Vision Science and Eye Health Journal

Evaluation of Intraocular Pressure Changes Following Trabeculectomy with Mitomycin-C (MMC): A One-Year Follow-Up Study at Undaan Eye Hospital, Indonesia

2025-02-08T15:34:54+07:00

Introduction: Trabeculectomy with mitomycin-C (MMC) is a widely used surgical intervention for the management of glaucoma. This study aimed to evaluate changes in intraocular pressure (IOP) before and after surgery, using statistical analyses of pre-operative and post-operative IOP measurements. Purpose: To determine the effectiveness of MMC in trabeculectomy and its role in enhancing surgical success. Methods: This retrospective observational study analyzed the medical records of 65 eyes from 52 glaucoma patients who underwent trabeculectomy with 2% MMC at Undaan Eye Hospital, Surabaya, Indonesia, between 2022 and 2023. Post-operative IOP was assessed at one, three, six, and twelve months. Statistical analyses were performed to identify patterns of IOP change over time. Results: A Kruskal-Wallis test, followed by Dunn's post hoc analysis (p < 0.001), revealed significant differences in IOP between the pre-operative and post-operative periods (p < 0.05). However, no significant differences were found among post-operative follow-up intervals (p > 0.05). Correlation analysis of IOP categories (< 20 mmHg vs. ≥ 20 mmHg) across observation points showed a negative correlation (r = -0.491, p < 0.001), indicating a tendency for IOP reduction over time. Regression analysis estimated that IOP decreased by approximately 1.141 mmHg per month. Conclusions: Significant reductions in IOP were observed post-operatively, with a sustained downward trend compared to pre-operative values. These findings provide valuable insights into the long-term effectiveness of trabeculectomy with MMC, emphasizing factors that optimize surgical outcomes for glaucoma management.

Use of Artificial Intelligence (AI) as a Diagnostic Modality for Keratoconus: A Comprehensive Meta-Analysis

2025-01-21T18:59:57+07:00

Introduction: Keratoconus is a degenerative corneal disorder leading to vision impairment. It is important to detect it early to prevent its progression by corneal cross-linking (CXL). Keratoconus is diagnosed using videokeratography and Scheimpflug tomography, which provide valuable data on the corneal surface. However, distinguishing keratoconus from normal variations remains challenging. Recent advances in artificial intelligence (AI) offer promising improvements in detecting subtle corneal changes, enhancing keratoconus detection and diagnosis. Purpose: To analyze AI as a diagnostic modality for keratoconus by calculating the pooled sensitivity and specificity to evaluate its accuracy. Methods: Databases involved PubMed, Scopus, Google Scholar, Embase, and Science Direct, from 2018 to March 2024. Also, to include unpublished works, the grey literature was searched, using the OpenGrey repository. Studies were included when they met the inclusion criteria. Results: We involved a total of 19 studies in this meta-analysis. The pooled sensitivity for detecting keratoconus was 95% confidence interval (CI) (91% to 98%), with a pooled specificity of 98% CI (96% to 99%). Additionally, the random forest model had a pooled sensitivity of 98.11% (CI, 96.77% to 99.44%), with a pooled specificity of 99% (CI, 98.24% to 99.76%). On the other hand, the convolutional neural network (CNN) model had a pooled sensitivity of 89.73% CI (79.77% to 99.69%), with a pooled specificity of 95.27% CI (91.88% to 98.66%). Conclusion: The results confirmed the reliability of different AI models in diagnosing keratoconus, especially the random forest model. This is important, as the early and accurate detection of keratoconus provides opportunities to reduce risk factors and offer treatments, including CXL, which can potentially slow its progression and improve the patient’s quality of life.

A Case of Chronic Incomplete Vogt-Koyanagi-Harada (VKH) Disease with Systemic Involvement in a 57-Year-Old Woman

2024-09-10T18:09:56+07:00

Introduction: Vogt–Koyanagi–Harada (VKH) disease is a systemic disorder that involves tissues containing pigmented cells. It is thought to be caused by an autoimmune T-cell-mediated process against melanocytes in systemic organs, particularly the eyes. VKH disease is a chronic, bilateral, diffuse, granulomatous panuveitis that involves integumentary, neurologic, and auditory aspects, which affects females and darkly pigmented ethnic groups. Here, we presented a rare case of VKH disease in a seronegative spondyloarthropathy patient. Case Presentation: A 57-year-old woman complaining of blurry vision in both eyes for three years. She was previously diagnosed with spondyloarthropathy, osteoarthritis, type 2 diabetes, hypertension, and dyslipidemia. Both eyelids exhibited periocular vitiligo and poliosis and were slightly hyperemic. Both eyes had perilimbal vitiligo and fine brown keratic precipitates. The anterior chambers were deep and quiet; however, the patient had posterior synechiae in both eyes. The fundus examination showed a sunset glow fundus appearance. Conclusions: VKH is a chronic disease that can relapse and recur. While the disease's prognosis is overall favorable, it is determined by the duration and frequency of recurrent inflammation episodes; thus, early detection and prompt treatment are essential for success. Poor visual prognosis is predicted by a larger number of complications, an older age at disease onset, a longer median duration of the disease, delayed treatment initiation, and a higher number of recurrent episodes of inflammation. To preserve vision, patients often require lifelong immunosuppressive therapy and need to be educated about the signs and symptoms to watch for when their condition relapses.

Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia Post-Endophthalmitis

2025-04-16T17:58:14+07:00

Introduction: Endophthalmitis is a severe eye disease. Due to the previous condition, selecting the appropriate type of secondary intraocular lens (IOL) is challenging. The Objective of this report is to describe the outcome of retropupillary iris-claw intraocular lens (RP- ICIOL) implantation to treat aphakia in patients with low corneal endothelial cell count, lack of capsular support, and a history of endophthalmitis. Case Presentation: A 73-year-old female patient reported experiencing hazy vision in her right eye (RE) for four months following cataract surgery. The patient had previously been diagnosed with aphakia and endophthalmitis RE and was admitted for three days. The visual acuity of the RE was 1/60. On anterior segment examination, the cornea was clear, the anterior chamber was deep, there was no flare or cell, vitreous strands were present in the anterior chamber, and the pupil was irregular with an aphakic lens. Examination of the posterior segment was within normal limits. Specular microscopy showing corneal endothelial cell density (CECD) of RE was 1086 cells/mm2. The patient then underwent RP-ICIOL implantation. Post-operatively, the visual acuity of the RE improved to 6/25, and the intraocular pressure (IOP) was 11 mmHg, as measured using non-contact tonometry. Three months post-op, the visual acuity was 6/30, the IOP was 17 mmHg in the RE and the CECD was 1108 cells/mm2. Conclusions: Good and appropriate management of endophthalmitis can save a patient's vision. Secondary iris-claw IOL implantation is a viable treatment option for aphakia following endophthalmitis, offering the advantage of maintaining the physiologic posterior position and being minimally invasive.

Neurotrophic Keratopathy Post-Herpes Zoster Ophthalmicus Infection

2024-05-23T14:02:32+07:00

Introduction: Neurotrophic keratopathy (NK) is a degenerative disease of the corneal epithelium caused by disruption of corneal trigeminal innervation, resulting in reduced corneal sensitivity, epithelial damage, and impaired corneal healing. It can be caused by various factors, such as viral infections (e.g. herpes simplex keratoconjunctivitis and herpes zoster), chemical or physical trauma, corneal surgery, and intracranial lesions. Management of NK is based on clinical severity to promote corneal healing and prevent progression to stromal melting or perforation. Case Presentation: A 64-year-old male presented with a three-month history of a whitish plaque on the right eye, accompanied by redness, foreign body sensation, and decreased vision. The patient had a history of herpes zoster ophthalmicus (HZO) on the left side of the forehead in June 2022. Ophthalmologic examination revealed a 4 x 5 mm corneal epithelial defect with stromal infiltrates and decreased corneal sensitivity in the left eye, consistent with stage 2 neurotrophic keratopathy. Ancillary tests revealed reduced tear production and instability of the tear film. The patient was treated with topical antibiotics, lubricants, cycloplegics, and systemic doxycycline, with weekly follow-up and no evidence of active bacterial or fungal infection. Conclusion: Neurotrophic keratopathy can occur as a complication of post-HZO infection. Early diagnosis, severity-based treatment, and close monitoring are crucial for achieving epithelial healing and preventing further corneal damage. Prognosis depends on the degree of sensory impairment and the response to treatment.

Subconjunctival Hemorrhage as a Sign of Intraocular Retinoblastoma Progression to Orbital Retinoblastoma

2025-02-08T15:35:19+07:00

Introduction: Retinoblastoma is the most common intraocular malignancy of childhood. While treatable when detected early, a delayed diagnosis can lead to orbital extension, which significantly worsens the prognosis. We report an unusual case in which a subconjunctival hemorrhage signaled the progression of intraocular retinoblastoma to orbital involvement. Case Presentation: A 2-year-4-month-old child presented with a one-month history of left-eye leukocoria. Ocular ultrasound and computed tomography (CT) confirmed features of an intraocular retinoblastoma (Group E), and urgent enucleation was planned. The surgery was delayed by two months; shortly before the operation, the child developed an inferonasal subconjunctival hemorrhage that rapidly expanded. During enucleation, a reddish-brown extrascleral tumor was discovered beneath the hemorrhage, indicating orbital extension. Histopathology revealed Grade 3 retinoblastoma with optic nerve invasion (resection margin free of tumor). Adjuvant chemotherapy was initiated postoperatively. Conclusion: Subconjunctival hemorrhage can be an unusual warning sign of orbital tumor extension in retinoblastoma. This case highlights the importance of raising awareness and reducing diagnostic delays, particularly in resource-constrained settings.