Weekly 23-8 Mar 22.pptx

WEEKLY REPORT
23rd February – 8th March 2022

Emergency patients (16 Total
patients)
Date Doctor New Patient Consult
WED
(23/02/2022)
Lestari / Ayu / Tari / Andy
C : Dr. dr. A A Mas Putrawati T, Sp.M(K)
2 0
THU
(24/02/2022)
Ria / Kevin / Ardy / Tia
C : Dr. dr. Ari Andayani, Sp.M(K)
3 0
FRI
(25/02/2022)
Prema / Wawa / Novi / Andy
C : dr. Ida Ayu Ary Pramita, M.Biomed.,Sp.M
0 0
SAT
(26/02/2022)
Ernes / Dewi / Yudi / Nurin
C : dr. Siska, Sp.M., M.Kes
3 2
SUN
(27/02/2022)
Ria / Pram / Wulan / Surya
C : Dr. dr. I Wayan Eka Sutyawan, Sp.M(K)
1 1
MON
(28/02/2022)
Prema / Clara / Tari / Cok Agung
C : dr. Ni Made Ari Suryathi, M.Biomed, Sp.M(K)
1 1
TUE
(1/03/2022)
Lestari / Stephanus / Prama / Rara
C : dr. I Made Agus Kusumadjaja, Sp.M(K)
2 0

Emergency patients (15 Total
patients)
Date Doctor New Patient Consult
WED
(02/03/2022)
Junetta / Dewi / Pande / Nurin
C : dr. Ni Made Ayu Surasmiati, M.Biomed, Sp.M(K) 2 0
THU
(03/03/2022)
Ernes / Clara / Angelo / Alex
C : dr. Made Paramita Wijayati, M.Biomed.,Sp.M
0 3
FRI
(04/03/2022)
Ria / Adji / Cok WInny / Tia
C : dr. Siska, Sp.M., M.Kes
0 1
SAT
(05/03/2022)
Prema / Pram / Yudi / Rara
C : dr. Ida Ayu Ary Pramita, M.Biomed.,Sp.M
1 0
SUN
(06/03/2022)
Lestari / Tjok Esa / Wulan / Angel
C : dr. I G A Ratna Suryaningrum, M.Biomed., Sp.M
4 0
MON
(07/03/2022)
Ernes / Dewi / Angelo / Cok Agung
C : Dr. dr. Ari Andayani, Sp.M(K)
2 0
TUE
(08/03/2022)
Junetta / Ayu / Winly / Dek Gus
C : dr. Ni Made Ayu Surasmiati, M.Biomed, Sp.M(K) 1 1

ues
1 Patient
Thursday, February 24th 2022
Ria/Kevin/Ardy/Tia
Consultant : dr. Ida Ayu Ary Pramita, M.Biomed, Sp.M

• Patient was referred from Sumbawa General Hospital
with diagnosis of LE Ocular Trauma + Intraorbital
Corpus Alienum and had been treated by:
• IVFD Ringer Lactate
• Ibuprofen syr 3xI cth orally
• Xitrol ed 6xI LE
• Timol 0.5% ed 2xI LE
• Redness on the left eye after being shot in the eye
by iron bullets from the air soft gun
• No family members witnessed the incident, bullet
fragments were not found
• When the patient is found, patient’s eye was already
red, painful (+), active bleeding (-), vomiting (+)
GS / M / 3 y.o. / 22011026
HISTORY OF TRAUMA (2 days BATH)
• LE Red eye
• Blurry vision
• Pain
AT THE TIME ADMITTED (24/2/2022)
• History of wearing spectacle (-), eye surgery (-), other
eye conditions (-)
• No allergy
• Screening COVID-19 risk was negative
PAST MEDICAL HISTORY

LE VA 1/300
Palpebrae Combustion (+), spasm (+), edema (+)
Conjunctiva
CVI (+), PCVI (+), SCB (+), bloody
chemosis (+), conjunctival rupture (+) full
thickness at 7-8 o’clock, round, diameter 2
mm, 4 mm from limbus, necrotic tissue (+)
at the edge of wound
Cornea Clear, FL (-)
COA Coagulum (+) disperse
Iris -
Funduscopy
Hard to evaluate
IOP 12
GCS : E4V5M6
BW : 15 kg
Physical Status
BETT’s criteria
Type : D
Grade: D
Pupil : Positive
Zone : III
OTS Score:
1 (raw score
33)

Skull X-Ray (22/2/2022 at Sumbawa General
Hospital)
Interpretation:
• Corpus Alienum with
the shape of bullet in
left ethmoid sinus.

USG Oculi LE (24/2/2022)
Cavum vitreous : echogenic
Reflectivity : moderate-high
Mobility : low-moderate
RCS : intact
Axial Longitudinal
Interpretation:
• Vitreous opacity ec Susp. Bleeding
dd/ Inflammation + Susp.
Intraocular Foreign Body

Laboratory Result (24/2/2022)
Interpretation:
• Mild microcytic anemia
• Hyperglycemia
WBC 7.37
HGB 11.5 L
MCV 77.0 L
MCH 26.1
MCHC 33.9
HCT 33.9 L
PLT 263.0
PPT 10.4
INR 0.92
APTT 25.7
SGOT17.8
SGPT 7.4 L
BUN 10.5
Sc 0.5 L
Na 143
K 3.9
Cl 104.9
GDS 104 H

