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Aims: In this study, we aimed to investigate the intercorrelations between tear film break up time, measured non-invasively using non-invasive keratographic break-up time (NIKBUT), higher order aberrations (HOA) and quality of vision (QoV) in pseudophakic patients. Study Design: Cross-sectional. Methods: Thirty-five pseudophakic aged patients aged 50 years or older, and 35 control phakic patients aged 17 to 23 years with corrected visual acuity of 20/20 were included in this study. All subjects underwent similar examination including QoV questionnaire, aberrometry to measure HOA, and NIKBUT. HOA was measured with the OPD-Scan/ ARK 10000 corneal analyzer (Nidek CO. Ltd), expressed as Root Mean Square (RMS) HOA and NIKBUT was assessed using non-invasive TF-Scan module Keratograph 5M (K5M), equipped with modified tear film scanning function (Oculus, Wetzlar, Germany). Statistical analysis was performed to find the correlation between NIKBUT, HOA and QoV. Results: Patients in the pseudophakic group were significantly older (median age 66 vs. 20 years; P

Aims: Image-guided systems are the gold standard for determining toric intraocular lens (IOL) axis alignment. However, their high cost prevents widespread use of these systems. As an alternative, a simpler and affordable method could be performed manually using a slit-lamp biomicroscope. This study aims to compare the accuracy of manual toric IOL axis marking using a slit-lamp compared to the CALLISTO eye image-guided system. Study Design: Prospective comparative Methods: In this prospective study, toric IOL axis alignment of 42 eyes with cataract and coexisting corneal astigmatism were evaluated using manual slitlamp method and CALLISTO eye image-guided method. Preoperative and postoperative uncorrected visual acuity, best corrected visual acuity, amount of spherical and astigmatic refractive errors, and postoperative IOL axis alignment were evaluated. Intraclass correlation of the manual method was calculated and the difference of IOL axis alignment to the image-guided method was compared. Results: Toric IOL implantation reduced the amount of astigmatic refractive error from -1.63 ± 0.65 D to -0.50 ± 0.19 D in the image-guided group and from -1.93 ± -0.90 D to -0.87 ± 0.26 D in the manual slitlamp group. As many as 90.5% of eyes in the image-guided group and 81.0% of eyes in the manual slitlamp group reached the target induced astigmatism (p=0.38). Manual axis marking showed intraclass correlation of 99.3%. However, when the manual method was compared to the image-guided method a mean difference in axis alignment of 10.98o (95% confidence interval: 9.32o - 12.63o) was observed. Conclusions: Alignment of toric IOL axis using the manual method demonstrated a consistent result; yet producing a considerable difference to the result of the image-guided method.

BACKGROUND Surgery has been proposed as a treatment of paralytic lagophthalmos. However, no consensus has been reached on the best treatment. This study was aimed to investigate the efficacy and safety between platinum chain and gold weight implants to treat paralytic lagophthalmos. METHODS This study used all randomized controlled trials or observational studies (prospective or retrospective) using platinum chain and gold weight implants for paralytic lagophthalmos surgery that were published from 1990 to 2020 in the PubMed, Cochrane, and Google Scholar databases. Efficacy was indicated by the reduction of ≥3 in lagophthalmos, and safety was measured based on complications after surgery. RESULTS The efficacy of platinum chain and gold weight implants were 60–100% and 10–93.6%, respectively. The complications of platinum chain implant were 0–2.9% of extrusion and 0–3.3% of migration. However, gold weight implant had 0–13.3% of migration. CONCLUSIONS Both platinum chain and gold weight implants have similar efficacy to treat paralytic lagophthalmos. However, gold weight implant has a higher rate of complication.

BACKGROUND Soft contact lens (SCL) wear can lead to a corneal hypoxia. However, there is a lack of studies looking for corneal hypoxia biomarkers in tear. This study aimed to investigate corneal hypoxia among SCL wearers based on hypoxia-inducible factor-1α (HIF-1α) expression, tear lactate dehydrogenase (LDH), and malate dehydrogenase (MDH) activities. METHODS A nonrandomized clinical trial was conducted on two groups. SCLs were prescribed for 2 months to a group of new wearers. Meanwhile, SCL wear was discontinued for 1 month in a group of long-term wearers. Tear samples were then collected on days 1, 7, 14, 28, and 56 after treatment. Repeated-measures analysis of variance and Friedman’s test with post-hoc statistical analysis were used to evaluate biomolecular changes (HIF-1α concentration, LDH, and MDH activities) in both groups. RESULTS A total of 14 subjects (28 eyes) were enrolled in each group. In new wearers, there was a significant decrease in MDH level (p = 0.010) and no effect on HIF-1α level. In long-term wearers, HIF-1α and LDH levels tended to decrease (p = 0.054). A significant decrease on MDH level was noted on days 7 (p = 0.003), 14 (p = 0.026), and 28 (p

Purpose To describe the prevalence of dry eye disease (DED) and its subtypes in elderly population with cataracts prior to surgery in Jakarta, Indonesia. Patients and Methods Forty-nine eyes of 49 patients (16 males, 33 females; mean age: 66.6 years) planned for phacoemulsification surgery were consecutively recruited from two tertiary eye hospitals in this hospital-based cross-sectional study. Symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, and the patient was defined as symptomatic if their OSDI score was ≥13. Objective examinations included the noninvasive tear film break up time (NIBUT) and Schirmer tests. The results were deemed abnormal if they were 70 years) was associated with poorer NIBUT and Schirmer test results and a significant difference between age groups was observed, especially in males. Conclusion Dry eye is a common problem among the elderly population with cataracts in Indonesia. Almost half of the subjects presented with dry eye symptoms and either categorized as DED or preclinical dry eye, while more than one quarter were predisposed to dry eye. Care must be taken prior to cataract surgery to rule out existing dry eye with additional attention on those presenting without any symptoms as dry eye may develop after surgery.

Purpose: To determine the level of intercellular adhesion molecule-1 (ICAM-1) in vitreous fluid of patients with proliferative diabetic retinopathy (PDR) and its affecting factors including HbA1c level, duration of diabetes mellitus (DM) and insulin usage. Methods: A cross-sectional study was conducted in Cipto Mangunkusumo National General Central Hospital, Jakarta, Indonesia from June 2015 to August 2016. Thirty-three consecutive vitreous samples harvested from PDR patients underwent vitrectomy. The level of vitreous ICAM-1 was determined by enzyme-linked immunosorbent assay. Results: Based on the glycemic status, vitreous ICAM-1 level in the uncontrolled glycemic group (21.61 ng/ml) was lower than controlled glycemic group (24.20 ng/ml). Patients with DM for more than 10 years had higher level of vitreous ICAM-1 (26.30 ng/ml). Vitreous ICAM-1 level in DM patients with insulin was higher than those without insulin (27.07 ng/ml vs. 24.17 ng/ml). There was no statistically significant difference between vitreous ICAM-1 levels among all groups (p > 0.05). Conclusion: The concentration of vitreous ICAM-1 may not be influenced by glucose control and conventional insulin therapy.

