To assess the use of eye care and its predictors among diabetic patients in Indonesia. Methods: Diabetic patients aged 18 years and older were recruited consecutively from a university clinic and 2 community clinics in Jakarta, Indonesia. Information obtained by questionnaire and record review included demographic and socioeconomic status, knowledge about diabetic retinopathy, and ocular and medical history. The main outcome was self-reported or record history of an eye examination by an eye care professional with dilation of the pupil within the preceding year. Results: Among 196 participants (mean [SD] age, 58.4 [9.4] years; 61.5% female), 166 (84.7%) had not undergone ocular examination in the last year, including 100 of 119 patients (84.0%) at the university clinic. Fewer than half (82 of 166 [49.4%]) of all patients reported being told of the need for eye examinations by their physician. In regression analyses, factors associated with having an eye examination were higher diabetic retinopathy knowledge score (odds ratio=1.52; P=.01) and years since being diagnosed as having diabetes (odds ratio=1.71 for third vs first tertile; P=.02). Education, income, health insurance status, and diagnosis of diabetic retinopathy were not predictive of examination. The most common reasons given by subjects for not having had eye examinations concerned lack of knowledge about the need for care (97 of 160 subjects [60.6%]), while financial barriers were cited by only 22 of 160 subjects (13.8%). Conclusion: The low proportion of diabetic subjects receiving recommended annual eye examinations in Indonesia might be improved through patient and physician education.

PurposeTo estimate the total healthcare cost associated with diabetic retinopathy (DR) in type 2 diabetes in Indonesia and its projection for 2025.MethodsA prevalence-based cost-of-illness model was constructed from previous population-based DR study. Projection for 2025 was derived from estimated diabetes population in 2025. Direct treatment costs of DR were estimated from the perspective of healthcare. Patient perspective costs were obtained from thorough interview including only transportation cost and lost of working days related to treatment. We developed four cost-of-illness models according to DR severity level, DR without necessary treatment, needing laser treatment, laser +intravitreal (IVT) injection and laser + IVT +vitrectomy. All costs were estimated in 2017 US$.ResultsThe healthcare costs of DR in Indonesia were estimated to be $2.4 billion in 2017 and $8.9 billion in 2025. The total cost in 2017 consisted of the cost for no DR and mild–moderate non-proliferative DR (NPDR) requiring eye screening ($25.9 million), severe NPDR or proliferative DR (PDR) requiring laser treatment ($0.25 billion), severe NPDR or PDR requiring both laser and IVT injection ($1.75 billion) and advance level of PDR requiring vitrectomy ($0.44 billion).ConclusionsThe estimated healthcare cost of DR in Indonesia in 2017 was considerably high, nearly 2% of the 2017 national state budget, and projected to increase significantly to more than threefold in 2025. The highest cost may incur for DR requiring both laser and IVT injection. Therefore, public health intervention to delay or prevent severe DR may substantially reduce the healthcare cost of DR in Indonesia.

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Background This case report describes two rare cases of Coats disease in nonjuvenile patients with preserved vision. Case presentation Two otherwise healthy Asian males aged 15 and 29 years old presented with unilateral gradual blurred vision and scotoma, respectively. Visual acuity was 6/6 (0 logMAR) with no other abnormalities observed in the anterior segment of the eyes. Both posterior segment examinations and fluorescein angiography revealed retinal telangiectatic vessels, exudation, and hemorrhage. Additionally, optical coherence tomography of the first patient showed subfoveal fluid. Both patients were diagnosed with stage 2 Coats disease. Laser photocoagulation was performed on both patients. The first patient showed initial good response to therapy with resolution of the subfoveal fluid; however, he developed cataract and underwent cataract surgery after 3 years. In the second case, although the exudates and hemorrhage still persisted, the macula was spared and the patient did not have visual complaints. No adverse events were reported, and final visual acuity of both patients remained 6/6. Conclusions Coats disease in adolescence and adulthood may present with good vision. In mild and moderate cases of Coats disease, laser photocoagulation monotherapy may help preserve vision. Nevertheless, as recurrences and complications may still occur later in life, lifelong monitoring is recommended.

Background Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy with features similar to wet age macular degeneration. The incidence of PCV is known to be higher in the Asian population compared to Caucasians. Imaging modality is needed to make the diagnosis of PCV. Although Indocyanine green angiography (ICGA) is still the gold standard, it is not routinely performed in vitreoretinal practice. Thus another imaging modality is currently a popular research area. Spectral domain optical coherence tomography (SD-OCT) has emerged as a new imaging modality mostly available in clinics. Some studies have reported the sensitivity and specificity of SD-OCT in diagnosing PCV with different results and thresholds. Methods Relevant studies from PubMed, Science Direct and Google Scholar databases were systematically searched. In random effect models using STATA 14 software, a meta-analysis was performed to determine the pooled diagnostic accuracy. QUADAS 2 was used to evaluate the risk of bias of each study by Revman 5.4 software. Results Seven eligible studies which met the inclusion and exclusion criteria were enrolled in this study. A total of 911 eyes were included to investigate the diagnostic accuracy of SD-OCT. As a result, the pooled sensitivity was 0.91 (95% CI 0.87–0.93), specificity 0.88 (95% 0.83–0.92), positive likelihood ratio 8, negative likelihood ratio 11, the area under the summary receiver operating characteristic curve 0.95 (95% CI 0.93–0.97), and diagnostic odds ratio 71.81 (95% CI 38.89–132.74). Conclusion SD-OCT provided a high diagnostic value for detecting PCV. Sharply peaked pigment epithelial detachment (PED), notched PED, bubble sign, multiple PED, and double-layer sign were the most common features found in PCV.

