KEGIATAN DIAGNOSIS PERIMETRI HUMPREY

Nama :
Tahap :
Semester :
Periode Tanggal :
Subdivisi : GLAUKOMA

NO Tanggal Nama Pasien / umur No. RM Diagnosa / Tindakan Supervisor Kode

Portofolio
Syarif Ali Husain/19 OD Normotension
6 4/5/2021 144205
tahun Glaucoma
OD SACG ec Lens
Induced Post
Hanaping Syam/ 52
7 6/5/2021 157452 Trabekulektomi+5F
tahun
U+ Releasable
Suture
ODS Open Angle
13.98.1 Glaucoma +
8 6/5/2021 Irmawati/49 tahun
5 Neovascular
Glaucoma
ODS Glaukoma
Zhafran Khairy/7 14.49.9 Kongenital +
9 7/5/2021
tahun 5 Aniridia + Ectopia
Lentis
ODS Juvenille
10 25/5/2021 Regis/53 tahun 143983 Open Angle
Glaucoma
ODS Primary Open
Angle Glaucoma
11 27/5/2021 Syamsuddin/ 38 thn 140279
post
Trabekulektomi
ODS Secondary
Angle Closure
12 31/5/2021 Ny. Hafsah/50 tahun 146756 Glaucoma, OD
Neovascular
Glaucoma
OD Secondary
Angle Closure
Glaucoma +
Keratopati Bulosa
Hambali Hamzah/
13 2/8/2021 151433 S/P
60 Tahun
Trabekulektomi +
5FU;
ODS Pseudofakia ,
OS PACS
14 2/8/2021 Hasanuddin Kamal/ 159827 OD POAG +
58 Tahun Pseudofakia+
Myop degeneratif
OS POAG +
Pseudofakia post
trabekulektomi +

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 5FU + releasable
suture
ODS NPDR, ODS
Dry Eye + DM Tipe
II
OD PAC Post LPI
+ Katarak Senilis
Imatur + OS
Pseudofakia +
PACG Post Acute
Attack Post
Trabekulektomi + 5
FU + Malignant
Muh. Sawe/ 68 Glaucoma SP/
15 2/8/2021 159681
Tahun Vitrektomi Anterior
+ IZHVS (Irido-
Zonule-Hyaloid
Vitreous Surgery)+
Decompresive
Retinopaty +
Macula edema
Post Injeksi Anti
VEGF
OD JOAG +
keratopati bullosa+
sikatrik kornea
OS JOAG +
Muh. Fatwa Raihan/
16 2/8/2021 160803 keratopati bullosa
15 Tahun
post trabekulektomi
+ EUA + needling
+ injeksi 5FU
subkonjungtiva
OS Afakia +
Secondary Angle
Closure Glaucoma
Without Pupillary
Bahrul Nur
17 2/8/2021 159181 Block + Vitreous
Malagunna
hemorragic +
Retinal
Detachment post
GDD implant
OD PAC Post LPI
+ Post
Trabekulektomi +
5FU; OS PACG
18 2/8/2021 Manisang / 53 tahun 155377
Post
Trabekulektomi +
5FU ODS Dry Eyes
+ keratitis pungtat
19 2/8/2021 Ikbal Fauzan/ 18 159988 ODS Secondary
tahun Open Open Angle
Glaucoma ec
Steroid induced
glaucoma Post

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Trabekulektomi +
5FU + releasable
suture + Vernal
Keratokonjungtivitis
+ Severe Dry Eye,
OD Katarak
ODS JOAG +
Moderate Dry Eye
+ Superficial
20 3/8/2021 Wahida/ 36 Tahun 159021 punctate keratitis
OD Compound
Myop Astigmat
OS Myop Gravior
ODS SACG
without pupillary
block ec ocular
inflammation; OD
Pseudofakia,
anterior Uveitis
Post Surgical
Wa Ode Amuma/ 44 Iridektomi + LPI +
21 3/8/2021 159483
Tahun Susp. Irvine Gass
Syndrome ;
OS Panuveitis +
Retinal
Detachment + Post
Trabekulektomi +
5FU + Katarak
Komplikata
OD Pseudofakia +
PACG post
Dorce Limbung/ 63
22 4/8/2021 160702 Trabekulektomi +
Tahun
5FU;
OS PAC post LPI
ODS SACG
without pupillary
block ec
Neovascular
23 4/8/2021 Herianto/ 39 Tahun 156472 Glaukoma
OD PDR + TRD
Post VPP + FAE +
EL + SO
OS PDR Post PRP
OD SOAG ec susp.
Muhammad Darwis/ Elevated Episcleral
24 4/8/2021 161815
58 Tahun Venous Pressure
ec TED
25 4/8/2021 Muh. Taufik L/ 21 159888 OD SOAG ec
Tahun Surgically induced
IOP elevation
OD Afakia +
Retinal Attached
post VPP +
Lensektomi + FAE