LE Blunt Trauma (Perforating) with
complications:
• Palpebral combustion
• Susp. Conjunctivoscleral Rupture Full-
Thickness with Necrotic Tissue
• Coagulum disperse
• Vitreous Opacity ec. Susp. Bleeding +
Intraocular Foreign Body
• Foreign Body (Iron Bullet) Regio Ethmoidal
GS / M / 3 y.o. / 22011026
Assessment
• LE Pro Repair Conjunctivoscleral Rupture Full-
Thickness + Exploration with GA
• Head CT-scan without contrast, orbital focus,
axial/sagittal/coronal/3D slices with anesthesia
• Consult to ROO Division for intraorbital foreign body
management and taking over further care
• Consult to VR Division for vitreous opacity and intraocular
foreign body management
• LE bandage using moist gauze
• Semi-Fowler’s position
• IVFD D5½NS 14 dpm
• Tetagam Inj. 1x IM
• Cefotaxime Inj. 3x500 mg IV
• Tranexamic acid Inj. 3x125 mg IV
• Paracetamol syr 3x1.5 cth PO
• Xitrol ed 6x1 LE
• Tropin 1% 1x1 LE
• Lyteers ed 6x1 LE
• Timol 0,5% ed 2x1 LE
Planning

A :
LE Blunt Trauma (Perforating) with complications:
• Susp. Conjunctivoscleral Rupture Full-Thickness with
Necrotic Tissue
• Vitreous Opacity ec. Susp. Bleeding + Intraocular
Foreign Body
• Foreign Body (Iron bullet) Regio Ethmoidal
P :
• Taken care by ROO Division
Thickness + Washing COA + Exploration + IOFB
Extraction using C-arm guidance with GA
• Head CT-scan without contrast, orbital focus,
axial/sagittal/coronal/3D slices with anesthesia
• Continue therapy from the team on duty
GS / M / 3 y.o. / 22011026
ROO Division (24/2/2022)
A :
Foreign Body
Necrotic Tissue
P :
• LE Pro Primary Repair Conjunctivoscleral Rupture
Full-Thickness + Exploration + Washing COA with
GA
• Observation while waiting for CT-scan result
VR Division (24/2/2022)

Head CT-scan without Contrast, Orbital Focus
(25/2/2022)
Interpretation:
• Supports the manifestation of a ruptured bulbi oculi
and left cornea with left intraocular hemorrhage
• Soft tissue hematoma and swelling of the left periorbita
region
• Defect in the left preseptal soft tissue region medial
aspect to the left extraconal space with pneumoorbita
and surrounding subcutaneous emphysematous
• Metal density hyperdense lesion in the apex region
of the left orbit to the left pterygopalatine fossa,
impression of the corpus alienum
• Left inferior orbital rim fracture
• Left ethmoidal, left sphenoid and left maxillary
hematosinus
• Soft tissue swelling left maxillary region
• There is no visible picture of intracerebral and
intracerebellar hemorrhage
• Left inferior turbinate hypertrophy

A : Patient with Physical Status ASA I
P :
• IEC with the patient and the patient’s family
• Prepare an anesthetic consent
• Fasting 8 hours before anesthesia
• IV line connected to the RL with a large bore catheter
• Pray
Pre-operative Follow Up
Anesthesia Department (25/2/2022)
A :
Necrotic Tissue
Foreign Body
P :
Thickness + Washing CoA + Exploration + IOFB
Extraction using C-arm guidance with GA
• Continue other therapy

Surgery Report (25/2/2022)
On exploration
 full thickness
palpebral rupture
at inferior
palpebra
horizontally
with size 1x0,5
cm
Conjunctiscleral
rupture
vertically with
size 1.5 cm from
limbus
Begin C-Arm
guiding
exploration
through
subcilliary
incision
approach
Iron bullet was
found and stuck
in medial
maxillary bone
IOFB Extraction
with C-arm
guidance
Periosteal and orbicularis
oculi suture using vicryl
6.0
Skin suture using prolene
6.0
Continue scleral
exploration  scleral
suture using vicryl 7.0
and conjunctival suture
using vicryl 8.0
Washing COA  fibrin
and coagulum (+) 
active bleeding when
irrigated  suture using
nylon 10.0
Pre Op Post Op

A :
• Post Op Exploration + Repair Conjunctivoscleral Rupture
Full-Thickness with GA
• Acute Post-operative Pain
P :
• Fentanyl 100 mg in 20 cc NS with rate 0.8 ml/hour
• Ibuprofen 100 mg every 8 hours PO
• Paracetamol 150 mg every 6 hours PO
Post-operative Follow Up
A :
LE Post Intraorbital Foreign Body (Iron Bullet)
Extraction + Post Repair Conjunctivoscleral Rupture
Full-Thickness + Washing COA D.0
P :
• Methylprednisolone 2x8 mg PO pulv
• Gentamycin eo 3x1 LE
• Stop Timol 0.5% 2x1 LE

Follow Up Day 1 (26/2/2022)
LE VA FO (patient was uncooperative)
Palpebrae
Spasm (+), edema (+), suture (+) at inferior
palpebra
Conjunctiva
chemosis (+) 360°, suture (+)
Cornea Edema (+)
Iris -
Funduscopy
Hard to evaluate
IOP 26/28/26
A :
• Post Op Exploration + Repair Conjunctivoscleral Rupture Full-
Thickness with GA
P : Continue therapy
A : LE Post Intraorbital Foreign Body (Iron Bullet) Extraction
+ Post Repair Conjunctivoscleral Rupture Full-Thickness +
Washing COA D.1
P : - Tonor ed 2x1 LE
- Continue therapy

