Ophthalmologica Indonesiana (OI) is a scientific journal published by Perhimpunan Dokter Spesialis Mata Indonesia (Perdami) released in February and August. For those who wish to publish their scientific papers in OI may submit scientific papers to the address of the Central Board of Directors in the form of soft copy with the provisions of applicable scientific writing. For members who write and read OI articles and write their resumes will get an assessment of P2KB Perdami which is a provision in obtaining a certificate of competence. Ophthalmologica Indonesiana is published two times a year by the Indonesian Ophthalmologist Association (IOA/Perdami), printed (ISSN 0216-1193) and online (e-ISSN 2460-545X) . Ophthalmologica Indonesiana is an official publication from IOA contains scientific ophthalmology associated articles and cooperates with Balai Penerbit Fakultas Kedokteran Universitas Indonesia, Jakarta.
The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))
Treatment Strategies of an Iris Implantation Cyst: A Case Report
Introduction: Iris cyst can be divided into primary and secondary, both originating from epithelial cells. Although rare, the entity has a high recurrence rate. This clinical case report highlights the treatment strategies to treat and prevent the recurrency of iris cyst. Case Report: We report a rare presentation of a secondary iris cyst in a 20-year-old male with a history of cataract surgery 17 years prior. The patient underwent fine-needle aspiration and intracystic alcohol injection. However, the iris cyst recurred eight months after the procedure. Afterward, the invasive strategy of iris cyst excision was conducted. Eight months after the secondary iris cyst surgery, the patient showed no signs of recurrence. Discussion: Iris cyst is known to have a high recurrence rate, however, a minimally invasive treatment is still preferred, supported by previous studies showing no recurrence in treatment with fine-needle aspiration and intracystic alcohol injection. In our case, the iris cyst relapsed eight months after this procedure, warranting for surgical excision. Eight months after the excision, the patient showed no signs of recurrence. Conclusion: Although the recurrency of iris cyst is high, the authors suggest starting with non-invasive treatment with follow-up ensuring no recurrence before opting for a more invasive treatment.
Copyright (c) 2025 Jessica Zarwan, Ayang Rashelda Maulidinia, Astrid Mariam Khairani Siregar, Syska Widyawati, Faraby Martha, Rio Rhendy https://creativecommons.org/licenses/by-nc-sa/4.0
UNUSUAL CASE OF A METAL FOREIGN OBJECT IN ORBITOCRANIAL INJURY: UNLOCKING THE MACCARTY KEYHOLE
Introduction. Penetrating orbitocranial injuries are quite rare but very fatal if left untreated. Various metal objects have been reported as foreign bodies that have penetrated the orbit. However, unusual objects such as motorcycle locks have never been reported before. Case Illustration. A 14-year-old boy was brought to the emergency room with a motorcycle lock embedded in his left temporal region. Examination of the left eye showed decreased vision, clear serous ciliary secretions, conjunctival hyperemia, chemosis, and relative afferent pupillary defect. Investigations using a 3D Head MSCT Scan revealed the presence of a metal object that penetrates the left optic nerve, the rectus lateralis muscle, and the frontal process of the left zygoma bone in the left temporal region, which is located around the MacCarty keyhole. The operation in the form of exploration and foreign object removal was then carried out in collaboration with the neurosurgeon. No postoperative complications were reported, but the patient had restricted movement of the left eye. Discussion. Penetrating orbitocranial injury should be treated as an emergency. Diagnosis should include comprehensive ophthalmological and neurological examinations. CT Scan continues to be the best cranial imaging technique. In this case, the motorcycle lock penetration was around the MacCarty keyhole, a structure that is frequently used to enter both the orbit and the frontal fossa, which located 7 mm superior and 5 mm posterior to the frontozygomatic suture. An appropriate surgical strategy is mandatory for removing the object because it may lead to serious consequences, including cerebral, infectious, vascular complications, and even death. Conclusion. Metal foreign objects such as motorcycle lock was considered unusual, particulary when it unlock an important landmark such as MacCarty keyhole. This case emphasizes the significance of a surgical strategy based on accurate anatomical tracking.
Copyright (c) 2025 Fadiah Gazzani Rahman, Andi Pratiwi, Halimah Pagarra, Suliati P. Amir https://creativecommons.org/licenses/by-nc-sa/4.0
COMBINATION OF DEXAMETHASONE IMPLANT AND ANTI-VEGF IN THE MANAGEMENT OF DIABETIC MACULAR EDEMA: A SYSTEMATIC REVIEW
Background: Anti Vascular Endothelial Growth Factor (anti-VEGF) and dexamethasone implant (DEX) are suggested as the first and second-line therapy for Diabetic Macular Edema (DME). However, persistent DME were found after six months of routine anti-VEGF injection. Intravitreal steroids have the advantage to control the inflammatory component of DME. Combining intravitreal anti-VEGF and DEX may reduce macular edema more effectively and more quickly theoretically. Hence, we aim to review the efficacy of adding DEX to anti-VEGF in treating DME. Methods: Literatures were obtained using comprehensive searching on PubMed and Proquest using the keywords “Dexamethasone implant”, “anti-VEGF therapy”, and “Diabetic Macular Edema” including their synonyms between 2018 to 2023. Non-English studies, animal studies, review articles, case studies, and editorial letters were excluded. This result was presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Results: A total of 3 studies with 265 eyes were included. All of the studies had Central Foveal Thickness (CFT) and Best Corrected Visual Acuity (BCVA) as the main outcomes. Improved CFT was seen in all of the studies (all p<0.05) with ∆CFT (200,40 μm in 6 months and 413 μm in 12 months). Most studies showed improved visual acuity after 8 months of injections which were shown by ∆BCVA (8,84 letters in 6 months and 21,6 letters in 12 months) and increased intraocular pressure as an adverse effect of steroids. Conclusion: Combination of DEX and anti-VEGF showed improvement in CFT and BCVA. Further studies are required due to the controversial intravitreal steroids’ ocular adverse effect.
