datang dengan keluhan mata kanan bergulir ke dalam sejak 8 bulan yang lalu. Keluhan dirasakan setelah pasien melakukan operasi pemasangan sclera buckle dan silicon oil 8 bulan yang lalu. Saat ini pasien juga mengeluhkan pandangan kabur yang sudah dirasakan sejak 1 bulan yang lalu setelah dilakukan pengangkatan silicon oil. Pada pemeriksaan ditemukan Hirschberg esotropia 15 derajat dan ditemukan ablasio retina pada mata kanan. Pasien didiagnosis dengan okuli dekstra rekuren ablasio retina pasca pengeluaran silicon oil (16 hari), dan kecurigaan esotropia didapat (acquired esotropia) ec pasca pemasangan sclera buckle. Pasien direncanakan untuk dilakukan Re-Vitrektomi Pars Plana (VPP), pelepasan sclera buckle, endolaser, re-tamponade silicon oil dan evaluasi otot ekstraokular durante operasi. Pada saat dilakukan evaluasi otot ekstraokular ditemukan adanya fibrosis pada keempat otot rektus dan tidak ditemukan adanya robekan pada otot ekstraokular. Kemudian dilakukan pembersihan dari fibrosis dan pelepasan dari sclera buckle. Keluhan strabismus tidak dirasakan membaik pasca dilakukan pembersihan fibrosis sehingga direncanakan untuk dilakukan tindakan lanjutan yaitu medial rectus reses dengan adjustable suture.Simpulan: Tindakan sclera buckle ini dapat dikombinasi dengan vitrektomi pada pasien muda, phakia, riwayat miopia tinggi lebih dari 6 dioptri, panjang bola mata lebih dari 26 milimeter, ditemukan adanya proliferatif vitreoretinopati, robekan multiple di bagian inferior retina dan robekan berulang. Pemasangan sclera buckle ini dapat menimbulkan komplikasi berupa strabismus pasca operasi. Penyebab dari terjadinya komplikasi ini salah satunya fibrosis pada otot ekstraokular sehingga terjadi perlekatan yang disebut dengan fat adheren syndrome. Tindakan yang dapat dilakukan untuk penanganan strabismus pasca operasi sclera buckle ini adalah salah satunya dengan pelepasan dari sclera buckle, namun apabila keluhan strabismus tidak membaik bisa dilakukan operasi pada otot ekstraokular untuk memperbaiki posisi bola mata.

Background: WHO, with program Vision 2020-the Right to Sight, has a responsibility to control the most cause of blindness, which is a cataract. General-purpose of this research is to identify the retinometry pre and post cataract surgery on senile cataract patients.Method: This study design is an analytical cross sectional study. All data were collected retrospectively from the medical report of retinometry of pre and post cataract surgery in Sanglah General Hospital.Results: A total number of 60 eyes from 59 patients were included in this study. The majority of the patients were male (63.3%), aged 61-70, and came from Denpasar District (38.3%). The grading of cataract (Burrato) in this study is Burrato III (60%). A nuclear cataract is common in this study (41.7%). There were relationships between the differences of retinometry post dan pre cataract surgery with the grading of cataract (Burrato) (p0.05).Conclusions: There is a significant difference between retinometry pre and post cataract surgery, no significant difference between retinometry post-cataract surgery with BCVA and type of cataract. Higher grades of cataract (Burrato V) significantly correlate with higher retinometry pre and post-cataract surgery.

Background: Visual impairment is affected by multiple factors which consists of internal factor and environmental factor especially near work activity and outdoor activity. The role of its factor depends on geographical situation, economical condition and local culture.Aim: This study aims to determine the prevalence of visual acuity reduction and associated factors towards visual acuity of local civilians in Ngis village, Manggis sub-district, Karangasem district, Bali province in 2017.Method: This study was a cross-sectional descriptive study with a sample of 63 people aged 12-70 years old (27 male; 38 female) in Ngis village. The data was obtained through a 6 meter Snellen chart examination and an interview with a questionnaire guide.Results: The results showed a sharp reduction in vision of the local civilians was 37 people (58.7%) which varying from mild impairment untill NLP. A significant relationship (p

Background: WHO shows that cataract is a major cause of avoidable blindness. The Purpose of this research is to find data related to blindness and visual impairment caused by senile cataracts. Barriers of cataract surgery in patient with senile cataract is a very favorable factor in this study. Method: Study design using cross-sectional method, data were collected from Ume Manekan Hospital November 2017. Assessment was done by clinical ophthalmologist evaluating the characteristics, type of cataract, visual acuity, and barriers to cataract surgery. Result: Total subjects in this study are 109. Prevalence of mature cataract is 55 (51%). Barriers most cataract surgery in this study is the inability of the community to pay the cost of surgery 54 (49.5%), followed by the lack of access to treatment that is 33 (30%), fearing the results of operations 15 (13.8%) and felt that treatment is not needed 7 (6.4%). The category of most vision loss in the operated eye was found in the blindness group ( Conclusion: Eye health system that must be well prepared at the level of regional holder considering the number of blindness due to high enough cataracts in TTS Timor Tengah Selatan district.

Diabetic retinopathy (DR) is one of the microvascular complication in diabetes mellitus (DM). Glycosylated hemoglobin (HbA1c) is an indicator that reflects the percentage of blood glucose tied to hemoglobin for the past three months. This study aims to determine if a high level of HbA1c increases the prevalence of proliferative diabetic retinopathy. Cross-sectional study. The participants were DM patients who were diagnosed with PDR and NPDR for the first time and HbA1c level was checked in the laboratory. Of the 74 participants, 37 participants were PDR, and 37 participants were NPDR. The ratio of prevalence (PR) was 3.87, with Confident of Interval (CI 95%): 1.96-7.67 and p < 0.001. Multivariate analysis shows Odd Ratio (OR) of HbA1c is 18.319 (5.334-62.919) and p < 0.001. High level of HbA1c as a risk factor of high prevalence of PDR.

BACKGROUND: Incomitant exotropia is one of ocular complication that has been reported after intranasal surgery. This case report aims to describe the causes of exotropia in a patient with a history of nasal polyp surgery.CASE PRESENTATION: A 50-years-old male, came with the main complaint of double vision 1 month after nasal polyp surgery. He also complained his right eye turned outward. The visual acuity on the right eye was 6/7.5 with his head turn to the left. On the examination, the Hirschberg test was XT 45°, and the Krimsky test > 95 ∆BI. Duction and version test on the right eye were -4 adduction. There was no shifting on the cover-uncover test. Ishihara test was within normal limit, and there was suppression on the right eye in WFDT. On force generation test, we found limited adduction on the right eye and no restriction in force duction test. Head MRI showed atrophy of medial recti on the right eye, 2.2 mm in size. The patient underwent vertical muscle transposition procedure surgery, and it was found atrophy of medial recti without any rupture. Two months after surgery, the double vision was decreased, the result of the Hirschberg test was XT 30° and Krimsky test 65°∆BI. DISCUSSION: Nasal polyp surgery-related incomitant exotropia mostly caused by extraocular muscles rupture. In this case, we found no rupture. Therefore, we suspected the abnormalities of muscles vascularisation, supported by the atrophy of medial recti.

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.