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""ABSTRAK"Tujuan: menilai kadar Hypoxia-inducible Factor-1? HIF-1? dan Intercellular Adhesion Molecule-1 ICAM-1 vitreus pada retinopati diabetik proliferatif yang diberikan bevacizumab intravitreal, serta hubungan keduanya terhadap ketebalan makula sentral previtrektomi.Metode: tiga puluh dua mata dirandomisasi menjadi 2 kelompok, yaitu yang mendapatkan suntikan bevacizumab intravitreal 1-2 minggu previtrektomi dan kelompok kontrol langsung dilakukan vitrektomi . Penghitungan kadar HIF-1? dan ICAM-1 dilakukan dengan metode enzyme-linked immunosorbent assay ELISA . Ketebalan makula sentral diukur saat awal, previtrektomi, serta 2, 4, dan 12 minggu pascavitrektomi dengan menggunakan Stratus OCT.Hasil: rerata kadar HIF-1? vitreus dalam ng/mg protein pada kelompok kontrol dan bevacizumab intravitreal masing-masing 0,020 0,006;0,077 dan 0,029 0,016;0,21 . Kadar ICAM-1 vitreus dalam ng/mL adalah 20,10 3,41;40,16 dan 23,33 0,63;68,5 . Rerata kadar HIF-1? dan ICAM-1 vitreus didapatkan tidak berbeda bermakna antara kedua kelompok.Simpulan: bevacizumab intravitreal 1-2 minggu previtrektomi belum dapat membuat kadar HIF-1? lebih rendah daripada kelompok kontrol. Kadar ICAM-1 kelompok bevacizumab didapatkan lebih tinggi pada kelompok kontrol. Tidak didapatkan hubungan yang bermakna antara ketebalan makula sentral previtrektomi terhadap kadar HIF-1? dan ICAM-1.Kata kunci: retinopati diabetic proliferatif, HIF-1?, ICAM-1, bevacizumab"

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""ABSTRACT"Purpose to assess the levels of Hypoxia inducible factor 1 HIF 1 and intercellular adhesion molecule 1 ICAM 1 in vitreous of proliferative diabetic retinopathy patients which were given intravitreal bevacizumab IVB , as well as its relation to the central macular thickness CMT measured prior to vitrectomy.Method this was post test only randomized clinical trial open label, in which thirty two eyes were randomized into two groups, one that received an IVB injection at 1 2 weeks previtrectomy and the control group. Measurement of HIF 1 and ICAM 1 was conducted using enzyme linked immunosorbent assay ELISA . The CMT were measured at the initial visit, prior to vitrectomy, and at follow up time 2, 4, and 12 weeks postoperative using Stratus OCT.Result The mean levels of HIF 1 vitreous ng mg protein in the control group and IVB respectively 0.020 0.006 0.077 and 0.029 0.016 0.21 . Vitreous levels of ICAM 1 ng mL in control group and IVB group were 20.10 3.41 40.16 and 23.33 0.63 68.5 . The mean levels of HIF 1 and ICAM 1 vitreous obtained did not differ significantly between the two groups.Conclusion Intravitreal bevacizumab 1 2 weeks prior to vitrectomy was not enough to make the levels of HIF 1 lower in IVB group. Median of ICAM 1 level in IVB group was higher than control group. There were no correlation between CMT with HIF 1 and ICAM 1 levels. "