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 + EL + SO 1300
e.c.
Rhegmatogenous
Retinal
Detachment;
OS Katarak
Juvenile
Suspek Marfan
Syndrome
ODS POAG Post
trabekulektomi+
5FU + Keratitis
Pungtat; OD Post
Irigasi Aspirasi
Suud Awad/ 62
26 4/8/2021 148439 Sisa Korteks +
Tahun
Bleb Needling +
Injeksi 5 FU
OD Pseudofakia +
OS Katarak Senilis
Imatur
OD PACG +
chorioretinopathy
sup. High myopia
post trabekulektomi
+ releasable
Muhammad Nasir/
27 6/8/2021 160821 suture.
44Tahun
OS SACG with
pupillary block ec.
phacomorphic
glaucoma post
trabekulektomi
OD SOAG post
Retinal surgery
28 6/8/2021 Tandi/ 41 Tahun 145118 OS SACG without
pupillary block ec
NVG end-stage
OD SACG Without
pupillary block ec
Syarifuddin Dg. Vitreoretinal
29 6/8/2021 39846
Naba/ 45 Tahun Surgery S/P
Implantasi GDD +
Needling + 5 FU
OD PACG post LPI
+ OS PACG Post
30 6/8/2021 M. Tahir/ 68 Tahun 154954
Trabekulektomi +
5FU
31 6/8/2021 Poppy Mariyanti S/ 153704 OD Ptisis Bulbi +
66 Tahun OS Pseudofakia +
PACG Kronik +
Post
trabekulektomi +
5FU + Post Injeksi
5FU
Subkonjungtiva OD

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Ptisis Bulbi
OS SOAG ec
ocular inflammation
32 6/8/2021 Nari/ 60 Tahun 162780
(uveitis) on
treatment
OD Glaukoma
sekunder +
Glakukoma
33 7/8/2021 Bahtiar B/70 tahun 143637
absolute; OS
Plateau Iris
Syndrome
ODS Secondary
Glaucomas ec
A. Hesti Musfira/ 23 Axenfield Rieger
34 9/8/2021 134257
Tahun Syndrome Post
Trabekulektomi + 5
FU
OD Afakia +
Aniridia + OD
Secondary
Pediatric
Glaucoma post
Zhafran Khairy R/ 7 eksplantasi Virna
35 9/8/2021 144995
Tahun GDD + Ablatio
retina, OS
Secondary
Pediatric
Glaucoma +
Aniridia
OS Afakia +
iridodialisis post
repair kornea +
Akram Dzaki/ 10
36 9/8/2021 157940 SACG without
Tahun
pupillary block post
needling 5 FU +
Repair bleb
Suspect ODS
Ocular
Yanti Sadikun/ 38
37 9/8/2021 162992 Hypertension +
Tahun
ODS Keratitis
Exposure
ODS PDR + NVG
post laser PRP +
38 10/8/2021 Jusman/ 42 thn 162515
Injeksi avastin
intravitreal
OD Secondary
angle closure
glaucoma without
39 10/8/2021 Anzar/ 39 Tahun 163106
pupillary block ec
Uveitis , OS PACS
+ Dry Eye
40 10/8/2021 A. Syamsir AT/ 56 163109 OD SACG without
Tahun pupillary block ec
NVG Post

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 paracentesis +
Injeksi anti VEGF
intravitreal, OS
POAG
OD Pseudofakia +
Secondary Angle
Closure without
pupillary block post
Muhammad Ikbal implan GDD dan
41 12/8/2021 156997
Umar/ 8 tahun Removing Rip
Cord + Post
pupiloplasti +
Ekstraksi Katarak +
IOL
ODS  Pseudofakia
42 12/8/2021 Jumriani/ 27 tahun 160922 + NTG, OS Brown
Syndrome
ODS PACG+ ODS
43 12/8/2021 Masnur/ 47 Tahun 163265 Dry eye + Keratitis
Punctata
OD PAC post LPI +
Dry eye + KSI, OS
Post Implantasi
GDD + Post
Merry Rau/ 56
44 13/8/2021 143388 trabekulektomi + 5
Tahun
FU ec SOAG post
uveitis +
Pseudofakia +
keratopati
ODS Pseudofakia
+  Secondary
Syifa Permata H/ 8 pediatric glaucoma,
45 13/8/2021 102052
Tahun OD Post
Trabekulektomi +
5FU
OD NVG suspek
46 14/8/2021 Wa ode arsida 146761
post Uveitis
OD Pseudofakia +
retinal attached
post VPP + FAE+
EL + SO 5000; OD
secondary Open
47 18/8/2021 Fitriyani/ 34 Tahun 148779 angle glaucoma
post retinal
surgery; OS
Katarak senil
imatur + Post laser
PRP
ODS POAG, OD
48 18/8/2021 Darwis/ 36 Tahun 163663 post
Trabekulektomi
49 18/8/2021 Rahmatia / 36 96848 OD ulkus kornea +
Tahun Descematocele +
SOAG without