Copyright (c) 2024 Ursula Natasya Pradnya Paramita, Tania Tania, Clarissa Clarissa, Salma Salsabila https://creativecommons.org/licenses/by-nc-sa/4.0
Determining The Etiology of Uveitis in Indonesia: The Role of Clinical Manifestation and Serological Test in Infectious Uveitis
Introduction: Uveitis is a heterogeneous group of intraocular diseases that significantly causes vision disabilities in patients worldwide. Establishing an etiological diagnosis can be challenging because of the extensive and varied clinical patterns and differential diagnoses across regions. Knowledge of these patterns is crucial in aiding physicians with diagnosis, reducing the need for costly ancillary tests, and facilitating timely management. Methods: We conducted a retrospective descriptive study using medical records data from a tertiary referral hospital in Indonesia over two years (2016-2017), involving 299 patients with uveitis. Discussion: Among the 299 patients, 152 were men (152/299, 50.8%) with a median age of 36. Panuveitis was the most frequent anatomical entity (152/199, 53.2%). Infectious etiology, primarily toxoplasmosis and tuberculosis, remained prevalent. Despite various final diagnoses, serological tests for IgG Toxoplasma and CMV were predominantly reactive in 192/251 (76.5%) and 228/236 (96.6%) of tested patients. At presentation, 106/299 (35%) of patients were categorized as blind, and 64/106 (60%) were without improvement. Complications were observed in 167/299 (55%) of patients, including cataracts (133/299, 44%) and glaucoma (32/299, 10%), contributing to 70/106 (66%) of blindness in our series. Conclusion: Panuveitis and infectious etiology, particularly toxoplasmosis and tuberculosis, were the most common causes of uveitis. Clinical patterns were better able to distinguish them than laboratory results. Understanding these uveitis patterns can guide physicians in diagnosing before performing expensive ancillary tests. Ocular complications were related to severe visual function; thus, timely referral in severe cases is essential. Keywords: Uveitis, Indonesia, epidemiology
Copyright (c) 2025 Gisela Haza Anissa, Rina La Distia Nora https://creativecommons.org/licenses/by-nc-sa/4.0
THE MULTIPLE OCULAR MANIFESTATIONS OF A NEGLECTED NEWLY DIAGNOSED MULTIBACILLARY LEPROSY WITH GRADE II DISABILITY
Introduction: Leprosy is a chronic granulomatous infection cause by Mycobacterium leprae that could involving the eye with prevalence within 51,6% to 85%. Despite the high prevalence of leprosy and ocular manifestation, ophthalmologist consultation is not routinely performed, thus leads to unrecognized ocular complications. This case report aims to portrays the ocular manifestation of multibacillary leprosy with grade II disability. Case report: A 71-year-old woman presented with severe corneal ulcer with perforation leading to the iris-lens prolapse resulted in total blindness of the left eye; peripheral ulcerative keratitis and neurotropic ulcer of the right eye; lagophthalmos, corneal hypoesthesia, and madarosis of both eye. The Dermatovenereology Department consultation revealed claw hand, ulnar nerve thickening on both upper extremity, and hypoesthesia on both upper and lower limb. The acid fast bacteria were identified from auricula skin scraping specimens with +3 bacterial index (BI) and 75% morphological index (MI). The patient was diagnosed with LE severe corneal ulcer with iris-lens prolapse, RE peripheral ulcerative keratitis (PUK) and neurotropic ulcer, RLE lagophthalmos, and multibacillary leprosy with grade II disability newly diagnosed. Left eye evisceration was performed after initiated the multidrug therapy (MDT) regiment. Conclusion: The ocular manifestation found in this case are corneal hypoesthesia, madarosis, corneal ulcer with perforation, iris-lens prolapse, peripheral ulcerative keratitis, and neurotropic ulcer. The management is directed to pathogen eradication and specific management on ocular manifestation. The collaboration with Dermatovenereology Department is required for comprehensive screening and management.
Copyright (c) 2025 Suci Purnamasari, Ovi Sofia https://creativecommons.org/licenses/by-nc-sa/4.0
Copyright (c) 2024 Widya Artini Wiyogo https://creativecommons.org/licenses/by-nc-sa/4.0
Refractive and Visual Outcomes of Pediatric Cataract Surgery in Indonesian Tertiary Eye Center
Introduction: Cataract remains as a leading cause of visual impairment in children. Surgical intervention and post-operative refractive correction remain fundamental. This study aims to describe the refractive and visual outcome of pediatric cataract surgery in a tertiary eye center in Indonesia. Methods: This retrospective study was conducted utilizing medical records of all congenital and developmental cataracts patients undergoing cataract extraction procedures with or without primary IOL implantation between January and December 2022. Exclusion criteria included patients who did not undergo visual acuity and objective refraction examination 1-month post-cataract surgery and those with incomplete medical records data. Results: A total of 118 eyes from 65 patients was included in this study. Most patients had bilateral cataracts (93.80%) and operated at the median age of 18 (0.96-212.64) months. Post-operatively, there were 71 (60.19%) aphakic and 47 (39.81%) pseudophakic patients with a respective refractive status of +18.00 (12.00 – 21.13) D and +0.60 (±2.37) D. Prediction error (PE) and absolute prediction error (APE) were obtained within 1.00 D. Most aphakic patients had unquantifiable visual acuity both before (91.50%) and after (83%) surgery. Among pseudophakic patients, nine (19.16%) had visual acuity of ≥ 6/12 and seven (14.89%) had visual acuity of <6/12 - 6/18 post-operatively. No patients had visual acuity ≥ 6/12 and <6/12 - 6/18 before surgery. Conclusion: Post-operative refractive status of both aphakic and pseudophakic patients were well within correctable range. There was an improvement of vision after surgery. Limited visual potential may be attributed to the presence of amblyopia.
