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"This book examines the role that oxidative and nitrosative stress plays in the complex physiology and pathophysiology of the retina and choroid. This book as a guide to the current understanding of retinal and choroidal cellular mechanisms involved in aging and disease. These 31 chapters summarize what is known about oxidative stress in retinal and choroidal disorders. "

"ABSTRAKGlaukoma merupakan penyakit multifaktorial dan penyebab kematian terbesar kedua di dunia. Riskesdas 2007, menyatakan sekitar 4.6 penduduk Indonesia menderita glaukoma. Baku emas penegakkan diagnosis glaukoma menggunakan nilai rerata RNFL. Tujuan penelitian ini untuk melihat korelasi nilai rim area dengan rerata RNFL sebagai alat diagnostik glaukoma primer sudut terbuka. Penelitian ini menggunakan metode studi potong-lintang dengan jumlah sampel sebanyak 55 subjek yang diambil dari total data rekam medis bulan februari 2015 hingga juni 2016. Hasil penelitian menunjukkan sebagian besar pasien glaukoma primer sudut terbuka berusia >58 tahun 56.4 , laki-laki 61.8 , cup-disk rasio >0.7 63.6 , nilai rerata RNFL 60.76 19.86 ?m, dan nilai rim area 0.73 0.56 mm2. Hasil uji korelasi pearson antara Rim area dengan rerata RNFL didapatkan nilai r 0,734 dan nilai p< 0,05 yang menyatakan kedua variabel memiliki korelasi kuat dan secara statistik bermakna. Pengukuran menggunakan ROC curve didapatkan nilai cut-off rim area sebasar 1.049 dengan nilai sensitivitas 81.8 dan spesifisitas 95.5 . Berdasarkan hasil tersebut dapat disimpulkan bahwa nilai Rim area memiliki korelasi dengan nilai rerata RNFL dan dapat digunakan sebagai alat diagnostik glaukoma primer sudut terbuka.

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ABSTRAKGlaucoma is a multifactorial disease and the second biggest cause of death in the world. Riskesdas 2007 report rsquo s stated around 4.6 population in Indonesia was diagnosed with glaucoma. The gold standard in diagnosing glaucoma is using the average RNFL.The purpose of this research is finding the correlation of rim area with average of RNFL as a diagnostic tools for primary open angle glaucoma. The method used in this research is a cross sectional study, the samples of which use 55 patient medical records from 2015 February until 2016 June. The result consist of the data that most of the patient with primary open angle glaucoma are older than 58 years old 56.4 , male 61.8 , cup disk ratio 0.7 63.6 , the average RNFL 60.76 19.86 m and rim area 0.73 0.56 mm2. Rim area and average RNFL are analyzed with pearson corelation test and the result of which are r value 0,734 and p value less than 0,05 which represent a strong correlation and statistically significant result. Measurement with ROC curve found that the cut off of rim area is 1.049 with 81.8 sensitivity and 95.5 specificity. As the conclution, rim area has corelation with average RNFL and can be used as a diagnostic tool for primary open angle glaucoma. "

"Glaukoma berada di peringkat kedua sebagai penyebab kebutaan di Indonesia. Penurunan lapang pandang yang ditandai dengan penurunan nilai mean deviation MD dan penipisan retinal nerve fiber layer RNFL adalah dua dari beberapa hal yang sering dikaitkan dengan glaukoma. Namun, kedua hal tersebut belum ditemukan secara jelas hubungannya satu sama lain. Penelitian ini bertujuan untuk mengetahui hubungan MD lapang pandang dengan ketebalan rerata RNFL pada pasien glaukoma primer sudut terbuka di RSCM kirana, Jakarta. Desain dari penelitian ini adalah cross-sectional dengan mengambil data dari rekam medis pasien RSCM Kirana dari Januari 2015 hingga Juni 2016 yang memiliki data hasil pemeriksaan optical coherence tomography OCT dan tes Humphrey. Terdapat 95 buah bola mata yang datanya diambil untuk sampel. Dari hasil analisa korelasi antara nilai MD lapang pandang dan ketebalan RNFL yang dilakukan pada data yang diperoleh, didapatkan nilai signifikansi.

