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"Latar Belakang: Pengawet dalam tetes mata memengaruhi permukaan okular, ditemukan terutama pada pasien yang menggunakan obat tetes anti-glaukoma. Beredar tetes mata timolol maleat dengan pengawet chlorhexidine gluconate (CHG) yang belum pernah diteliti efeknya terhadap parameter permukaan okular.Tujuan: Mengetahui pengaruh pengawet chlorhexidine gluconate 0,002% dalam sediaan timolol maleat 0,5% (timolol-CHG) terhadap permukaan okular pasien glaukoma dan hipertensi okuli.Metode: Penelitian eksperimental terandomisasi dengan samar tunggal pada 54 mata pasien dengan diagnosis glaukoma maupun hipertensi okuli yang menggunakan timolol maleat 0,5% pengawet polyquaternium-1 (timolol-PQ1) <12 bulan. Dua puluh tujuh mata mengganti pengobatan ke timolol-CHG dan 27 mata melanjutkan timolol-PQ1. Dinilai tear break up time (TBUT), tear break up pattern (TBUP), skor pewarnaan kornea konjungtiva (staining), skor ocular surface disease index (OSDI), Schirmer I dan TIO awal dan sesudah satu bulan intervensi.Hasil: Nilai rerata selisih TBUT 0,15±5,28 detik pada kelompok timolol-CHG dan (- 1,30)±3,47 pada timolol-PQ1. Tidak terdapat perbedaan bermakna selisih nilai parameter permukaan okular (TBUT, staining, OSDI, Schirmer I) maupun TIO antar kedua kelompok. Line dan dimple pattern merupakan TBUP yang paling banyak ditemukan pada kedua kelompok baik sebelum maupun sesudah intervensi. Analisis dalam kelompok mendapatkan penurunan TBUT bermakna (p < 0,05) pada kelompok timolol-PQ1 setelah dibandingkan dengan sebelum intervensi, pada kelompok timolol-CHG tidak didapatkan perbedaan bermakna.Kesimpulan: Timolol-CHG memiliki efek terhadap permukaan okular dan TIO sebanding dengan timolol-PQ1. Penggunaan timolol-CHG dapat dipertimbangkan sebagai alternatif jangka pendek pengobatan glaukoma.

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Background: Patients with glaucoma and ocular hypertension using topical anti-glaucoma medication are more likely to have ocular surface problems. It happens mainly due to the preservatives in the eye drops. Chlorhexidine gluconate (CHG) as a preservative have not been studied for their effects on ocular surface parameters.

Objective: To evaluate the effect of chlorhexidine gluconate 0,002% preseved timolol maleate 0,5% (timolol-CHG) on the ocular surface of patients with glaucoma and ocular hypertension.

Methods: Randomized single-blind controlled trial in 54 eyes of patients diagnosed with glaucoma or ocular hypertension that has been using polyquaternium-1 preserved timolol maleate 0.5% (timolol-PQ1) for <12 months. Twenty-seven eyes switched therapy to timolol- CHG, and 27 eyes continued with timolol-PQ1. Tear break-up time (TBUT), tear break-up pattern (TBUP), corneal-conjunctival staining score, ocular surface disease index (OSDI) scoring, Schirmer I, and intraocular pressure (IOP) were assessed at baseline and one month post intervention.

Results: Mean differences (1 month-baseline) of TBUT were 0.15±5.28 seconds in timolol- CHG group and (-1.30)±3.47 in timolol-PQ1 group. There were no difference (p > 0.05, for all) between groups in terms of ocular surface parameters (TBUT, staining, OSDI, Schirmer I) and IOP mean differences. Line and dimple pattern were the most common break-up pattern found in both group at baseline and at 1 month. Analysis within group found significant difference (p < 0.05) of timolol-PQ1 TBUT at 1 month compared to baseline, TBUT were lower at 1 month.

Conclusion: Timolol-CHG has comparable effects on the ocular surface and IOP comparable to timolol-PQ1. The use of timolol-CHG may be considered as a short-term alternative for glaucoma treatment."