"Latar Belakang: Stres oksidatif merupakan salah satu faktor patogenesis terjadinya retinopati diabetik (RD). Fotokoagulasi laser dan anti-VEGF bermanfaat pada penanganan RD. Keberhasilan terapi dan prognosis dapat dilakukan melalui penilaian klinis dan penanda biologis stres oksidatif. Tujuan: Penelitian ini bertujuan membandingkan pengaruh fotokoagulasi laser dan bevacizumab intravitreal (BIV) terhadap penanda biologis stres oksidatif, antara lain aktivitas ALDH plasma, kadar VEGF, MDA dan aktivitas SOD vitreus pada penyandang RD proliferatif. Metode: Penelitian ini adalah penelitian prospektif dengan desain uji klinis acak tersamar tunggal. Sebanyak 72 mata dari 69 penyandang RD proliferatif di Rumah Sakit Cipto Mangunkusumo (RSCM) antara Februari 2011 ? Juni 2013 dirandomisasi menjadi 4 kelompok terdiri dari kelompok 1) kontrol yaitu kelompok langsung vitrektomi sesuai indikasi (n = 18), 2) kelompok yang mendapat fotokoagulasi laser pre-vitrektomi (n = 18), 3) kelompok yang mendapat BIV pre-vitrektomi(n = 18) dan 4) kelompok yang mendapat kombinasi BIV dan fotokoagulasi laser previtrektomi (n = 18). Hasil: Hasil penelitian ini mendapatkan bahwa pada kelompok 1, 2, 3 dan 4 masingmasing rerata aktivitas ALDH plasma (IU/mg protein) (0,034+0,02; 0,027+0,02; 0,025+0,02; 0,031+0,1; p = 0,66), kadar MDA vitreus (nmol/mL) (1,661+1,21; 1,557+1,32; 1,717+1,54; 1,501+1,09; p = 0,96), dan aktivitas SOD (U/mL) (0,403+0,50; 0,210+0,18; 0,399+0,49; 0,273+0,32 p = 0,38) dan tidak terdapat perbedaan bermakna, sedangkan perbandingan rerata kadar VEGF vitreus (pg/mL) (0,356+0,60; 0,393+0,45; 0,150+0,24; 0,069+0,13; p = 0,05) menunjukkan perbedaan yang bermakna. Kadar VEGF kelompok kombinasi BIV dengan fotokoagulasi laser lima kali lebih rendah dibandingkan dengan kelompok kontrol. Simpulan: Kombinasi BIV dan fotokoagulasi laser tidak berpengaruh terhadap aktivitas ALDH plasma dan SOD vitreus, namun berpengaruh terhadap kadar MDA dan VEGF vitreus penyandang RD proliferatif. Kombinasi BIV dengan fotokoagulasi laser perlu dilakukan pada RD proliferatif. Pengukuran ALDH plasma dapat digunakan sebagai faktor prognostik untuk perubahan CMT dan visus.

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Background: Diabetic Retinopathy (DR) is retinal vascular complications in patients with diabetes mellitus (DM). Oxidative stress plays a major role in the pathogenesis of this disease. The current management of DR includes laser photocoagulation (LF) and administration of anti-VEGF, such as intravitreal bevacizumab (IVB). Clinical parameters are usually applied in determining the outcomes of these methods of therapies. However, the measurement of biomarkers of oxidative stress can possibly be used to determine the prognosis.

Purpose: This study was aimed to compare the effect of LF, IVB and combined treatments on biomarkers of oxidative stress such as plasma ALDH and vitreal SOD activities, and vitreal VEGF and MDA level on proliferative DR patients.

Methods: In this single blind randomized clinical trial, 72 eyes from 69 cases of proliferative DR in Cipto Mangunkusumo Hospital (RSCM) between February 2011 - June 2013 were randomized into 4 groups : 1) control group (n = 18), 2) LF previtrectomy group (n = 18), 3) IVB pre-vitrectomy group (n = 18) and 4) combined IVB and LF pre-vitrectomy group (n = 18). In all groups, the biomarkers of oxidative stress were measured as the primary outcome and visual acuity and CMT as secondary outcome.

Results: There were no statistically significant differences in the comparison of the average plasma ALDH activity (IU/mg protein) (0.034+0.02; 0.027+0.02; 0.025+0.02; 0.031+0.1; p = 0.66), vitreal MDA level (nmol/mL) (1.661+1.21; 1.557+1.32; 1.717+1.54; 1.501+1.09; p = 0.96) and SOD activity (U/mL) (0.403+0.50; 0.210+0.18; 0.399+0.49; 0.273+0.32 p = 0.38) among these four groups, respectively. However, the average of vitreal VEGF level (pg/mL) among these 4 group showed a statistically significant difference (0.356+0.60; 0.393+0.45; 0.150+0.24; 0.069+0.13; p = 0.05), with the level of vitreal VEGF in the combined group was 5 times lower than control.