Iwan Soebijantoro,1 Tjahjono D Gondhowiardjo,1 Marsetyawan Soesatyo2 1JEC Eye Hospitals and Clinics, Jakarta, Indonesia; 2Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, IndonesiaCorrespondence: Iwan SoebijantoroJEC Eye Hospitals and Clinics, Jalan Terusan Arjuna Utara Nomor 1, Jakarta Barat, DKI, Jakarta, 11520, IndonesiaTel +62 813 1102 0020Email iwan@jec.co.idPurpose: To study the association between corneal endothelial cell density (ECD) and degree of anterior chamber angle (ACA) opening in eyes with chronic angle closure glaucoma.Methods: The study was conducted at JEC Eye Hospitals in Indonesia. Treatment-naïve patients aged ≥ 40 years with IOP > 21 mmHg and peripheral anterior chamber depth (ACD) grade 2 or less by Van Herick’s technique were recruited. Trabecular iris angle (TIA; degree) was measured using anterior segment optical coherence tomography (AS-OCT) and classified as: grade 1 ≤ 10°, grade 2 11– 20°, and grade 3 > 20°. Noncontact specular microscopy was performed, and the following corneal parameters were obtained:ECD (cells/mm2), coefficient of variation (CV; μm2/cell), percentage of hexagonal cells, and central corneal thickness (CCT; μm).Results: A total of 52 eyes from 52 subjects were recruited (16 grade 1 TIA, 24 grade 2 TIA, and 12 grade 3 TIA). Presenting IOP was not significantly different between groups. The median central corneal ECD was 2684.5 (1433– 2934), 2587.0 (1902– 3103), and 2441.0 (1659– 3005) cells/mm2 in grade 1, 2, and 3 TIA, respectively, with no significant differences across the groups (P = 0.67). The CV was lowest in grade 3 TIA (36.4 ± 7.2 μm2/cell), and highest in grade 1 TIA (38.3 ± 9.6 μm2/cell), but the differences were not significant (P = 0.74). Likewise, the percentage of hexagonality and CCT was not significantly different. TIA was not correlated with IOP but was modestly correlated with age.Conclusion: The corneal ECD and morphological characteristics such as CV and hexagonality were not significantly different across various TIA grading in chronic angle closure. This may reflect the lack of chronic and gradual IOP insult on corneal endothelial parameters as TIA did not show direct effect towards IOP.Keywords: corneal endothelium, primary angle closure glaucoma; PACG, trabecular iris angle; TIA

[This corrects the article DOI: 10.13181/mji.oa.203818]

BACKGROUND Minimizing inflammation on the ocular surface after pterygium surgery is essential to prevent recurrence. Currently, limited data are available for the comparison between freeze-dried amniotic membrane (FD-AM) and conjunctival–limbal graft (CLG). Therefore, this study aimed to assess conjunctival inflammation and the interleukin (IL)-6 levels in tears after pterygium excision between both techniques. METHODS This prospective, single-blinded, randomized clinical trial included 26 eyes of 26 patients with primary or recurrent pterygium and who were indicated for pterygium surgery at Cipto Mangunkusumo Hospital, Indonesia from October 2017 until February 2018. The patients were scheduled for pterygium excision with FD-AM or CLG based on block randomization. Conjunctival inflammation and the level of IL-6 in tears were measured on day-7 and -28 after surgery. RESULTS The 26 eyes (13 in each group) were subjected to a complete 1-month follow-up period. Day-7 after the surgery, severe inflammation occurred in 4/13 (31%) eyes having FD-AM and 8/13 eyes (62%) having CLG (p = 0.59). The IL-6 tear level increased similarly in FD-AM (22.85 pg/ml) and CLG (23.51 pg/ml) in (p = 0.78). No severe adverse events occurred. CONCLUSIONS Pterygium excision using FD-AM yield a milder inflammation than CLG on day-7 and -28 after surgery. The tear IL-6 levels similarly increased on day-7.

Purpose To revisit the concept of retinectomy and the theory of mechanical forces on the retina occurring in rhegmatogenous retinal detachment (RRD) and to describe the potential application of radial retinectomy in RRD with advanced proliferative vitreoretinopathy (PVR). Methods A literature search was performed to identify all English language articles reporting the use of retinectomy for the management of RRD with PVR. We reviewed the theoretical background of mechanical forces occurring in RRD. Results Detachment of the retina from the retinal pigment epithelium (RPE)/choroid is influenced by disequilibrium of several physical forces: tangential forces on the epiretinal membrane $$\left( {T_{1} } \right)$$ T 1 and radial traction on the retina $$F_{R}$$ F R exceeding the retinal adhesion force to the RPE $$\left( {T_{1} \;\text{ + }F_{R} \;\text{ > }\;F_{A} } \right)\,\,$$ T 1 + F R > F A . PVR may exaggerate the amounts of tangential and radial forces ($$\left( {T_{1} } \right)$$ T 1 and $$F_{R}$$ F R ) that pull the retina off. Relaxing radial retinectomy, by the nature of its cutting pattern, may theoretically decrease the amounts of both forces, therefore restoring the equilibrium between tensile and adhesive forces on the retinal surface $$\left( {T_{1} \;\text{ + }F_{R} \;\text{ = }\;F_{A} } \right)\,\,$$ T 1 + F R = F A . Conclusion Relaxing radial retinectomy may potentially be applied in RRD with advanced PVR but has rarely been reported to date. Future studies are needed to evaluate its outcomes and long-term complications.

Purpose To describe the prevalence of dry eye disease (DED) and its subtypes in elderly population with cataracts prior to surgery in Jakarta, Indonesia. Patients and Methods Forty-nine eyes of 49 patients (16 males, 33 females; mean age: 66.6 years) planned for phacoemulsification surgery were consecutively recruited from two tertiary eye hospitals in this hospital-based cross-sectional study. Symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, and the patient was defined as symptomatic if their OSDI score was ≥13. Objective examinations included the noninvasive tear film break up time (NIBUT) and Schirmer tests. The results were deemed abnormal if they were 70 years) was associated with poorer NIBUT and Schirmer test results and a significant difference between age groups was observed, especially in males. Conclusion Dry eye is a common problem among the elderly population with cataracts in Indonesia. Almost half of the subjects presented with dry eye symptoms and either categorized as DED or preclinical dry eye, while more than one quarter were predisposed to dry eye. Care must be taken prior to cataract surgery to rule out existing dry eye with additional attention on those presenting without any symptoms as dry eye may develop after surgery.

