Basic Concept of Ophthalmology and Visual Disorder

The eye is a complex sensory organ that is responsible for vision. Within the protective sheath, each eye has receptors, a lens system for focusing light on receptors, and a nervous system for transmitting impulses from the receptors to the brain. Visual dysfunction can be caused by abnormal eye movements or changes in visual acuity, refraction, color vision, or accommodation. Visual dysfunction may also be a secondary effect of other neurological disorders. This narrative review aims to describe the structure of the eye in general and visual disturbances caused by the aging process and disorders of the protective structure of the eye.

Factors Affecting Generalization of Ocular Myasthenia Gravis in Palembang

Introduction. Ocular myasthenia gravis (OMG) is an autoimmune disease which is characterized by weakness of extraocular muscles, levator palpebrae and orbicularis oculi, resulting in ptosis and binocular diplopia. Nearly all patients present with eyelid and extra ocular muscles involvement. Approximately 30% to 80% of patients with OMG experience a conversion to generalized myasthenia gravis (GMG) within 2 years. There are not only have ptosis and diplopia but also limb weakness,bulbar symptoms, or even respiratory failure. This study was aimed to observe the clinical features of OMG to GMG and risk factors and median time to conversion of OMG to GMG of myasthenia gravis patients in Mohammad Hoesin General Hospital Palembang. Method. This study is a cohort retrospective study and the data were collected from the medical records of 91 patients who were registered as myasthenia gravis patients during September 2018 to March 2020. Sosiodemographic and clinical characteristics, including onset of OMG to GMG, history of smoking, presence of thymic abnormalities, and medications received were reviewed retrospectively. Result. A total of 91 OMG patients were observed in this study with 32 (35,2%) patients converted from ocular myastenia gravis to general myastenia gravis. Median conversion time to GMG was 34 months. Risk factor for convertion cases of OMG to MGG was receiving immunosupressive agents (Risk: 14.7, 95% CI 4.83, 44.7), thymus hyperplasia (Risk: 3.36, CI 95% 0.33, 33.6), Female (Risk: 2.41, 95% CI 0.94, 6.17), Smoking (Risk: 1.56, 95% CI 0.31, 7.81). Conclusion. Ptosis was the definitive sign for OMG in this study, with all patients had ptosis, thus it needs the colaboration from neuroophthalmologist and neurologist to diagnose and manage this case. Most of converted case was female and those who receive an immunosupressive agent therapy.

Risk Factors Related to Decreased Vision in Primary School Children in Palembang

Introduction. Visual acuity is the ability of the eye to see an object clearly, and this depends on the ability of the eye to accommodate. Myopia is one of the causes of a sharp decline in vision in children aged 8-12 years. Close working distance is one of the most frequently mentioned risk factors for myopia. Head and back posture that bends forward when reading or doing other close-up tasks causes a higher prevalence of myopia. This study was conducted to describe risk factors related to decreased vision in elementary school children. Methods. The study was a descriptive research with a sample of 100 elementary school children taken by simple random sampling. Data was taken using a questionnaire and a Snellen chart. Results. A total of 100 students participated in this study. Most of the participants were aged 11 years old. Based on visual acuity, 20 students have decreased right eye vision, and 21% have decreased left eye vision. Most respondents read every day for 1 hour time as many as 58 (58%) people and had screen time for less than 2 hours (52%). In addition, based on family history, most respondents had parents' glasses (73%). Conclusion. More elementary school children had normal right and left eye vision than those with decreased vision. Most respondents have less screen time and less reading duration.

History and Basic Principles of Photodynamic Therapy Use in Ophthalmology

Photodynamic therapy (PDT) is a therapy that uses drugs, called photosensitizers or photosensitizing agents, and a specific type of light. When photosensitizers are exposed to certain wavelengths of light, they produce oxygen that kills nearby cells. PDT is achieved by a photodynamic reaction induced by the excitation of a photosensitizer exposed to light. In the field of ophthalmology, PDT was approved for the first time about ten years ago for cases of age-related macular degeneration (AMD). Neovascular age-related macular degeneration (AMD) is a vision-threatening disease characterized by pathological macular neovascularization. After that, PDT was approved for use in choroidal neovascularization (CNV) cases in pathological myopia.3 This literature review aims to describe the history of PDT use and the basic principles of photodynamic therapy in ophthalmology.