Conclusion: Combined treatments of DR by IVB and LF does not have any effect on the activities of plasma ALDH and vitreal SOD. However, these combined treatments were correlated with lower vitreal MDA and VEGF level, higher SOD activity and lower VEGF level in proliferative DR. Combined treatments with IVB and LF are recommended for the management of proliferative DR patients. The measurement of plasma ALDH can be used as a prognostic factor for determining the visual acuity and CMT."

"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."

"ABSTRAKTujuanUntuk membandingkan efektivitas intravitreal triamcinolone acetonide (IVTA) danBevacizumab (IVB) dalam mengurangi ketebalan makula sentral (CMT) pada edemamakular diabetik (EMD) tipe kistoid dan difusMetodeStudi ini adalah sebuah uji klinis acak tersamar tunggal. Sebanyak 24 subyek (28mata) dengan non-proliferatif diabetic retinopathy (NPDR) yang belum pernahmenerima terapi apapun sebelumnya akan dibagi menjadi 2 kelompok berdasarkangambaran OCT, yaitu tipe difus dan kistoid. Subyek dalam setiap kelompok akandiacak untuk menerima IVTA atau IVB. Evaluasi akan dilakukan pada 1 hari, 1minggu dan 2 minggu setelah injeksi. Penilaian perubahan ketebalan makula sentral(KMS) akan dinilai dengan Optical Coherence Tomography (OCT) lagi pada minggupertama dan minggu kedua.HasilPenurunan KMS kelompok kistoid setelah injeksi IVTA dan IVB berbeda secarasignifikan dengan p <0,05 pada 1 minggu setelah injeksi (256,14 ± 146.58 vs 20.00 ±110,00) dan juga 2 minggu setelah injeksi (294,86 ± 154,93 vs 98,71 ± 124,44). Padatipe difus, penurunan KMS setelah injeksi IVTA atau IVB tidak berbeda secarastatistik (p> 0,05), namun penurunan tersebut secara klinis kami nilai signifikanberdasarkan hasil OCT (KMS 1 minggu setelah injeksi adalah 111,57 ± 49,72 vs32,43 ± 37,23 dan 2 minggu setelah injeksi 135,86 ± 68.42 vs 31.86 ± 35.96)KesimpulanInjeksi intravitreal triamcinolone acetonide merupakan terapi yang lebih tepat untukedema makula diabetik tipe kistoid

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ABSTRACTObjectivesTo compare the effectiveness of intravitreal Triamcinolone Acetonide (IVTA) andBevacizumab (IVB) in reducing central macular thickness (CMT) of diffuse type andcystoid type diabetic macular edema (DME)MethodsThis is a prospective, single blind, randomized clinical trial. A total of 24 subjects (28eyes) with non-proliferative diabetic retinopathy who had never received any priortherapy, was divided into 2 groups based on the description of the Optical CoherenceTomography (OCT) to differentiate the type of diffuse and cystoid. Subjects in eachgroup were randomized to receive IVTA or IVB. Follow up was conducted at day 1,week 1 and week 2 after injection. CMT were reassesed with OCT on follow up week1 and week 2.ResultCMT decrease in the cystoid group after IVTA and IVB were significantly differentwith p<0.05 (256.14±146.58 vs 20.00±110.00) and also week 2 (294.86±154.93 vs98.71±124.44). There were no different statistically (p>0.05 ) in CMT decreasebetween IVTA and IVB, but the decrease were still clinically significant in our OCTfindings (in week 1 CMT were 111.57±49.72 vs 32.43±37.23 and in week 2 were135.86 ±68.42 vs 31.86±35.96)ConclusionIntravitreal injection of triamcinolone acetonide is more proper therapy for cystoidtype diabetic macular edema."