Aim:To evaluate the predictive factors of LASIK procedure for high myopia with or without astigmatism using a combination of high-frequency femtosecond-assisted LASIK followed by an excimer laser.Methods:This study was a retrospective interventional case series study to evaluate myopic eyes undergoing high platform LASIK with FEMTO LDV Z2 intervention, followed by WaveLight®EX500 excimer laser machine. Subjects were divided into 2 groups: high myopia (SE of -6.01 to -9.00 D) and very high myopia (SE of -9.01 D or higher). Myopic eyes (Spherical Equivalent/SE) less than –13 D were included in this study. Visual Acuity (VA) was evaluated 1 day and 60 days after the procedure. Predictive factors, such as age, degree of sphere, degree of astigmatism, keratometric reading and axial length were analyzed to detect any influences affecting the final VA results.Results:A total of 316 myopia eyes underwent intervention, mean age: 25.3±3.8 years. Target treatment was achieved in 96.1% of patients with high myopia and 69.9% of patients with very high myopia. High degree of sphere and astigmatism constitutes an important factor influencing final VA.Conclusion:Modern machines provide a more promising efficacy and success of LASIK procedure in high myopia: important predictive factors were a high degree of sphere and astigmatism for achieving the optimal final outcome.

Laser in-situ keratomieleusis (LASIK) is a common intervention for young, active, ametropic individuals to improve their visual acuity. pseudo-accommodative cornea (PAC), a variant of LASIK, to correct ametropia among presbyopic patients is proven in maintaining good distant vision; yet, the satisfactory spectacle free reading vision is limited to the ageing progression. However, successful treatments do not guarantee patient’s satisfaction. Assesment of the objective topographic indicators, visual acuity, higher order abrasion, and contrast sensitivity; revealed the clarification of a mild headache as a personal subjective experience after the treatment. The role of the persistent, dominant eye, the brain perception, seems to be critical factor to a patient’s satisfaction. To a certain degree, the interplay amongst the optical part and it’s supporting tissue, within and between the eyeballs, as well as its relationship to the neurosensory parts of the visual systems after Lasik surgery have not yet been assessed and reported elsewhere.

Tujuan: Mengetahui efektivitas dan keamanan fakoemulsifikasi torsional dan transversal dilihat melalui parameter intraoperatif berupa phaco time dan parameter perioperatif berupa perubahan kepadatan sel endotel kornea dan ketebalan sentral kornea.Metode: Penelitian prospektif ini menggunakan pasien katarak dengan NO 3-4 (LOCS III) yang telah dibagi menjadi dua kelompok torsional (Ozil IP®) atau transversal (Ellips FX®) mengunakan randomisasi. Keluaran utama yang dinilai adalah lama phaco time, endothelial cell density (ECD), central corneal thickness (CCT), tajam penglihatan jauh dikoreksi pada hari 1, 7, dan 30 hari pasca operasi. Hasil: Penelitian ini menggunakan data 61 subjek dengan data karakteristik dasar yang setara. Lama phaco time kelompok torsional (CDE) hanya satu pertiga lama phaco time kelompok transverasl (EFX). Besar rerata penurunan ECD pada kelompok torsional dan transversal adalah 7.9% dan 8.9%. Rerata perubahan CCT pada kelompok torsional 37.75 ?m dan kelompok transversal 42.67 ?m. Tidak ada perbedaan bermakna secara statistik pada penurunan ECD dan perubahan CCT antara kedua kelompok. Simpulan: Phaco time kelompok torsional lebih rendah dibandingkan dengan kelompok transversal. Oleh karena adanya perbedaan algorithma pada setiap mesin berbeda dalam menghitung phaco time, perbandingan efektivitas antara kedua mesin tidak adapat dibandingkan secara langsung. Namun, dapat dinilai secara tidak langsung berdasarkan penilaian terhadap perubahan ECD dan CCT. Sehingga efektivitas dan keamanan antara kelompok torsional dan transversal dinilai setara.

Purpose: to assess the levels of Hypoxia-inducible factor-1α (HIF-1α) and intercellular adhesion molecule-1 (ICAM-1) in vitreous of proliferative diabetic retinopathy patients which were given intravitreal bevacizumab (IVB), as well as its relation to the central macular thickness (CMT) measured prior to vitrectomy. Methods: thirty-two eyes were randomized into two groups, one that received an IVB injection at 1-2 weeks previtrectomy and the control group which did not receive any injection. Measurement of HIF-1α and ICAM-1 was conducted using enzyme-linked immunosorbent assay (ELISA). The CMT were measured at the initial visit, prior to vitrectomy, and at follow up time (2, 4, and 12 weeks postoperatively) using Stratus OCT. Results: The mean levels of HIF-1α vitreous (ng/mg protein) in the control group and IVB respectively 0.020 (0.006; 0.077) and 0.029 (0.016; 0.21). Vitreous levels of ICAM-1 (ng /mL) in control group and IVB group were 20.10 (3.41; 40.16) and 23.33 (0.63; 68.5). The mean levels of HIF-1α and ICAM-1 vitreous obtained did not differ significantly between the two groups. Conclusion: The levels of HIF-1α and ICAM-1 in PDR patients do not decrease after one injection of intravitreal Bevacizumab 1-2 weeks prior to vitrectomy. The concentration of vitreous HIF-1α and ICAM-1 are not directly related to the CMT.

Background: Posterior capsule opacification (PCO) is the most common postoperative consequence of cataract surgery which may cause visual acuity reduction, yet the incidence in Indonesia has not been reported. The objectives of this study were to evaluate three years cumulative incidence of PCO and factors associated with PCO formation at Cipto Mangunkusumo Hospital, Jakarta.Methods: This was a retrospective descriptive study on patients with uneventful senile cataract surgery during year 2010. All related data were retrieved from medical records in year 2013, which included patient demographics, type of surgery, intraocular lens (IOL) characteristics (material, optic edge design and diameter). Moreover, time to first PCO diagnosis (month), and best corrected visual acuity (BCVA) pre-operatively, at time PCO was diagnosed and two weeks after Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser were noted (decimal).Results: A total of 578 eyes (485 patients) were involved in this study. Three years cumulative incidence of the PCO was 8.82% (51 eyes). Phacoemulsification surgery was performed in 496 (85.8%) eyes. The median time to PCO diagnosis was 21 months (range 1 to 34 months), mean of BCVA was 0.50 ± 0.26. Age (65 years old) was not associated to PCO. Higher incidence of PCO was found in patients using hydrophilic acrylic IOL (10.7%) than in hydrophobic acrylic (6.2%). After Nd:YAG laser was performed, BCVA was improved to 1.00.Conclusion: Three years cumulative incidence of PCO was 8.82% and there was no defined factor related to PCO formation, but higher percentage of PCO occured in patients using hydrophilic acrylic IOL than in hydrophobic acrylic.