LE VA FO (patient was uncooperative)
Palpebrae
Spasm (+), edema (+), suture (+) at inferior
palpebra
Conjunctiva
chemosis (+) 360°, suture (+)
Cornea Edema (+)
Iris -
Funduscopy
Hard to evaluate
IOP 22/19/19

A :
• Post Op Exploration + Repair Conjungtivoscleral Rupture
Full-Thickness with GA
P :
• Ibuprofen 100 mg every 8 hours PO
• Paracetamol 150 mg every 6 hours PO
A :
LE Post Intraorbital Foreign Body (Iron Bullet)
Extraction + Post Repair Conjunctivoscleral Rupture
Full-Thickness + Washing COA D.2
P :
• Cefotaxime Inj. 3x500 mg IV  Cefixime syr 2x100 mg
(5 ml) PO
• Tranexamic acid Inj. 3x125 mg IV  Tranexamic acid
3x250 mg PO pulv
• Methylprednisolone 2x8 mg PO pulv for first 2
weeks, tapering off 1x8 mg for 1 week, and 1x4 mg for 1
week afterward
• Antacid 3x1 cth PO
Patient’s families requested to continue therapy in Sumbawa

ues
1 Patient
Saturday, February 26th 2022
Ernes/Dewi/Yudi/Nurin
Consultant : dr. Siska, Sp.M, M.Kes

◻ History of eye surgery (-)
◻ History of wearing spectacles (-)
◻ History of allergies (-)
◻ History of systemic disease (-)
IMR/M/23 y.o/22011401
1 DAY BATH
• Right eye was hit by an iron particle while iron welding.
• Patient is not sure if any part of iron has entered his eyes or
not.
• Patient referred from Karangasem Hospital, diagnosed with
RE Sharp ocular trauma and has received initial therapy C.
Ulcori ed 6x1 RE, lyteers ed 6x1 RE, Methylprednisolon 3x16
mg, and ciprofloxacin 2x500 mg.
• Screening COVID-19 was found no risk
AT THE HOSPITAL
◻ The patient complained of painful on the right eye with
redness, watery, and blurry eye.
◻ There has never been a history of complaints like this before.
◻ The history of the wound being washed with running water
was denied.

RE
VA 6/7.5 PH NI
Conjunctiva CVI(+), PCVI (+)
Corneo-sclera
Full-thickness rupture, diagonal shaped, at 4-5
O’clock, size 5x2mm, 2mm from limbus, FL(-),
vitreous (-) membrane (+)
COA VH3, VH1 at margin of the wound, cell (+2), flare (+1)
Iris
Ireguler, prolaps (+) at wound age 4-5 O’Clock,
tremulans (-)
Pupil reflex (-)
Lens Clear
Fundus
ONH round, well demarcated, CDR 0.3, aa/vv 2/3,
retina hemorrhage (+) inferonasal, MR (+)
IOP 14
Ocular movement
Good at all direction, pain (-)
Picture at Emergency Room
Open Globe
Injury
Bett’s criteria
Type : C
Grade : A
Pupil : B
Zone : II
OTS
Raw Points
77
Visual
Prognosis per
OTS : 3

22
RE

23
• WBC 11.88 H
• RBC 6.16 H
• HGB 19.00 H
• HCT 59.30 H
• PLT 303
• NLR 7.14 H
Conclusion
• Leukocytosis
• Polycythemia
• SGOT 34.5 H
• SGPT 19.90
• GDS 98
• BUN 7.10 L
• Creatinin 1.03
Rapid antigen SARS COV-2: Negative

24
Head CT scan orbital focused, axial, sagittal and
coronal (26/2/2022)
Conclusion:
◻ Right cornea and sclera rupture soft tissue
swelling on the left preseptal
◻ Right Pneumoorbita
◻ Hyperdense Lesion with density (1000-2400 HU)
in the posterior segment of the right bulb oculi,
susp. corpus alienum
◻ Currently there are no signs of intracranial
hemorrhage
◻ No fractures of the calvarial bones or the base of
the skull are seen

A:
RE Blunt Trauma with Complication:
- Corneosclera Rupture full-thickness
- Iris Prolapse
- Traumatic iritis
- IOFB intraocular
25
P:
 Admitted to the hospital
 RE pro Repair corneoscleral rupture+
exploration + Iris reposition under GA
 Consult to Vitreoretina Division for evaluation
of vitreous and retinal hemorrhage and IOFB
intraocular
 Consult to Anesthesia Department pre
operation
IMR/M/23 y.o/22011401

P: - IVFD RL 20 drop per minute
- Tetagam inj. 1 amp IM
- Ceftriaxone 1x2 gram IV
- Ketorolac 3x1 amp IV
- P-Pred ed 6x1 RE
- Optiflox ed 6x1 RE
- Lyteers ed 6x1 RE
IMR/M/23 y.o/22011401