"Tujuan: Untuk mengetahui pengaruh suplementasi pycnogenol 150 mg perhari selama 8 minggu terhadap amplitudo dan waktu implisit pada gelombang b dan oscillatory potential (OP) ERG skotopik retinopati diabetik nonproliferatif ringan dan sedang.Metode: Uji klinik acak tersamar. Empat puluh subjek dengan retinopati diabetik nonproliferatif ringan sedang diacak dan dibagi menjadi dua kelompok, 20 subjek mendapat pycnogenol, 20 subjek mendapat pycnogenol. Pengukuran objektif dilakukan sebelum pemberian suplementasi dan 8 minggu setelahnya, yang meliputi amplitudo gel.b, waktu implisit gel.b, amplitudo sum OP, waktu implisit sum OP .Hasil: Pada kelompok pycnogenol sebelum perlakuan, amp gel.b 397,9±109,6μV, waktu implisit gel.b 48,7 (44,3-68,2) ms, amp sum OP 193,05 (15,2-498,9) μV dan waktu implisit sum OP 126,18± 7,8ms. Setelah 8 minggu pada kelompok pycnogenol, amp gel.b 396,2±115,7 μV, waktu implisit gel.b 47,8 (43,4-58,4)ms, amp sum OP 228,45 (16,3-511,8) μV dan waktu implisit sum OP 126,2 (118,2-137) ms. Pada kelompok plasebo sebelum intervensi, amp gel.b 349± 79 μV, waktu implisit gel.b 48,7 (44,3-68,2) ms, amp sum OP 101,45 (28,3-301,2) μV dan waktu implisit sum OP 130 (121,6-163,5) ms. Setelah 8 minggu pada kelompok plasebo, amp gel.b 334,65±70,3 μV, waktu implisit gel.b 49,15 (44,3 -68,2) ms, amp sum OP 124,9 (51,3-303,8)μV dan waktu implisit sum OP 130 (121,6-163,5) ms. Tidak terdapat perbedaan bermakna secara statistik pada semua keluaran.Kesimpulan: Tidak terdapat perbedaan yang bermakna secara statistik parameter amplitudo gel.b, waktu implisit gel.b, amplitudo sum OP, waktu implisit sum OP dari pemberian pycnogenol 150 mg sehari selama 8 minggu pada retinopati diabetik nonproliferatif ringan sedang.

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Objective: This study is to evaluate the effect of eight weeks supplementation of 150 mg pycnogenol, to b-wave amplitude, b-wave implicit time, sum Oscillatory Potential (OP) amplitude and sum Oscillatory Potential (OP) implicit time on Electroretinography (ERG) result of mild - moderate nonproliferative diabetic retinopathy (NPDR) patient, compared to plasebo.Methods: Randomized clinical trial of 40 mild - moderate NPDR patients, which further equally divided into two groups. The b-wave amplitude (amp), b-wave implicite time (it), sum OP amplitude (amp), sum OP implicit time (it) ERG were evaluated before and after eight weeks pycnogenol supplementationResults:The ERG results of pycnogenol group before intervention were as follows: b wave amp 397,9±109,6μV, b-wave it 48,7 (44,3-68,2) ms, sum OP amp 193,05 (15,2-498,9) μV and sum OP it 126,18± 7,8ms. After 8 weeks in pycnogenol group, b wave amp 396,2±115,7 μV, b wave it 47,8 (43,4-58,4)ms, sum OP amp 228,45 (16,3-511,8) μV and sum OP it 126,2 (118,2-137) ms. Meanwhile in placebo group before intervention, the b wave amp was 349± 79 μV, b-wave it 48,7 (44,3-68,2) ms, sum OP amp 101,45 (28,3-301,2) μV and sum OP it 130,8±8,4 ms. After 8 weeks in placebo group, b wave amp 334,65±70,3 μV, b-wave it 49,15 (44,3 -68,2) ms, sum OP amp 124,9 (51,3-303,8)μV and sum OP it 130 (121,6-163,5) ms. No statistical significant differences in all outcomeConclusions: No significant differences in b-wave amplitude, b-wave implicite time, sum OP amplitude and sum OP implicit time ERG after 150 mg pycnogenol supplementation for 8 weeks in mild-moderate NPDR compare with placebo."