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Glaucoma is the second leading cause of blindness in Indonesia. Visual field loss which is indicated by reduced mean deviation MD value and retinal nerve fiber layer RNFL depletion are two of several things frequently related to glaucoma. However, the correlation between the two variables is yet to be clearly discovered. The objective of this research is to know the correlation between visual field MD and RNFL average thickness in primary open angle glaucoma patients in RSCM kirana, Jakarta. The design which is used in this research is cross sectional by retrieving data from RSCM Kirana patients rsquo medical record from January 2015 to June 2016 which have optical coherence tomography OCT and Humphrey test results. There were 95 eyes whose data was retrieved as samples. After analyzing the correlation between visual field MD value and RNFL thickness retrieved from the samples, it was found that the significance value is"

"Tujuan: Mengetahui pengaruh fotokoagulasi laser terhadap kadar Hypoxia-inducible Factor-1α (HIF-1α) vitreus dan kadar Intercellular Adhesive Molecule-1 (ICAM-1) vitreus pada Retinopati Diabetik Proliferatif. Metode: Penelitian ini adalah uji klinis acak terbuka. Desain penelitian adalah uji klinis acak terbuka. Dua puluh dua mata dirandomisasi menjadi 2 kelompok, yaitu yang mendapatkan fotokoagulasi laser panretinal 1-2 minggu pre-vitrektomi dan kontrol. Kadar HIF-1α dan ICAM-1 dihitung menggunakan enzyme-linked immunosorbent assay (ELISA). Central macula thickness (CMT) diukur saat baseline, pre-vitrektomi, follow-up 2, 4, dan 12 minggu paska vitrektomi. Hasil: Analisis hasil didapatkan rerata kadar HIF-1α vitreus (dalam ng/mL) pada kelompok kontrol dan fotokoagulasi laser masing-masing 0,152±0,015 dan 0,164±0,033 sedangkan kadar ICAM-1 vitreus(dalam ng/mL) adalah 17,840±14,140 dan 27,027±10,452. Tidak terdapat perbedaan bermakna rerata kadar HIF-1α dan ICAM-1 vitreus serta CMT di setiap waktu follow up antara kedua kelompok. Terdapat korelasi antara kadar HIF-1α dan HbA1c (r=0,463, p=0,03). Pengukuran CMT pre-vitrektomi dan kadar HIF-1α vitreus pada penelitian ini mempunyai korelasi positif pada kedua kelompok (r = 0,447 dan r = 0,32). Simpulan: Fotokoagulasi laser 1-2 minggu pre-vitrektomi tidak menyebabkan kadar HIF-1α dan ICAM-1 yang lebih rendah dibandingkan dengan yang tidak mendapatkan laser. Kadar HIF-1α vitreus berkorelasi dengan tebalnya CMT, sedangkan kadar ICAM-1 vitreus tampak tidak berhubungan. Kontrol glikemik yang lebih buruk pada kelompok fotokoagulasi laser mempengaruhi hasil dari kadar HIF-1α maupun ICAM-1 vitreus.

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Purpose: to determine the effect of pre-treatment of laser panretinal photocoagulation (PRP) before vitrectomy to Hypoxia-inducible Factor-1α (HIF-1α) and Intercellular Adhesive Molecule-1 (ICAM-1) in the vitreous fluid of patients with diabetic retinopathy proliferative.

Methods: This is post-test only randomized clinical trial open label study. Twenty two eyes were recruited, and 11 eyes had pre-treatment of PRP pre-vitrectomy and other 11 eyes were served as control. HIF-1α and ICAM-1 were measured by enzyme-linked immunosorbent assay (ELISA). At the beginning of PRP and just before vitrectomy (1-2 week after PRP), and at the time of follow-up of 2,4, and 12 week after vitrectomy, central macular thickness (CMT) was measured.

Results: Mean of HIF-1α(ng/mL) were 0,152±0,015 and 0,164±0,033in control and photocoagulation group, respectively. Mean of ICAM-1(ng/mL) were 17,840±14,140 and 27,027±10,452. There were no statistically significant differences in the comparison of both HIF-1α and ICAM-1 in each group and CMT at each time of follow up. The positive correlation between ICAM-1 in the vitreous body and HbA1c was clinically significant (r=0,463, p=0,03). The positive correlation between both level of HIF-Iα the vitreous body of both groups and CMT was found (r = 0,447 dan r = 0,32).