Pediatric cataract, axial length, corneal curvature, BCVA, Biometric
Copyright (c) 2025 Feti Karfiati Memed, Rizki Adi Santosa, Irawati Irfani, Sesy Caesarya, Primawita Oktarima Amiruddin, Mayasari Wahyu Kuntorini https://creativecommons.org/licenses/by-nc-sa/4.0
COMPARISON OF VISUAL ACUITY RESULTS AFTER FEMTOSECOND LASER-ASSISTED IN SITU KERATOMILEUSIS (FS-LASIK) AND SMALL INCISION LENTICULE EXTRACTION (SMILE)
Introduction: Two of the most popular refractive surgery methods currently used are Femtosecond Laser-Assisted In Situ Keratomileusis (FS-LASIK) which creates a flap using femtosecond laser and stromal ablation using excimer laser, and Small Incision Lenticule Extraction (SMILE), a flapless procedure in which a lenticule is extracted through a small incision. The aim of this study is to compare the visual acuity results of FS-LASIK and SMILE. Methods: This is a descriptive cross-sectional study. Data were collected from the medical record of patients who underwent FS-LASIK or SMILE procedure at Cicendo Eye Hospital, the national eye centre, in 2022. Patients were followed up at 1 day, 1 week, and 1 month postoperatively and visual acuity outcomes between the two procedures were compared. Results: A slightly higher percentage of eyes in FS-LASIK (46.6%) achieved a UCVA of 1.0 at 1 day postoperatively compared to SMILE (45.5%). At 1 week and 1 month, SMILE showed superior results with 83% and 94.6% of eyes achieving a UCVA of 1.0, meanwhile FS-LASIK had 72.2% and 86.2%. Residual refractive error at 1 month had a median of -0.6146 and -0.3125 in the FS-LASIK and SMILE groups. Conclusion: This study found better UCVA results in the FS-LASIK group compared to the SMILE group at 1 day postoperatively. Meanwhile, UCVA at 1 week and 1 month postoperatively, showed superior results in the SMILE group. Residual refractive error at 1 month postoperatively also showed better results in SMILE than FS-LASIK.
Copyright (c) 2024 Nafisa Mardhiyya, Andrew M. H. Knoch, Emmy D. Sugiarti, Ludwig M. Tjokrovonco, Budiman https://creativecommons.org/licenses/by-nc-sa/4.0
INTERNUCLEAR OPHTHALMOPLEGIA IN MULTIPLE SCLEROSIS PATIENT
Introduction: Internuclear ophthalmoplegia (INO) characterized by impaired adduction of the affected eye caused by a lesion in the medial longitudinal fasciculus (MLF). The common cause of INO is demyelinating disease including multiple sclerosis. INO arguably the most discrete localizing sign in medicine, has considerable value in predicting multiple sclerosis. Due to its high spatial resolution, MRI has allowed us to depict in vivo the anatomic organization of the human oculomotor nerve complex, the MLF, and related structures in the brainstem. Case Report: A 48-year-old female presented with blurred vision of both eyes for 2 weeks, but then slowly resolved. Best corrected visual acuity presentation on both eyes were 20/20 with normal intraocular pressure (IOP). Adduction deficit observed on the left eye with no nystagmus. Convergence are not impaired in both eyes. Anterior segments was normal except minimal lens cloudiness in both eyes. Funduscopic examination result also within normal limit. Patient had undergone Computerised Tomography (CT-Scan) and the result was normal, no ischemic area or Space occupied lesion (SOL) or intracranial bleeding were found. Brain MRI showed bilateral optic perineuritis and multiple lesion in bilateral frontoparietalis and in the left side of the pons suggested multiple sclerosis. Discussion: Impairment of adduction movement on the patient’s left eye caused by demyelinating plaque related multiple sclerosis on the left side of the pons as shown MRI imaging. Management in this patient is based on the underlying condition. Conclusion: Internuclear ophthalmoplegia in this cases maybe caused by lesion in the medial longitudinal fasciculus could be related with multiple sclerosis.
Copyright (c) 2024 Fahrian Tirkal, Yunita Mansyur, Batari Todja Umar, Junus Baan, Yudy Goysal, Junus Baan https://creativecommons.org/licenses/by-nc-sa/4.0
Development and Application of Targeted Multi-plex Polymerase Chain Reaction to Help Diagnose Infectious Uveitis
Introduction: Clinical pattern recognition is paramount in uveitis diagnosis. Pathogen detection from ocular fluid samples is often necessary to support infectious uveitis diagnosis, particularly in cases presenting with atypical clinical appearance. This study aims to present the process of developing targeted multiplex PCR and evaluate its application in infectious uveitis diagnosis. Methods: This was a cross-sectional study to evaluate the diagnostic performance of targeted multiplex PCR in infectious uveitis. We obtained ocular fluid samples and reviewed medical records of uveitis patients who underwent ocular fluid analysis at Cipto Mangunkusumo Hospital from February 2022 to March 2023. PCR detection threshold values (DNA copies/mL) were 10.9 for Mycobacterium tuberculosis (Mtb), 672 for Epstein-Barr virus (EBV), 4.77 for Cytomegalovirus (CMV), 6.37 for Toxoplasma gondii (T. gondii), and 5.53 for Herpes simplex virus (HSV). With multiple pathogen selection, this method requires a lower volume of samples than single-plex PCR, as the latter will increase the sample volume linearly with each additional pathogen tested. Discussion: Forty-seven aqueous or vitreous samples were analyzed. The positivity rate was 23.4% (11/47) with Mtb yielding the highest positivity (7/41; 17.1%). With final diagnosis as a reference, targeted multiplex PCR resulted in 32.3% (95% CI: 16.7 – 51.4%) sensitivity, 93.8% (95% CI: 69.8 – 99.8%) specificity, 90.9% (95% CI: 58.4 – 98.6%) positive predictive value, and 41.7% (95% CI: 35.2 – 48.4%) negative predictive value. Conclusion: With its high specificity, targeted multiplex PCR is useful as a confirmatory but not screening tool in uveitis diagnosis. Ocular fluid analysis is an important part of the stepwise diagnostic approach in uveitis.