"Penelitian ini bertujuan untuk mengetahui kesesuaian antara SDE dengananalisis ImageJ dalam menilai hiperemia konjungtiva pada pemakaian LKL dalam2 minggu. Penelitian ini merupakan studi analitik prospektif berpasangan dengan100 subjek mata dari 50 orang dengan miopia yang belum pernah menggunakanLKL sebelumnya. Penilaian hiperemia konjungtiva dengan SDE dan imageJdengan mengevaluasi foto konjungtiva yang diambil pada sebelum, hari ketujuh,dan keempat belas penggunaan LKL. Subjek terdiri dari 80,8% (n=42) perempuandengan rerata usia 22,12±1,79 tahun. Awal evaluasi didapatkan terbanyakhiperemia trace (49%) dan ringan (51%) pada konjungtiva bulbar dan hiperemiatrace (92%) pada limbus. Evaluasi imageJ didapatkan median densitas vaskular11,80 (4,56-17,61) %area dan rerata diameter vaskular 85,81±4,07 μm. Terdapatpeningkatan hiperemia konjungtiva tingkat ringan sebesar 19% dan sedang 6%antara setelah 2 minggu penggunaan LKL. Terdapat perbedaan diameter (p<0,05)dan densitas vaskular (p=0,000) yang bermakna secara statistik setelah pemakaianLKL selama 2 minggu. Pada hari keempatbelas, persentase terbanyak yaituhiperemia menetap (59%) dan meningkat sebesar 35% pada konjungtiva bulbarkeseluruhan. Didapatkan peningkatan 1 tingkat SDE sebesar 33% dan peningkatan2 tingkat SDE sebesar 2% setelah pemakaian LKL 2 minggu. Terdapat kesesuaianpada penilaian hiperemia konjungtiva bulbar dan limbus antara SDE dengandensitas dan diameter vaskular dengan perbedaan antar masing-masing kelompokSDE yang bermakna (p<0,05).

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This study aimed to evaluate the conformity of EGS with ImageJ analysisin assessing conjunctival hyperemia in SCL use within 2 weeks. This is a pairedprospective analytic study which included 100 eyes from 50 subjects with myopiawho have not used SCL routinely before. Conjunctival hyperemia assessments weredone with EGS and ImageJ with evaluating conjunctival images taken at before,day 7, and day 14 of using SCL. Subjects were 80,8% (n=42) female with mean ageof 22,12±1,79 years old. At initial evaluation, there were trace (49%) and mild(51%) grade hyperemia in bulbar conjunctiva and trace hyperemia (92%) in limbus.ImageJ evaluation found medial vascular density of 11.80 (4.56-17.61)% area andmean vascular diameter of 85,81±4,07 μm. There was an increase of mild gradeconjunctiva hyperemia of 19% and moderate grade of 6% between before and after2 weeks of using SCL. There was a significant difference of vascular diameter(p<0.05) and density (p=0.000) after using SCL for 2 weeks. At day 14 evaluation,most percentage was found persistent grade (59%) and increasing grade (35%) inoverall bulbar conjunctiva. There were 1 EGS grade increase of 33% and 2 gradesincrease of 2% after using SCL for 2 weeks. Good conformity was found in bulbarconjunctiva and limbal hyperemia evaluation between EGS and vascular densityand diameter with significant difference between each EGS group (p<0.05)"

"Latar belakang: Kelainan kornea merupakan salah satu penyebab utama kebutaan dan gangguan penglihatan di Indonesia. Penanganan gangguan penglihatan karena kornea terhambat karena terbatasnya jumlah donor kornea. Pendekatan rumah sakit yang dipengaruhi oleh pengetahuan, sikap, dan perilaku tenaga kesehatan terhadap pelayanan donor kornea dapat menjadi strategi mengatasi kekurangan donor kornea. Tujuan: Mengetahui gambaran pengetahuan, sikap, dan perilaku perawat di Rumah Sakit dr. Cipto Mangukusumo (RSCM) terhadap pelayanan donor kornea. Metode penelitian: Pemilihan subjek menggunakan teknik quota sampling dan pengisian kuesioner yang teruji validitas dan reliabilitasnya. Hasil: Terdapat 422 responden dengan proporsi unit instalasi gawat darurat, ruang rawat inap intensif, ruang rawat inap non intensif, rawat jalan, dan ruang operasi secara berurutan sebesar 8,3%, 13,7%, 50%, 16,6%, dan 11,4%. Sebagian besar responden memiliki pengetahuan kurang (55,4%), sikap positif (50,2%), dan perilaku baik (59,5%). Terdapat hubungan signifikan antara tingkat pengetahuan dan sikap responden terhadap perilaku, namun tidak terdapat hubungan antara faktor demografi dengan perilaku. Usia ≤ 36 tahun, pengetahuan baik, dan sikap positif merupakan faktor prediktor perilaku baik. Kesimpulan: Terdapat hubungan antara pengetahuan dan sikap terhadap perilaku perawat RSCM terhadap pelayanan donor kornea di rumah sakit.