Conclusion: Laser photocoagulation 1-2 weeks before vitrectomy did not cause lower concentration of vitreous level of HIF-1α dan ICAM-1. Glycemic control status that worse in laser photocoagulation group could influence the level of HIF-1α and ICAM-1 vitreus."

"Uveitis adalah inflamasi intraokular yang terjadi pada saluran uvea mata ataupun jaringan yang berada di dekatnya, diantaranya retina atau vitreous. Uveitis merupakan penyebab kebutaan nomor tiga di dunia dengan prevalensi tertinggi pada kelompok umur pekerja aktif 20-50 tahun . Selama ini diagnosis uveitis infeksi dan non-infeksi di Indonesia ditegakkan secara klinis dan didukung pemeriksaan serologi darah. Pemeriksaan antibodi pada cairan akuos dan serum serta marka genetik, khususnya HLA B-27 belum pernah dilakukan. Penelitian ini dilakukan untuk memberikan alternatif pendukung diagnosis klinis yaitu pemeriksaan deteksi molekuler HLA B-27 dan deteksi antibodi dengan perhitungan koefisien Goldmann-Witmer. Subjek penelitian adalah pasien uveitis aktif di Poliklinik Infeksi dan Imunologi RSCM Kirana yang berjumlah 79 orang. Berdasarkan koefisien Goldmann-Witmer, mikroba penyebab uveitis adalah Toxoplasma gondii dan virus Varicella zoster. Gen HLA-B27 ditemukan pada enam subjek penelitian dan terdapat kesesuaian dengan kasus uveitis non-infeksi tetapi belum dapat dibuktikan kemaknaannya secara statistik.

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Uveitis is an intraocular inflammation which occurs on the uvea or its surrounding tissue such as retina or vitreous. Uveitis is known as the third major cause of blindness in the world with the highest prevalence is productive age group 20 50 years old . To date, infectious and non infectious uveitis stipulation in Indonesia is based on clinical examination and serology test. The aqueous and serum antibody titer measurement as well as genetic marker examination, especially on HLA B27, has never been done before. In this research we perform HLA B27 detection through molecular analysis and antibody titer measurement to know the Goldmann Whitmer coefficient. Sample size used in this research is 79 patients with active uveitis obtained from ldquo Poliklinik Infeksi dan Imunologi RSCM Kirana rdquo . The analysis of Goldmann Whitmer coefficient showed that the pathogens responsible for uveitis are Toxoplasma gondii and Varicella zoster. HLA B27 were found in six patients and there is similiarity between non infectious uveitis but this value does not have prove statistically. "

"Koroid memiliki peran dalam mengatur metabolisme fotoreseptor dan epitel pigmen retina (EPR) serta sumber perdarahan ke lapisan luar retina. Pada miopia terjadi elongasi aksial yang berdampak pada penipisan ketebalan koroid dan memengaruhi prognosis visual. Studi ini bertujuan mengetahui hubungan antara ketebalan koroid dengan derajat miopia dan ketebalan fotoreseptor-EPR. Studi ini merupakan studi potong lintang yang dilakukan pada 102 mata. Setiap subjek dikelompokkan menjadi empat kelompok, yaitu emetropia, miopia ringan, sedang, dan berat. Setiap subjek dilakukan pemeriksaan mata menyeluruh dan pemindaian makula menggunakan spectral domain optical coherence tomography (SD-OCT), dengan pengaturan HD-1-Line100x dan enhanced depth imaging (EDI). Gambar pemindaian dinilai secara manual dan dikelompokkan berdasarkan Early Treatment of Diabetic Retinopathy Study (ETDRS) grid. Hasil studi menunjukkan ketebalan koroid terbesar ditemukan di subfovea atau lingkar superior bergantung pada kelompok, dan ketebalan terendah ditemukan pada regio nasal setiap kelompok. Terdapat perbedaan signifikan ketebalan koroid dengan derajat miopia pada setiap kelompok. Korelasi signifikan ketebalan koroid dan ketebalan lapisan fotoreseptor-EPR hanya ditemukan pada lingkar inferior dalam (r=0,34; p<0,001). Penelitian ini menunjukkan ketebalan koroid yang beragam dan signifikan tiap derajat miopia, serta korelasi negatif lemah antara ketebalan koroid dan ketebalan lapisan fotoreseptor-EPR pada di regio inferior.