Copyright (c) 2025 Rachel Ethelind, Rina La Distia Nora https://creativecommons.org/licenses/by-nc-sa/4.0
The Relationship Between Tumor Necrosis Factor-Alpha (TNF-α) with Retinal Nerve Fiber Layer (RNFL) Thickness in Diabetic Retinopathy Patients at Prof. CPL Universitas Sumatera Utara General Hospital and Affiliated Hospital
Introduction: Retinal neurodegeneration may be an early indicator of diabetic retinopathy, the second most common complication after nephropathy. Tumor Necrosis Factor-Alpha (TNF-α) plays a role in the pathogenesis of inflammatory and neovascular eye disorders and is associated with intraocular inflammatory diseases like macular edema and proliferative diabetic retinopathy. This study aims to find the relationship between TNF-α levels and Retinal Nerve Fiber Layer (RNFL) thickness in diabetic retinopathy patients at Prof. CPL Universitas Sumatera Utara General Hospital and affiliated hospital. Methods: This cross-sectional study included 45 patients with type 2 DM and diabetic retinopathy at Prof. CPL Universitas Sumatera Utara General Hospital and affiliated hospital from March to June 2024. RNFL and posterior segment examinations were conducted. TNF-α levels were measured from blood samples.Blood sugar data were taken from medical records. Results: Of the 45 participants, 24 were men (53.3%) and 21 women (46.7%). 32 (71.1%) had DM for >5 years, and 27 (60%) experienced PDR. Highest location for RNFL thickness examination was superior (19, 42.2%). Average TNF-α with thin RNFL was 65.67 ng/L, and with thick RNFL was 64.78 ng/L. Mean TNF-α with thin superior RNFL was 65.74 ng/L, and thick was 63.70 ng/L. Mean TNF-α with thin inferior RNFL was 65.73 ng/L, and thick was 63.9 ng/L. Mean TNF-α with thin temporal RNFL was 68.73 ng/L, and thick was 67.19 ng/L. Mean TNF-α with thick nasal RNFL was 67.06 ng/L. Conclusion: There was no statistically significant relationship between TNF-α and RNFL thickness in diabetic retinopathy patients.
Diabetes mellitus, diabetic retinopathy, TNF-α, RNFL layer
Copyright (c) 2025 Wahyu Medsa Yeltas Putra, Delfi, Taufik Ashar https://creativecommons.org/licenses/by-nc-sa/4.0
Scleral Buckling for Retinopathy of Prematurity: A Case Report
Introduction The selection of management for advanced retinopathy of prematurity (ROP) requires careful consideration. The purpose of this study is to report the effectiveness of scleral buckling in patient with retinopathy of prematurity stage 4B of both eyes within 3 months. Case Description A 4-month-old female baby came to the Pediatric Ophthalmology Unit in Cipto Mangunkusumo General Hospital (RSCM) Kirana with chief complain did not make eye contact of both eyes. Her eyes were moving on their own since she was 3.5 months old, and sometimes squint. The patient came to the pediatrician and was referred to pediatric ophthalmology for further treatment. There was a history of premature delivery at 30 weeks with oxygen therapy for 3 weeks. The Pediatric ophthalmology division performed ultrasonography and retcam, and the diagnosis of retinopathy of prematurity stage 4B of both eyes was made. Scleral buckling was performed in the right and left eyes at the postmenstrual age of 49 weeks, and 52 weeks respectively by vitreoretinal division. Conclusion The management of ROP depends on the type ROP. For advanced ROP, surgery is indicated. The scleral buckle is a treatment option for advanced retinopathy of prematurity patients with retinal detachment if it is assumed that intraocular surgery presents a greater risk. In short-term period, for the right eye, the scleral buckling is effective. Further time to follow up is needed to show the long-term period effectiveness of scleral buckling in patients with advanced ROP.
Copyright (c) 2025 Gustiandari Fidhya Permanik, Julie Dewi Barliana, Anggun Rama Yudantha https://creativecommons.org/licenses/by-nc-sa/4.0
OCULAR GNATHOSTOMIASIS IN A FARMER FROM SOUTH SULAWESI, INDONESIA
Introduction: Ocular Gnathostomiasis is a rare parasitic infection caused by the third-stage larvae of the spiruroid nematode. Gnathostome species are mostly seen in tropical and subtropical areas. It is a food-borne zoonosis caused by the consumption of raw or undercooked freshwater of fish, amphibians, reptiles, birds, and mammals, all of which are known to harbor the larval stages of Gnathostome species. Case Report: A 37-year-old farmer complained of seeing moving objects in his left eye accompanied by blurred vision. At the previous visit, the patient had a history of red left eye with increased intraocular pressure, a visual acuity (VA) of 20/30 with the best corrected visual acuity (BCVA) of 20/20 and normal intraocular pressure. Slit lamp examination showed slight hyperemia of the conjunctiva and a live worm moving in the anterior chamber (AC). The worm was immediately removed using corneal clear incision and sent for parasitological examination. Discussion: Ocular Gnathostomiasis by third-stage larvae of spiruroid nematode was found at the eye of a man from Siwa, South Sulawesi. Patients with complaints of recurrent redness of the eyes accompanied by increased intraocular pressure and a history of living in an area with a habit of eating raw freshwater fish should be considered the possibility of harboring helminth in the eye. Conclusion: Patients with complaints of recurrent eye redness increased intraocular pressure, and a history of living in an area with a habit of eating raw freshwater fish should be considered the possibility of harboring helminth in the eye especially Gnathostome.
Gnathostomiasis, human, ocular, Indonesia
Copyright (c) 2025 Dian Trisnawaty, Batari Todja Umar https://creativecommons.org/licenses/by-nc-sa/4.0
ISOLATED UNILATERAL PTOSIS DUE TO JUVENILE OCULAR MYASTHENIA GRAVIS, CASE REPORT
Introduction: Ocular myasthenia gravis in children is an uncommon autoimmune condition impacting the neuromuscular junction. Typical manifestations include weakness in the levator palpebrae, orbicularis oculi, or extraocular muscles, leading to symptoms such as ptosis and binocular diplopia. Case Report: a 5-year-old girl was brought in with the primary concern of her right eyelid drooping for the last 11 days. The weakness of the eyelid is more pronounced during daytime and nighttime but improves upon waking up in the morning. The patient did not experience difficulties in speaking, swallowing, or breathing. There was no extremity weakness. Ophthalmologic examination reveals orthophoric eye position without restriction of eye movement. The patient exhibited drooping of the right eyelid. Repetitive Nerve Stimulation (RNS) confirmed the presence of a lesion at the neuromuscular junction. Consequently, the diagnosis was made of myasthenia gravis causing the right eye ptosis. Seven months after beginning treatment with oral pyridostigmine, there was a noticeable improvement in the patient's condition during a follow-up examination. Discussion: Juvenile ocular myasthenia gravis, can present with isolated unilateral ptosis. Diagnosis of mechanical/congenital ptosis, external ophthalmoplegia, and Horner syndrome has ptosis as a manifestation was ruled out. Conclusion: The diagnosis and initial management of juvenile ocular myasthenia gravis play a crucial role in preventing disease progression. First-line therapy with oral pyridostigmine is safe and effective. The prognosis for ocular myasthenia gravis in prepubertal patients is generally favorable.