Secara global telah diterima bahwa perkembangan kemampuan ekonomi suatu Negara, berjalan parallel dengan peningkatan usia harapan hidup masyarakat-nya. Saat ini, usia harapan hidup penduduk Indonesia, berkisar antara 69 tahun (pria) dan 72 tahun (wanita). Kondisi demograpik ini secara tidak langsung akan terkait dengan pergeseran distribusi pola penyakit, terutama pergeseran pola penyakit berdasarkan infeksi menjadi pola penyakit/keadaan degeneratif yang terkait dengan gaya hidup. Hal itu dapat terlihat pada edisi ini, yang di-dominasi oleh makalah segment posterior yang terkait dengan peningkatan usia harapan hidup dan degenerasi (age related macular degeneration), atau kondisi yang secara tidak langsung merupakan refleksi gaya hidup (Diabetes Mellitus atau kualitas viskositas darah). Kondisi tsb memperlihatkan bahwa, walaupun jaringan bolamata bersifat sangat spesifik dan merupakan suatu kompartemen yang relatif terpisah dengan adanya sawar darah-bolamata, namun tetap terkait dengan berbagai kondisi sistemik; sehingga bolamata dapat menjadi “jendela” kondisi sistemik. Pergeseran pola penyebab kebutaan ke sisi segmen posterior, menuntut peningkatkan peralatan diagnostik digital dan peralatan intervensi yang lebih canggih, seperti foto-koagulasi laser, vitrektomi dan penggunaan berbagai jenis gas, yang tentunya menuntut keterampilan khusus baik bagi operator maupun paramedis-nya; serta pengobatan anti vascular endothelial growth factor (anti VEGF) secara serial yang relatif mahal, sebagaimana ketiga makalah yang ditampilkan. Pergeseran pola penyakit tsb, secara tidak langsung menuntut kita, baik sebagai insititusi pelayanan ataupun pendidikan, maupun sebagai individu untuk ikut menyesuaikan diri, terutama dalam mengembangkan pola fikir untuk selalu dapat memberikan yang terbaik bagi pasien-pasien kita. Namun sayangnya, tanpa sadar kita telah membuat dinding-dinding pembatas yang cenderung membatasi upaya pencapaian tujuan; dan yang relatif dibuat tanpa mempertimbangkan situasi dan kondisi lokal. Berbagai batasan tsb, baik yang terjadi secara internal, maupun external telah membelenggu kita terhadap kemungkinan menumbuhkan daya inovasi maupun kreativitas untuk pengembangan keilmuan demi kemaslahatan masyarakat. Pada era jaminan kesehatan saat ini, pengobatan anti VEGF awalnya mendapat pembiayaan, namun kemudian di hentikan karena pembiayaan terhadap upaya pencegahan kebutaan yang dianggap terlalu tinggi. Hal itu terjadi, antara lain karena penolakan terhadap bukti ilmiah yang menyatakan bahwa sekalipun preparat anti VEGF dengan harga yang lebih murah, terdaftar untuk kondisi lain; namun terbukti tidak ada perbedaan effektivitas dibandingkan dengan jenis obat yang spesifik untuk kelainan mata yang lebih mahal. Selain itu, karena pengabaian pernyataan Badan Kesehatan Dunia yang menyatakan bahwa obat tsb termasuk obat essential untuk pencegahan kebutaan. Penghentian pendanaan itu, merupakan ironi karena di berbagai Negara tetangga dengan pendapatan domestik yang lebih tinggi, justru memperbolehkan penggunaan obat tsb. Di berbagai Negara maju, dasar penentuan prioritas pendanaan pemerintah dibuat berdasarkan kajian biaya penatalaksaan / tindakan langsung, serta kerugian akibat terjadi pengabaian karena hilangnya potensi individu, keluarga dan masyarakat, baik dalam sisi sosial dan ekonomi bagi Negara (health technology assessment / HTA), berjalan lurus dengan besaran nilai prevalensi, dan Year of Lost Life due to Disability (YLD) serta (disability of activity loss / DALY) akibat suatu kondisi / penyakit. Nilai YLD dan DALY menampilkan besaran kehilangan produktivitas individu, akibat suatu penyakit dan dampaknya pada besaran biaya kesehatan yang harus ditanggung; data tersebut dibandingkan dengan nilai serupa untuk penyakit/keadaan lain, seperti stroke, gangguan kardio-vaskular, berbagai jenis kanker dll.

Terdapat beberapa hal positif dalam edisi kali ini, yang terkait dengan perkembangan majalah kita bersama ini; yaitu adanya dua sumber makalah yang berbeda dari rutinitas selama ini. Makalah pertama, berasal institusi pelayanan nun jauh di ujung timur negeri kita yang tercinta ini, yang walaupun hanya berupa telaah kepustakaan, namun menampilkan bahasan perkembangan teknologi yang relatif mutahir sebagai penatalaksanaan suatu keadaan klinis yang berpotensi mempunyai prevalensi yang cukup tinggi. Namun, ironi-nya belum banyak dilaporkan oleh sejawat yang berada di kota besar atau institusi pendidikan sekalipun; hal itu mungkin disebabkan karena keterbatasan kemampuan klinis untuk mengenali gejala dan petanda, ataupun karena ketiadaan alat diagnostik. Makalah kedua, adalah laporan penanganan kasus Orbital Cellulitis, berasal dari disiplin THT, namun terkait erat dengan profesi kita dengan topik yang dapat dikatagorikan sebagai kegawatan mata, yang apabila tidak dikenali dan ditangani dengan tepat dapat menyebabkan kebutaan, atau bahkan kematian. Sejalan dengan itu, telaah kepustakaan mengenai Methanol-induced Toxic Optic Neuropathy dapat di- katagori-kan juga sebagai kegawat daruratan mata. Kedua keadaan ini, tidak jarang kita jumpai, secara tidak langsung menunjukkan rendahnya tingkat pengetahuan dan kondisi sosial masyarakat kita; dan tentunya merupakan bagian dari tugas kita dalam memberikan penyuluhan kesehatan mata. Kedua makalah ini, perlu kita pahami dan dalami dengan sebaik-baik nya, sehingga kita mampu melakukan penanganan dan tindakan dengan tepat dan cepat untuk menghindari terjadi nya kebutaan pada pasien kita. Prinsip dasar dan tujuan suatu teknologi baru adalah “lebih baik (better), lebih cepat (faster), dan lebih murah (cheaper)” dari teknologi baku yang telah digunakan selama ini. Di bidang kedokteran maka penerapan teknologi tentunya harus di dasari dengan prinsip “saver (aman, tidak merugikan pasien)”. Oleh karena itu, semakin canggih suatu teknologi, maka akan tampak semakin sederhana; namun sebagai pengguna (user) seharusnya sebelum diterapkan, kita harus terlebih dahulu memper-luas dan mendalami pengetahuan dasar dan terapan yang terkait dengan teknologi baru tsb. Sedikitnya terdapat beberapa prinsip yang harus kita sadari; suatu teknologi akan berhasil guna secara optimal bila diterapkan pada suatu sistem (techno-system) dan infra-struktur (techno-structure) yang sesuai, karena teknologi dikembangkan oleh seorang pemikir (techno-logist) sesuai dengan filosofi yang di anut-nya (techno- sophy). Pada suatu kebaharuan yang bersifat keterampilan, diperlukan pelatihan tindakan (wetlab); asistensi tindakan dan supervisi untuk memastikan keamanan tindakan dan optimalisasi hasil tindakan. Sesuai dengan tingkat kesulitan dan keamanan tindakan, maka diperlukan pengakuan keterampilan tsb (sertifikat kompetensi). Secara ilmiah, suatu evaluasi/publikasi hasil teknologi baru harus di-dasar-kan pada metodologi yang benar sehingga didapatkan kesimpulan yang sahih, dan dapat dipertanggung jawabkan....