Vitreoretina Division
P:
- Primary repair and other therapy
according to the team of care
- Consideration of consult advice to
EED division for Vancomycin-
Ceftazidime injection
(endophthalmitis prophylaxis)
- OD pro VPP + EL + SO/Gas +
IOFB extraction with GA —>
scheduled elective on polyclinic
Anesthesia Department
A:
- Physical status ASA II
P:
- Fasting 8 hours before anesthesia
- Install IV line large bore threeway
connected + RL
- Thorax X-ray
- Blood gas analysis
IMR/M/23 y.o/22011401
P:
- Observation
- Metilprednisolon injection 1x62.5 mg
IV
- Cefazolin injection 1 mg/ 0.1 cc
intracameral after procedure
- Ketorolac injection  Paracetamol
1x1000 mg IV
- Therapy in accordance with team in
charge
EED Department

Intra op
Surgery Report (27/02/2022)
Membrane
Evaluation 
deepitelization
at surface of iris
prolapse
Peritomy conjunctiva 
Found corneoscleral
rupture
Iris Reposition with sinsky
from sideport at 2 O’clock
Limbus Hecting with Nylon
10.0
Scleral Hecting with Vicryl
8.0 and nylon 10.0
alternately
Conjunctival Hecting with
Vicryl 8.0
Cefazoline injection
intracameral
AB eye drops, eye
ointment,
Wound dressing
Post-Op
A:
RE post Fullthickness
Corneoscleral Rupture Repair +
Exploration + Iris Reposition D.0 et
causa Blunt Trauma + IOFB
Intraocular
P:
• IVFD RL 20 drop per minute
• Ceftriaxone 1×2 gram IV
• Metilprednisolon 1x62.5 mg IV
• Analgesic according to TS
Anesthesia
• P-pred ed 6x1 RE
• Optiflox ed 6x1 RE
• Lyteers ed 6x1 RE
• Tropin ed 3x1 RE
RE
Pre op
Post op

RE
VA 6/12 PH NI
Palpebra Edema (+) minimal
Conjunctiva CVI(+), PCVI (+), Suture (+) medial
Cornea
Edema (+) peripheral, suture (+) perifer at 4 O’clock,
intact (+)
COA Flare (+3), Cell (+3)
Iris Ireguler
Pupil Middilatation on tropin
Lens Clear
Fundus
ONH round, well demarcated, CDR 0.3, aa/vv 2/3,
IOP 19
Ocular movement
FOLLOW UP (28/02/2022)

A:
RE Post Corneoscleral Fullthickness
Rupture Repair + Exploration + Iris
Reposition D.1 et causa Blunt Trauma +
IOFB Intraocular
30
P:
- Cefixime 2x100 mg PO
- Metilprednisolon 3x16 mg PO
- Paracetamol 4x500 mg IV
- P-Pred ed 9x1 RE
- Lyteers ed 6x1 RE
- Tropin ed 3x1 RE
- Allowed to polyclinic on Sunday,
7/3/2022
FOLLOW UP (28/02/2022)

RE
VA 6/15 PH 6/12
Palpebra Normal
Conjunctiva CVI(+), PCVI (+), Suture (+) intact
Cornea Edema (+), suture (+) at 4 O’clock, intact (+)
COA Flare (-), Cell (-)
Iris Ireguler
Pupil Middilatation
Vitreous IOFB (+) Iron
Fundus
ONH II round, well demarcated, CDR 0.3, aa/vv 2/3,
IOP 19
Ocular movement
FOLLOW UP (07/03/2022)

A:
RE Post Corneoscleral Fullthickness
Rupture Repair + Exploration + Iris
Reposition D.10 et causa Blunt Trauma +
IOFB Intraoculi
32
P:
- Paracetamol 4x500 mg PO
- P-Pred ed 6x1 RE
- Lyteers ed 6x1 RE
- Control : Retinal Division
FOLLOW UP
(07/03/2022)

33 Vitreoretina Division
(7/3/2022)
A:
RE Post Repair Corneosclera Rupture
full-thickness + Exploration + Iris
Reposition D.10 ec Blunt Trauma +
IOFB intraoculi
P:
- RE pro VPP + EL + SO/Gas +
IOFB extraction with GA —>
Control 11/3/2022 meet spv
- Therapy in accordance with CRS
division
- Consult to EED Division for
Infection Suspicion in left eye
(Work up diagnostic)

ues
1 Patient
Wednesday, March 2nd 2022
Netta/Dewi/Pande/Nurin
Consultant : dr. Ni Made Ayu Surasmiati, M.Biomed.,Sp.M(K)

• Chief complaints of the RE can’t see since 2 days
ago. The blurred eye complaints were felt suddenly
since 25/2/2022 accompanied by red eye, watery eye
and pain.
• On 24/2/2022 -> got Astrazeneca booster vaccine ->
the next day he complained of fever accompanied by
red eyes, swelling, sore and watery on the RE.
• On 27/2/2022 -> went to Ramata Hospital for red
eye,pain and worsen blurred vision-> hospitalized.
Referred from RAMATA Hospital with diagnosis:
RE Secondary Glaucoma ec hyphema +
Vitreous Hemorrhage ec Immune-mediated
Thrombocytopenia and have been getting
therapy:
• Methylprednisolone 3x16 mg
• Tranexamic Acid 3x500 mg IV
• Glauseta 3x250mg
• Aspar K 2x300 mg
• Timol 0,5% ed 2x1 RE
• Glopac ed 3x1 RE
NAW / M / 45 y.o / 22011956
• History of using spectacle (+) -> S-4,75 RE and S-7,00 LE
• History of eye surgery (-), systemic disease (-), eye trauma (-
), allergies (-)
• history of long diarrhea (-), bloody diarrhea or vomiting (-),
petechiae on the skin of the hands and feet(-) , epitaxis (-)
Screening COVID-19 was found no risk