Copyright (c) 2025 Adji Pramanto, Eka Sutyawan https://creativecommons.org/licenses/by-nc-sa/4.0
Emerging Challenges of Acute Bilateral Diabetic Cataract in Pediatric: Insight to Early Detection and Management– A Case Report
Purpose: To report rare case of acute bilateral cataract in pediatric with Type 1 Diabetes Mellitus as ocular complication despite of good glycaemic controls and its management. Methods: A 17-year-old male patient complained of blurry vision and glare in both eyes(BE) since 3 months in newly diagnosed T1DM (HbA1c 10% --> now 6.3%). Visual Acuity (VA) was 6/45PH6/21f2, with correction S-1.50 advancing to 6/18 in BE. Slitlamp examination of BE revealed lens opacity (P3),central position, 3mm in diameter, retinometri 0.32. Posterior segment evaluation and intraocular pressure (IOP) were within normal limits. Right eye (RE) was underwent lensectomy and IOL insertion under GA. Results: Postoperative RE with final VA of 6/18 PHNI and IOP of 43 mmHg. Patient was given antiinflammation eyedrops, oral and topical antiglaucoma, and received controlled final IOP of 8mmHg within 3 days and remain stable until now without antiglaucoma. Result was satisfying despite of uncomplicated secondary glaucoma as short-term complication that resolved with therapy. Evaluation and close monitoring postoperatively is needed and play significant role in visual outcome. Conclusions: Early detection for ocular complication in DM is needed as cataract genesis process still progressing despite of good glycaemic control. Ocular manifestation may present as early sign of undiagnosed T1DM or as its complications. Comprehensive and holistic multidicipline treatment, glycaemic control, and routine evaluation is essential and play significant role in the success of metabolic cataract therapy and progression of microvascular complications due to DM. Lensectomy + IOL implantation still the mainstay therapy in pediatric cataract. Awareness play vital role as it possibly cause decreased vision and or amblyopia, leading to blindness.
Copyright (c) 2025 Clara Valentina, MD, I Wayan Eka Sutyawan, MD, Ni Made Ayu Surasmiati, MD, I Made Agus Kusumadjadja, MD, I Wayan Gede Jayanegara https://creativecommons.org/licenses/by-nc-sa/4.0
Secondary Glaucoma due to Mucopolysaccharodis: a Case Report
Introduction: Mucopolysaccharidosis (MPS) is a rare, autosomal recessive inherited lysosomal storage disorder involved in glycosaminoglycans (GAG) degradation. Glaucoma, as a leading cause of irreversible blindness, in MPS patients has a very low occurrence rate, indicating that this condition needs attention and more research to improve MPS patients’ quality of life. Case Report: A 15-year-old boy came with a chief complaint of progressive onset of blurred vision in both eyes 4 years prior to admission. He was being treated as hypermetropia since then. Opacity was noticed in both eyes in addition to deteriorating vision for the last 3 months. Genetic test supported the possibility of MPS type VI. Hence this patient was diagnosed as secondary glaucoma due to MPS. Glaucoma medications were unable to control the intraocular pressure, thus trabeculectomy was planned. After the surgery, the patient was given antibiotic, analgetic, steroid, and anti-glaucoma medications. Releasable suture was removed on the 14th day post-surgery due to elevated IOP. Unfortunately, the patient did not make any visit afterward for further follow-up. Discussion: Our case faces several difficulties with anterior and posterior ophthalmological examinations. Corneal opacity with corneal thickening often occurs in MPS type VI. The exact mechanisms underlying corneal opacities remain elusive. IOP measurements can be helpful for the diagnosis and monitoring of glaucoma. Changes in corneal thickness can affect IOP measurements, and corneal opacity can prevent accurate visualization of the optic nerve and cornea-sclera angle, as well as supportive diagnostic devices such as Funduscopy, Ultrasound Biomicroscopy (UBM), and Optical Coherence Tomography (OCT), are difficult to perform. Conclusion: The underlying syndrome was suspected only after glaucoma occurred. Early detection and regular assessment play an important role in MPS. Routine follow-up is needed to ensure IOP control and determine the long-term outcome of IOP after trabeculectomy. Keywords: Glaucoma, Mucopolysaccharidosis, trabeculectomy
Copyright (c) 2025 Irene Carolin Mulyadi, Franky Richard Kasih https://creativecommons.org/licenses/by-nc-sa/4.0
Outcomes of GDD Implantation in NVG Patients at Cipto Mangunkusumo Hospital: A 3-Year Study
Introduction: Neovascular glaucoma is a challenging type of glaucoma to manage, due to its progressive nature. Achieving good intraocular pressure (IOP) in neovascular glaucoma cases often requires the aid of filtering surgery, preferably with a glaucoma implant/drainage device. This study aims to evaluate the outcomes of glaucoma drainage device (GDD) implantation for neovascular glaucoma patients in Cipto Mangunkusumo Hospital. Methods: A total of 77 eyes with neovascular glaucoma were included in this study, which underwent GDD implantation in Cipto Mangunkusumo Hospital between 2020 to 2022. Baseline data include age, gender, laterality, implant type used, underlying ocular condition, systemic comorbid, visual acuity (VA), IOP, and prescribed glaucoma medications. The postoperative VA and IOP were measured at 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, and 18 months or above. Complications and additional surgical interventions were noted. Success criteria based on the IOP and amount of glaucoma medications were evaluated at least 6 months postoperatively. Results: The mean IOP at baseline was 45.91 ± 13.9 mmHg with 3.42 ± 0.77 glaucoma medications. At 6 months postoperative, mean IOP was decreased to 13.84 ± 8.6 mmHg with 1.21 ± 1.18 glaucoma medications. At 6 months follow-up, 32.0% patients achieved complete success and 48.0% patients achieved qualified success. At 1 year postoperative, the Kaplan-Meier analysis for GDD success in neovascular glaucoma cases was estimated to be 79.2%. Conclusion: GDD implantation is an effective surgical option in treating neovascular glaucoma cases.