"Iskemia makula merupakan penyebab penurunan penglihatan pada retinopati yang berhubungan dengan progresi retinopati diabetik dan dapat terjadi sebelum mikroaneurisma terlihat secara klinis. Fovea avascular zone (FAZ) merupakan area di makula yang mencerminkan kondisi mikrokapiler makula dan sensitif terhadap iskemia. Penelitian ini bertujuan untuk mengetahui perbandingan parameter area dan sirkularitas FAZ pleksus kapiler superfisial (PKS) dan pleksus kapiler dalam (PKD) yang diukur menggunakan Optical Coherence Tomography Angiography (OCTA) pada pasien diabetes melitus (DM) dengan dan tanpa retinopati diabetik. Penelitian potong lintang dilakukan pada 90 mata pasien diabetes yang terbagi menjadi lima kelompok yaitu DM tanpa retinopati diabetik , non proliferative diabetic retinopathy (NPDR) ringan, NPDR sedang, NPDR berat, dan proliferative diabetic retinopathy (PDR). Area dan sirkularitas FAZ PKS dan PKD pada OCTA makula 3x3 mm diukur menggunakan ImageJ. Area FAZ PKS pada NPDR ringan, NPDR berat, dan PDR secara bermakna lebih lebar dibandingkan dengan DM tanpa retinopati diabetik (p=0,026). Sirkularitas FAZ PKD secara bermakna lebih rendah pada kelompok NPDR sedang dan berat dibandingkan dengan NPDR ringan (p=0,003). Pelebaran dan perubahan bentuk FAZ PKS dan PKD pada retinopati diabetik dapat dideteksi dengan OCTA. Pelebaran FAZ PKS dan penurunan sirkulasi FAZ PKD terjadi mulai dari retinopati derajad awal.

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Macular ischemia is cause of decreased vision in diabetic retinopathy (DR) associated with the progression of retinopathy and can occur before microaneurysms are detected clinically. Fovea avascular zone (FAZ) is an area in macula that reflects the condition of macular microcapillaries and sensitive to ischemia. This study aims to compare area and circularity of superficial capillary plexus (SCP) and deep capillary plexus (DCP) FAZ as measured using Optical Coherence Tomography Angiography (OCTA) in diabetic patient with and without DR. A cross-sectional study was conducted on 90 eyes of diabetic patients divided into five groups, namely DM with no DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). Area and circularity of SCP and DCP FAZ in 3×3 mm macular OCTA was measured using ImageJ. The SCP FAZ area was significantly larger in mild NPDR, severe NPDR, and PDR compared to no DR (p=0.026). DCP FAZ circularity was significantly lower in moderate and severe NPDR compared to the mild NPDR (p=0.003). Enlargement and irregularity of SCP and DCP FAZ in DR can be detected by OCTA. Enlargement of SCP FAZ area and decrease in DCP FAZ circularity occurs from early degree of DR.

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"ABSTRAKEdema makula diabetik (EMD) merupakan salah satu penyebab utama kebutaan pada pasien diabetes. Saat ini terapi utama pada pasien edema makula diabetik adalah injeksi intravitreal anti VEGF. Pada beberapa keadaan, hal ini menjadi kendala karena 50% pasien yang menjalani rangkaian injeksi intravitreal anti VEGF memiliki edema makula yang refrakter. Vitrektomi pars plana dan internal limiting membran (ILM) peeling diharapkan dapat menjadi alternatif terapi pada EMD refrakter. Penelitian ini bertujuan menilai hasil terapi tindakan vitrektomi dan ILM peeling pada pasien non proliferative diabetic retiopathy (NPDR) dengan EMD refrakter. Penelitian ini merupakan penelitian uji klinis dengan intervensi single arm. Subjek dengan NPDR dan EMD refrakter menjalani tindakan vitrektomi dan ILM peeling. Nilai ketebalan makula sentral (CMT) dan tajam penglihatan diukur sebelum, 1 bulan, 2 bulan, dan 3 bulan sesudah tindakan. Komplikasi pasca tindakan juga dinilai pada setiap kunjungan yang direncanakan. Rentang usia 62,5 (39-72) tahun, lama menderita diabetes 10 (3-18) tahun, kadar HbA1C 6,4 (5,5 -10,8)%. Nilai CMT sebelum, 1 bulan, 2 bulan dan 3 bulan sesudah tindakan adalah [492,0 (303-895) : 277,5 (97-809) : 264 (147-608) : 264,0 (142-660) µm] (p=<0,001). Tajam penglihatan terbaik adalah [1,02 (0,60-1,30) : 1,04 (0,60-1,70) : 1,06 (0,52-2,00) : 1,04 (0,52-2,00) LogMAR] (p=0,635). Terdapat komplikasi pasca tindakan pada pengamatan bulan kedua meliputi retinal detachment dan macular hole. Pada penelitian ini, tindakan vitrektomi dan ILM peeling pada pasien NPDR dengan EMD refrakter memberikan perubahan CMT yang bermakna. Tidak terdapat perubahan yang bermakna secara statistik pada nilai tajam penglihatan namun mayoritas subjek menunjukkan stabilitas tajam penglihatan.