Background: Injection of Silicon oil (SO) is a standard procedure for vitreous replacement in vitrectomy procedure for retinal detachment cases. It acts as a great tamponading agent for reattachment of retinal breaks or retinal detachment. Despite its minor side effect, SO could cause several complications such as cataract, endothelial decompensation, increased intraocular pressure, and secondary glaucoma. Thus needed to be evacuated after the retinal reattachment is stabilized. Following the evacuation procedure, visual acuity is known to be significantly improved. However, some cases show decreased of visual acuity due to retinal redetachment, optic nerve damage due to secondary glaucoma, hypotony, vitreous hemorrhage, expulsive hemorrhage, and cornea abnormality. Methods: A retrospective descriptive study of retinal detachment patients underwent SO evacuation procedure in Cipto Mangunkusumo Hospital,Results: There were seventy-seven cases of retinal detachment undergoes SO evacuation within the period of September 2017-January 2018. There was an improvement of visual acuity (greater than 6/60) after one month of SO evacuation. Anatomical retinal reattachment was successfully observed in 91% patient. The most occurring complication after SO evacuation includes secondary glaucoma and retinal redetachment.Conclusion: SO evacuation is a standard procedure following a vitrectomy in retinal detachment cases. The evacuation procedure yields in positive benefit for patient in term of visual acuity and anatomical structure.

Objective: To demonstrate the clinical course of hypertensive chorioretinopathy in preeclampsia. Case Report: Here we present a case of 27-year-old pregnant female of fulminating pre-eclampsia who presented with blurred vision. Eye examination revealed the vision was 3 meters finger-counting. Fundoscopy showed decreased retinal arteriole-to-venule ratio, intraretinal hemorrhages and cotton-wool spots. She responded to preeclampsia protocol treatment with improved vision and fundoscopy showing resolved intraretinal hemorrhages and fading Elschnig's spots. Conclusion: The outcome of hypertensive chorioretinopathy in preeclampsia is excellent with risk factor control.

In the past decades, indications for PPV in paediatric patients has been rising with large heterogeneity outcomes among studies. Our objective is to present a pilot descriptive study in Indonesia, regarding pars plana vitrectomy (PPV) success rate in paediatric patients with rhegmatogenous retinal detachment (RRD) in Dr. Cipto Mangunkusumo Hospital (CMH). A retrospective study was conducted on 16 paediatric eyes diagnosed for RRD and treated in CMH during the period of January 2017 to December 2017. A total of 16 RRD eyes were identified in 15 individuals. Majority of the patients were male and were in the age group of 12-18 years. There were 13 patients undergone PPV with or without SB. Functional anatomical success rate was determined from the macula status while functional success rate on final BCVA. Among 16 patients, 14 had constant or increased final BCVA and 11 had reattached macula. The success rate of PPV in terms of anatomical outcome was 11 out of 16 eyes and in functional outcome was 8 out of 16 eyes. Keywords: pars plana vitrectomy, paediatric ophthalmology, rhegmatogenous retinal detachment.   Karakteristik dan Hasil Vitrektomi Pars Plana pada Pasien Pediatrik di Divisi Vitreoretina Rumah Sakit Cipto Mangunkusumo Tahun 2017 Abstrak Indikasi tindakan vitrektomi pars plana (PPV) pada pasien pediatrik bertambah secara signifikan dalam beberapa dekade terakhir. Penelitian ini dilakukan sebagai studi awal di Indonesia, terkait tingkat keberhasilan PPV pada pasien anak dengan rhegmatogenous retinal detachment (RRD) khususnya di RS Cipto Mangunkusumo (RSCM). Studi retrospektif dilakukan terhadap 16 mata RRD pada 15 pasien anak di RSCM pada periode Januari 2017 – Desember 2017. Mayoritas pasien merupakan laki-laki dalam kelompok umur 12-18 tahun. Terdapat 13 pasien yang menjalani PPV dengan atau tanpa scleral buckle (SB). Tingkat keberhasilan anatomi dilihat dari status penempelan makula, sementara tingkat keberhasilan fungsional dinilai dari visus akhir. Tingkat keberhasilan anatomi PPV dalam studi ini adalah 11/16 mata, dan tingkat keberhasilan fungsional mencapai 8/16 mata. Kata kunci: vitrektomi pars plana, oftalmologi pediatrik, rhegmatogenous retinal detachment.