Copyright (c) 2025 Andrew John Widya Sieman, Virna Dwi Oktariana https://creativecommons.org/licenses/by-nc-sa/4.0
Role of Optical Coherence Tomography Angiography (OCTA) in Anterior Ischemic Optic Neuropathy
Introduction: Anterior ischemic optic neuropathy (AION) is the most common type of optic neuropathy with symptoms of sudden and painless visual field defect and vision loss. Although evaluating the nonperfusion areas of the vascular ischemia have traditionally been visualized through fluorescein angiography, OCTA has proven to be effective in noninvasively representing the retinal vascular network. This literature review aims to evaluate the quantitaive OCTA assessment of peripapillary vessel density (VD) changes in AION. Methods: Literature search was performed in four databases (PubMed, ScienceDirect, ProQuest, and Cochrane Library) from 2018 to 2022 to identify relevant articles. Five studies were included in this review. Results: All five studies on OCTA findings of NAION eyes reported a reduction in the vessel density of peripapillary capillary plexus when compared to either the healthy control eyes or the fellow unaffected eyes. OCTA reveals vascular changes in both forms, aiding prognosis and treatment. One study comparing NAION and AAION indicates reduced vessel density in NAION and AAION, with more severe abnormalities and reduction of vessel density in AAION. Conclusion: OCTA can visualize alterations in vascular density in both types of AION, AAION and NAION, with a notably more pronounced reduction in peripapillary vessel density observed in AAION. Keywords: anterior ischemic optic neuropathy, optical coherence tomography angiography, peripapillary vessel density
optical coherence tomography angiography
Copyright (c) 2025 Calista Nathasya Gunawan, Syntia Nusanti https://creativecommons.org/licenses/by-nc-sa/4.0
Giant Intracranial Aneurysm Presenting as Temporal Hemianopia: When the Eyes Reveal a Hidden Danger
Introduction: Giant intracranial aneurysms (GIA) are rare and deadly diseases due to the high risk of rupture. The purpose of this report is to describe a case of GIA presenting as temporal hemianopia. Case Report: A 52-year-old male presented with worsening blurry vision three weeks before admission. Visual acuity was light perception in the right eye and 6/18 in the left eye. Neuro-ophthalmic examination revealed a relative afferent pupillary defect in the right eye and bilateral optic atrophy. At the next visit, the visual acuity of the right eye recovered to 6/18. Visual field testing showed temporal hemianopia in the left eye and generalized depression in the right eye. Magnetic resonance imaging demonstrated a 0,4 cm x 2,5 cm x 1,9 cm saccular aneurysm, on the medial side of the left internal carotid artery (ICA). Discussion: A giant (diameter ≥2.5 cm) ICA aneurysm may compress the optic chiasm, leading to various stages of visual loss. Several factors are known to delicate balance between thrombogenesis and thrombolysis within the aneurysmal sac. Spontaneous intra-saccular thrombosis in an unruptured GIA may be induced by calcification within the atherosclerotic wall of the aneurysm and loss of elastic lamina. It is prone to occur in a narrow aneurysm neck (<0.4 cm). Thrombosis reduces the size of the aneurysm sac, in which the accumulated fluid is reabsorbed. This may explain the decompression effect on optic chiasm and spontaneous visual recovery. Conclusion: Intracranial aneurysms are a rare cause of optic chiasm compression but can still be considered in cases of temporal hemianopia.
Copyright (c) 2025 Annisa Nindiana Pertiwi, Syntia Nusanti, Marsha Rayfa Pintary, Salmarezka Dewiputri, Sita Paramita Ayuningtyas, Muhammad Sidik https://creativecommons.org/licenses/by-nc-sa/4.0
MINIMIZING PROLIFERATIVE VITREORETINOPATHY REACTION IN RHEGMATOGENOUS RETINAL DETACHMENT: IS THERE A ROLE OF PREOPERATIVE ANTI-INFLAMMATORY?
Copyright (c) 2024 Ari Djatikusumo, Widya Artini Wiyogo https://creativecommons.org/licenses/by-nc-sa/4.0
CORRELATION OF CENTRAL CORNEAL THICKNESS TO ACTUAL INTRAOCULAR PRESSURE IN MYOPIA PATIENTS
Background : Central Corneal Thickness (CCT) is promote in the diagnosis and management of glaucoma, especially in myopic patients. Understanding the correlation between CCT and IOP (Intraocular Pressure) aids in glaucoma detection and control. The objective of this study is to determine the correlation between CCT and actual IOP in myopic patients. Methods : This research is an observational study with ethical committee approval, involving medical students from the Faculty of Medicine at Andalas University undergoing clinical clerkships at Dr. M Djamil Padang General Hospital. They were grouped into emmetropia, mild myopia, and moderate myopia. Data included visual acuity measurements, autorefraction, CCT measurements using OCT, and IOP with CCT correction. Samples with eye abnormalities, systemic conditions, myopia > 6D, a history of eye surgery, contact lens wear, and IOP > 21 mmHg were excluded. All data were analyzed statistically. Results : The study involved 78 eyes from 78 individuals, consisting of 26 eyes per group. The actual CCT and IOP values in mild myopia, moderate myopia and emmetropia are 506.31 ± 11,263 μm with 15.81 ± 1,234 mmHg, 533.96 ± 21,342 μm with 16.12 ± 1,336 mmHg, and 487.81 ± 28,272 μm with 15.35 ± 1.056 mmHg. There was a strong positive correlation between CCT and IOP (r=0.737, p=0.000), as well as a moderate negative correlation between CCT and actual IOP (r=-0.492, p=0.000). Conclusion : This research reveals a negative correlation between CCT and actual IOP in myopic patients, highlighting the importance of glaucoma screening for myopic patients due to their thinner corneas.