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ABSTRACTDiabetic macular edema (DME) is one of the leading causes of blindness in diabetic patients. The main therapy of DME, up until now is intravitreal injection of anti-vascular endothelial growth factor (VEGF). In certain situation, medical dilemma appeared as in such circumstances 50% patients that underwent series of intravitreal injection of anti VEGF experienced the refractory DME. Pars plana vitrectomy and internal limiting membrane (ILM) peeling is expected to be an alternative treatment in refractory DME. The aim of this study was to assess the result of vitrectomy and ILM peeling in patients with non-proliferative diabetic retinopathy (NPDR) with refractory DME. This study was a clinical trial with single arm intervention. The patients with NPDR with DME underwent vitrectomy and ILM peeling surgery. The assessment of the central macular thickness (CMT) and the visual acuity was conducted before the treatment and 1 month, 2 months and 3 months after. The complication after the treatment was assessed in each scheduled visit. The average age was 62.5 years old with range of 39-72 years old, the history duration of diabetes mellitus was 10 years (3-18) years, level of HbA1C was 6.4 (5.5-10.8)%. The CMT before treatment, 1 month, 2 months and 3 months after treatment were [492,0 (303-895) : 277,5 (97-809) : 264 (147-608) : 264,0 (142-660) µm] (p=<0,001). The best corrected visual acuity was [1,02 (0,60-1,30) : 1,04 (0,60-1,70) : 1,06 (0,52-2,00) : 1,04 (0,52-2,00) LogMAR] (p=0,635). The recorded complication after the treatment was retinal detachment and macular hole. These complications were found on the 2nd month. This study concluded that there was a significant CMT changes in patients with NPDR and refractory DME who underwent vitrectomy and ILM peeling. There was no statistically significant changes in the visual acuity yet majority of the subjects showed a stable visual acuity after the treatment."

"ABSTRAKTujuan tesis ini adalah mengetahui pengaruh laser fotokoagulasi panretinal 532 nm durasi 20 ms dosis tunggal, 100 ms dosis tunggal dan 100 ms-3 sesi terhadap ketebalan makula sentral (KMS). Desain penelitian adalah uji klinis acak terkontrol tersamar ganda. Tiga puluh tiga mata yang memenuhi kriteria inklusi dirandomisasi untuk mendapatkan laser 20 ms dosis tunggal atau 100 ms dosis tunggal atau 100 ms-3 sesi. Keluaran primer adalah KMS yang diukur menggunakan time-domain Optical Coherence Tomography pada baseline, 4 minggu dan 8 minggu pasca laser. Analisis hasil didapatkan rerata ( + SE) KMS baseline kelompok 100 ms, 20 ms dan 100 ms-3 sesi berturut-turut adalah 212,18 + 12,18 µm; 199,18 + 12,18 µm; 215,36 + 12,18 µm. Empat minggu pasca laser, KMS berturut-turut meningkat menjadi 232,09 + 18,63 µm; 206,27 + 18,63 µm; 254,09 + 18,63 µm. Delapan minggu pasca laser, KMS meningkat pada kelompok 100 ms dan 20 ms (237,90 + 17,47 µm; 208,27 + 17,47 µm), namun menurun pada kelompok 100 ms-3sesi (252,36 + 17,47 µm).