RE
VA NLP
Palpebra normal
Conjunctiva CVI (+), PCVI (+)
Cornea Edema (+) minimal
COA
Deep, hyphema (+) 1 mm, cell (+2),
flare (+4)
Iris regular
Pupil Middilatation on tropin
Lens Clear
Vitreous Haze (+4)
Funduscopy Fundus reflex (-)
IOP 20

37
RE

LE
VA 2/60 PH 6/120 -> S-8,00 -> 6/9 PHNI
Palpebra normal
Conjunctiva normal
Cornea Clear
COA Deep
Iris Regular
Pupil
Round, Pupillary reflex direct/indirect
(+/-)
Lens Clear
Vitreous Clear
Funduscopy
ONH round shaped, well demarcated,
CDR 0.5, myopic crescent, cupping (-),
aa/vv 2/3, tigroid retina (+), macular
reflex (+)
IOP 19

39
• WBC 12.6 H
• RBC 5.48
• HGB 16.0
• HCT 48.8
• PLT 244
• LED 10
• GDS 111
Conclusion
• Leukocytosis
Rapid antigen SARS COV-2: Negatif
• BT 1.30
• CT 8.00
• PPT 10.4
• INR 0.91
• APTT 28.6

Result:
◻ cavum vitreous echogenic
◻ Low-moderate mobility
◻ Moderate-high reflectivity
◻ Intact RKS
◻ Conclusion : Moderate Vitreous Opacity ec suspect
hemorrhage dd/ Inflammation
USG (2/3/2022)
RE

Assessment :
• RE Secondary Glaucoma ec
Hyphema + Vitreous
Hemorrhage ec susp
Vaccine-induced Immune
Thrombotic Trombocytopenia
• OS High Myopia
NAW / M / 45 y.o / 22011956
• Continuing therapy
• Methylprednisolon 3x16 mg PO
• Tranexamic Acid 3x500 mg PO
• Glauseta 3x250mg PO
• Aspar K 2x300mg PO
• Timol 0,5% 2x1 RE
• Tropin ed 3x1 RE
• Consult to Glaucoma Division for further treatment and take over
care
• Consult to Vitreoretina Division for vitreous opacity treatment
• Consult to Internal Medicine Department for evaluation of the
hemorrhage etiology related to vaccine
• Explain to the patient about the sign & symptoms of acute
glaucoma (pain on the eye), or if the patient experience any
problems on the Left eye, he can go to the hospital immediately
Planning

NAW / M / 45 y.o / 22011956
• A:
• RE Secondary Glaucoma ec hyphema + vitreous
hemorrhage
• P:
• - Conservative
• - Internal Medicine doesn’t joining care
• - Based on the evaluation, we currently found no
manifestation of bleeding from other sources and other
conditions that can cause eye bleeding
•
Internal Medicine Department:

NAW / M / 45 y.o / 22011956
• A:
• - RE Secondary Glaucoma ec hyphema + vitreous hemorrhage ec susp Vaccine-induced
Immune Thrombotic Trombocytopenia
• - LE high myopia
• P:
• Take over care to Glaucoma Division
• Aff IVFD
• Methylprednisolon 3x16 mg PO
• Tranexamic Acid 3x500 mg PO
• Glauseta 3x250mg PO
• Aspar K 2x300mg PO
• Timol 0,5% 2x1 RE
• Polyclinic, Control on Monday, 7/3/2022 to the Glaucoma Division
Glaucoma Division:
The IOP was checked before the
patient polyclinic :
RE 23
LE 17

NAW / M / 45 y.o / 22011956
• A:
• - RE Vitreous opacity ec vitreous hemorrhage ec
Vaccine-induced Immune Thrombotic Thrombocytopenia
dd/ retinal vena oclusion dd/ myopia CNV + Secondary
Glaucoma ec hyphema
• - LE high myopia
• P:
• Vitreous hemorrhage observation for 2 weeks  if
unresolved, RE pro VPP  cheduled through polyclinic
• Consult to Neuroophthalmology Division to Evaluate the
possibility of the thrombosis
• Educate about sleeping position with the high pillow
• Therapy is in accordance with team in charge and
glaucoma division
Vitreo-retina Division:

1 Patient
Sunday, March 6th 2022
Lestari/Tjok Esa/Wulan/Angel
Consultant : dr. IGA Ratna Suryaningrum, M. Biomed, Sp.M

MK / M / 26 yo / 22011839
9 DAYS BATH
• Mechanism of accident: patient felt to left side, while riding
motor cycle and was hit from behind, and his left eye hit the
motorcycle handlebar, helmet (-)
• The patient did not remember the accident
• History of nausea (-), vomiting (+) 2 times, the patient was
admitted to RSUD Ende
• History of past eye illness (-) eye surgery (-)
• History of wearing spectacles (-)
• History of systemic conditions (-), allergy (-)
AT THE HOSPITAL (RSUD Ende)
◻ Hematome on right eye
◻ The patient had CT Scan orbita without contrast, and get 2
drug eye drop, timol ed, 0.5 5 2x1 gtt LE, p.pred ed 6x1 gtt
LE, and was referred to Sanglah Hospital
AT THE HOSPITAL (TIME OF CONSULT)
◻ Pain on left eye (+)
◻ Also complained of red eye (+), headache (+), watery
(+), blurred vision (+), glare (+), eye discharge (-),
nausea (+), vomiting (-)