CCT, central corneal thickness, IOP, intraocular pressure, actual IOP, myopia, glaucoma
Copyright (c) 2025 Hadwer Wicaksono Pandjaitan, Andrini Ariesti https://creativecommons.org/licenses/by-nc-sa/4.0
Diagnostic Challenges in Retinoblastoma with Panophthalmitis-Like Manifestation: A Case Report
Purpose: To highlight the importance and challenges of diagnostic examination and modalities to diagnose retinoblastoma with varieties of manifestation such as panophthalmitis-like. Case Report: A 4-year-old boy presented with red and swollen right eye since two days prior to admission. The position of the right eye was hypotrophy with restricted eye movement towards all directions and there was a presence of proptosis with edema, spasm, hyperemia with yellowish crust. Ultrasonography result came with severe anterior-posterior vitreous haziness with calcified mass suggesting an intraocular tumor of the right eye. Orbital CT-scan was performed and suggestive of panophthalmitis with superior palpebra abscess of the right eye. The inflammation was proposed due to prior intraocular surgery of cataract extraction and trabeculectomy that led to progression and worsening of the retinoblastoma, such invasive surgery led to atypical presentation of panopthalmitis-like. Patient initial visit was due to symptoms of leukocoria and squinting, but even though ocular ultrasonography was performed, the patient had failed to be diagnosed with retinoblastoma. Patient had CT scan and was confirmed of an intraocular mass with calcification inside the right eye with some palpebral abscess. MRI was performed to confirm the extension of the mass, which fortunately did not extend outside the eye. The patient then underwent chemo reduction therapy, before finally got enucleation with dermatofat graft surgery. Histologic examination confirmed the diagnosis of retinoblastoma. This case was an example of how sometimes clinical misdiagnosis among retinoblastoma can happen which can be due to inadequate diagnostic examination or atypical presentation. Preventing clinical misdiagnosis of retinoblastoma can improve the treatment and likelihood of survival of patients with retinoblastoma. Conclusion: Clinical misdiagnosis of retinoblastoma can happen without adequate diagnostic tools and prowess which may result in mismanagement and/or delayed treatment leading to poorer prognosis of patient with retinoblastoma.
Copyright (c) 2025 Rino Nugrahaputra, Julie Dewi Barliana https://creativecommons.org/licenses/by-nc-sa/4.0
CHALLENGE IN TREATING OPTIC NEURITIS IN PATIENT WITH CEREBRAL TOXOPLASMOSIS RELATED TO IMMUNOCOMPROMISED CONDITION
Introduction: This study aimed to discuss the prognosis of optic neuritis in a patient with cerebral toxoplasmosis related to an immunocompromised condition. Case Report: A 28-year-old female complained of blurred vision and double vision 2 weeks before admission, accompanied by headache, low extremities weakness, dysphonia, and dysphagia. Visual acuity of both eyes was 6/30 and worsened to 6/60 in a couple of days. Anterior segment examination revealed anisocoria pupil, and RAPD was positive in the left eye. Funduscopic examination showed a blurry margin and hyperemia of the optic nerve head. There was impaired eye movement, indicating oculomotor and abducens nerve palsies. High titer of IgG Antibody Toxoplasma (264) and very low titer of CD4 (<50) with non-reactive HIV rapid test were found in laboratory findings. Multiple ring enhancement was shown in MRI finding. Unfortunately, patient passed away during hospitalization due to respiratory failure. Discussion: Toxoplasmosis-associated optic neuritis is rare and usually becomes potentially serious. Although parasite detection by microscopy and bioassay is considered the gold standard for the diagnosis of toxoplasmosis, clinical diagnosis relies more on serological examination methods. The high proportion of deaths from this disease is mostly caused by late diagnosis of the infection. Conclusion: Optic neuritis that accompanied by systemic disorders needs special attention and comprehensive treatment among multidisciplinary divisions, especially in the immunocompromised condition. Early detection and primary prevention are important to improve prognosis and survival rate.
Binocular horizontal diplopia, Nystagmus, Pontine lesion, HIV, Cerebral toxoplasmosis
Copyright (c) 2024 Latifah, Wino Vrieda Vierla https://creativecommons.org/licenses/by-nc-sa/4.0
SURGICAL OUTCOME OF MUSCLE TRANSPLANTATION AS A MONOCULAR SURGERY FOR LARGE ANGLE STRABISMUS
Introduction: The management of large-angle strabismus can be difficult for surgeons, and successful outcomes may require multiple surgeries. However, modern surgical techniques aim to achieve desired results with a single operation. Muscle transplantation is one such technique that increases the effective muscle length, allowing for a large correction in a one-stage surgery. Objective: To report the outcome of muscle transplantation surgery in large-angle strabismus. Case Illustration: Three patients presented with large-angle strabismus, of which two cases showed >50∆ ET and one case had >50∆XT. All patients had normal anterior and posterior segment findings and underwent muscle transplantation under general anaesthesia. The first and second cases showed good alignment post-surgery, with no limitations in ocular motility in all gaze directions and improved visual acuity. However, none of the cases achieved stereoscopic vision due to chronic strabismus. In the third case, improvement in the primary position was observed two weeks post-operative, but ocular motility still had limitations. Conclusion: Muscle transplantation is a good option to correct large-angle strabismus, specifically in the unilateral case in a single procedure.
Copyright (c) 2024 Ika Puspita, Rani Yunita Patong, Marlyanti Nur Rahmah, Ratih Natasha Maharani https://creativecommons.org/licenses/by-nc-sa/4.0
REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY
Abstract Introduction & Objectives : Introduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal. Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power >1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation. Results : Day-1 follow-up keratometry shown that corneal astigmatism was still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism was better in 600um incision depth. Conclusion : When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.