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 pupillary block ec
NVG post injeksi
Intrastromal,
Tractional retinal
detachment, OS
POAG post Laser
PRP, DM Tipe II
OD SACG without
pupillary block ec
Neovaskular
Glaucoma +
Abd. Ganing/ 65
50 18/8/2021 142746 Keratitis Pungtat
Tahun
OS Pseudofakia +
POAG Post
Trabekulektomi +
5FU
ODS PACG + OD
post
Trabekulektomi +
51 19/8/2021 Hasan K/ 74 Tahun 160396
5FU + ODS
keratitis + Katarak
senilis imatur
OD Pseudofakia;
OD PACG Acute
Attack post
Trabekulektomi + 5
FU + Sinekiolisis +
Muh. Saleh Azis/ 53
52 19/8/2021 161647 FAC (Flat anterior
Tahun
Chamber) gr3 ec
overfiltrasi DD/ low
tension malignant
glaucoma, OS PAC
Post LPI
OD PACG +
Pseudofakia,OS
53 24/8/2021 Muh Tahir/ 76 thn 160679 PACG Post
Trabekulektomi +
KSI
OD suspect PDR
dd/ NPDR, OS
54 30/8/2021 Nurham/ 56 thn 164865
Pseudofakia +
SOAG
ODS Ocular
55 6/9/2021 Darwis fadli/ 15 thn 165619 Hypertension DD/
JOAG

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 KEGIATAN DIAGNOSIS LENSA 90
Nama :
Tahap :
Semester :
Periode Tanggal :
Subdivisi : GLAUKOMA

NO Tanggal Nama Pasien / umur No. RM Diagnosa / Tindakan Supervisor Kode

Portofolio
Syarif Ali Husain/19 OD Normotension
6 4/5/2021 144205
tahun Glaucoma
OD SACG ec Lens
Induced Post
Hanaping Syam/ 52
7 6/5/2021 157452 Trabekulektomi+5F
tahun
U+ Releasable
Suture
ODS Open Angle
13.98.1 Glaucoma +
8 6/5/2021 Irmawati/49 tahun
5 Neovascular
Glaucoma
ODS Glaukoma
Zhafran Khairy/7 14.49.9 Kongenital +
9 7/5/2021
tahun 5 Aniridia + Ectopia
Lentis
ODS Juvenille
10 25/5/2021 Regis/53 tahun 143983 Open Angle
Glaucoma
ODS Primary Open
Angle Glaucoma
11 27/5/2021 Syamsuddin/ 38 thn 140279
post
Trabekulektomi
ODS Secondary
Angle Closure
12 31/5/2021 Ny. Hafsah/50 tahun 146756 Glaucoma, OD
Neovascular
Glaucoma
OD Secondary
Angle Closure
Glaucoma +
Keratopati Bulosa
Hambali Hamzah/
13 2/8/2021 151433 S/P
60 Tahun
Trabekulektomi +
5FU;
ODS Pseudofakia ,
OS PACS
14 2/8/2021 Hasanuddin Kamal/ 159827 OD POAG +
58 Tahun Pseudofakia+
Myop degeneratif
OS POAG +
Pseudofakia post
trabekulektomi +
5FU + releasable

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 suture
ODS NPDR, ODS
Dry Eye + DM Tipe
II
OD PAC Post LPI
+ Katarak Senilis
Imatur + OS
Pseudofakia +
PACG Post Acute
Attack Post
Trabekulektomi + 5
FU + Malignant
Muh. Sawe/ 68 Glaucoma SP/
15 2/8/2021 159681
Tahun Vitrektomi Anterior
+ IZHVS (Irido-
Zonule-Hyaloid
Vitreous Surgery)+
Decompresive
Retinopaty +
Macula edema
Post Injeksi Anti
VEGF
OD JOAG +
keratopati bullosa+
sikatrik kornea
OS JOAG +
Muh. Fatwa Raihan/
16 2/8/2021 160803 keratopati bullosa
15 Tahun
post trabekulektomi
+ EUA + needling
+ injeksi 5FU
subkonjungtiva
OS Afakia +
Secondary Angle
Closure Glaucoma
Without Pupillary
Bahrul Nur
17 2/8/2021 159181 Block + Vitreous
Malagunna
hemorragic +
Retinal
Detachment post
GDD implant
OD PAC Post LPI
+ Post
Trabekulektomi +
5FU; OS PACG
18 2/8/2021 Manisang / 53 tahun 155377
Post
Trabekulektomi +
5FU ODS Dry Eyes
+ keratitis pungtat
19 2/8/2021 Ikbal Fauzan/ 18 159988 ODS Secondary
tahun Open Open Angle
Glaucoma ec
Steroid induced
glaucoma Post
Trabekulektomi +

