Sriwijaya Journal of Ophthalmology

Eyelid Squamous Cell Carcinoma in Palembang, Indonesia: A 5-Year Retrospective Study

2025-02-11T01:30:12+00:00

Introduction: Eyelid squamous cell carcinoma (SCC) is a prevalent malignancy with potentially severe consequences if not detected and managed early. This study aimed to investigate the prevalence, clinical characteristics, and histopathological features of eyelid SCC patients at Dr. Mohammad Hoesin General Hospital Palembang, Indonesia, over a 5-year period.

Methods: A retrospective analysis of medical records was conducted on 20 patients diagnosed with eyelid SCC between 2020 and 2024. Data on demographics, clinical presentation, tumor characteristics, and histopathological findings were collected and analyzed. Univariate analysis was performed to describe the characteristics of the study population. Correlation tests were conducted to explore the relationships between various factors and eyelid SCC.

Results: The prevalence of eyelid SCC was 16.67%, with the highest incidence in 2024 (25%). The majority of patients were ≥ 50 years old (60%), with an equal distribution between males and females. Outdoor occupations (45%) and lower education levels (60% with primary education) were common characteristics. Lesions were mostly multiple (45%), >3cm in size (55%), and located on the right side (60%). Histopathological analysis revealed well-differentiated (25%) and poorly differentiated (25%) SCC as the most common subtypes. Correlation analysis revealed significant associations between age and tumor size, occupation and tumor size, education level and tumor size, smoking status and differentiation, tumor size and lymphovascular invasion, and perineural invasion and differentiation.

Conclusion: Eyelid SCC in Palembang predominantly affects older individuals with outdoor occupations and lower education levels. Multiple, large, and right-sided lesions are frequent findings. Emphasis on sun protection and early detection is crucial, particularly for outdoor workers.

Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Retinopathy of Prematurity: A Systematic Review

2025-07-15T06:52:53+00:00

Introduction: Retinopathy of prematurity (ROP) remains a leading cause of childhood blindness, with its pathogenesis linked to aberrant vascular development and systemic inflammation. There is a critical need for accessible biomarkers to improve risk stratification beyond current screening standards. This systematic review critically appraises the evidence for the neutrophil-to-lymphocyte ratio (NLR), a widely available inflammatory marker, as a predictor of ROP.

Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, ScienceDirect, ProQuest, and SpringerLink for observational studies published between January 1^st, 2015, and December 31^st, 2024. Studies assessing the association between NLR and ROP in preterm infants were included. Two reviewers independently performed study selection, data extraction, and a formal risk-of-bias assessment using the Newcastle-Ottawa Scale (NOS). A narrative synthesis was performed due to significant heterogeneity.

Results: The search identified 32 records, with 6 retrospective studies ultimately meeting the inclusion criteria, encompassing a total reported sample of 1,065 infants. The methodological quality of the included studies was low to moderate, with NOS scores ranging from 5 to 7 out of a possible 9. The evidence base was defined by profound methodological heterogeneity, particularly in the timing of blood sample collection, which was unspecified in half of the studies, and inconsistent reporting of core population data. A narrative synthesis of the findings showed that several studies reported a statistical association between an elevated NLR or related inflammatory markers and ROP. However, one study reported no significant association, and the interpretation of others was complicated by a focus on different biomarkers or a lack of statistical significance.

Conclusion: The available evidence, derived exclusively from retrospective studies of varying quality, suggests a possible association between elevated NLR and ROP, a link supported by strong biological plausibility. However, the current evidence base is severely limited by methodological flaws and profound heterogeneity, making it insufficient to support the adoption of NLR into clinical practice. NLR is not a standalone diagnostic or predictive tool for ROP. Its potential utility can only be realized through large-scale, methodologically rigorous prospective studies designed to overcome the limitations identified in this review.

Navigating Therapeutic Challenges in Adult-Onset Coats' Disease: Successful Vitrectomy for Tractional Retinal Detachment Following Laser Photocoagulation

2025-07-25T04:18:00+00:00

Introduction: Adult-onset Coats' disease, an infrequent variant of idiopathic exudative retinopathy, presents a unique management paradigm. While laser photocoagulation is a primary treatment for the characteristic retinal telangiectasia, it can paradoxically trigger a severe inflammatory and fibrotic cascade, leading to vision-threatening complications. This report addresses a critical clinical question: What is the optimal management strategy when first-line ablative therapy not only fails but leads to iatrogenic tractional retinal detachment?

Case presentation: A 35-year-old male presented with a 15-day history of metamorphopsia in his right eye. Best-corrected visual acuity (BCVA) was 20/20. Multimodal imaging confirmed Stage 2B Coats' disease. Following sectoral argon laser photocoagulation, his BCVA declined to a nadir of 20/60. Within two months of laser, optical coherence tomography (OCT) documented the rapid development of an epiretinal membrane and a subsequent superior macular tractional retinal detachment (TRD). A 23-gauge pars plana vitrectomy (PPV) with membrane peeling was performed. Anatomical success was achieved, and at the six-month follow-up, the retina remained attached, and BCVA improved to 20/40.

Conclusion: This case demonstrates that laser-induced inflammation can rapidly convert an exudative process into a complex fibro-proliferative state in adult-onset Coats' disease. When confronted with iatrogenic fibrosis, medical management is insufficient. This report validates that timely and definitive surgical intervention with PPV is not merely an option but an essential strategy for reversing the disease trajectory, achieving anatomical restoration, and salvaging vision.

Dissociated Therapeutic Regimen: Systemic Corticosteroids and Topical Natamycin in Traumatic Fungal Keratitis

2025-12-17T01:52:49+00:00

Introduction: Penetrating ocular trauma complicated by secondary fungal keratitis presents a fundamental inflammatory paradox in ophthalmology. While corticosteroids are clinically imperative to suppress trauma-induced fibrinoid syndrome and prevent phthisis bulbi, they are traditionally contraindicated in active mycotic infections due to the risk of potentiating fungal proliferation. This report evaluates a dissociated therapeutic protocol utilizing systemic corticosteroids alongside topical antifungals to navigate this therapeutic impasse.

Case presentation: We present the case of a 26-year-old male sustaining a penetrating corneal injury from a metallic nail. Following primary repair, the patient developed a severe anterior chamber reaction with Standardization of Uveitis Nomenclature (SUN) Grade 3+ cells and a corneal infiltrate exhibiting feathery margins. Potassium Hydroxide 10% wet mount confirmed the presence of fungal hyphae. A dissociated therapeutic regimen was initiated: intensive topical Natamycin 5% administered hourly to target the ocular surface infection, synchronized with oral Methylprednisolone (24 mg/day; 0.4 mg/kg) to control intraocular inflammation via the systemic circulation. The regimen successfully decoupled the immune response. Intraocular inflammation resolved within 14 days, preventing the formation of permanent synechiae or cyclitic membranes. The fungal infection was eradicated, confirmed by negative serial corneal smears and the clinical resolution of the infiltrate into a stable leucoma. Visual acuity improved from Hand Motion (LogMAR 2.30) at presentation to 6/45 (LogMAR 0.88) at Day 35. No fungal recurrence was observed during the follow-up period.

Conclusion: A dissociated strategy using intermediate-dose systemic corticosteroids to manage internal inflammation, while reserving the ocular surface for aggressive topical antifungal therapy, may offer a viable strategy for globe salvage in complex traumatic fungal keratitis cases where standard protocols are undefined.