Successful Treatment of Mixed Amblyopia with Optic Nerve Hypoplasia (ONH) in an Adult Indonesian Patient
Downloads
Introduction: Amblyopia significantly contributes to low vision and blindness in adults in an Indonesian rural setting. The treatment of amblyopia, particularly anisometropic and/or strabismic amblyopia, has long been challenging for many clinicians. This study aims to report a promising result of refractive correction, occlusion therapy, and oral citicoline on mixed amblyopia with optic nerve hypoplasia in adult Indonesian patients. Case Presentation: A 20-year-old male with a chief complaint of blurry right eye since one year ago, becoming more severe lately. The patient had been strabismic since his childhood. History of using a -5 concave spherical lens on his RE, with the normal eye on his LE. Visual acuity (VA) of his RE was 3/60 and his LE was 6/30. The RE was deviated, with 30° of exotropia. Nystagmus was also found. Optical coherence tomography (OCT) examination found maculopathy and optic nerve hypoplasia in both eyes. We treated the patient with spectacles to correct the refractive error, occluded his fixing eye, and gave an oral citicoline. Conclusions: Refractive correction and occlusion therapy are still meaningful choices of therapy and have shown to be effective in treating amblyopia, combined with oral citicoline to prevent nerve cell damage. Our case of refractive correction, combined with occlusion therapy and oral citicoline on mixed amblyopia in an adult Indonesian patient, showed good results and a promising post-treatment prognosis with a decrease of exotropia degree and disappearance of nystagmus in just two months.
Hashemi H, Pakzad RMs, Yekta A, Bostamzad P, Aghamirsalim M, Sardari SMs, et al. Global and regional estimates of prevalence of amblyopia: A systematic review and meta-analysis. Strabismus 2018;26:168–183. https://doi.org/10.1080/09273972.2018.1500618.
Wang Y, Liang YB, Sun LP, Duan XR, Yuan RZ, Wong TY, et al. Prevalence and causes of amblyopia in a rural adult population of Chinese the Handan Eye Study. Ophthalmology 2011;118:279–283. https://doi.org/10.1016/j.ophtha.2010.05.026.
Fu Z, Hong H, Su Z, Lou B, Pan C-W, Liu H. Global prevalence of amblyopia and disease burden projections through 2040: A systematic review and meta-analysis. Br J Ophthalmol 2020;104:1164–1170. https://doi.org/10.1136/bjophthalmol-2019-314759.
Saw S-M, Husain R, Gazzard GM, Koh D, Widjaja D, Tan DTH. Causes of low vision and blindness in rural Indonesia. Br J Ophthalmol 2003;87:1075–1078. https://doi.org/10.1136/bjo.87.9.1075.
Maconachie GDE, Gottlob I. The challenges of amblyopia treatment. Biomed J 2015;38:510–516. https://doi.org/10.1016/j.bj.2015.06.001.
Dahl S, Pettersson M, Eisfeldt J, Schröder AK, Wickström R, Teär Fahnehjelm K, et al. Whole genome sequencing unveils genetic heterogeneity in optic nerve hypoplasia. PLoS One 2020;15:e0228622. https://doi.org/10.1371/journal.pone.0228622.
Astle AT, McGraw P V, Webb BS. Can human amblyopia be treated in adulthood? Strabismus 2011;19:99–109. https://doi.org/10.3109/09273972.2011.600420.
Milla M, Piñero DP. Characterization, passive and active treatment in strabismic amblyopia: A narrative review. Int J Ophthalmol 2020;13:1132–1147. https://doi.org/10.18240/ijo.2020.07.18.
Zagui RMB. Amblyopia: Types, Diagnosis, Treatment, and New Perspectives. Am Acad Ophthalmol 2019. https://www.aao.org/disease-review/amblyopia-types-diagnosis-treatment-new-perspectiv (accessed February 7, 2022).
Atakan M, Culfa S, Calli U, Penbe AD, Atakan TG, Ozerturk Y. Evaluation of retinal nerve fiber layer and macular thickness in amblyopia. J Clin Exp Ophthalmol 2015;6:1–4. https://doi.org/10.4172/2155-9570.1000437.
Pescosolido N, Stefanucci A, Buomprisco G, Fazio S. Amblyopia treatment strategies and new drug therapies. J Pediatr Ophthalmol Strabismus 2014;51:78–86. https://doi.org/10.3928/01913913-20130107-01.
Iulia C, Ruxandra T, Costin L-B, Liliana-Mary V. Citicoline - A neuroprotector with proven effects on glaucomatous disease. Rom J Ophthalmol 2017;61:152–158. https://doi.org/10.22336/rjo.2017.29.
Singh I, Sachdev N, Brar GS, Kaushik S. Part-time occlusion therapy for amblyopia in older children. Indian J Ophthalmol 2008;56:459–463.
Copyright (c) 2022 Ria Indah Wahyuningtyas, Niken Indah Noerdiyani, Rozalina Loebis
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Vision Science and Eye Health Journal by Universitas Airlangga is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The journal allows the author to hold the copyright of the article without restrictions.
The journal allows the author(s) to retain publishing rights without restrictions.
The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution-Share-Alike (CC BY-SA).
The Creative Commons Attribution-Share-Alike (CC BY-SA) license allows re-distribution and re-use of a licensed work on the conditions that the creator is appropriately credited and that any derivative work is made available under "the same, similar or a compatible license”. Other than the conditions mentioned above, the editorial board is not responsible for copyright violations.