Copyright (c) 2024 https://creativecommons.org/licenses/by-nc-sa/4.0
Outcome of laser Treatment for Retinopathy of Prematurity
Abstract Introduction & Objectives : Retinopathy of prematurity is a proliferative disorder that requires urgent treatment. Proper case finding and treatment will prevent permanent blindness in infants. Laser photocoagulation is an preferred technique for the treatment of ROP. Aim of this study to describe the result of laser indirect Ophthalmoscopy in Makassar, South Sulawesi, Indonesia. Methods : This is Observational retrospective study, from 1130 screening procedures during 2020 until 2022. This study found 41 ROP patients who had received therapy. Results : From 43 patients who received therapy, most were ROP stage 3 (80%), APROP (19%) and the rest were Stage IV A . 40 infants received lasers photocoagulation, and one infant received both laser photocoagulation and intravitreal anti-VEGF. Regression was found in all cases of stage 3 ROP. Patients with aggressive posterior ROP also were treated successfully, except one patient progressed to stage 4 ROP. Conclusion : with screening and prompt treatment, good outcomes have been obtained for infants with ROP
Outlook of Diabetic Retinopathy Management through Universal Health Care in Indonesia from 2015 – 2020
Abstract Introduction & Objectives : To identify the National Health Expenditure associated with diabetic retinopathy (DR) from the perspective of Jaminan Kesehatan Nasional [JKN]. Methods : A dataset of 1% of all individuals registered in JKN database was used from 2015 to 2020. We retrieved primary diagnosis with type 2 diabetes mellitus (T2DM) (ICD-10 E11) and/or T2DM with ophthalmic complications (E11.3). Further diagnosis with DR (H36) was retrieved. Four groups of medical procedures related to DR management were developed according to Indonesian Case Base Groups (INA-CBGs): diagnostic, laser photocoagulation and cryotherapy, minor (intravitreal injection), and major surgical procedures (e.g., vitrectomy). We performed descriptive analyses for the annual costs incurred for procedures, premium classifications, and regions. Results : Overall DR costs were US $41.5 million from 156,752 individuals with DR in JKN database sample. The total cost and per unit procedures cost specifically increased annually from 2015 to 2019 but declined substantially in 2020. The largest amount was spent on intravitreal injection ($36.3 million [87.5%]), whereas vitrectomy was the least ($145.0 million [0.3%]). Region 1 (Java Island) with non- beneficiaries of government subsidies (PBPU and PPU) was the major number of claims ($12.5 million [30.1%] and ($7.3 million [17.7%]), while beneficiaries of government subsidies (PBI) outside Java Island, conversely, were under average. Conclusion : There was significant increase in health expenditure associated with DR in Indonesia from 2015 to 2019, but decreased in 2020 possibly due to COVID-19 pandemic. Majority of funding was spent to treat severe spectrum of DR and concerned in urban area.
The Association between Atrial Fibrillation and Central Retinal Artery Occlusion: A Meta-Analysis and Systematic Review
Abstract Introduction & Objectives : Central retinal artery occlusion (CRAO) is a condition where the central retinal artery is blocked. Atrial Fibrillation (AF) is commonly associated with retinal embolism that originates anywhere between the heart and the ophthalmic artery. This study aims to explore the incidence of AF in CRAO. Methods : A systematic search was performed in three databases: Pubmed, EBSCO host, and Proquest. Newcastle-Ottawa Scale was used to assess the risk of bias in the study included. Results : Our systematic review comprises six studies, 4 studies included CRAO patients as the study population and AF as the endpoint, and the others 2 studies with CRAO as the endpoint. Meta- analysis of the first group resulted in a significantly favorable AF incident after CRAO with an odds ratio (OR) of 1.46 (95% CI 1.17-1.81, p=0.0007). The second meta-analysis supports CRAO with an OR of 4.86 (95% CI 2.30-10.28, p<0.0001). Conclusion : It is crucial to identify AF in preventing ocular infarction. This study revealed that AF was identified as a risk factor in patients with CRAO and vice versa.
Comparative Validity of LEA Contrast Sensitivity Chart to Pelli-Robson Contrast Sensitivity Chart in Neuroophthalmology Patients
Abstract Introduction & Objectives : The Pelli-Robson and LEA contrast sensitivity chart are widely used to measure clinical contrast sensitivity. The Pelli-Robson is a gold standard with the limitation of its bulky size. The LEA contrast sensitivity chart offers a reliable test in a way more practical and portable chart. This condition led to a question of whether we can predict Pelli-Robson score based on the LEA score. This study developed a conversion method to facilitate the transition from the LEA to the Pelli-Robson and validating the conversion score. Methods : This study retrospectively examined the relationship between LEA and Pelli-Robson Contrast Sensitivity Test. There were 120 eyes included in this study. We produced a conversion table using the equipercentile equating method. Then, we evaluated the reliability and accuracy of this algorithm to convert the LEA to the Pelli-Robson contrast sensitivity score. Results : LEA scores were converted to Pelli-Robson scores according to a conversion table that achieved a reliability of 0.91 based on intraclass correlation. The accuracy of this algorithm was 81.6% within 1 point difference from the raw score. Conclusion : This study reported a reliable and comparable conversion algorithm for transforming LEA scores into converted estimated Pelli-Robson scores. This method will enhance the utility of existing data in clinical and research settings.
POSTOPERATIVE COMPLICATIONS OF ORBITAL TUMOR REMOVAL IN SARDJITO GENERAL HOSPITAL
Abstract Introduction & Objectives : Orbital tumor removal surgery represent a small but significant portion of ophthalmologic surgery, and few reports of the associated complications are available. The aim of this study is to report the complications of orbital tumor removal surgery in Sardjito General Hospital, Yogyakarta. Methods : Descriptive retrospective study was carried out 138 patients who undergone orbital tumor removal surgery during July 2021-March 2023. Surgery approach and postoperative complications were collected from medical record. Results : Of approximately 138 patients, 12 (8%) patients had postoperative complications. Five (5%) of 75 patients who undergone anterior orbitotomy had postoperative complications. One percent had lagophthalmos, 1% had ptosis, 2% had decreased vision, and 1% had ocular movement disorders. Lateral orbitotomy was done in 21 patients. Three (12%) patients had postoperative complications. Four percent had ptosis, 4% had decreased vision, and 4% had ocular movement disorders. Four (60%) of 6 patients who undergone medial orbitotomy had ptosis (16%) and decreased vision (50%). Posterior orbitotomy was done in 8 patients. One (12,5%) patient had complication of ptosis. Conclusion : Anterior orbitotomy was the most common surgery approach for orbital tumor removal. The most common postoperative complications were ptosis and decreased vision. Informed consent is an important aspect to improve patient’s knowledge of postoperative complications.