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 5FU + releasable
suture + Vernal
Keratokonjungtivitis
+ Severe Dry Eye,
OD Katarak
ODS JOAG +
Moderate Dry Eye
+ Superficial
20 3/8/2021 Wahida/ 36 Tahun 159021 punctate keratitis
OD Compound
Myop Astigmat
OS Myop Gravior
ODS SACG
without pupillary
block ec ocular
inflammation; OD
Pseudofakia,
anterior Uveitis
Post Surgical
Wa Ode Amuma/ 44 Iridektomi + LPI +
21 3/8/2021 159483
Tahun Susp. Irvine Gass
Syndrome ;
OS Panuveitis +
Retinal
Detachment + Post
Trabekulektomi +
5FU + Katarak
Komplikata
OD Pseudofakia +
PACG post
Dorce Limbung/ 63
22 4/8/2021 160702 Trabekulektomi +
Tahun
5FU;
OS PAC post LPI
ODS SACG
without pupillary
block ec
Neovascular
23 4/8/2021 Herianto/ 39 Tahun 156472 Glaukoma
OD PDR + TRD
Post VPP + FAE +
EL + SO
OS PDR Post PRP
OD SOAG ec susp.
Muhammad Darwis/ Elevated Episcleral
24 4/8/2021 161815
58 Tahun Venous Pressure
ec TED
25 4/8/2021 Muh. Taufik L/ 21 159888 OD SOAG ec
Tahun Surgically induced
IOP elevation
OD Afakia +
Retinal Attached
post VPP +
Lensektomi + FAE
+ EL + SO 1300

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 e.c.
Rhegmatogenous
Retinal
Detachment;
OS Katarak
Juvenile
Suspek Marfan
Syndrome
ODS POAG Post
trabekulektomi+
5FU + Keratitis
Pungtat; OD Post
Irigasi Aspirasi
Suud Awad/ 62
26 4/8/2021 148439 Sisa Korteks +
Tahun
Bleb Needling +
Injeksi 5 FU
OD Pseudofakia +
OS Katarak Senilis
Imatur
OD PACG +
chorioretinopathy
sup. High myopia
post trabekulektomi
+ releasable
Muhammad Nasir/
27 6/8/2021 160821 suture.
44Tahun
OS SACG with
pupillary block ec.
phacomorphic
glaucoma post
trabekulektomi
OD SOAG post
Retinal surgery
28 6/8/2021 Tandi/ 41 Tahun 145118 OS SACG without
pupillary block ec
NVG end-stage
OD SACG Without
pupillary block ec
Syarifuddin Dg. Vitreoretinal
29 6/8/2021 39846
Naba/ 45 Tahun Surgery S/P
Implantasi GDD +
Needling + 5 FU
OD PACG post LPI
+ OS PACG Post
30 6/8/2021 M. Tahir/ 68 Tahun 154954
Trabekulektomi +
5FU
OD Ptisis Bulbi +
OS Pseudofakia +
PACG Kronik +
Post
Poppy Mariyanti S/
31 6/8/2021 153704 trabekulektomi +
66 Tahun
5FU + Post Injeksi
5FU
Subkonjungtiva OD
Ptisis Bulbi

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 OS SOAG ec
ocular inflammation
32 6/8/2021 Nari/ 60 Tahun 162780
(uveitis) on
treatment
OD Glaukoma
sekunder +
Glakukoma
33 7/8/2021 Bahtiar B/70 tahun 143637
absolute; OS
Plateau Iris
Syndrome
ODS Secondary
Glaucomas ec
A. Hesti Musfira/ 23 Axenfield Rieger
34 9/8/2021 134257
Tahun Syndrome Post
Trabekulektomi + 5
FU
OD Afakia +
Aniridia + OD
Secondary
Pediatric
Glaucoma post
Zhafran Khairy R/ 7 eksplantasi Virna
35 9/8/2021 144995
Tahun GDD + Ablatio
retina, OS
Secondary
Pediatric
Glaucoma +
Aniridia
OS Afakia +
iridodialisis post
repair kornea +
Akram Dzaki/ 10
36 9/8/2021 157940 SACG without
Tahun
pupillary block post
needling 5 FU +
Repair bleb
Suspect ODS
Ocular
Yanti Sadikun/ 38
37 9/8/2021 162992 Hypertension +
Tahun
ODS Keratitis
Exposure
ODS PDR + NVG
post laser PRP +
38 10/8/2021 Jusman/ 42 thn 162515
Injeksi avastin
intravitreal
OD Secondary
angle closure
glaucoma without
39 10/8/2021 Anzar/ 39 Tahun 163106
pupillary block ec
Uveitis , OS PACS
+ Dry Eye
40 10/8/2021 A. Syamsir AT/ 56 163109 OD SACG without
Tahun pupillary block ec
NVG Post
paracentesis +

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Injeksi anti VEGF
intravitreal, OS
POAG
OD Pseudofakia +
Secondary Angle
Closure without
pupillary block post
Muhammad Ikbal implan GDD dan
41 12/8/2021 156997
Umar/ 8 tahun Removing Rip
Cord + Post
pupiloplasti +
Ekstraksi Katarak +
IOL
ODS  Pseudofakia
42 12/8/2021 Jumriani/ 27 tahun 160922 + NTG, OS Brown
Syndrome
ODS PACG+ ODS
43 12/8/2021 Masnur/ 47 Tahun 163265 Dry eye + Keratitis
Punctata
OD PAC post LPI +
Dry eye + KSI, OS
Post Implantasi
GDD + Post
Merry Rau/ 56
44 13/8/2021 143388 trabekulektomi + 5
Tahun
FU ec SOAG post
uveitis +
Pseudofakia +
keratopati
ODS Pseudofakia
+  Secondary
Syifa Permata H/ 8 pediatric glaucoma,
45 13/8/2021 102052
Tahun OD Post
Trabekulektomi +
5FU
OD NVG suspek
46 14/8/2021 Wa ode arsida 146761
post Uveitis
OD Pseudofakia +
retinal attached
post VPP + FAE+
EL + SO 5000; OD
secondary Open
47 18/8/2021 Fitriyani/ 34 Tahun 148779 angle glaucoma
post retinal
surgery; OS
Katarak senil
imatur + Post laser
PRP
ODS POAG, OD
48 18/8/2021 Darwis/ 36 Tahun 163663 post
Trabekulektomi
49 18/8/2021 Rahmatia / 36 96848 OD ulkus kornea +
Tahun Descematocele +
SOAG without
pupillary block ec

