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"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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"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."

"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)."

"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."

"Latar belakang: Retinopati diabetik (diabetic retinopathy, DR) merupakan komplikasi diabetes mellitus (DM) yang dapat menyebabkan kebutaan. Kesadaran pasien DM terhadap DR dapat diukur dari pengetahuan, sikap, dan perilaku (knowledge, attitude, practice, KAP) dalam pencegahan DR.Tujuan: Mengetahui serta membandingkan pola karakteristik demografi dan skor KAP pasien DM tanpa DR terhadap DM dengan DR di Puskesmas Provinsi DKI Jakarta menggunakan kuesioner yang teruji valid dan reliabel.Metode: Subjek dirandomisasi menggunakan cluster random sampling terhadap 17 Puskesmas di Provinsi DKI Jakarta yang telah dilakukan skrining DR terhadap pasien DM.Hasil: Subjek terdiri dari 205 subjek dengan DR & 210 subjek tanpa DR. Terdapat perbedaan bermakna antar kelompok durasi DM, pendidikan terakhir, dan penghasilan perbulan terhadap pengetahuan. Terdapat perbedaan bermakna antar kelompok durasi DM, pendidikan terakhir, penghasilan perbulan, dan pekerjaan terhadap sikap. Terdapat perbedaan bermakna antar seluruh variabel kelompok terhadap perilaku. Pada kelompok tanpa DR, terdapat korelasi antara pengetahuan dan perilaku (p <0.001) dengan korelasi lemah (r: 0.37) dan terdapat korelasi antara sikap dan perilaku (p <0.001) dengan korelasi sedang (r: 0.45). Pada kelompok dengan DR, terdapat korelasi antara pengetahuan dan perilaku (p <0.001) dengan korelasi lemah (r: 0.40) dan terdapat korelasi antara sikap dan perilaku (p <0.001) dengan korelasi sedang (r: 0.45). Terdapat perbedaan bermakna rerata skor perilaku (p: 0.036) antar kelompok tanpa DR dan dengan DR, tidak terdapat perbedaan bermakna dari rerata skor pengetahuan dan sikap.Kesimpulan: Terdapat hubungan antara pengetahuan dan sikap terhadap perilaku penderita DM tanpa DR dan dengan DR. Terdapat perbedaan bermakna perilaku antara kelompok tanpa DR dan dengan DR.

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Background: Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM) which can cause blindness. DM patient awareness of DR can be measured from knowledge, attitude and practice (KAP) in preventing DR.

Purpose: Determine and compare the pattern of demographic characteristics and KAP scores of DM without DR to DM with DR groups at the DKI Jakarta Provincial Health Center using a valid and reliable questionnaire.Methods: Subjects were randomized using the cluster random sampling to 17 Community Health Centers in DKI Jakarta Province which had DR screening done for DM patients.

Result: Subject consists of 205 subjects with DR & 210 subjects without DR. There were significant differences between groups of duration of DM, last education, and monthly income towards knowledge. There were significant differences between groups of duration of DM, last education, monthly income, and job towards attitude. There were significant differences between all group variables towards practice. In the group without DR, there was a correlation between knowledge and practice (p <0.001) with a weak correlation (r: 0.37) and there was a correlation between attitude and practice (p <0.001) with a moderate correlation (r: 0.45). In the group with DR, there was a correlation between knowledge and practice (p <0.001) with a weak correlation (r: 0.40) and there was a correlation between attitude and practice (p <0.001) with a moderate correlation (r: 0.45). There was a significant difference in the mean practice score (p: 0.036) between two groups, but there was no significant difference in the mean knowledge and attitude scores.

Conclusion: There were a correlation between knowledge and attitude towards the practice of without DR and with DR groups. There were significant differences in practice between DM with DR and DM without DR groups."

"This book is designed with two overriding objectives, to help readers understand the impact of vision impairment in people living daily with diabetes rather than considering diabetic retinopathy solely as a medical problem, and to explore what we know and don't know about the ways diabetes affect the eye. With the plethora of new information being generated, there are still a series of fundamental questions that must be addressed if effective treatments for diabetic retinopathy are to be found and applied. Developed by a renowned group of authorities, Visual dysfunction in diabetes, the science of patient impairment and improvement offers responses and context for a range of questions, such as, do metabolic factors beyond glucose contribute to vision-threatening diabetic retinopathy? If so, how do these lead to vision impairment? Is diabetic retinopathy a response to systemic metabolic abnormalities or are there unique ocular problems related to insulin resistance? What is the relationship between the neural, vascular, and inflammatory abnormalities in diabetic retinopathy? Do they represent a pathological cascade induced sequentially or simultaneous responses to one or more metabolic perturbations? The authors note that if we do not address these types of questions, it is possible that the long process of developing new therapeutic"

"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."