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ABSTRACT

The purpose of this study was to determine the effect of panretinal laser photocoagulation 532 nm of 20 ms duration single session (SS), 100 ms SS and 100 ms (3 session) toward central macular thickness (CMT). The study design was a double-blind, randomized controlled clinical trial. Thirty-three subjects who met inclusion criteria were randomized to receive 20 ms SS laser or 100 ms SS or 100 ms (3 session). Primary output was CMT, measured by time-domain Optical Coherence Tomography at baseline, 4 weeks and 8 weeks post-laser. Results showed mean ( + SE) CMT at baseline from 100 ms SS group, 20 ms SS and 100 ms-3 session were 212.18 + 12.18 μm; 199.18 + 12.18 μm; 215.36 + 12.18 μm respectively. Four weeks after laser, CMT was increased to 232.09 + 18.63 μm; 206.27 + 18.63 μm; 254.09 + 18.63 μm respectively. Eight weeks post laser, CMT was increased in 100 ms SS and 20 ms SS (237.90 + 17.47 μm; 208.27 + 17.47 μm), but decreased 100 ms-3session group (252.36 + 17.47 μm)."

"Diabetes melitus (DM) merupakan ancaman serius bagi pembangunan kesehatan dan pertumbuhan ekonomi nasional serta merupakan penyebab penting timbulnya kecacatan dan kematian. Dari semua kasus DM, DM tipe 2 mencakup lebih dari 90% dari semua pasien diabetes. Nefropati diabetik dan retinopati diabetik merupakan komplikasi mikroangiopati pada DM tipe 2 yang paling ditakuti dan keduanya sering ditemukan bersamaan. Perkembangan lanjut dari keduanya menyebabkan gagal ginjal tahap akhir dan kebutaan. Tujuan dari penelitian ini adalah untuk mengetahui kadar albumin urin dalam membedakan retinopati diabetik dan non retinopati diabetik. Penelitian potong lintang ini terdiri dari 100 subyek yang terbagi atas kelompok retinopati diabetik 50 orang dan non retinopati diabetik 50 orang dari populasi DM tipe 2. Penderita didiagnosis DM tipe 2 oleh dokter Divisi Metabolik Endokrin Departemen Ilmu Penyakit Dalam Rumah Sakit Ciptomangunkusumo. Untuk retinopati diabetik dan non retinopati diabetik, diagnosis dilakukan dengan foto fundus pada pupil yang didilatasi oleh dokter Divisi Retina Departemen Ilmu Penyakit Mata Rumah Sakit Ciptomangunkusumo. Pada kedua kelompok dicatat data karakteristik subyek dan dilakukan pemeriksaan kadar albumin urin. Kadar albumin urin pada kelompok retinopati diabetik lebih tinggi secara bermakna dibandingkan pada kelompok non retinopati diabetik (303,41±11,14 mg/g kreatinin vs 28,14±4,90 mg/g kreatinin, p <0,001). Nilai cut-off kadar albumin urin untuk membedakan retinopati diabetik dan non retinopati diabetik adalah 118 mg/g kreatinin dengan sensitivitas 72%, spesifisitas 78%, nilai duga positif 77%, nilai duga negatif 74%, rasio kemungkinan positif 3,27 dan rasio kemungkinan negatif 0,36. Kami menyimpulkan pemeriksaan kadar albumin urin dapat dipakai untuk membedakan retinopati diabetik dan non retinopati diabetik.

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Diabetes mellitus (DM) is a worldwide public health concern as they impose enormous medical, economic and social costs on both patient and the health care system. Together they contribute to serious morbidity and mortality. Type 2 DM affects more than 90% of all DM cases. Diabetic nephropathy and diabetic retinopathy are the two most dreaded complications of diabetes and frequently found together. Progression of both is the leading cause of end-stage renal disease and blindness. The aim of this study is to investigate albumin urine level in distinguishing diabetic retinopathy and non-diabetic retinopathy.

This cross-sectional study consisted of 100 respondents, in which 50 of them were categorized as diabetic retinopathy and 50 as non-diabetic retinopathy. The patients were diagnosed with type 2 DM by a doctor from Endocrinology Metabolic Division of Internal Medicine Department at Ciptomangunkusumo Hospital. Meanwhile diabetic retinopathy and non-diabetic retinopathy were diagnosed by ophthalmologist from Retina Division of Eye Medicine Department at Ciptomangunkusumo Hospital. Baseline characteristics of both groups were recorded and the albumin urine level was measured.