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 NVG post injeksi
Intrastromal,
Tractional retinal
detachment, OS
POAG post Laser
PRP, DM Tipe II
OD SACG without
pupillary block ec
Neovaskular
Glaucoma +
Abd. Ganing/ 65
50 18/8/2021 142746 Keratitis Pungtat
Tahun
OS Pseudofakia +
POAG Post
Trabekulektomi +
5FU

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 KEGIATAN DIAGNOSIS INDIRECT FUNDUSCOPY
Nama :
Tahap :
Semester :
Periode Tanggal :
Subdivisi : GLAUKOMA

NO Tanggal Nama Pasien / umur No. RM Diagnosa / Tindakan Supervisor Kode

Portofolio
OD Pseudofakia +
Secondary Angle
Closure without
pupillary block post
Muhammad Ikbal implan GDD dan
41 12/8/2021 156997
Umar/ 8 tahun Removing Rip
Cord + Post
pupiloplasti +
Ekstraksi Katarak +
IOL
ODS  Pseudofakia
42 12/8/2021 Jumriani/ 27 tahun 160922 + NTG, OS Brown
Syndrome
ODS PACG+ ODS
43 12/8/2021 Masnur/ 47 Tahun 163265 Dry eye + Keratitis
Punctata
OD PAC post LPI +
Dry eye + KSI, OS
Post Implantasi
GDD + Post
Merry Rau/ 56
44 13/8/2021 143388 trabekulektomi + 5
Tahun
FU ec SOAG post
uveitis +
Pseudofakia +
keratopati
ODS Pseudofakia
+  Secondary
Syifa Permata H/ 8 pediatric glaucoma,
45 13/8/2021 102052
Tahun OD Post
Trabekulektomi +
5FU
OD NVG suspek
46 14/8/2021 Wa ode arsida 146761
post Uveitis
47 18/8/2021 Fitriyani/ 34 Tahun 148779 OD Pseudofakia +
retinal attached
post VPP + FAE+
EL + SO 5000; OD
secondary Open
angle glaucoma
post retinal
surgery; OS
Katarak senil
imatur + Post laser

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 PRP
ODS POAG, OD
48 18/8/2021 Darwis/ 36 Tahun 163663 post
Trabekulektomi
OD ulkus kornea +
Descematocele +
SOAG without
pupillary block ec
Rahmatia / 36 NVG post injeksi
49 18/8/2021 96848
Tahun Intrastromal,
Tractional retinal
detachment, OS
POAG post Laser
PRP, DM Tipe II
OD SACG without
pupillary block ec
Neovaskular
Glaucoma +
Abd. Ganing/ 65
50 18/8/2021 142746 Keratitis Pungtat
Tahun
OS Pseudofakia +
POAG Post
Trabekulektomi +
5FU
ODS PACG + OD
post
Trabekulektomi +
51 19/8/2021 Hasan K/ 74 Tahun 160396
5FU + ODS
keratitis + Katarak
senilis imatur
OD Pseudofakia;
OD PACG Acute
Attack post
Trabekulektomi + 5
FU + Sinekiolisis +
Muh. Saleh Azis/ 53
52 19/8/2021 161647 FAC (Flat anterior
Tahun
Chamber) gr3 ec
overfiltrasi DD/ low
tension malignant
glaucoma, OS PAC
Post LPI
OD PACG +
Pseudofakia,OS
53 24/8/2021 Muh Tahir/ 76 thn 160679 PACG Post
Trabekulektomi +
KSI
OD suspect PDR
dd/ NPDR, OS
54 30/8/2021 Nurham/ 56 thn 164865
Pseudofakia +
SOAG
ODS Ocular
55 6/9/2021 Darwis fadli/ 15 thn 165619 Hypertension DD/
JOAG
56 16/9/2021 Idris Gaffar/ 54 thn 164423 ODS PACG Kronik
Post LPI, Post