"Retinopati diabetik merupakan komplikasi mikrovaskular akibat hiperglikemi pada diabetes melitus, komplikasi tersebut memberikan dampak bagi pasien berupa penurunan fungsi penglihatan sehingga dapat mempengaruhi kualitas hidup. Tujuan dari penelitian ini adalah untuk mengidentifikasi faktor-faktor yang berhubungan dengan kualitas hidup pasien retiopati diabetik.Metode penelitian ini adalah potong lintang/cross sectional dengan pendekaran observasi analitik.Jumlah responden sebanyak 160 pasien. Hasil penelitian menunjukan bahwa faktor – faktor yang tidak berhubungan dengan kualitas hidup adalah jenis kelamin (p=0,617) dan kepuasan pengobatan (P=0,106). Faktor-faktor yang berhubungan dengan kualitas hidup pasien retinopati diabetik adalah usia (p=0,002), lama menderita DM (p=0,005), derajat keparahan retinopati diabetik (p=0,0001), stress (p=0,045), dukungan keluarga (p=0,024), status fungsional (p=0,046). Pasien retinopati diabetik yang memiliki usia kurang dari 50 tahun, lama menderita DM lebih dari 10 tahun, derajat DR NPDR) dan dukungan keluarga baik berpeluang mengalami kualitas hidup baik sebesar 40%. Hasil analisis multivariat menunjukan faktor yang paling dominan berhubungan dengan kualitas hidup pasien retinopati diabetik adalah dukungan keluarga dengan nilai OR= 4,172(CI 95%= 1,860; 16,414). Dengan penelitian ini di harapkan dapat menjadi acuan bagi perawat dalam mengembangkan pola asuhan keperawatan pada pasien gangguan penglihatan terkait kualitas hidup pasien.

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Diabetic retinopathy is a microvascular complication due to hyperglycemia in diabetes mellitus, this complication affects the patient in the form of decreased visual function so that it can affect the quality of life. The purpose of this study was to identify factors related to the quality of life of diabetic retiopathy patients. The method of this study is cross sectional / cross sectional with an analytic observation approach. The number of respondents was 160 patients. The results showed that factors not related to quality of life were gender (p = 0.617) and treatment satisfaction (P = 0.106). Factors related to the quality of life of diabetic retinopathy patients were age (p = 0.002), duration of DM (p = 0.005), severity of diabetic retinopathy (p = 0.0001), stress (p = 0.045), family support ( p = 0.024), functional status (p

= 0.046). Diabetic retinopathy patients who have a age of less than 50 years, long suffering from diabetes more than 10 years, level of severity is DR (NPDR) and good family support have the opportunity to experience a good quality of life of 40%. The results of multivariate analysis showed that the most dominant factor related to the quality of life of patients with diabetic retinopathy was family support with an OR value of 4.172 (95% CI = 1.860; 16.414). With this research, it is hoped that it can become a reference for nurses in developing patterns of nursing care for vision impaired patients regarding the quality of life of patients"

"Retinopati diabetik (DR) merupakan komplikasi mikrovaskular diabetes melitus (DM). Fenofibrat oral dapat mencegah progresivitas DR dengan mekanisme pengaturan kadar lipid lipid-related dan mekanisme lain nonlipid-related, antara lain dengan mencegah disfungsi endotel, mengurangi inflamasi, dan angiogenesis. Penelitian ini bertujuan mengetahui efek fenofibrat oral terhadap ketebalan makula sentral (CMT) dan volume makula, serta pengaruhnya pada kadar penanda biologis serum disfungsi endotel eNOS, inflamasi (VCAM-1), dan angiogenesis (VEGF) pada penyandang DR dengan dislipidemia.Penelitian prospektif ini menggunakan disain uji klinis acak tersamar ganda dengan membagi subjek menjadi kelompok intervensi simvastatin dan fenofibrat dan kontrol simvastatin dan plasebo. Penelitian berlangsung sejak Nopember 2016 hingga Oktober 2017, di Klinik Vitreo-retina, Departemen Medik Mata ndash;RSCM Kirana, melibatkan 60 mata dari 30 pasien penyandang DR non-proliferatif NPDR dengan dislipidemia. Penelitian pada tiap subjek dilakukan selama tiga bulan dengan evaluasi klinis, foto fundus, dan spectral domain optical coherence tomography (SD-OCT) makula tiap bulan. Pengukuran kadar eNOS, VCAM-1, dan VEGF, serta HbA1c dan profil lipid dilakukan sebelum dan setelah tiga bulan pengobatan.Sebelum intervensi, pada kedua kelompok tidak didapatkan perbedaan karakteristik demografik, klinik, dan penanda biologis serum. Tidak didapatkan perbedaan bermakna pada CMT kelompok simvastatin fenofibrat 248,0 40,4 m dibandingkan kelompok simvastatin plasebo 265,8 40,8 m, namun CMT lebih rendah secara bermakna pada bulan ke-1 pada kelompok simvastatin fenofibrat. Pada subjek dengan edema makula diabetik DME pemberian simvastatin fenofibrat setelah tiga bulan menunjukkan CMT lebih rendah secara bermakna. Volume makula setelah tiga bulan pemberian obat 10086 886,4 m3 pada kelompok simvastatin fenofibrat dan 10307 1058,6 m3 pada simvastatin plasebo. Perbedaan tersebut tidak bermakna, namun pada subjek dengan regulasi glukosa darah yang baik HbA1c 7 didapatkan volume makula lebih rendah pada bulan ke-2. Kadar penanda biologis serum setelah tiga bulan pemberian obat menunjukkan rerata kadar eNOS dan median VEGF sebesar 3878,8 873,33 pg/mL dan 242,8 86 - 1123,3 pg/mL pada kelompok simvastatin fenofibrat, dibandingkan 4031,2 742,56 pg/mL dan 370 134,8 - 810,6 pg/mL pada kelompok simvastatin plasebo, yang tidak berbeda bermakna, namun penurunan kadar VCAM-1 serum lebih besar secara bermakna pada kelompok simvastatin fenofibrat 50,7 pg/mL, 32,5 - 223,4 pg/mL vs. 40,4 pg/mL, 27,9 - 94,2 pg/mL . Pada subjek dengan kontrol glukosa darah ketat HbA1c 6,5 kadar VEGF 128,7 114,5 - 145,2 pg/mL, lebih rendah secara bermakna dibandingkan 423 86 - 1233,3 pg/mL pada subjek dengan HbA1c > 6,5 .Disimpulkan pemberian simvastatin fenofibrat selama tiga bulan pada subjek DR dengan dislipidemia secara umum tidak menurunkan CMT dan volume makula, namun menurunkan CMT khusus pada subjek DR dengan DME. Pemberian simvastatin fenofibrat pada subjek DR tidak mencegah penurunan kadar eNOS, peningkatan kadar VCAM-1 dan VEGF, namun pengendalian gula darah yang baik dapat mencegah peningkatan kadar VEGF. Simvastatin fenofibrat dapat dipertimbangkan sebagai terapi ajuvan pada penyandang DR dengan DME yang disertai dislipidemia. Pengontrolan glukosa yang baik merupakan manajemen utama pada DR.