LE
VA LPBP
Palpebra spasm (+), hematoma (+)
Conjunctiva CVI (+), PCVI (+), SCB (+)
Cornea Edema (+), FL (-)
COA DTE, hyphemia (+) full
Iris DTE
Pupil DTE
Lens DTE
Fundus DTE
IOP
59 mmHg
Evaluate in an hour after glauseta (00.00) 500mg PO -> IOP 50
mmHg
Evaluate in an hour after gliserin (03.30) 50cc PO -> 51 mmHg

LE
Ocular Movement
restricted (+) to superior, superomedial, inferomedial, and
inferior, pain (+)
FDT DTE (patient not cooperative)
FGT DTE (patient not cooperative)

Conclusion:
- LE Hemorrhage posterior chamber dd/ LE
vitreous hemorrhage
- LE dislocation lens to posterior chamber
- Susp. Hemorrhage left intraconal medial with
injury at left nervus opticus and LE muscle
rectus medial
- Fracture left lamina papyracea (Medial orbital
wall) and left orbital floor
- Hematosinus at left ethmoidal, left frontal, and
left spenoidal
- Soft tissue swelling at LE regio preseptal and
left periorbita
Head CT Scan Orbital Focus without contrast (26/2/2022)
RSUD Ende

◻ Vitreous cavity: echogenic
◻ Reflexivity: low-medium
◻ Mobility: medium-high
◻ RKS: intact impression
◻ Conclusion: Vitreous opacity ec. Susp.
Haemorrhage
LE Ultrasound (7/3/2022)
WBC 11.39 H
HGB 16.70
HCT 47.40
MCV 81.70
MCH 28.80
MCHC 35.20
RDW 11.70
PLT 322.00
MPV 9.40
NLR 9.75 H
PPT 10.2
INR 0.89 L
APTT 24.6
SGOT 24.3
SGPT 71.50 H
BUN 11.50
Kreatinin 0.82
Kalium 2.81 L
Natrium 135 L
Chlorida 98.5
Conclusion
- Leukocytosis
- Transaminitis
- Hypokalemia

A:
LE blunt trauma with complication:
- Hematoma palpebra
- Subconjunctiva bleeding
- Hyphemia
- Susp lens subluxation
- Secondary Glaucoma
- Vitreous opacity ec susp hemorrhage
- Susp. EOM entrapment ec Fracture of orbital floor, Fracture of left Lamina
papyracea
RE Corneal erosion
MK / M / 26 yo / 22011839

P:
- Hospitalized
- LE pro I/A hyphemia with GA
- IVFD RL 20 dpm
- Laboratories check
- Glauseta 500 mg PO at 00.00  evaluate in an hour after treatment
- Gliserin 50 cc PO at 03.30 (BS 169)  evaluate in an hour after treatment
- Glauseta 3x250 mg PO
- Aspar K 1x1 tab PO
- Methylprednisolone 3x16 mg PO
- Tranexamic acid 3x500 mg IV
- Timol 0.5% ed 2x1 OS
- Lyteers ed 6x1 OS
- Tropin ed 3x1 OS
- P-pred ed 6x1 OS
MK / M / 26 yo / 22011839

P:
- Gentamicin eo 3x1 applic on LE palpebra
- Semi fowler position
- LE cold compress
- Consult to ROO division to take over care and treatment of susp muscle
entrapment fr. Lamina papyracea
- Consult to CRS division to treatment susp lens subluxation
- Consult to VR division to treatment the vitreous opacity
- Consult to Anaesthesia department
- Swab PCR
- Education
MK / M / 26 yo / 22011839

A:
- Hematoma palpebra
- Hyphemia
- Susp. EOM entrapment ec Fracture of orbital
floor, Fracture of left Lamina papyracea
RE Corneal erosion
P: LE Pro VPP + EL + SO/gas under GA join op
with glaucoma division
ROO Division
A:
- Hematoma palpebra
- Hyphemia
- Susp. EOM entrapment ec Fracture of orbital floor,
Fracture of left Lamina papyracea
RE Corneal erosion
P:
LE pro exploration medial orbital fracture under GA
join op with glaucoma division
VR Division
MK / M / 26 yo / 22011839

MK / M / 26 yo / 22011839
A:
- Susp lens subluctation
- Haematome palpebra
- Hyphema
- Vitreous opacity ec susp haemorrhage
RE Corneal erosion
P: Polyclinic, evaluation of lens subluctation if the
hyphema decrease
CRS Division

Anaesthesia (8/3/2022):
A:
Physical status ASA II
P:
- Pray
- Ready to Facilitate surgery
- Educate Patient and family
- Fasting 8 hours pre anesthesia
- IVFD Threeway Large Bore + RL
- Blood order according operator
MK / M / 26 yo / 22011839
Interna Department (8/3/2022):
A:
- Hypokalemia ec susp. Low intake
- LE Blunt trauma pro VPP under GA
P:
- Advice therapy: KSR 600mg every 24 hours
PO
- Na, K check tonight
- Join care nephrology department

Last Condition (9/3/2022)
Day 3
VA LPBP
Palpebra spasm (+), hematoma (+)
Conjunctiva CVI (+), PCVI (+), SCB (+)
Cornea Edema (+), FL (-)
COA DTE, hyphemia (+) full
Iris DTE
Pupil DTE
Lens DTE
Fundus DTE
IOP 59 mmHg