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Surgical
Iridektomi , ODS
Katarak Senil
Imatur + Pterygium
Gr. II
Oculus Dextra
Inflammatory
glaucoma dd/
Steroid +
skleromalaise +
57 5/10/2021 A Reski / 19th 165742 sikatrik kornea post
uveitis ; Oculus
Sinistra PAC +
keratokonjungtivitis
Flikten + uveitis
posterior ?
OD Secondary
Angle Closure
Glaukoma e.c
Waode Mariani / Fakomorfik
58 5/10/2021 166857
57th Glaukoma Post
Trabekulektomi + 5
FU; ODS Katarak
senilis
OD post
penetrating
keratoplasti ec
59 6/10/2021 Nurul Aulia / 23th 157955 Leukoma Kornea
ec Ulkus Kornea +
OHT, OS Stafiloma
Kornea
OD Secondary
60 6/10/2021 Suardi / 28th 167570 Open Angle
Glaucoma
OD PAC, OS
61 6/10/2021 Kasma / 64th 167667 PACG post acute
attack, ODS KSI
OD Secondary
Angle Closure
Glaucoma e.c.
62 6/10/2021 Jamaluddin / 59th 167868
Subluksasi lensa
Post Surgical
Iridectomy 2 site
OS Secondary
Angle Closure +
Retinal Attached
Post VPP + FAE +
EL + SO 1300 +
Muhammad
63 7/10/2021 150924 Optic Capture Post
Fachrul / 15th
VPP + Evakuasi
IOL Drop +
Implantasi IOL
Sekunder, ODS
Pseudofakia

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 OD PACG post
acute attack dd/
Muhammad Mujib /
64 7/10/2021 168273 sub acute angle
32th
closure glaucoma,
OS PACG
OS Secondary
Angle Closure
Glaucoma susp
65 7/10/2021 Hamsina/ 52 Tahun 168313 inflammatory
glaucoma +
suspect TON + HT
grade II
ODS PACG post
acute attack S/P
Trabekulektomi + 5
FU + Premature
66 8/10/2021 Murni / 77th 167201 Entry,OD severe
glaucoma, ODS
Inflamatory
glaucoma (SACG),
OS Ptisis Bulbi
OS post implantasi
GDD ec NVG
suspek iskemik
67 8/10/2021 Liling / 71th 165688 posterior ; OD
retinopathy
hipertensi grade II;
ODS KSI
OD PAC Post LPI,
OS PACG post
68 8/10/2021 Ny. Kasma / 59th 167494
acute Attack, ODS
KSI
OS post implantasi
La Ode Pribadi Minu
69 8/10/2021 144252 GDD ec NVG ;
/ 45th
ODS PDR + DME
OS Phacomorfic
Glaucoma ec
70 11/10/2021 Habo / 64th 168567
Subluksai Lensa ec
Trauma
OS SOAG + Post
Evakuasi Silicon
71 11/10/2021 Basman / 38th 142539
Oil + ODS
Pseudofakia
OS PACG Post
72 11/10/2021 Hasnah / 63th 168566 Trabekulektomi +
5FU, OD PACG
OD Post
Trabekulektomi +
5FU, ODS PACG +
73 11/10/2021 Damaris Lisu / 52th 143698
Katarak Senilis
Imatur + severe dry
eye
74 11/10/2021 Nuraeni / 58th 100870 OD ADVANCE
PACG post

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Trabekulektomi +
Pseudofakia, OS
APAC post
Trabekulektomi +
5FU
OD PACS post LPI
+ OS Acute
Primary Angle
75 13/10/2021 Rohana/ 64 thn 153230
Closure post
Trabekulektomi + 5
FU
suspect NTG dd/
76 13/10/2021 Rahmat Kurniawan / 168730
JOAG
OD NTG dd
77 13/10/2021 Budiman Tjaru / 65th 168814
POAG, OS PACG
OD pseudofakia +
S/P
Trabekulektomi et
cause PAC +
78 13/10/2021 Ristianto / 68th 164250 Phacormorphic
glaucoma; OS
PACS Post LPI;
ODS Severe dry
eye
Computer vision
Lilis Ambarwati / syndrome +
79 14/10/2021 168904
28th Convergence
Insuficiensy
ODS Normotension
80 14/10/2021 Kalma / 56th 168588
Glaukoma Suspect
OD PEX
syndrome, OS
SACG et causa
81 14/10/2021 Hinara Masua / 80th 168915 PEX glaucoma +
Suspek subluklasi
Lensa + Bullous
Keratopathy
ODS Post
Syamsuddin/ 66 Trabeculectomy +
82 15/10/2021 83503
Tahun 5FU+ Re-needling
ec POAG
OS SACG et causa
83 15/10/2021 Hadawiah / 50th 168983 Suspek drug
induced glaucoma
ODS Primary
Congenital
Glaucoma late
onset, OD Post
84 18/10/2021 Muh. Al Gazalih / 5th 167591
Trabekulektomi +
trabekulotomi +
injeksi 5FU
subkonjungtiva
85 18/10/2021 Muh. Akmal Wahyu / 165996 OS Pseudofakia
29th post Lensektomi +

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Sinekiolisis +
Implantasi IOL +
Injeksi Intrakameral
+ Neovaskular
Glaukoma.
OD PACG Post
86 18/10/2021 Yohanis Agul / 52th 158452 Acute Attack ,OS
PAC
Oculus Sinistra
Amir Syam/ 69
87 19/10/2021 69638 Normotension
Tahun
Glaucoma

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 KEGIATAN DIAGNOSIS APLANASI GOLDMAN
Nama :
Tahap :
Semester :
Periode Tanggal :
Subdivisi : GLAUKOMA