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Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus (DM) due to structural and biochemical changes. Previous studies showed that oral fenofibrate prevents DR progression through lipid-regulating and nonlipid-related mechanisms, including preventing endothelial dysfunction, reducing inflammation and angiogenesis. This study aims to investigate the effects of oral fenofibrate on central macular thickness CMT and macular volume, and on specific biomarkers of endothelial dysfunction eNOS, inflammation VCAM-1 , and angiogenesis VEGF in DR individuals with dyslipidemia.This is a prospective, double-blind randomized clinical trial, with subjects divided into intervention group simvastatin fenofibrate and control group simvastatin placebo. This study was conducted from November 2016 to October 2017 at the Vitreo-retina Clinic, Department of Ophthalmology ndash; RSCM Kirana, involving 60 eyes from 30 non-proliferative DR patients NPDR with dyslipidemia that met inclusion criteria. Each subject was observed for three months, with monthly clinical evaluation, fundus photo, and macular spectral domain optical coherence tomography SD-OCT . Serum eNOS, VCAM-1, and VEGF biomarkers, as well as HbA1c and lipid profile, were examined before and after intervention.Before intervention, there were no differences in demographic and clinical characteristics, and serum biomarker levels between two groups. After three months of treatment, there was no significant difference between CMT in the intervention group and the control group 248 40.4 ? m vs. 265.8 40.8 ? m , but a significantly lower CMT was observed in the intervention group at the first month. There was also a significantly lower CMT compared to the control group 294 39,2 vs 263 24,4, p=0,045 in eyes with diabetic macular edema DME . Macular volume after three-month treatment was 10086 886.4 ? m3 in the intervention group and 10307 1058.6 ? m3 in the control group, this difference was not significant. However, in all subjects with good blood glucose regulation HbA1c 7 , macular volume in the second month was significantly lower compared to subjects with HbA1c > 7 . Serum biologic marker levels after three-month treatment showed no significant difference between control and intervention group, respectively, in mean eNOS 3878.8 873.33 pg/mL vs 4031.2 742.56 pg/mL and median VEGF levels 242.8 86 - 1123.3 pg/mL vs 370 134.8 - 810.6 pg/mL . Nonetheless, the decrease in VCAM-1 level was significantly higher in the intervention group 50.7 pg/mL, 32.5 - 223.4 pg/mL vs. 40.4 pg/mL, 27.9 - 94.2 pg/mL . In subjects with tighter blood glucose control HbA1c 6.5 , serum VEGF level was 128.7 114.5 - 145.2 pg/mL, which was significantly lower compared to 423 86 - 1233.3 pg/mL in subjects with HbA1c > 6.5 .In conclusion, three-month treatment with simvastatin fenofibrate does not reduce CMT and macular volume in overall DR subjects with dyslipidemia, but it reduces CMT in subjects with DME. Simvastatin fenofibrate treatment in DR subjects does not prevent lowering of serum eNOS levels, elevation of VCAM-1 levels, and elevation of VEGF levels, but tight blood sugar control prevents elevation of serum VEGF. Although good glucose control remains the most essential in the management of DR, simvastatin fenofibrate may be considered as adjuvant therapy for DR with dyslipidemia and DME."

"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."