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"Macular edema is a kind of human sight disease as a result of advanced stage of diabetic retinopathy. It affects the central vision of patients and in severe cases lead to blindness. However, it is still difficult to diagnose the grade of macular edema quickly and accurately even by the medical doctor's skill. This paper proposes a new method to classify fundus images of diabetics by combining Self-Organizing Maps (SOM) and Generalized Vector Quantization (GLVQ) that will produce optimal weight in grading macular edema disease class. The proposed method consists of two learning phases. In the first phase, SOM is used to obtain the optimal weight based on dataset and random weight input. The second phase, GLVQ is used as main method to train data based on optimal weight gained from SOM. Final weights from GLVQ are used in fundus image classification. Experimental result shows that the proposed method is good for classification, with accuracy, sensitivity, and specificity at 80%, 100%, and 60%, respectively."

"ABSTRAKTujuan untuk menilai hubungan antara respons elektrofisiologis makula menggunakan multifocal electroretinogram (MfERG), ketebalan makula sentral (KMS) menggunakan Spectral Domain Optical Coherence Tomography (SD-OCT) dan tajam penglihatan pasca-injeksi anti-VEGF intravitreal pada pasien edema makula diabetik (EMD). Desain penelitian studi prospektif, intervensi tanpa randomisasi. Total 33 mata dari 16 pasien non-proliferative diabetic retinopathy dan 17 pasien non-high-risk proliferative diabetic retinopathy yang memenuhi kriteria inklusi mendapatkan injeksi bevacizumab 1,25mg intravitreal, setelah melalui pemeriksaan tajam penglihatan dengan koreksi (TPDK) menggunakan ETDRS chart, pemindaian SD-OCT dan pemeriksaan 61-heksagon MfERG pada baseline, 1 minggu dan 1 bulan pasca-injeksi. Parameter MfERG yang dinilai adalah first-order MfERG (N1,N2 dan P1) pada daerah dua-derajat sentral makula. Hasil Terdapat perbaikan tajam penglihatan sebesar 2LogMar disertai 19% penurunan KMS pada satu bulan pasca-injeksi (p<0.05). Terjadi penurunan amplitudo P1 satu minggu pasca-injeksi (p<0.01) diikuti perbaikan amplitudo P1 satu bulan pasca injeksi (p>0.05). Tampak pemendekan waktu implisit P1 namun secara statistik tidak bermakna. Tidak didapatkan korelasi antara peningkatan TPDK, penurunan KMS, perbaikan amplitudo serta pemendekan waktu implisit gelombang P1 MfERG. Tidak ditemukan efek samping okular maupun sistemik yang berbahaya pasca-injeksi.. Simpulan Dalam jangka pendek, injeksi bevacizumab intravitreal dapat meningkatkan tajam penglihatan, mengurangi ketebalan makula sentral/KMS dan memperbaiki respons MfERG pasien DME namun tidak bermakna secara statistik. Perbaikan TPDK tidak memiliki korelasi dengan penurunan KMS dan respons MfERG secara statistik namun kombinasi penggunaan SD-OCT dan MfERG dapat digunakan untuk mengevaluasi fungsi makula pasien EMD yang mengalami perburukan tajam penglihatan.

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ABSTRACTPurpose To evaluate and investigate any possible correlation between changes of visual acuity (VA), central macular thickness/CMT using Spectral Domain Optical Coherence Tomography (SD-OCT) and electrophysiological responses using multifocal electroretinography (MfERG) in diabetic macular edema (DME) following intravitreal injection of bevacizumab Methods Prospective, non-randomized, interventional case study. Thirty-three eyes of 33 DME patients, consists of 16 non-proliferative diabetic retinopathy patients and 17 non-high-risk proliferative diabetic retinopathy patients, receives intravitreal bevacizumab 1,25mg. All patients underwent complete ophthalmic examination including ETDRS VA testing, Sixty-one scaled hexagon MfERG and SD-OCT scan at baseline, 1-week, and 1-month post-injection. Components of the first order kernel (N1, N2 and P1) in central 2o were measured. Results MfERG showed reduced P1 amplitude (P<0.05) at 1-week after injection followed by increased P1 amplitude (P>0.05) at 1-month after treatment as compared to the baseline in all subjects. Improvement were seen in the implicit time P1 but without statistical significance. There was 19% improvement in CMT and 0.2Logmar VA improvement 1-month post-injection compared to the baseline (P<005). This study showed no serious ocular adverse effects. Conclusion In this study intravitreal injection bevacizumab resulting in improved visual acuity, reduction in CMT and mild improvement in the MfERG amplitude and implicit time. Although VA changes did not correlate with reduced CMT nor with improved responses of MfERG, the combined use of SD-OCT and MfERG may be used to evaluate macular function in DME patient with worsened visual acuity post anti-VEGF injection."