A:
- Hematoma palpebra
- Hyphemia
RE Corneal erosion
Glaucoma Division P:
- LE pro I/A hyphemia with GA
- IVFD RL 20 dpm
- Ceftriaxone 1x2gr IV
- Glauseta 3x250 mg PO
- KSR 1x600mg tab PO
- Methylprednisolone 3x16 mg PO
- Tranexamic acid 3x500 mg IV
- Timol 0.5% ed 2x1 OS
- Lyteers ed 6x1 OS
- Tropin ed 3x1 OS
- P-pred ed 6x1 OS
- Gentamicin eo 3x1 applic on LE palpebra
- Semi fowler position
- LE cold compress
- Pro mannitol 5ml/kgBW if the IOP >30 before
operation

A:
- Hematoma palpebra
- Hyphemia
RE Corneal erosion
P: LE Pro VPP + EL + SO/gas under GA join op
with glaucoma division
ROO Division
A:
- Hematoma palpebra
- Hyphemia
- Susp. EOM entrapment ec Fracture of orbital floor,
Fracture of left Lamina papyracea
RE Corneal erosion
P:
LE pro exploration medial orbital fracture under GA
join op with glaucoma division
VR Division

Bali Mandara Eye Hospital
Operating Theatre
March 2nd - 8th 2022
dr. Saphira Evani
dr. Ni Kompyang Rahayu, Sp.M(K)
2 patients

No Date ID/MR Dx Plan Complications Difficulties
PreOp
VA
Post op
VA
(1st day)
SPV
1 07/03/2021 NMP/ F / 72 / 133224
RE IMMATURE
SENILE
CATARACT +
PACS
RE PHACO +
IOL + PI
Corneal edema
CCC
6/21 6/12
dr. Ni
Kompyang
Rahayu
Sp.M(K)
2 07/03/2021 AD / M / 58 / 184150
LE IMMATURE
SENILE
CATARACT +
SECONDARY
GLAUCOMA
LE PHACO +
IOL + PI
Corneal edema
CCC 6/30 6/9
dr. Ni
Kompyang
Rahayu
Sp.M(K)

March 07th 2022
dr. Saphira Evani
dr. Ni Kompyang Rahayu, Sp.M(K)
1 Patient
OPERATING THEATER

◻ Patient : AD / M / 58 / 184150
◻ VA Pre Op : 6/30
◻ Lens Opacity : NO2NC2
◻ Ass : LE IMMATURE SENILE CATARACT + SECONDARY GLAUCOMA
◻ Tx : LE Phaco + IOL (18.00 D) + PI under LA
◻ Difficulty : CCC
◻ Complication : Corneal edema
◻ VA Post Op : 6/9

LE Pre op LE Post op
PRE & POST OPERATION

DRYLAB REPORT
Monday, February 27th 2022
Phacoemulsification
dr. Clara
Supervisor:
dr. Siska, Sp.M, M.Kes

NEXT WEEK schedule
9th March 2022 – 15th March 2022

Stage I & II
 dr. Ernes : EED
 dr. Prema : EED
 dr. Lestari : EED
 dr. Anik : Refraction (RSMBM)
 dr. Ria : Refraction
 dr. Netta : Refraction
 dr. Dewi : CRS
 dr. Kevin : CRS (RSMBM)
 dr. Putra : CRS
 dr. Kusuma : CRS (Mangusada)
 dr. Clara : CRS
 dr. Saphira : CRS (RSMBM)
 dr. Tjok Esa : Glaucoma
 dr. Intan : Glaucoma (RSMBM)
 dr. Adji : Glaucoma
 dr. Priscilla : Glaucoma
 dr. Ayu : Retina
 dr. Anin : Retina (RSMBM)
 dr. Stephanus : Retina
 dr. Winly : POS
 dr. Cok Winny : POS
 dr. Pande : ROO
 dr. Wulan : NO
 dr. Yudi : NO
 dr. Novi : Glaucoma (RSMBM)
 dr. Prama : CRS
 dr. Ardy : Community Ophthalmology
 dr. Angelo : Community Ophthalmology
 dr. Tari : Ocular HIV & Travel Medicine
 dr. Mega : Ocular HIV & Travel Medicine
RESIDENT STAGE 9th – 15th March 2022

CHIEF STAGE
◻ Poli 1 :
◻ dr. Rara
◻ dr. Tia
◻ dr. Dwi
◻ dr. Daivi
◻ dr. Nurin
◻ dr. Dek Gus
◻ dr. Cahya
◻ dr. Alex
◻ dr. Angel
◻ dr. Andy
◻ Ward :
◻ dr. Wistya
◻ Operating Theatre:
◻ dr. Cok Agung
◻ RS Udayana :
◻ dr. Cipta
◻ RSMBM :
◻ dr. Abdi
◻ dr. Surya
◻ Ambon :
◻ dr. Elvira
RESIDENT STAGE 9th – 15th March 2022