Congenital Blindness and Psychosis: A Literature Review

Low vision has been declared by the World Health Organization (WHO) to be one of the major ophthalmologic problems requiring global attention. Low-vision patients experience a reduced vision-related quality of life due to impaired visual function. However, this condition that interfere their daily life could also make a significant effect on their mental health. Therefore, the final goal of low-vision rehabilitation is to improve the daily quality of life. However, the absence of vision at birth appears to protect against psychosis, whereas later-life visual loss appears to predispose to the development of psychotic symptoms. Thus, our purpose in this literature review is to learn how the onset of visual loss may affect patient's mental health.

Prevalence of Depression in Patients with Visual Impairment in Cataract: A Systematic Literature Review

Introduction. Depression is a chronic and often recurrent psychiatric disorder among older people, and its association with cataracts has not been well defined. Several studies have shown that depression is a prevalent mental health problem in ophthalmological practice and is often unrecognized or untreated. A systematic review was conducted to investigate the prevalence of depression in patients with visual impairment in cataracts.Methods. A literature search was performed on PubMed and Medline in the last 10 years (2011 to 2021). The search strategy used the following terms: (prevalence) and (visual impairment or blindness) and (cataract) and (depression or depressive symptoms). Of the 544 electronics, 226 articles were selected in free full text and 10 studies were identified as being possibly relevant. Results. Depression was associated with visual impairment in all studies. The prevalence of depression is higher in patients with eye disease.Conclusion. The prevalence of depression among eye disease patients was higher than that in healthy people. Cataract surgery is associated with an improvement in depressive symptomatology. More research is needed to identify effective strategies for the prevention and management of depression in patients with cataracts or visual impairment.

Factors Affecting Generalization of Ocular Myasthenia Gravis in Palembang

Introduction. Ocular myasthenia gravis (OMG) is an autoimmune disease which is characterized by weakness of extraocular muscles, levator palpebrae and orbicularis oculi, resulting in ptosis and binocular diplopia. Nearly all patients present with eyelid and extra ocular muscles involvement. Approximately 30% to 80% of patients with OMG experience a conversion to generalized myasthenia gravis (GMG) within 2 years. There are not only have ptosis and diplopia but also limb weakness,bulbar symptoms, or even respiratory failure. Objective. To observe the clinical features of OMG to GMG and risk factors and median time to conversion of OMG to GMG of myasthenia gravis patients in Mohammad Hoesin General Hospital Palembang. Method. This study is a cohort retrospective study and the data were collected from the medical records of 91 patients who were registered as myasthenia gravis patients during September 2018 to March 2020. Sosiodemographic and clinical characteristics, including onset of OMG to GMG, history of smoking, presence of thymic abnormalities, and medications received were reviewed retrospectively. Result. A total of 91 OMG patients were observed in this study with 32 (35,2%) patients converted from ocular myastenia gravis to general myastenia gravis. Median conversion time to GMG was 34 months. Risk factor for convertion cases of OMG to MGG was receiving immunosupressive agents(Risk: 14.7, 95% CI 4.83, 44.7), thymus hyperplasia (Risk: 3.36, CI 95% 0.33, 33.6), Female (Risk: 2.41, 95% CI 0.94, 6.17), Smoking (Risk: 1.56, 95% CI 0.31, 7.81). Conclusion. Ptosis was the definitive sign for OMG in this study, with all patients had ptosis, thus it needs the colaboration from neuroophthalmologist and neurologist to diagnose and manage this case. Most of converted case was female and those who receive an immunosupressive agent therapy.