"ABSTRAK Edema makula diabetik EMD adalah salah satu penyebab kebutaan utama pada pasien diabetes. Pemberian terapi injeksi anti VEGF selain dapat mencegah perburukan EMD juga mampu memperbaiki tajam penglihatan. Penelitian ini bertujuan mengamati perubahan ketebalan makula sentral CMT , elektroretinogram ERG makula, dan tajam penglihatan setelah pemberian injeksi Aflibercept intravitreal. Penelitian ini adalah penelitian uji klinis dengan intervensi single arm. Subjek dengan EMD diberikan satu kali injeksi Aflibercept intravitreal. Nilai CMT, ERG makula, dan tajam penglihatan diukur sebelum, satu minggu, dan satu bulan setelah injeksi. Sebanyak 36 dan 35 subjek diamati pada 1 minggu dan 1 bulan pasca injeksi. Rerata usia, lama menderita diabetes, dan kadar HbA1C subjek adalah 56,33 6,39 tahun, 96 12-240 bulan, dan 7,33 1,41 . Perbandingan nilai sebelum, 1 minggu setelah injeksi, dan 1 bulan setelah injeksi dari CMT adalah [408 264 ndash;1025 vs 329,5 208 ndash;629 vs 303 213 ndash;567 , ABSTRACT Diabetic macular edema DME is a major cause of blindness in diabetic patients. Anti VEGF injections had been shown not only able to slow the worsening of DME, but can also improve visual acuity VA . The aim of this study is to observe changes in central macular thickness CMT , macular electroretinogram ERG and VA after single intravitreal Aflibercept injection IAI . This is a single arm, pre post intervention clinical study. Subjects with DME were given single, unilateral IAI. Changes in CMT , multifocal ERG, and VA were observed one week and one month after IAI was given. We included 36 and 35 eyes in this study for one week and one month follow up. Subjects 39; mean age, duration of diabetes, HbA1C level were 56.33 6.39 years, 96 12-240 months, and 7.33 1.41 respectively. Comparing across follow up periods [pre, one week, one month post IAI] there were statistically significant differences of CMT [408 264 ndash;1025 vs 329.5 208 ndash;629 vs 303 213 ndash;567 , p="

"ABSTRAKEdema makula diabetik (EMD) merupakan salah satu penyebab utama kebutaan pada pasien diabetes. Saat ini terapi utama pada pasien edema makula diabetik adalah injeksi intravitreal anti VEGF. Pada beberapa keadaan, hal ini menjadi kendala karena 50% pasien yang menjalani rangkaian injeksi intravitreal anti VEGF memiliki edema makula yang refrakter. Vitrektomi pars plana dan internal limiting membran (ILM) peeling diharapkan dapat menjadi alternatif terapi pada EMD refrakter. Penelitian ini bertujuan menilai hasil terapi tindakan vitrektomi dan ILM peeling pada pasien non proliferative diabetic retiopathy (NPDR) dengan EMD refrakter. Penelitian ini merupakan penelitian uji klinis dengan intervensi single arm. Subjek dengan NPDR dan EMD refrakter menjalani tindakan vitrektomi dan ILM peeling. Nilai ketebalan makula sentral (CMT) dan tajam penglihatan diukur sebelum, 1 bulan, 2 bulan, dan 3 bulan sesudah tindakan. Komplikasi pasca tindakan juga dinilai pada setiap kunjungan yang direncanakan. Rentang usia 62,5 (39-72) tahun, lama menderita diabetes 10 (3-18) tahun, kadar HbA1C 6,4 (5,5 -10,8)%. Nilai CMT sebelum, 1 bulan, 2 bulan dan 3 bulan sesudah tindakan adalah [492,0 (303-895) : 277,5 (97-809) : 264 (147-608) : 264,0 (142-660) µm] (p=<0,001). Tajam penglihatan terbaik adalah [1,02 (0,60-1,30) : 1,04 (0,60-1,70) : 1,06 (0,52-2,00) : 1,04 (0,52-2,00) LogMAR] (p=0,635). Terdapat komplikasi pasca tindakan pada pengamatan bulan kedua meliputi retinal detachment dan macular hole. Pada penelitian ini, tindakan vitrektomi dan ILM peeling pada pasien NPDR dengan EMD refrakter memberikan perubahan CMT yang bermakna. Tidak terdapat perubahan yang bermakna secara statistik pada nilai tajam penglihatan namun mayoritas subjek menunjukkan stabilitas tajam penglihatan.