Background: This study aims to assess the quality of life and the time trade off-utility value of the first eye cataract surgery and the second eye cataract surgery in Lombok Island-Indonesia. Methods: This was an epidemiologic survey study on community of cataract surgery. Evaluations of quality of life (QoL) and time trade-off (TTO) were performed using questionnaire prior and three weeks after cataract surgeries who had either first (group A) or second eye cataract surgery (group B). Personal data was noted especially on self-care, mobility, socially, and mentally status. Data was analyzed by chi-square test for categorical data and unpaired t-test or Mann-Whitney test for numeric data. Results: A total of 77 subjects was included in this study, there were 50 subjects in group A and 27 subjects in group B. Elements of QoL were improved after surgeries including self care, mobility, social, and mental status in both groups (p < 0.001). The modified TTO was accepted in 35 subjects in group A and 22 subjects in group B. Quality of life was improved in 46 patients in group A, there was further improvement in 22 patients in group B. The degree of patient’s expectation was good in 87% of all subjects. Conclusion: Second- eye cataract surgery showed further improvement in QoL despite better outcome of the first- eye cataract surgery. The outcome of cataract surgery conducted was relevant to the patient’s expectation. (Med J Indones. 2013;22:107-13)Keywords: First and second cataract surgery, quality of life, senile cataract, time trade-off

Severe exposure keratopathy in thyroid eye disease is caused by the drying of the ocular surface due to lagophthalmos caused by proptosis, upper eyelid retraction, and blinking disorders. The eyelids play a crucial role in the blinking mechanism for secretion, distribution, and drainage processes of the tear fluid to maintain a healthy ocular surface. It is therefore the eyelid position which causes severe exposure keratopathy to occur, and if not managed properly, it will end with perforation and blindness. An emergency surgical intervention in order to cover the cornea using a very simple technique is blepharotomy (full-thickness eyelid transection) to lengthen the upper lid, performed with local anesthesia, generating a good eyelid function and cosmetic result.

Background: Acute primary angle closure (APAC) is one of the causes of blindness in Department of Ophthalmology Cipto Mangunkusumo General Hospital. Management of APAC is still controversial. Laser peripheral iridotomy is difficult to be done due to corneal edema as a result of persistent high intraocular pressure (IOP). It is believe that paracentesis will lower IOP immediately. The objective of the study was to assess outcome of paracentesis as the initial management in Malay Indonesian eyes with APAC.Methods: This intervention study was conducted at the Eye Clinic of Cipto Mangunkusumo Hospital and Jakarta Eye Center commencing in January 2005 until December 2007. Malay Indonesian eyes with APAC were included in this study in accordance with the new Asia Pacific consensus. All APAC eyes underwent paracentesis to lower IOP. The presenting and post-paracentesis IOP and peripheral anterior synechiae were noted. The outcome was termed as good when IOP was ≤ 21 mmHg and poor when IOP was > 21 mmHg.Results: A total of 45 APAC eyes were recruited. Thirty-eight of these belonged to women; mean age was 54.6 ± 1.56 years. Meanwhile, average duration of symptoms was 13.15 ± 7.4 days and mean of extent of peripheral anterior synechiae (PAS) was 7.7 ± 3.1 hours. There was a strong correlation regarding duration of symptoms to the formation of PAS (r = 0.672; p < 0.001). The mean presenting IOP was 55 ± 13.37 mmHg and mean post-paracentesis IOP was 27 ± 12.78 mmHg. A decrease of 49% in IOP ( p < 0.001) was observed after paracentesis with good outcome in 19 eyes and poor outcome in 26 eyes.Conclusion: Paracentesis as an initial intervention in APAC eyes reduces the IOP immediately, but only as a temporary response. (Med J Indones. 2012;21:113-7)Keywords: Acute primary angle closure (APAC), intraocular pressure (IOP), paracentesis, peripheral anterior synechiae (PAS)

Objective: Posterior capsule opacification (PCO) is the most common postoperative consequence of cataract surgery which may cause visual acuity reduction. The incidence of PCO in Indonesia has not been reported yet. The objectives of this study were to evaluate three years cumulative incidence of PCO and factors associated with PCO formation at Cipto Mangunkusumo (CM) Hospital. Methods: This was a retrospective descriptive study to patients with uneventful senile cataract surgery in year of 2010. All related data were retrieved from those medical records in year of 2013, which included patient demographics, type of surgery, time of PCO stated, IOL characteristics (material, optic edge design and diametere. Best corrected visual acuity (BCVA) pre operatively, when PCO was determined and Nd:YAG laser (Neodymium- doped yttrium aluminium garnet) was performed in decimal. Result: A total of 578 eyes (485 patients) was involved in this study. Three years cumulative incidence of the PCO was 8.82% (51 eyes). Phacoemulsification surgery was conducted in 496 (85.8%) eyes. The median time to PCO was being determined was 21 months (range 1 to 34 months) with the mean of BCVA was 0.50±0.26. Age, gender, and type of surgery had no related factors to PCO, but higher evidence in using of hydrophilic acrylic IOL (10.7%) was found. After laser Nd:YAG laser was performed, BCVA was improved. Conclusion: Three years cumulative incidence of PCO was 8.82% and there was no defined related factor to PCO reformation, but eye had been using hydrophilic acrylic IOL seem to be higher percentage

PURPOSE To measure aqueous humor levels of TGF-β2 and TNF-α in Indonesian eyes with acute primary angle closure (APAC) and to investigate their relationship to response to treatment. DESIGN A prospective observational study. METHODS On presentation, aqueous humor samples were taken from APAC eyes by paracentesis. All APAC eyes then underwent laser peripheral iridotomy (LPI). Two weeks following LPI, trabeculectomy was performed if the intraocular pressure (IOP) was still high. Alternatively, phacoemulsification was performed in cases of normal IOP. Aqueous humor samples were taken again at the time of both surgical procedures. Age-matched cataract patients were included as a control group. Cytokine samples were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS Forty-three Indonesian APAC subjects were recruited in this study. The mean presenting IOP was 56.4 ± 0.52 mmHg and 53% underwent trabeculectomy. Comparison of the APAC eyes to the control group showed there was a significant difference in the mean levels of TGF-β2 (2007.7 ± 827.2 pg/mL vs 466.1 ± 219.3 pg/mL, p < 0.001) and TNF-α (0.714 ± 0.33 pg/mL vs 0.228 ± 0.16 pg/mL, p < 0.001). There was no significant difference in the presented TGF-β2 and TNF-α levels between the trabeculectomy and phacoemulsification groups (p:0.391 and p:0.494). Between presentation and surgery in the trabeculectomy subgroup, both cytokine levels appeared to be significantly different (p < 0.035 and p < 0.038). CONCLUSIONS This study showed the aqueous humor levels of TGF-β2 and TNF-α appeared high at presentation but decreased subsequently, with no difference detected between groups with persistently high IOP and those with normalized IOP.