Risk Factors for Diabetic Retinopathy

Introduction.Diabetic retinopathy is a progressive microangiopathy characterized by damage and occlusion of small blood vessels. The earliest pathologic changes are thickening of the capillary endothelial basement membrane and a reduction in the number of pericits. Diabetic retinopathy is the main cause of vision loss in type 1 of DM patients and has various risk factors such as chronic hyperglycemia, hypertension, hypercholesterolemia, and elevated HbA1C levels. Methods.This research was conducted using a descriptive observational analytic method with a cross sectional approach at The Eye Polyclinic (RSUP) Dr. Mohammad Hoesin Palembang used secondary data on diabetic retinopathy patients. The sample consisted of 64 patients with a total sampling technique, there were 50 patients who met the inclusion criteria. Results.There was a significant relationship between HbA1C levels (p value = 0.050) with a PR value = 1.463 and total cholesterol (p value = 0.038) with a PR value = 1.667 for diabetic retinopathy. Conclusion.HbA1C levels and total cholesterol are significant risk factors for diabetic retinopathy.

Intravitreal Ranibizumab Injection As A Treatment For Diabetic Macular Edema

ABSTRACT Introduction : In general, diabetic retinopathy is classified into early stage, namely non proliferative diabetic retinopathy (NPDR), and advanced stage, proliferative diabetic retinopathy (PDR). Diabetic macular edema is the most common cause of visual impairment in cases of early stage or NPDR. Purpose : To describe Diabetic Macular Edema (DME) with intravitreal injection of anti-VEGF as a treatment. Case report : 43 old female, came with chief complaint of blurred vision on her right eye since six months ago. Blurring is felt slowly. Patient has a history of uncontrolled diabetes since 10 years and a history of hypercholesterolemia since 1 year ago. visual acuity of the right eye is 4/60. On posterior segment examination, neovascularization of the papilla was found. Decreased foveal reflex (+), hard exudates (+) within 500 µm from the central macula. Microaneurism (+), dot hemorrhage (+), blot (+) in 4 quadrants, hard exudates (+) in 2 quadrants in her right eye. The patient was planned for intravitreal injection of anti-VEGF on her right eye. Conclusion : Intravitreal injection of anti-VEGF can improve visual acuity and reduce exudate and hemorrhage in retina from ophthalmoscope and fundus photography examination. In addition, the investigation with OCT was found to improve with reduced macular thickness.

Fortified Fluconazole Eyedrops for Treatment of Culvularia Corneal Ulcer

Introduction. Fungal keratitis is less common than bacterial keratitis, generally representing less than 5%–10% of corneal infections in reported clinical series in the United States. But in developing countries (Ghana, India, China) it accounts for more than 90% of the cases. Corneal trauma by plant or vegetative material is the leading risk factor for fungal keratitis. One or more topical antifungals are usually administered with systemic support of oral antifungals. The most common classes of antifungal used for medical therapy include the polyenes, azoles, and the echinocandins. Case Illustration. A 47-year-old male presented with a widening white patch on his left eye since 4 days before coming to our hospital. The left eye was injured by wood flakes 3 weeks ago. He felt a sore, red, watery left eye and blurred vision. He washed his eyes with betel leaf water. His left eye visual acuity was 1/60 and not improved with pinhole. There were blepharospasm, ciliary and conjunctival injection. Corneal examination showed a cloudy cornea, a central corneal defect sized 8x6 mm with an irregular margin, 2/3 to stromal depth, infiltrate, satellite lesion, and positive fluorescein staining at the defect margin. KOH examination demonstrated hyphae. The culture test of left corneal discharge identified a fungi species (Curvularia sp). We prescribed fortified fluconazole eye drops in combination with supportive therapy for 2.5 months. This regimen showed a significant increase in visual acuity to 6/30 with pinhole improvement of 6/21 in the left eye. Discussion. Imidazole acts by inhibiting ergosterol biosynthesis of the fungal cell wall, through action on the cytochrome P450-dependent enzyme. This leads to cell membrane destabilization and leakage. Curvularia sp belongs to the family of dematiaceous fungi. Its clinical manifestations include raised lesions and feathery edges; hypopyon rarely occurs, and the prognosis is quite good. Fluconazole (2 mg/ml) is available for injection and is a well-tolerated eye drop. The intravenous injection can be used as a topical treatment and can be given subconjunctivally at the same concentration. Conclusions. Fortified fluconazole eyedrops (2 mg/ml) can become an alternative and additional therapy for deep fungal keratitis, especially for Curvularia sp.