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Salmarezka Dewiputri
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Health Professions Medicine & Pharmacology Public Health

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Uncover the Hidden Veils: Ophthalmoplegia in Breast Cancer: Poster Presentation - Case Report - Ophthalmologist SITA PARAMITA AYUNINGTYAS; Syntia Nusanti; Salmarezka Dewiputri; M. Sidik
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/dcgyvr90

Abstract

Abstract Introduction : Breast cancer can metastasize to many sites, but the orbit is an infrequent location. Orbital metastases represent 1%–13% of all orbital tumors, and the prognosis is rather poor. We reported a case of orbital metastases of breast cancer that led to findings of other sites involvement. Case Illustration : A 50-year-old female presented with an inward squint and double vision for 9 months before admission. Esotropia, abduction, and elevation deficits in both eyes were observed. The visual acuity of both eyes was 6/6. Orbital MRI revealed an intraconal irregular lesion near the medial rectus muscle, which was hyperintense with contrast and thickened medial rectus muscles of both eyes. She underwent lumpectomy of breast mass two years before admission and no follow-up after surgery. Histopathology showed invasive lobular carcinoma (ILC). We referred her to hematologist- oncologist to have workup on metastases and treatment. Lung and extensive bone metastases were discovered. She was diagnosed with metastatic breast cancer (stage IV) and treated with hormonal therapy and bisphosphonates. On 3-month follow-up, diplopia and gaze limitations persist. Discussion : Diplopia and motility disturbances are the most common symptoms and signs of orbital metastases, including extraocular muscle involvement. The horizontal rectus muscles are more commonly involved. ILC is more frequent histological subtype involving orbital as the orbits are rich in fat and may attract disseminated ILC cells. Conclusion : Ocular symptoms in patients with a history of breast cancer should always be investigated for metastatic disease. A multidisciplinary approach is mandatory to achieve the best therapeutic management and long-term surveillance.
Terson Syndrome: A Rare, Treatable Visual Loss After Subarachnoid and Intraventricular Hemorrhage: Poster Presentation - Case Report - Resident DITA PERMATASARI; SYNTIA NUSANTI; MUHAMMAD SIDIK; SALMAREZKA DEWIPUTRI; SITA PARAMITA AYUNINGTYAS
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/af396t72

Abstract

Abstract Introduction : Intracranial pathologies commonly affect vision through optic neuropathy. However, visual loss could be due to vitreous hemorrhage as in Terson syndrome. This report warns us rare cases of visual loss after intracranial hemorrhage that requires totally different management than more commonly found optic neuropathies. Case Illustration : Female, 46 years old, had a severe headache and decreased consciousness two days later. CT angiography revealed wide subarachnoid hemorrhage and intraventricular hemorrhage causing hydrocephalus. She received emergency lumbar drainage followed by digital subtraction angiography and flow diverter device. Postoperative she regained consciousness, CT scan showed reduced ventricular size without residual hemorrhage, yet visual acuity of left eye reduced to hand movement and did not improve until one month later. Ophthalmologic examination showed vitreous hemorrhage of the left eye. Right eye was normal. Vitrectomy was planned to clear the vitreous hemorrhage. Discussion : Terson syndrome is intraocular hemorrhage associated with subarachnoid hemorrhage, cerebral hemorrhage, or traumatic brain injury. The proposed mechanisms were transmission of subarachnoid blood to the optic nerve sheath and rapid effusion of cerebrospinal fluid into the optic nerve sheath due to sudden increase of intracranial pressure. It compresses central retinal vein, causing vascular rupture. The manifestations could be vitreous, subhyaloid, subretinal, or intraretinal hemorrhage. Visual prognosis is good in those resolved spontaneously or receiving vitrectomy in nonresolving cases. Conclusion : Visual loss from intracranial hemorrhage or trauma could be caused by intraocular hemorrhage. It deserved different management than optic neuropathies. Prompt recognition should improve the management and the prognosis of rare cases such as Terson syndrome.
A peculiar case of idiopathic orbital myositis in adolescence: Poster Presentation - Case Report - Resident NABILA ALJUFRI; Agung Nugroho; Sita Paramita; Salmarezka Dewiputri; M. Sidik; Syntia Nusanti
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/837snw43