Purpose: To describe clinical outcomes after a novel type of corneal surgery, implantation of an artificial cornea, AlphaCor, and to evaluate outcomes in comparison with alternative keratoprostheses and high-risk grafts. Methods: Case reports and data from a noncontrolled clinical trial and a literature review. Results: The probability of AlphaCor retention to 1 year is 80%. Postoperative best corrected visual acuity ranges from Perception Light to 20/30. The most significant complications are stromal melts and optic depositions, for both of which the main risk factors have been identified. Complications can be managed without loss of the eye. Conclusion: Results from the clinical trial period have helped to determine the indications and risk factors for AlphaCor surgery and to refine surgical techniques. Continued monitoring of outcomes as the series increases will allow a more accurate determination of comparative outcomes. The series provides preliminary evidence that AlphaCor may have a lower incidence of complications than traditional keratoprostheses and may prove to be preferable to a donor graft in high-risk cases.

Edisi ini menampilkan dua makalah terkait dengan keberhasilan penatalaksanaan trauma bolamata yang dapat mengancam kebutaan. Makalah pertama menunjukkan pentingnya untuk segera melakukan pemeriksaan neuro imaging pada dugaan adanya benda asing intra okular, yang sangat membantu penatalaksaan dan tindakan bedah selanjutnya. Makalah kedua, memperlihatkan bahwa pemberian methylprednisolon intra vena awitan dini (kurang dari 24 jam) pasca trauma tumpul pada syaraf optik (Neuropati Optik Traumatik) dapat memberikan perbaikan tajam penglihatan yang signifikan, walaupun tidak didapatkan adanya faktor-faktor yang bisa dijadikan sebagai prediktor. Disisi lain, ketebalan serabut syaraf retina (RFNL) di kuadrant temporal yang terlihat dengan pemeriksaan digital Optical Coherence Tomography (OCT) dapat menjadi prediktor fungsi penglihatan sentral pada penderita Non Arteritik Iskemik Neuropati (NAION). Secara tidak langsung, ketiga makalah tsb menunjukkan bahwa sekalipun mungkin terdapat ketergantungan kita pada bantuan pemeriksaan imaging digital, namun ketajaman eksekusi klinis tetap harus menjadi hal utama dalam penanganan kedaruratan penglihatan. Kondisi pasien yang berpotensi menyebabkan kebutaan dan relatif sering dijumpai adalah ulkus kornea; yang menurut World Health Organization (WHO) merupakan penyebab kebutaan ke empat di dunia. Sayangnya, makalah deskriptif terkait ulkus kornea yang ditampilkan terasa penuh dengan duplikasi penampilan data (pada teks, grafik atau tabel), sehingga kita kurang dapat menga mbil manfaat pembelajaran. Hal itu, disebabkan karena kurang menampilkan substansi yang seharusnya dapat di tonjolkan, yang justru mungkin menjadi faktor pembeda atau kesamaan (compare and contrast) dengan laporan serupa yang berasal dari insititusi dengan situasi dan lingkungan yang berbeda. Begitu pula dengan kesimpulan yang terasa datar dan umum. Makalah yang menunjukkan adanya keterkaitan yang bermakna pada aktivitas luar gedung yang kurang dari empat (4) jam per hari pada pelajar sekolah dengan kondisi myopia, kedalaman pembahasan-nya akan menjadi lebih tajam apabila dilakukan analisa bi variate. Issu yang menarik ini, telah menjadi dasar kebijakan dalam kurikulum pendidikan sekolah dasar di Negara maju, yang meng-alokasi-kan sejumlah waktu tertentu bagi para peserta didik untuk beraktifitas /belajar diluar gedung. Katarak, adalah keadaan yang hampir selalu terjadi pada penderita pasca vitrektomi, terutama dengan penggunaan minyak silikon. Tindakan fakoemulsifikasi merupakan treatment of choice untuk keadaan tsb, namun termasuk dalam katagori tindakan yang sulit; sehingga dalam era BPJS ini masuk dalam kriteria yang seharusnya di tangani pada rumah sakit rujukan tipe A. Artikel yang ditampilkan, menunjukkan bahwa tindakan fakoemulsifikasi terbukti dapat meningkatkan kemampuan penglihatan penderita dengan angka komplikasi yang rendah apabila dilakukan oleh operator yang handal, namun kemungkinan terjadi nya re-detachment terpantau meningkat pada penderita yang minyak silikon nya telah dikeluarkan. Hal ini merupakan suatu kenyataan dan implementasi langsung dari konsep “volume pressure” sebagai bagian dari homeostasis regulasi cairan akueous bolamata.

To review outcomes of AlphaCor artificial cornea implantation in patients with and without a history of ocular herpes simplex virus (HSV) and to determine whether herpetic eye disease is an indication for AlphaCor surgery.Outcomes of the initial 40 implantations were reviewed and stratified by the presence of a history of ocular disease caused by HSV. Outcomes measures (complications, visual acuity gained) were compared.Eight of the 40 AlphaCor implantations (20%) were in patients with a history of ocular HSV. Six of these eight patients (75%) developed melt-related complications after AlphaCor insertion. Half of the affected patients required removal of the AlphaCor and replacement with a donor corneal graft to restore ocular integrity. In comparison, only six of the 32 (18.8%) patients without HSV developed a melt after AlphaCor insertion. Patients with HSV with devices in situ exhibited a mean loss of 0.3 line of best-corrected visual acuity compared with the preoperative visual acuity, whereas patients without HSV exhibited a mean gain of 1.4 lines of best-corrected visual acuity.The extensive lamellar corneal surgery involved in AlphaCor implantation may precipitate reactivation of latent HSV such that reactivation and resultant inflammation reduce device biointegration and facilitate melting of corneal stromal tissue anterior to the device. Although there may be some benefit from systemic antiviral medication, the current series is not large enough to demonstrate such a benefit, and melting can occur despite medication. The statistically significant difference in outcomes between recipients of AlphaCor with and without HSV is evidence that a history of HSV should be an exclusion factor for AlphaCor surgery.