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ABSTRACTDiabetic macular edema (DME) is one of the leading causes of blindness in diabetic patients. The main therapy of DME, up until now is intravitreal injection of anti-vascular endothelial growth factor (VEGF). In certain situation, medical dilemma appeared as in such circumstances 50% patients that underwent series of intravitreal injection of anti VEGF experienced the refractory DME. Pars plana vitrectomy and internal limiting membrane (ILM) peeling is expected to be an alternative treatment in refractory DME. The aim of this study was to assess the result of vitrectomy and ILM peeling in patients with non-proliferative diabetic retinopathy (NPDR) with refractory DME. This study was a clinical trial with single arm intervention. The patients with NPDR with DME underwent vitrectomy and ILM peeling surgery. The assessment of the central macular thickness (CMT) and the visual acuity was conducted before the treatment and 1 month, 2 months and 3 months after. The complication after the treatment was assessed in each scheduled visit. The average age was 62.5 years old with range of 39-72 years old, the history duration of diabetes mellitus was 10 years (3-18) years, level of HbA1C was 6.4 (5.5-10.8)%. The CMT before treatment, 1 month, 2 months and 3 months after treatment were [492,0 (303-895) : 277,5 (97-809) : 264 (147-608) : 264,0 (142-660) µm] (p=<0,001). The best corrected visual acuity was [1,02 (0,60-1,30) : 1,04 (0,60-1,70) : 1,06 (0,52-2,00) : 1,04 (0,52-2,00) LogMAR] (p=0,635). The recorded complication after the treatment was retinal detachment and macular hole. These complications were found on the 2nd month. This study concluded that there was a significant CMT changes in patients with NPDR and refractory DME who underwent vitrectomy and ILM peeling. There was no statistically significant changes in the visual acuity yet majority of the subjects showed a stable visual acuity after the treatment."

"Latar Belakang: Saat ini, injeksi intravitreal anti-VEGF merupakan tatalaksana medikamentosa lini pertama pada DME. Namun monoterapi bevacizumab dinilai kurang efektif dalam mengobati DME derajat sedang-berat, sehingga meningkatkan jumlah re-injeksi. Selain VEGF, mediator inflamasi juga berperan penting dalam pathogenesis DME. Sehingga diperlukan terapi adjuvant pada kasus dengan respon suboptimal.Tujuan: Mengetahui perbedaan perubahan sensitivitas retina, ketebalan makula sentral (CMT) dan BCVA sesudah dilakukan injeksi intravitreal Bevacizumab dengan kombinasi Triamsinolon Asetonid (TA)  dibandingkan dengan monoterapi Bevacizumab pada pasien dengan edema makula diabetik derajat sedang-berat.Metodologi: Pada studi eksperimental lengan ganda dengan randomisasi blok ini didapatkan sejumlah 28 subjek dengan CMT > 400 mm dibagi menjadi dua kelompok. Subjek pada kelompok intervensi diberikan injeksi kombinasi Bevacizumab 1,25 mg dan TA 2 mg intravitreal, sedangkan subjek kelompok kontrol hanya diberikan injeksi Bevacizumab 1,25 mg. Evaluasi BCVA dan CMT dilakukan pada 1 minggu dan 1 bulan pasca injeksi, evaluasi sensitivitas retina pada 1 bulan pasca injeks, serta peningkatan TIO dan efek samping.Hasil: Pasca 1 bulan injeksi didapatkan penurunan CMT yang lebih besar yang bermakna pada kelompok intervensi (-269,1 (170-413) mm vs -133,6 (50-218) mm, p< 0,001), begitu juga dengan peningkatan sensitivitas retina yang lebih baik pada kelompok intervensi (2,4 (0,02-7,1) dB vs 1,3 (0,16-3,5) dB, p = 0,035). Tidak didapatkan perbedaan bermakna pada luaran BCVA logMAR antar kedua kelompok (0.2 (0-0.5) vs 0.15 (0-0.5)).Kesimpulan: Terapi kombinasi bevacizumab dan TA ini terbukti efektif dan cost-effective sebagai dalam menurunkan edema makula segera dan memperbaiki sensitivitas retina pada pasien DME derajat sedang-berat dan DME persisten.......Backgrounds: Intravitreal bevacizumab (IVB) monotherapy is less effective in treating moderate-to-severe diabetic macular edema (DME), potentially increasing the number of injections and the risk of permanent vision loss. In addition to VEGF, inflammatory mediators also play an important role in the pathogenesis of DME. Therefore, there is a need for additional treatment options for DME cases with suboptimal response to anti-VEGF therapy.Objectives: To compare the efficacy and safety of the combination of IVB and triamcinolone acetonide (TA) with IVB monotherapy in treating moderate to severe DME.Methods: In this double-arm randomized controlled trial study, a total of 28 DME patients with central macular thickness (CMT) >400 mm were assigned into two groups according to the therapeutic method: 1,25 mg of  bevacizumab combined with 2 mg of  TA as the intervention group and 1,25 mg of IVB as the control group. BCVA and CMT were observed at 1 week and 1 month follow-up, retinal sensitivity was observed at 1 month follow-up, as well as increased IOP and other side effects.Results: CMT reduction after 1 month were higher in the intervention group with statistically significant different (-269,1 mm vs -133,6 mm, p< 0,001) as well as retinal sensitivity improvement also better in the intervention group (2,4 dB vs 1,3 dB, p = 0,035). But there was no statistically different in BCVA changes after 1 month follow-up (0,2 vs 0,15, p= 0,874) between the groups, even though 35,7% of the intervention group has gained more than 10 BCVA letters. No significant increase in IOP were observed at the end of the follow-up.Conclusions: It is effective and cost-effective to treat moderate-to-severe or persistent DME by utilizing TA as an adjunct to anti-VEGF."