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The choroid is crucial for regulating the metabolism of photoreceptors and the retinal pigment epithelium (RPE) while supplying blood to the outer retinal layer. Myopia, characterized by axial elongation, is linked to choroidal thinning, impacting visual prognosis. This study investigates the relationship between choroidal thickness (CT), different myopia degrees, and photoreceptor-RPE thickness. In a cross-sectional study of 102 eyes, categorized into emmetropia, mild, moderate, and high myopia groups, comprehensive eye exams and macular scans using spectral domain optical coherence tomography (SD-OCT) with HD-1-Line100x settings and enhanced depth imaging (EDI) were conducted. Manual evaluations of scan images based on the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid revealed varied and significant CT across myopia degrees. The thickest CT found either in the subfovea or superior ring depending on the group, and the thinnest consistently in the nasal region for all groups. A significant correlation between choroidal thickness and photoreceptor-RPE layer thickness was noted in the inner inferior circle (r=0.34; p<0.001). In summary, this study unveils varying and significant CT across myopia degrees, emphasizing weak negative correlations between choroidal thickness and photoreceptor-RPE layer thickness, specifically in the inferior region."

"In this book, experts from around the world describe how digital teleretinal screening can be set up and optimally utilized. Technical issues are discussed, and the appropriate use of screening for different diseases and in different age groups is explained. The major part of the book draws upon the clinical experience of leading practitioners in a wide range of teleretinal applications. "

"BACKGROUND:proliferative diabetic retinopathy (DR) is an advanced form of DR that eventually could lead to blindness. Levels of vitreous advanced glycation end products (AGEs) and D-dimer may reflect the pathological changes in the retina, but only few studies have assessed their correlation with blood hemoglobin A1C (HbA1c) levels. This study aimed to find the association between blood HbA1c levels with vitreous AGEs and D-dimer levels in patients with proliferative DR. METHODS:an analytical cross-sectional study was performed in subjects with proliferative DR who underwent vitrectomy. Subjects were divided into 2 subgroups, i.e. uncontrolled (HbA1c >7%) and controlled (HbA1c <7%) groups. Vitreous AGEs and D-dimer levels were assessed; the levels were compared between uncontrolled and controlled hyperglycemic patients. Statistic correlation tests were also performed for evaluating blood HbA1c, vitreous AGEs, and D-dimer levels.RESULTS:a total of 47 patients were enrolled in this study and 32 (68.1%) of them were women. Median vitreous AGEs level was 11.0 (3.0 - 48.0) µg/mL; whereas median vitreous D-dimers level was 5,446.0 (44.0 - 37,394.0 ) ng/mL. The median vitreous AGEs levels was significantly higher in patients with uncontrolled vs. controlled hyperglycemia (14.0 vs. 4.0 mg/mL; p<0.001). There was a significant positive correlation with moderate strength between blood HbA1c level and vitreous AGEs level (r=0.524; r2=0.130; p=0.0001). Blood HbA1c level could be used to predict vitreous AGEs level by using the following calculation: vitreous AGEs = -1.442+ (1.740xblood HbA1c). Vitreous D-dimer levels were not significantly different between uncontrolled and controlled hyperglycemia (median 4607.5 vs. 5701.6 ng/mL; p = 0.458). There was a positive significant correlation between blood HbA1c and vitreous D-dimer levels (r = 0.342; p = 0.019); however the correlation was weak. Vitreous AGEs level had a positive significant correlation with vitreous D-dimer levels (r = 0.292; p = 0.046) and the correlation strength was also weak.CONCLUSION:median vitreous AGEs levels were significantly higher in proliferative DR patients with uncontrolled than those with controlled hyperglycemia. Blood HbA1c level can be used to assess vitreous AGEs level in patients with proliferative DR by using the following calculation: vitreous AGEs = -1.442+(1.740 x HbA1c). However, the blood HbA1c level can not be used to predict vitreous D-dimer level in patients with proliferative DR.