NO Tanggal Nama Pasien / umur No. RM Diagnosa / Tindakan Supervisor Kode

Portofolio
OD PAC post LPI +
Dry eye + KSI, OS
Post Implantasi
GDD + Post
Merry Rau/ 56
44 13/8/2021 143388 trabekulektomi + 5
Tahun
FU ec SOAG post
uveitis +
Pseudofakia +
keratopati
ODS Pseudofakia
+  Secondary
Syifa Permata H/ 8 pediatric glaucoma,
45 13/8/2021 102052
Tahun OD Post
Trabekulektomi +
5FU
OD NVG suspek
46 14/8/2021 Wa ode arsida 146761
post Uveitis
OD Pseudofakia +
retinal attached
post VPP + FAE+
EL + SO 5000; OD
secondary Open
47 18/8/2021 Fitriyani/ 34 Tahun 148779 angle glaucoma
post retinal
surgery; OS
Katarak senil
imatur + Post laser
PRP
ODS POAG, OD
48 18/8/2021 Darwis/ 36 Tahun 163663 post
Trabekulektomi
OD ulkus kornea +
Descematocele +
SOAG without
pupillary block ec
Rahmatia / 36 NVG post injeksi
49 18/8/2021 96848
Tahun Intrastromal,
Tractional retinal
detachment, OS
POAG post Laser
PRP, DM Tipe II
50 18/8/2021 Abd. Ganing/ 65 142746 OD SACG without
Tahun pupillary block ec

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Neovaskular
Glaucoma +
Keratitis Pungtat
OS Pseudofakia +
POAG Post
Trabekulektomi +
5FU
ODS PACG + OD
post
Trabekulektomi +
51 19/8/2021 Hasan K/ 74 Tahun 160396
5FU + ODS
keratitis + Katarak
senilis imatur
OD Pseudofakia;
OD PACG Acute
Attack post
Trabekulektomi + 5
FU + Sinekiolisis +
Muh. Saleh Azis/ 53
52 19/8/2021 161647 FAC (Flat anterior
Tahun
Chamber) gr3 ec
overfiltrasi DD/ low
tension malignant
glaucoma, OS PAC
Post LPI
OD PACG +
Pseudofakia,OS
53 24/8/2021 Muh Tahir/ 76 thn 160679 PACG Post
Trabekulektomi +
KSI
OD suspect PDR
dd/ NPDR, OS
54 30/8/2021 Nurham/ 56 thn 164865
Pseudofakia +
SOAG
ODS Ocular
55 6/9/2021 Darwis fadli/ 15 thn 165619 Hypertension DD/
JOAG
ODS PACG Kronik
Post LPI, Post
Surgical
56 16/9/2021 Idris Gaffar/ 54 thn 164423 Iridektomi , ODS
Katarak Senil
Imatur + Pterygium
Gr. II
Oculus Dextra
Inflammatory
glaucoma dd/
Steroid +
skleromalaise +
57 5/10/2021 A Reski / 19th 165742 sikatrik kornea post
uveitis ; Oculus
Sinistra PAC +
keratokonjungtivitis
Flikten + uveitis
posterior ?

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 OD Secondary
Angle Closure
Glaukoma e.c
Waode Mariani / Fakomorfik
58 5/10/2021 166857
57th Glaukoma Post
Trabekulektomi + 5
FU; ODS Katarak
senilis
OD post
penetrating
keratoplasti ec
59 6/10/2021 Nurul Aulia / 23th 157955 Leukoma Kornea
ec Ulkus Kornea +
OHT, OS Stafiloma
Kornea
OD Secondary
60 6/10/2021 Suardi / 28th 167570 Open Angle
Glaucoma
OD PAC, OS
61 6/10/2021 Kasma / 64th 167667 PACG post acute
attack, ODS KSI
OD Secondary
Angle Closure
Glaucoma e.c.
62 6/10/2021 Jamaluddin / 59th 167868
Subluksasi lensa
Post Surgical
Iridectomy 2 site
OS Secondary
Angle Closure +
Retinal Attached
Post VPP + FAE +
EL + SO 1300 +
Muhammad
63 7/10/2021 150924 Optic Capture Post
Fachrul / 15th
VPP + Evakuasi
IOL Drop +
Implantasi IOL
Sekunder, ODS
Pseudofakia
OD PACG post
acute attack dd/
Muhammad Mujib /
64 7/10/2021 168273 sub acute angle
32th
closure glaucoma,
OS PACG
OS Secondary
Angle Closure
Glaucoma susp
65 7/10/2021 Hamsina/ 52 Tahun 168313 inflammatory
glaucoma +
suspect TON + HT
grade II
66 8/10/2021 Murni / 77th 167201 ODS PACG post
acute attack S/P
Trabekulektomi + 5
FU + Premature