"Latar Belakang: Tata laksana edema makula terus dievaluasi, dengan terapi anti-VEGF sebagai lini pertama. Subthreshold micropulse laser (SML) diajukan sebagai alternatif adjuvan. Studi retrospektif terdahulu menunjukkan efektivitas SML 577-nm sebagai monoterapi pada edema makula dengan ketebalan di bawah 400 μm. Akan tetapi, data prospektif efektivitas SML sebagai adjuvan masih minim. Tujuan: Menilai pengaruh pemberian kombinasi bevacizumab dan laser SML 577-nm dibanding bevacizumab monoterapi terhadap ketebalan makula sentral dan tajam penglihatan pasien edema makula diabetik ringan-sedang.Metode: Penelitian ini merupakan studi eksperimental lengan ganda. Dilakukan randomisasi acak terhadap pasien edema makula diabetik dengan rentang ketebalan makula 300-600 μm, kelompok kontrol mendapatkan protokol standar. Kelompok studi mendapatkan adjuvan laser SML kuning satu minggu pascainjeksi. Pasien menjalani follow-up penilaian tajam penglihatan dan ketebalan makula sentral pada 28 dan 35 hari pascainjeksi.Hasil: Terdapat 26 subjek yang terbagi rata pada kelompok studi dan kontrol. Ditemukan signifikansi nilai CMT pada kontrol 28 hari dan 35 hari pascainjeksi baik pada kelompok studi (p=0,011 dan 0,014) maupun kontrol (p=0,006 dan p=0,001). Akan tetapi, tidak ditemukan perbedaan signifikansi selisih nilai CMT antara kedua kelompok pada kontrol 28 hari (p=0,317) dan 35 hari (p=0,84). Tidak ditemukan perbedaan selisih TPDK ETDRS antara kelompok studi dan kontrol pada kelompok 28 hari (p=0,568) dan 35 hari (p=0,128) pascainjeksi.Kesimpulan: Kombinasi SML dengan bevacizumab intravitreal dapat mengurangi ketebalan makula sentral dan memperbaiki tajam penglihatan namun tidak ditemui perbedaan yang signifikan dengan monoterapi standar.......Background: The management of macular edema is constantly evaluated, with anti-VEGF therapy being the first line. Subthreshold micropulse laser (SML) has been proposed as an alternative adjuvant. A previous retrospective study demonstrated the effectiveness of 577-nm SML as monotherapy in macular edema with CMT below 400 μm. However, prospective data on the effectiveness of SML as an adjuvant are lacking.Objective: To assess the effect of the combination of bevacizumab and 577-nm SML laser compared to bevacizumab monotherapy on central macular thickness and visual acuity in mild-moderate diabetic macular edema patients.Methods: This research is a double arm experimental study. A randomized trial was performed on diabetic macular edema patients with macular thickness range of 300-600 μm. The control group received a standard protocol and the study group received a yellow SML laser adjuvant one week after injection. Patients underwent follow-up assessment of visual acuity and central macular thickness at 28 and 35 days postinjection.Results: There were 26 subjects which were equally divided into study and control groups. Significant decrease in CMT were found in study group (p=0.011 and 0.014) and the control group (p=0.006 and p=0.001). However, there was no significant difference in delta CMT values between the two groups in the 28-day (p=0.317) and 35-day controls (p=0.84). There was no difference in ∆TPDK ETDRS between the study and control groups at 28 days (p=0.568) and 35 days (p=0.128) after injection.Conclusion: The combination of SML and intravitreal bevacizumab can reduce central macular thickness and improve visual acuity but there was no significant difference with standard monotherapy."