Purpose: To evaluate the result of diffractive-refractive multifocal intraocular lens (IOL) implantation, regarding the visual acuity, spectacle independency, and also related disturbing visual pnenomenon such as halo and glare. Methods: Seventeen articles collected from multiple sources including Pubmed, Clinical Key, and Ophthalmology Advance were reviewed. Visual acuity. Five types of diffractive-refractive multifocal IOL were found including ReSTOR SA60D3, SN60D3, SA6AD3, SA6DA1, and AT Lisa 809M. Uncorrected and corrected visual acuity, spectacle independency and undesired visual phenomenon data of each IOL were analyzed. Results: For binocular uncorrected distance and intermediate vision, ReSTOR SN6AD1 is better than other IOL. Meanwhile, in binocular uncorrected near visual acuity category, ReSTOR SA60D3 is superior. Highest percentage of patients reporting spectacle independency found in ReSTOR SA60D3 group. Halo was found in each IOL group, ranged from 32 to 65 percent patients. Glare was found in a smaller percentage, ranged from 25 to 61 percent patients. Conclusion: The best option for patients aiming for best visual acuity in distance to intermediate activity without spectacle use is ReSTOR SN6AD1. Meanwhile, the best option for patients aiming for best near visual acuity is ReSTOR SA60D3. Comprehensive preoperative education is crucial, considering the cost and benefit aspects of multifocal IOL implantation.

Spektrum keilmuan Oftalmologi berada diantara dua sisi, kebutaan dan penglihatan yang optimal; oleh karena itu, sejalan dengan perkembangan ilmu pengetahuan dan teknologi, paradigma oftalmologi bergeser dari rehabilitasi kebutaan dan pencegahan kebutaan menjadi optimalisasi kemampuan penglihatan. Kondisi tsb tercermin pada berbagai makalah yang ditampilkan pada edisi ini. Artikel case report memperlihatkan ketepatan pengobatan yang ahirnya dapat membedakan dua keadaan yang mengancam kebutaan namun dengan prognosis yang berbeda. Dua artikel lain, inovasi untuk menggunakan pemeriksaan kartu Amsler untuk menilai adanya gangguan lapang pandang penderita Glaukoma, dan pemberian obat acetazolamide pasca bedah katarak masuk katagori pencegahan kebutaan. Begitu pula makalah deskripsi retrospektif tumor orbita primer pada anak, yang diskusi maupun kesimpulan nya terasa menjadi sesuatu yang umum. Kedalaman substansi dan ketajaman pembahasan makalah-makalah kita cenderung kurang terasa menjadi sesuatu pengetahuan baru. Hal ini, disatu sisi, dapat dimengerti karena umumnya artikel tsb merupakan hasil proses pendidikan para peserta program studi; namun, disisi lain menunjukkan kurangnya arahan, keterlibatan atau ketidak pedulian para pengampu-nya. Namun, hal itu sebenarnya adalah suatu ironi karena pada dasarnya yang paling di-untung-kan oleh adanya persyaratan publikasi bagi peserta didik adalah institusi pendidikan dan individu pengampu-nya dalam konteks akreditasi institusi maupun personal. Secara tidak langsung, keadaan itu juga terlihat dari asal institusi makalah yang ditampilkan, yang relatif hanya berasal dari institusi pendidikan tertentu saja, relatif sangat jarang adanya artikel dari anggota profesi yang berada di jalur pelayanan yang tidak membutuhkan nilai publikasi tsb. Hal yang sebaliknya, terlihat pada presentasi oral di acara ilmiah, terutama yang menampilkan aspek psiko motor dan yang berciri cutting edge technology justru dimunculkan oleh profesional dari sarana pelayanan. Keadaan itu menunjukkan spektrum kondisi dan situasi profesional kita sesuai dengan penjenjangan tingkatan kebutuhan individu berdasarkan teori Maslow’, dimana tingkatan tertinggi kebutuhan individu, adalah aktualisasi diri; yang secara nyata ditunjukkan dengan menampilkan karya -karya, atau berbagi pengalaman yang baik atau bahkan yang buruk pada pertemuan ilmiah tahunan profesi, atau menuliskan nya dalam makalah. Sesungguh-nya leader dalam suatu profesi adalah mereka yang mau berbagi kelebihan-nya di luar keterikatan pada lingkup bidang tugas-nya. Situasi dan kondisi keterbatasan materi untuk publikasi yang kurang kondusif, di negeri tercinta kita ini, maaf, telah berlangsung hampir seumur majalah organisasi profesi kita. Memang, ada geliat sporadik di beberapa pusat pendidikan dan pelayanan, namun terbukti belum mampu menggerakkan gerbong profesi kita secara serentak. Harus diakui, kita memang terperangkap dalam rutinitas yang menjebak, serta terlena dalam tidur nyenyak kenyamanan yang berkepanjangan. Dalam era Jaminan sosial (baca BPJS) saat ini untuk sebagian kecil dari kita, menjadi perluang besar dengan melakukan upaya entrepreunership dengan membuka klinik-klinik yang dapat melakukan operasi katarak; sedangkan, mayoritas anggota profesi akan semakin terjebak dengan rutinitas akibat membanjirnya jumlah pasien dengan nilai remunerasi yang tanpa disadari cenderung semakin minim....