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Latar belakang: retinopati diabetik (RD) tipe proliferatif merupakan bentuk lanjut RD yang selanjutnya dapat menyebabkan kebutaan. Kadar produk akhir glikasi/advanced glycation end products (AGEs) dan D-dimer cairan vitreus dapat menggambarkan perubahan patologi pada retina, tetapi hanya ada sedikit penelitian yang menilai korelasi antara kedua parameter tersebut dengan kadar HbA1c dalam darah. Tujuan penelitian ini menemukan hubungan antara kadar HbA1c darah dengan kadar AGEs dan D-dimer cairan vitreus pada pasien dengan RD tipe proliferatif. Metode: penelitian bersifat analitik potong lintang pada pasien dengan RD tipe proliferatif yang menjalani vitrektomi. Pasien dibagi dalam 2 kelompok yaitu hiperglikemi tidak terkendali (HbA1c > 7%) dan terkendali (HbA1c < 7%). Kadar AGEs dan D-dmer cairan vitreus diukur dan kadarnya dibandingkan antara pasien hiperglikemi tidak terkendali dan terkendali. Uji korelasi statistik juga dilakukan antara kadar HbA1c darah dengan kadar AGEs dan D-dimer cairan vitreus.

Hasil: pasien berjumlah 47, dengan 32 (68.1%) pasien adalah wanita. Nilai median kadar AGEs cairan vitreus 11.0 (3.0 – 48.0) μg/mL, dan nilai median kadar D-dimer cairan vitreus 5,446.0 (44.0 – 37,394.0 ) ng/mL. Nilai median kadar AGEs cairan vitreus lebih tinggi bermakna pada pasien dengan hiperglikemia tidak terkendali dibandingkan dengan hiperglikemia terkendali (14.0 vs. 4.0 mg/mL; p<0.001). Terdapat korelasi positif bermakna dengan kekuatan sedang antara kadar HbA1c darah dan kadar AGEs cairan vitreus (r = 0.524; r2 = 0.130; p=0.0001). Kadar HbA1c darah dapat digunakan untuk memperkirakan kadar AGEs cairan vitreus dengan menggunakan rumus: kadar AGEs cairan vitreus = -1.442+(1.740xHbA1c darah). Kadar D-dimer cairan vitreus pasien dengan hiperglikemia tidak terkendali tidak berbeda bermakna dengan pasien hiperglikemia terkendali (median 4607.5 vs. 5701.6 ng/mL; p = 0.458). Terdapat korelasi positif bermakna tetapi dengan kekuatan lemah antara kadar HbA1c darah dengan kadar D-dimer cairan vitreus (r = 0.342; p = 0.019). Kadar AGEs cairan vitreus memiliki korelasi positif bermakna dengan kekuatan lemah dibandingkan dengan kadar D-dimer cairan vitreus (r = 0.292; p = 0.046).

Kesimpulan: nilai median kadar AGEs cairan vitreus lebih tinggi bermakna pada pasien RD proliferatif dengan hiperglikemia tidak terkendali dibandingkan hiperglikemia terkendali. Kadar HbA1c darah dapat digunakan untuk memperkirakan kadar AGEs cairan vitreus pada pasien RD proliferatif dengan menggunakan rumus: kadar AGEs cairan vitreus = -1.442+ (1.740x HbA1c darah). Kadar HbA1c darah pada pasien RD proliferatif tidak dapat digunakan untuk memperkirakan kadar D-dimer cairan vitreus."

""This book opens with a comprehensive overview of the scientific basis of lung function in health and disease. It then provides detailed coverage of the broad array of diseases and disorders affecting the respiratory system, including obstructive and restrictive diseases, pulmonary vascular disorders, sleep-disordered breathing, lung neoplasms, respiratory infections, and respiratory failure, among others.""

"The hereditary retinopathy, retinitis pigmentosa (RP), which affects 1 in 3,500 people worldwide, is the most common cause of registered visual handicap among those of the working age in developed countries. RP is a highly variable disorder where patients may develop symptomatic visual loss in early childhood, while others may remain asymptomatic until mid-adulthood. "