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Background: Corneal blindness is one of the leading cause of blindness and visual disturbances in Indonesia. The management of corneal blindness in Indonesia is impeded by the rarity of corneal donor. Hospital approach affected by knowledge, attitude, and practice of health workers could be a strategy to improve the scarcity of corneal donor. Purpose: Determine the knowledge, attitude, and practice of nurses in RSCM toward hospital corneal procurement Methods: Subjects are chosen by quota sampling and surveyed with a valid and reliable questionnaire. Results: There were 422 respondents with the proportion of emergency ward, intensive care, non-intensive care, polyclinics of 8.3%, 13.7%, 50%, 16.6%, and 11.4% respectively. Most of the respondent were lacking in knowledge (55.4%), had positive attitude (50.2%), and had good practice (59.5%). There were significant correlation between knowledge and attitude towards practice but no significant correlation found between demographic factors to practice. Age ≤ 36 years old, good knowledge, and positive attitudes are predictor factors for good practice. Conclusion: There were correlation between knowledge and attitude of health workers in RSCM towards practice of corneal donor procurement in hospital."

"Iskemia makula merupakan penyebab penurunan penglihatan pada retinopati yang berhubungan dengan progresi retinopati diabetik dan dapat terjadi sebelum mikroaneurisma terlihat secara klinis. Fovea avascular zone (FAZ) merupakan area di makula yang mencerminkan kondisi mikrokapiler makula dan sensitif terhadap iskemia. Penelitian ini bertujuan untuk mengetahui perbandingan parameter area dan sirkularitas FAZ pleksus kapiler superfisial (PKS) dan pleksus kapiler dalam (PKD) yang diukur menggunakan Optical Coherence Tomography Angiography (OCTA) pada pasien diabetes melitus (DM) dengan dan tanpa retinopati diabetik. Penelitian potong lintang dilakukan pada 90 mata pasien diabetes yang terbagi menjadi lima kelompok yaitu DM tanpa retinopati diabetik , non proliferative diabetic retinopathy (NPDR) ringan, NPDR sedang, NPDR berat, dan proliferative diabetic retinopathy (PDR). Area dan sirkularitas FAZ PKS dan PKD pada OCTA makula 3x3 mm diukur menggunakan ImageJ. Area FAZ PKS pada NPDR ringan, NPDR berat, dan PDR secara bermakna lebih lebar dibandingkan dengan DM tanpa retinopati diabetik (p=0,026). Sirkularitas FAZ PKD secara bermakna lebih rendah pada kelompok NPDR sedang dan berat dibandingkan dengan NPDR ringan (p=0,003). Pelebaran dan perubahan bentuk FAZ PKS dan PKD pada retinopati diabetik dapat dideteksi dengan OCTA. Pelebaran FAZ PKS dan penurunan sirkulasi FAZ PKD terjadi mulai dari retinopati derajad awal.

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Macular ischemia is cause of decreased vision in diabetic retinopathy (DR) associated with the progression of retinopathy and can occur before microaneurysms are detected clinically. Fovea avascular zone (FAZ) is an area in macula that reflects the condition of macular microcapillaries and sensitive to ischemia. This study aims to compare area and circularity of superficial capillary plexus (SCP) and deep capillary plexus (DCP) FAZ as measured using Optical Coherence Tomography Angiography (OCTA) in diabetic patient with and without DR. A cross-sectional study was conducted on 90 eyes of diabetic patients divided into five groups, namely DM with no DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). Area and circularity of SCP and DCP FAZ in 3×3 mm macular OCTA was measured using ImageJ. The SCP FAZ area was significantly larger in mild NPDR, severe NPDR, and PDR compared to no DR (p=0.026). DCP FAZ circularity was significantly lower in moderate and severe NPDR compared to the mild NPDR (p=0.003). Enlargement and irregularity of SCP and DCP FAZ in DR can be detected by OCTA. Enlargement of SCP FAZ area and decrease in DCP FAZ circularity occurs from early degree of DR.