Dalam era globalisasi infomasi ini, kita selalu dituntut untuk melakukan atau menerapkan semua tindakan atau keputusan berdasarkan bukti ilmiah (evidence-based). Ironinya, sebagian besar dari kita mungkin tidak pernah tersentuh atau memahami apakah evidence-based itu. Oleh karena itu, edisi ini memuat dua buah makalah meta-analisis yang berupaya untuk menjelaskan tahapan pencapaian kesimpulan yang berdasarkan bukti yang kuat dari berbagai tingkatan kesahihan suatu laporan; baik dalam prosedur diagnose klinik, maupun dalam pola penatalaksanaan terkini. Tanpa kesadaran akan proses pencapaian standar evidence-based, maka dengan mudah kita akan menggunakan suatu jenis obat, hanya berdasarkan hasil suatu makalah, misalnya efek penggunaan myrtogenol yang ditampilkan dalam edisi ini. Disisi lain, perlu disadari bahwa pemahaman dogmatis dari ketentuan evidence-based tsb, mempunyai dampak negatif, yaitu pembatasan terhadap pemikiran kreativitas dan innovasi untuk mengatasi masalah yang ada di negara berkembang, baik karena ketiadaan sarana maupun prasarana; apalagi membuat terobosan untuk kebaruan pengembangan keilmuan. Dengan kata lain, kita akan terus digiring untuk menjadi pengguna teknologi baru berdasarkan pengetahuan yang berkembang di negara-negara industri. Sebagaimana biasanya, makalah yang ditampilkan masih didominasi oleh institusi pendidikan; yang umumnya dibuat oleh peserta didik. Oleh karena itu, kita dapat melihat bahwa seringkali terkesan sebagai output dari tahapan pendidikan, yaitu belajar meneliti dengan membuktikan suatu keadaan / teknologi yang relatif sudah baku. Di sisi lain, hal ini mempunyai nilai positif karena dapat menunjukkan bahwa perlakuan atau tindakan yang sederhana dan baku, seperti metode pencil push up, suntikan oxytetracyclin intra lesi dapat memberi hasil pengobatan yang sesuai dengan harapan. Data retrospektif yang ditampilkan dapat dibaca sekedar sebagai data deskriptif, yang relatif juga merupakan informasi baku; seperti misalnya insiden kekeruhan kapsul posterior lensa pasca operasi katarak, dan keberhasilan tindakan fotokoagulasi laser pada robekan retina. Dari sisi lain, hal itu dapat dilihat, atau digunakan sebagai data pembanding terhadap kualitas pelayanan di insititusinya sendiri atau institusi lainnya. Hal itu disebabkan karena pada hakekatnya kekeruhan kapsul lensa posterior adalah akibat dari ketidaksempurnaan teknik operasi katarak yang kita lakukan; begitu pula dengan robekan retina pasca fotokoagulasi laser terkait dengan kecepatan waktu tindakan, serta ketepatan dosis dan tembakan laser pada proses fotokoagulasi tersebut. Makalah yang membahas perbandingan kadar Placenta Growth factor dengan dan tanpa intervensi Aflibercept; secara tidak langsung menunjukkan bahwa, kita membutuhkan peran disiplin lain untuk dapat memahami perkembangan ilmu dan teknologi kedokteran secara umum; dan tentunya diharapkan dapat mengembangkannya dengan melakukan inovasi yang lebih spesifik untuk profesi kita. Hal yang serupa dengan laporan penatalaksanaan tumor Triton langsung menunjukkan bahwa tanpa peran pemeriksaan histopatologi maka kondisi mata pasien berpotensi untuk menjadi buta dan bahkan mungkin kematiannya. Kedua contoh tersebut, pada hakekatnya menggambarkan kebutuhan kita untuk dapat bekerjasama baik dalam aspek inter-disiplin, maupun intra-disiplin (baca: sebagai profesi kita sendiri) dengan semangat kolegialitas untuk kemaslahatan pasien-pasien kita, profesi oftalmologi di masa mendatang. Perkembangan profesi yang sehat, menuntut adanya keseimbangan dalam berbagai aspek kehidupan profesi, namun kenyataan menunjukkan bahwa dalam berbagai kegiatan organisasi maupun ilmiah, mayoritas anggota yang berperan sebagai ujung tombak profesi kita di masyarakat dan yang berada di berbagai tingkatan pelayanan kesehatan relative bersikap pasif. Di sisi lain, hal itu merupakan alasan yang mendasar bagi mereka yang mengemban amanah organisasi profesi kita untuk dapat mengarahkan anggota untuk dapat menyamakan persepsi, kemampuan klinis dan keterampilan operatif yang siap untuk beradaptasi dalam gelombang perubahan saat ini dengan diterapkannya sistim Jaminan Kesehatan Nasional dan era pasar bebas ASEAN mendatang.

In this study we investigated the properties of corneal aldehyde dehydrogenase (ALDH) in keratoconus corneas using various electrophoretic techniques combined with immunochemical and zymographic identification. Normal corneas and other pathologic corneal buttons obtained during keratoplastic surgery were used as a control. A significant (p < 0.001) lower enzymatic activity was found in keratoconus epithelial extracts (3.1 +/- 2.1 IU/mg protein) compared with normal controls (5.5 +/- 2.6 IU/mg protein), whereas no significant differences were observed in the stromal and endothelial extracts. No significant differences were observed for the corneal ALDH thermolability behavior, nor did any marked changes occur in the position of the 54- and 88-kDa species when comparing the pathologic corneas and normal controls. On the other hand, isoelectric focusing analysis showed a different pattern for the pathologic corneas as compared with controls. Moreover, native-polyacrylamide gel electrophoresis analysis showed that normal corneas exhibit three bands, whereas keratoconus and other pathologic corneas only show two bands. The shift from the three-band pattern to the two-band pattern could be reproduced in vitro using reducing agents, such as glutathione.

[no abstract available]

[no abstract available]

Purpose To describe corneal sensitivity changes caused by different incision methods-manual small-incision cataract surgery (manual SICS) and phacoemulsification-and their influence on tear film quantity and quality. Methods This was a prospective observational study conducted in 30 subjects undergoing manual SICS or phacoemulsification. Corneal sensitivity was assessed before and 1, 7, and 15 days after surgery by Cochet-Bonnet esthesiometer. Tear meniscus, noninvasive breakup time, lipid pattern, and Schirmer test results were evaluated. Patient symptoms were reviewed based on the Ocular Surface Disease Index. Results In the group undergoing phacoemulsification, corneal sensitivity decreased at the incision site and at other sites on days 1, 7, and 15 after surgery, whereas in the group undergoing manual SICS, no change in corneal sensitivity was noted. Between-group difference in corneal sensitivity was significant on days 1, 7, and 15. Aqueous production significantly (P = 0.016) increased on the first day in both groups and returned to presurgery level on day 15. Tear film quality decreased on day 1 only in the group undergoing manual SICS (P = 0.035). Tear meniscus and tear lipid profile showed no change in either group. Patient symptoms significantly increased on day 1 in both groups, and the difference between the 2 groups was significant on day 15 (P = 0.044). Conclusions Compared with manual SICS, temporal-side incision in phacoemulsification decreased corneal sensitivity in the incision site and other sites until day 15 and changes in tear film quantity and patient symptoms only on day 1.

Purpose: To determine whether or not contrast sensitivity test and conjunctival impression cytology can be used as diagnostic tools to detect sub-clinical vitamin-A deficiency; and if there is a correlation within the two diagnostic methods.Methods: A series of diagnostic studies comprising of contrast sensitivity test, conjunctival impression examination and serum retinol concentration were performed on literate children, six to ten years old, at West Java Elementary School. All subjects underwent a basic eye examination. Sample size, receiver operator curve, negative and positive predictive values, sensitivity and specificity were calculated.Results: A total of 109 subjects out of 154 elementary school children corresponding to the inclusion criteria were included in this study. Forty-four (41.9%) children were detected to have sub-clinical vitamin-A deficiency. The contrast sensitivity test had a sensitivity value of 45.5% and a specificity value of 50.8% with a positive predictive value of 40%. The area under the receiver operator characteristic (ROC) curve was 49.5% (95% CI 38.1%- 60.9%), whereas the conjunctival impression cytology test had a sensitivity value of 90.9%, and a specificity value of 16.4% with a positive predictive value of 43.9%. The ROC area was 56.1% (95% CI 45.0% - 67.1%). Pearson’s analysis showed that there is no correlation between the two diagnostic tools (p 0.538).Conclusion: The results of this study indicated that neither the contrast sensitivity test nor the conjunctival impression cytology was found to be a favorable screening tool to detect sub-clinical vitamin-A deficiency. Moreover, there is no correlation between the two methods.