74
DATE NAME DIAGNOSIS PLANNING OPERATOR
Wednesday
09/03/2022
I Made Sumetra LE RRD + susp IOL drop LE Pro VPP + EL + SO /
gas + heavy fluid +/- IOL
drop evacuation with
peribulbar + MAC
Dr. dr. Ari Andayani, SpM(K)
Dwi Putra Setiawan LE vitreus hemorrage ec
susp PCV
LE Pro VPP + EL + SO /
gas with subtenon +
MAC
dr. Ni Made Ari Suryathi,
M.Biomed, SpM(K)
Milham AMD. RE RRD + PVR grade B RE Pro VPP + MP + EL
+ SO / gas with
*subtenon + MAC*
I Gusti Made Bawa RLE PDR HRC + ischemic
CRVO + Immature Senile
Cataract
RE pro Avastin injection
intravitreal under LA
M.Biomed, SpM(K)
Hesti Withiono RLE vitrectomized eye +
PDR + pseudophakia
RE pro Avastin injection
intravitreal under LA
M.Biomed, SpM(K)
Jack Sidharta RLE Wet AMD LE Pro Patriza Injection
Intravitreal under LA

75
Thursday
10/03/2022
M. Ali Hamzah RE inferior Palpebral tumor
ec susp
Rhabdomyosarcoma
RE pro incisional
biopsy under GA
Dr. dr. Putu Yuliawati,
Sp.M (K)
Maria Lusia Tia RE non axial Proptosis ec
Rhabdomyosarcoma dd/
retinoblastoma
RE Orbital
excenteration under
GA
Sp.M (K)
Oktaviana Bete RE Conjunctival Tumor ec.
Susp. Capillary
Hemangioma; RE
Deprivative amblyopia
RE pro Cryotherapy
bulbar conjunctival
mass under LA
Sp.M (K)
Markus Kita LE blunt trauma with
complications (Vitreous
opacity ec susp
hemorrage, palpebral
hematoma, SCB,
hyphema, susp. Lens
subluxation, secondary
glaucoma, susp. EOM
Entrapment)
LE pro VPP + EL+
SO/GAS +I/A
Hifema (join op
glaucoma division)
under GA
dr. Ni Made Ari
Suryathi,M.Biomed,
Sp.M(K)

76
Friday
11/03/2022
I Dewa Putu
Sadwika Wiguna
Exotropia + RE
Secondary IOOA (RE
SO Palsy)
Bilateral Reses 7 mm + RE
reses IO under GA
dr. Ni Made Ayu Surasmiati,
M.Biomed, Sp.M(K)
Monday
14/03/2022
Sugeng Sugianto RLE Metabolic cataract +
moderate NPDR
OD pro phaco + IOL
(Rayone 17.00 D) under LA
Dr. dr. I Wayan Gede
Jayanegara, Sp.M(K)
Gusti Putu Rusmini RE Mature Cataract ec
Steroid Induced, LE
Pseudophakia
RE Pro Phaco +IOL
(Rayone 20.0) under LA
Dr. dr. I Wayan Gede
Jayanegara, Sp.M(K)
I Putu Angga Ariesta RLE cicatricial +
neovascularization of the
cornea
Avastin Intrastromal
injection under GA
I Nyoman Wenten LE Nucleus in COA +
aphakia + glaukoma
sekunder post phaco
minggu ke 6
LE pro rehecting corneal
suture + Lens evacuation +
Anterior vitrectomy +
Secondary Implant (Yamane
technique) (Amosensar
22.0) under GA

Tuesday
14/03/2022
Ni Wayan Suryani RE PAC + immature
senile cataract
RE Pro Phaco + IOL
(Rayone 23.50D) +
Goniosynekiolysis under
LA
dr. I Made Agus
Kusumadjaja, Sp.M (K)
Doko Soebagio LE Neovaskular +
papilary atrophy ec
metabolic + pseudophakia
+ corneal cicatrix
LE Pro GDD + anti
VEGF intravitreal
injection
dr. I Made Agus
Ni Luh Rempuh RE PACG + immature
senile cataract +post
trabeculectomy
RE Pro Phaco + IOL
(23.50 D) under LA
dr. I Made Agus

Next week schedule
78
WED
(9/3/2022)
Ria / Adji / Cok Winny / Dwi
C : Dr. dr. I Wayan Gede Jayanegara, Sp.M(K)
THU
(10/3/2022)
Lestari / Pram / Tari / Angel
C : Dr. dr. I Wayan Eka Sutyawan, Sp.M(K)
Thesis Result Seminar
dr. Yoga, dr. Ane, dr. Aryawan, dr. Anom, dr. Puri
FRI
(11/3/2022)
Prema / Tjok Esa / Yudi / Tia
C : dr. I G A Made Juliari, Sp.M(K), M.Kes
Thesis Result Seminar
dr. Nadia, dr. Thedi, dr. Gungtha, dr. Uya, dr Tyo
SAT
(12/3/2022)
Ernes / Stephanus / Ardy / Dwi
C : Dr. dr. Putu Yuliawati, Sp.M(K)
SUN
(13/3/2022)
Ria / Adji / Winly / Daivi
C : dr. Ni Made Ari Suryathi, M.Biomed, Sp.M(K)
MON
(14/3/2022)
Junetta / Priscilla / Wulan / Nurin
C : Dr. dr. A A Mas Putrawati T, Sp.M(K)
TUE Lestari / Clara / Angelo / Cahya

Weekly 23-8 Mar 22.pptx

Recommended

Recommended

More Related Content

Similar to Weekly 23-8 Mar 22.pptx

Similar to Weekly 23-8 Mar 22.pptx (20)

Recently uploaded

Recently uploaded (20)

Weekly 23-8 Mar 22.pptx