Abstract

Abstract Introduction : Idiopathic orbital myositis, an inflammation localized at the extraocular muscles, is rarely reported in pediatrics. Until now, the prevalence and incidence of orbital myositis remain unknown. This paper aims to report a case of idiopathic orbital myositis in a young girl with headache. Case Illustration : A-16-year-old presented with a droopy eyelid of the left eye (LE) and double vision since 1 week before admission. She also experienced swollen eyelid and cluster headache for 5 months with no neurological abnormalities. Ophthalmic examinations showed exotropia with limited eye movement of LE. Ptosis of LE was noted with margin reflex distance 1 (MRD-1) +2 mm, while MRD-1 +6 mm for the right eye. Other examinations were unremarkable with normal funduscopy and negative RAPD. Non-contrast orbital sinus CT-Scan revealed an enlargement of the superior rectus and lateral rectus muscle. The laboratory result showed slight leucocytosis and normal ESR. High-dose intravenous corticosteroid was administered and tapered with oral steroid. The orbital clinical findings showed improvements, better ocular movements, and diminished headache complaints. Discussion : As a rare case, the diagnosis of orbital myositis in adolescence can be challenging and requires detailed examination, and proper imaging to exclude other diagnosis such as ophthalmoplegic migraine, infections, malignancies, or congenital lesions (hemangioma). The first-line therapy is a systemic corticosteroid, which well responded in this patient. Conclusion : In this patient, intravenous corticosteroid represent an effective treatment. Close monitoring of the disease progression is required after switching to oral therapy to prevent relapse.
Can Optical Coherence Tomography Angiography be a Useful Adjunctive Diagnostic Tool in Patient with Non Arteritic Ischaemic Optic Neuropathy? Poster Presentation - Case Series - Resident Laura Agnestasia Djunaedi; Syntia Nusanti; M. Sidik; Salmarezka Dewiputri; Sita Paramita
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/3zzp0093

Abstract

Abstract Introduction : Perfusion deficiency of the optic nerve head is presumed to have an immense role in the pathogenesis of non-arteritic ischaemic optic neuropathy (NAION). Optical coherence tomography angiography (OCTA) is a non-invasive method that can assess posterior pole vasculature at multiple levels. Thus, these case series want to compare the OCTA in the acute (before four weeks) and chronic phases (after six weeks) of NAION with their fellow unaffected eyes to give an overview of vasculature changes in NAION. Case Illustration : This case series consists of four patients with NAION. Half of them came with a sudden painless blurry vision, and the remaining presented with an abrupt visual field defect. All of them have diabetes mellitus and hypertension. None of them have superimposed vascular pathology. The first OCTA was taken within seven days of the first symptoms, and the second OCTA was taken more than six weeks after. Discussion : The high percentage of systemic vascular risk factors and the acute onset supported the vascular occlusive hypothesis in the pathogenesis of NAION. Meanwhile, the OCTA provides an actual overview of the vasculature changes. Microvasculature is more likely to expand in the acute phase, and a more significant expansion was found in greater optic disc edema. On the other hand, microvascular tend to attenuate in the chronic phase, representing the pruning of capillaries. A swept-source OCTA with deeper penetration might give a better peripapillary choriocapillaris image in the acute phase. Conclusion : OCTA is a promising adjunctive tool for diagnosing and monitoring progression in patients with NAION.
Progressive Bilateral Ptosis in Adduction Deficit: True Internuclear Ophthalmoplegia (INO) or Pseudo-INO? Poster Presentation - Case Report - Resident MARSHA RAYFA PINTARY; Salmarezka Dewiputri; Annisa Nindiana Pertiwi; Syntia Nusanti; Sita Paramita Ayuningtyas; Mohamad Sidik
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/stqqd995