The albumin urine level in diabetic retinopathy group was significantly higher than that in the non-diabetic retinopathy group (303,41±11,14 mg/g kreatinin vs 28,14±4,90 mg/g kreatinin, p <0,001). The albumin urine level cut-off value used to distinguish diabetic retinopathy and non-diabetic retinopathy was 118 mg/g creatinine with sensitivity of 72%, specificity of 78%, positive predictive value of 77%, , negative predictive value of 74%, positive likelihood ratio of 3,27, and negative likelihood ratio of 0,36.

We conclude that albumin urine level test can be utilized to distinguish diabetic retinopathy from non-diabetic retinopathy."

"Latar Belakang: Retinopati Prematuritas atau ROP merupakan gangguan vaskular retina bayi prematur yang dapat menyebabkan pelepasan retina dan terjadinya kebutaan. Variasi gen Norrie disease Pseudoglioma (NDP) serta paparan oksigen diduga terlibat dengan kejadian dan perkembangan ROP.Tujuan: Mengetahui peran variasi NDP serta faktor layanan neonatal khususnya paparan oksigen dalam memprediksi kejadian ROP pada bayi prematur Indonesia. Metodologi: Studi dilaksanakan tahun 2009-2014 di beberapa pusat pelayanan perinatologi dan mata sekitar Jakarta. Sebanyak 6 situs mutasi pada ekson 3 dideteksi yaitu C597A, L108P, R121W, A105T, Val60Glu, dan C110G. Perubahan susunan basa gen NDP dianalisis dengan mengampilifikasi gen NDP bagian ekson 3 menggunakan metode Polymerase Chain Reaction (PCR-RFLP dan PCR-SSP). Hasil diverifikasi dengan sekuensing DNA. Model multivariat hasil analisis regresi logistik dan regresi Cox digunakan sebagai model skoring untuk memprediksi kejadian dan keparahan ROP.Hasil: Tidak ditemukan polimorfisme dan mutasi pada situs NDP exon 3. Hasil analisis multivariat didapatkan BBL, PJT(NCB-KMK), transfusi tukar, lama suplementasi O2, SpO2 terendah, dan sosial ekonomi sebagai variabel yang berhubungan dengan kejadian ROP. Sedangkan dalam hubungannya dengan keparahan ROP, didapatkan usia gestasi, lama suplementasi O2 > 7 hari, SpO2 terendah, rujukan RS, dan sosial ekonomi.Kesimpulan: Tidak didapatkan polimorfisme dan mutasi gen NDP exon 3 pada kasus ROP bayi prematur Indonesia. Lama suplementasi O2 dan nilai SpO2 terendah mempunyai peran dalam meningkatkan risiko kejadian dan berkembangnya ROP menjadi lebih berat.

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Background: Retinopathy Prematurity or ROP is retinal vascularization disorder on premature infants that causing retina detachment and eventually blindness. NDP gene mutation and oxygen exposure might have role in incidence of ROP.Objective: This study was conducted to determine the role of NDP gene polymorphism and mutation, and oxygen exposure for predicting the incidence of ROP in Indonesia.Methodology: Data were collected from few Perinatology and Opthalmology centres around Jakarta during 2009-2014. DNA samples isolated from blood and buccal cell. This study tried to detect 6 mutations site on exon 3 of NDP gen which are C597A, L108P, R121W, A105T, Val60Glu, and C110G. Alterations of NDP gene were analized with amplification of NDP gene in exon 3 region using Polymerase Chain Reaction (PCR-RFLP dan PCR-SSP) methods. The result verified with DNA sequencing. Scoring model were made by using logistic regression to predict the incidence and development of ROP.Result: No NDP gene polymorphism and mutations at exon 3 region was detected. The result have been analized with PCR-RFLP and verified with DNA sequencing. Multivariate analysis using logistic regression for incidence of ROP retain birth weight, IUGR, gender, respiratory distress, exchange transfussion, length of O2 supplementation, SpO2 minimum, and socioeconomic variables. As for ROP severity, multivariate analysis retain gestational age, gender, access to hospital (inborn/outborn), apnea, length of O2 supplementation, SpO2 minimum, and socioeconomic variables.Conclusion: The relationship between polymorphisms and mutations of NDP gene and ROP cases that happened in Indonesian premature infants population did not showed in this study. Length of O2 supplementation and minimum value of SpO2 85 - 90% significantly increase the risk for ROP incidence and development of severe ROP."