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"ABSTRAKTujuan: Mengevaluasi efek injeksi anti-VEGF intravitreal, bevacizumab, terhadap kadar cystatin C plasma dan VEGF plasma dan meninjau korelasi antara kedua faktor tersebut.Metodologi: Penelitian ini merupakan studi eksperimental satu kelompok dengan sampel dipilih secara konsekutif dari populasi terjangkau. Pemeriksaan oftalmologi lengkap, tekanan darah, laboratorium darah perifer lengkap, dan pemeriksaan kadar cystatin C plasma dan VEGF plasma dilakukan pada subjek sebelum injeksi dan 14 hari pasca injeksi bevacizumab intravitreal dosis 1,25 mg (0,05 cc).Hasil: 33 subjek dilibatkan dalam penelitian ini. Dari seluruh subjek, 63,6% adalah perempuan dan 36,4% adalah laki-laki dengan usia rata-rata 66,4 ± 8,3 tahun. Tidak terdapat perbedaan bermakna secara statistik antara kadar VEGF plasma pre dan pasca injeksi (p=0,339). Tidak terdapat perbedaan bermakna secara statistik antara kadar cystatin C plasma pre dan pasca injeksi (p=0,709). Uji korelasi antara perubahan VEGF plasma dengan perubahan cystatin C plasma pre dan pasca injeksi menunjukkan korelasi yang tidak bermakna (p=0,142).Kesimpulan: Kadar cystatin C plasma tidak berubah secara signifikan pre dan pasca injeksi bevacizumab pada injeksi satu kali. Tidak ditemukan adanya korelasi antara penurunan kadar VEGF plasma dengan peningkatan kadar cystatin C pada pasien AMD neovaskuler pasca injeksi bevacizumab.

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ABSTRACTObjective: To evaluate the effect of intravitreal bevacizumab injection on plasma cystatin C and plasma VEGF levels and the correlation between the two factors.Methodology: This research was a single arm study with samples selected consecutively from an assigned population. Ophthalmology examinations, blood pressure, complete blood count, and assessments of plasma cystatin C and plasma VEGF levels were carried out on subjects before and 14 days after intravitreal bevacizumab injection of 1.25 mg (0.05 cc).Results: 33 subjects were included in this study. Of all subjects, 63.6% were women and 36.4% were men with an average age of 66.4±8.3 years. There was no statistically significant difference between pre and post injection plasma VEGF and plasma cystatin C levels (p=0.339 and 0.709 respectively). Correlation test between changes in plasma VEGF with changes in plasma cystatin C pre and post injection showed no significant correlations (p=0.142).Conclusion: Plasma cystatin C levels did not change significantly before and after injection of bevacizumab on one-time injection. No correlation was found between decreasing plasma VEGF levels and increasing levels of cystatin C in patients with neovascular AMD after bevacizumab injection."

"Tujuan: Menilai perubahan latensi dan amplitudo P100 PRVEP pada kelompok yangdiberikan suplementasi sitikolin oral dibandingkan dengan terapi oklusi saja.Metode: Penelitian ini merupakan studi double masked randomized clinical trialProses randomisasi membagi pasien menjadi 2 kelompok yaitu kelompok denganpemberian sirup sitikolin 500 mg (n: 15 S-ambliopia) dan sirup placebo (n: 15 Pambliopia).Jumlah subjek pada akhir follow-up bulan ke-3 sebanyak 12 subjekkelompok sitikolin dan 11 subjek kelompok plasebo. Pemeriksaan oftalmologilengkap dan PRVEP (checkerboard 15 min arc dan 60 min arc) dilakukan sebelumintervensi, follow up bulan ke-1 dan follow up bulan ke-3.Hasil: 23 subjek dilibatkan dalam penelitian ini. Dari seluruh subjek, 65,2% adalahperempuan dan 34,8% adalah laki-laki dengan usia rata-rata 9,1 ± 2,11 tahun. Tidakterdapat perbedaan bermakna secara statistik perubahan nilai amplitudo (15 min arcp=0,806; 60 min arc p=0,975) dan latensi (15 min arc p=0,218; 60 min arc p=0,734)P100 PRVEP pada follow up ke-3 pada kelompok sitikolin dibandingkan dengankelompok plasebo.Kesimpulan: Perubahan nilai amplitudo dan latensi P100 PRVEP serta proposionalkenaikan tajam penglihatan pada kelompok sitikolin tidak berbeda dibandingkandengan kelompok plasebo. Tidak adanya korelasi antara perubahan amplitudo danlatensi terhadap proporsional kenaikan tajam penglihatan pada pasien ambliopia.

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Objectives: To assess the changes in amplitude and latency P100 PRVEP in the group

given oral citicoline supplementation compared to occlusion therapy alone.

Methods: This study was a double-masked, randomized clinical trial. The

randomization process divided patients into two groups, namely the group with 500

mg of citicoline syrup (n: 15 C-amblyopia) and placebo syrup (n: 15 P-amblyopia).