Abstract

Abstract Introduction : Bilateral INO is a rare disease caused by a lesion in the medial longitudinal fasciculus (MLF) in the pons, resulting in adduction deficit. Progression to ptosis is rare and may confuse with pseudo-INO as in ocular myasthenia gravis (OMG). This case aims to report progressive ptosis in bilateral INO that mimics pseudo-INO. Case Illustration : A 36-year-old woman complained sudden binocular diplopia 4 days before admission. Bilateral adduction deficits (-3 and -2 of right and left eye, respectively) with nystagmus were seen. There was no ptosis. The patient was diagnosed with bilateral INO. One month later, the patient returned with bilateral ptosis. The marginal reflex distance 1 (MRD1) were 0 on both eyes. Post fatigue and ice pack test showed 2mm difference of MRD1. The single fiber electromyography (EMG) result came out negative with jitter <10%. Brain MRI revealed lesions in the posterior pons and periaqueductal on the level of midbrain. Discussion : The MLF controls 6th and contralateral 3rd cranial nerve nucleus for horizontal gaze. Ptosis in INO can occurred due to central caudal subnucleus involvement in midbrain that innervates levator palpebra. The result of fatigue and ice pack test may be misleading, as those are not pathognomonic for OMG. The single-fiber EMG are valuable modalities to exclude pseudo-INO in this case. Conclusion : Progressive bilateral ptosis may occur in bilateral INO. Fatigue and ice pack test may give false- positive results leading to confusion with pseudo-INO, rather than true INO. Supporting examinations are needed to confirm the diagnosis.
Navigating Through The Diagnostic and Management Maze of Atypical Optic Neuritis Due To Autoimmune: Poster Presentation - Case Report - Resident Andi Marsa Nadhira; Syntia Nusanti; Salmarezka Dewiputri; Sita Paramita; Muhammad Sidik
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/ym9gge17

Abstract

Abstract Introduction : Typical and atypical optic neuritis (ON) have many overlapping characteristics; however, atypical ON have different features, with more lasting visual impairment and devastating prognosis. This paper describes a challenging case of recurrent, atypical ON due to autoimmune. Case Illustration : 42-year-old female complained of recurrent attacks of bilateral blurry vision, eye pain, and headachefor the past two years. Patient had been on multiple rounds of high-dose oral methylprednisolone, but symptoms reappeared every time it was tapered down. Visual acuity of both eyes was 3/60 and 6/45 (without and with correction, respectively), with normal intraocular pressure, anterior and posterior segment, and cranial nerves. No relative afferent pupillary defect was present. Brain magnetic resonance imaging (MRI) revealed intracerebral chronic small vessels; with no lesion in both optic nerves nor signs of neuromyelitis optica. Blood work-up showed elevated C-reactive protein, platelet aggregation, fibrinogen, D-dimer; positive rheumatoid factor, antinuclear antibody, and lupus anticoagulant; and negative Aquaporin-4 IgG. Diagnosis of atypical ON was established. Internal medicine and neurology departments diagnosed her with non-radiographic axial spondyloarthritis and migraine due to attributed autoimmune, respectively. After administration of intravenous pulse dose of methylprednisolone, her vision recovered to 6/7,5 of both eyes and symptoms alleviated. Discussion : Atypical features usually give hints for atypical ON, while laboratory examination and imaging modalities may aid in etiology identification. Early immunosuppressant therapy is commonly required. Conclusion : Recognizing symptoms of ON and necessitating further evaluation through ancillary tests, and collaborations with other specialties can minimize long-lived ailment and improve patients’ quality of life.
Co-Authors Agung Nugroho Andi Marsa Nadhira Annisa Nindiana Pertiwi Dita Permatasari Laura Agnestasia Djunaedi M. Sidik Marsha Rayfa Pintary Mohamad Sidik Muhammad Sidik Nabila Aljufri Sita Paramita SITA PARAMITA AYUNINGTYAS Syntia Nusanti