The number of subjects at the end of the 3rd-month follow-up was 12 subjects in the

citicoline group and 11 subjects in the placebo group. Complete ophthalmological

examination and PRVEP (checkerboard 15 min arc and 60 min arc) were performed

before the intervention, a month follow-up, and a three-month follow-up.

Results: 23 subjects were included in this study. Of all the subjects, 65.2% were

female, and 34.8% were male with a mean age of 9.1 ± 2.11 years. There was no

statistically significant difference in changes in the amplitude (15 min arc p=0,806;

60 min arc p=0,975) and latency (15 min arc p=0,218; 60 min arc p=0,734) values of

the P100 PRVEP 3rd-month follow-up in the citicoline group compared to the placebo

group.

Conclusion: Changes in the amplitude and latency values of the PRVEP P100 and

the mean proportional improvement in visual acuity in the citicoline group were not

different compared to the placebo group. There was no correlation between changes

in amplitude and latency with a mean proportional improvement in visual acuity in

amblyopia patients."

"Latar belakang. Penelitian ini bertujuan mendapatkan gambaran data dasar nilai normal pERG, ketebalan RNFL dan GCIPL pada subjek normal dan subjek dengan POAG derajat early, moderate dan severe serta menilai korelasi antara masing-masing modalitas pemeriksaan.Metode. Penelitian potong lintang yang dilakukan pada 36 mata normal dan 42 mata dengan POAG (derajat early, moderate dan severe) usia 18-60 tahun di RSCM. Semua subjek menjalani pemeriksaan oftalmologi dasar dan pemeriksaan penunjang yaitu Humphrey standard automated perimetry, OCT peripapil dan makula menggunakan CirrusTM dan pERG menggunakan MonPack One dari Metrovision.Hasil. Berdasarkan data normal didapatkan ketebalan rerata RNFL 106,3 ± 11,0 μm, ketebalan rerata GCIPL 83,3 ± 3,5 μm, waktu implisit P50 52,7ms , amplitudo P50 7,9 (3,4 – 15,6) μV, waktu implisit N95 101,3 ± 5,2 ms, amplitudo N95 10,6 (6,0 – 18,7) μV. Dibandingkan dengan kelompok POAG early didapatkan perbedaan bermakna pada ketebalan RNFL (p = 0,007), amplitudo P50 (p = 0,005) dan amplitudo N95 (p = 0,004), tanpa perbedaan bermakna pada ketebalan GCIPL, sedangkan pada kelompok moderate dan severe didapatkan perbedaan pada semua variabel (p<0,05). Korelasi positif sedang dan lemah ditemukan pada kelompok normal antara ketebalan RNFL dengan amplitudo P50 dan N95, tidak ada korelasi hasil pemeriksaan pERG dengan ketebalan GCIPL.Kesimpulan. Pattern ERG adalah pemeriksaan objektif yang dapat membedakan antara kelompok normal dengan POAG, pemeriksaan pERG pada POAG harus memperhatikan floor effect.

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Introduction. The study aims to evaluate and compare the pERG result, RNFL and GCIPL thickness in normal group to the groups with early, moderate and severe POAG and evaluate its correlation.

Methods. Cross-sectional study was done on 36 normal eyes and 42 eyes with POAG (mild, moderate and severe),subjects with age range of 18-60 years old in RSCM Kirana. Each group underwent complete basic ophthalmology examinations, Humphrey standard automated perimetry, peripapillary and macular OCT CirrusTM and MonPack One pERG from Metrovision.

Results. The data on normal group were as follow: RNFL thickness 106,3 ± 11,0 μm, GCIPL thickness 83,3 ± 3,5 μm, P50 implicit time 52,7 ms , P50 amplitude 7,9 (3,4 – 15,6) μV, N95 implicit time 101,3 ± 5,2 ms, N95 amplitude 10,6 (6,0 – 18,7) μV. Significant differences were found in RNFL thickness (p = 0,007), P50 amplitude (p = 0,005) and N95 amplitude (p = 0,004) in the early POAG group compared to the normal group, meanwhile on moderate and severe group all of the variable examination result including the GCIPL thickness were significantly different (P<0,05). Positive moderate and weak correlations were found between RNFL thickness in normal group with P50 and N95 amplitude, no correlation between pERG result with GCIPL thickness.

Conclusion. Pattern ERG is an objective tools to differentiate between normal and POAG subjects, pERG examination in POAG group especially the severe group needs to evaluate the floor effect by doing the prior OCT examination."