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Entry,OD severe
glaucoma, ODS
Inflamatory
glaucoma (SACG),
OS Ptisis Bulbi
OS post implantasi
GDD ec NVG
suspek iskemik
67 8/10/2021 Liling / 71th 165688 posterior ; OD
retinopathy
hipertensi grade II;
ODS KSI
OD PAC Post LPI,
OS PACG post
68 8/10/2021 Ny. Kasma / 59th 167494
acute Attack, ODS
KSI
OS post implantasi
La Ode Pribadi Minu
69 8/10/2021 144252 GDD ec NVG ;
/ 45th
ODS PDR + DME
OS Phacomorfic
Glaucoma ec
70 11/10/2021 Habo / 64th 168567
Subluksai Lensa ec
Trauma
OS SOAG + Post
Evakuasi Silicon
71 11/10/2021 Basman / 38th 142539
Oil + ODS
Pseudofakia
OS PACG Post
72 11/10/2021 Hasnah / 63th 168566 Trabekulektomi +
5FU, OD PACG
OD Post
Trabekulektomi +
5FU, ODS PACG +
73 11/10/2021 Damaris Lisu / 52th 143698
Katarak Senilis
Imatur + severe dry
eye
OD ADVANCE
PACG post
Trabekulektomi +
74 11/10/2021 Nuraeni / 58th 100870 Pseudofakia, OS
APAC post
Trabekulektomi +
5FU
OD PACS post LPI
+ OS Acute
Primary Angle
75 13/10/2021 Rohana/ 64 thn 153230
Closure post
Trabekulektomi + 5
FU
suspect NTG dd/
76 13/10/2021 Rahmat Kurniawan / 168730
JOAG
OD NTG dd
77 13/10/2021 Budiman Tjaru / 65th 168814
POAG, OS PACG
78 13/10/2021 Ristianto / 68th 164250 OD pseudofakia +

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 S/P
Trabekulektomi et
cause PAC +
Phacormorphic
glaucoma; OS
PACS Post LPI;
ODS Severe dry
eye
Computer vision
Lilis Ambarwati / syndrome +
79 14/10/2021 168904
28th Convergence
Insuficiensy
ODS Normotension
80 14/10/2021 Kalma / 56th 168588
Glaukoma Suspect
OD PEX
syndrome, OS
SACG et causa
81 14/10/2021 Hinara Masua / 80th 168915 PEX glaucoma +
Suspek subluklasi
Lensa + Bullous
Keratopathy
ODS Post
Syamsuddin/ 66 Trabeculectomy +
82 15/10/2021 83503
Tahun 5FU+ Re-needling
ec POAG
OS SACG et causa
83 15/10/2021 Hadawiah / 50th 168983 Suspek drug
induced glaucoma
ODS Primary
Congenital
Glaucoma late
onset, OD Post
84 18/10/2021 Muh. Al Gazalih / 5th 167591
Trabekulektomi +
trabekulotomi +
injeksi 5FU
subkonjungtiva
OS Pseudofakia
post Lensektomi +
Sinekiolisis +
Muh. Akmal Wahyu /
85 18/10/2021 165996 Implantasi IOL +
29th
Injeksi Intrakameral
+ Neovaskular
Glaukoma.
OD PACG Post
86 18/10/2021 Yohanis Agul / 52th 158452 Acute Attack ,OS
PAC
Oculus Sinistra
Amir Syam/ 69
87 19/10/2021 69638 Normotension
Tahun
Glaucoma

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 KEGIATAN DIAGNOSIS TONOMETRI SCHIOTZ
Nama :
Tahap :
Semester :
Periode Tanggal :
Subdivisi : GLAUKOMA

NO Tanggal Nama Pasien / umur No. RM Diagnosa / Tindakan Supervisor Kode

Portofolio

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 KEGIATAN TINDAKAN BEDAH TRABEKULEKTOMI
Nama :
Tahap :
Semester :
Periode Tanggal :
Subdivisi : GLAUKOMA

NO Tanggal Nama Pasien / umur No. RM Diagnosa / Tindakan Supervisor Kode

Portofolio
ODS POAG Post
trabekulektomi+
5FU + Keratitis
Pungtat; OD Post
Irigasi Aspirasi
Suud Awad/ 62
26 4/8/2021 148439 Sisa Korteks +
Tahun
Bleb Needling +
Injeksi 5 FU
OD Pseudofakia +
OS Katarak Senilis
Imatur
OD PACG +
chorioretinopathy
sup. High myopia
post trabekulektomi
+ releasable
Muhammad Nasir/
27 6/8/2021 160821 suture.
44Tahun
OS SACG with
pupillary block ec.
phacomorphic
glaucoma post
trabekulektomi
OD SACG Without
pupillary block ec
Syarifuddin Dg. Vitreoretinal
29 6/8/2021 39846
Naba/ 45 Tahun Surgery S/P
Implantasi GDD +
Needling + 5 FU
OD PACG post LPI
+ OS PACG Post
30 6/8/2021 M. Tahir/ 68 Tahun 154954
Trabekulektomi +
5FU
31 6/8/2021 Poppy Mariyanti S/ 153704 OD Ptisis Bulbi +
66 Tahun OS Pseudofakia +
PACG Kronik +
Post
trabekulektomi +
5FU + Post Injeksi
5FU
Subkonjungtiva OD

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Ptisis Bulbi
OS SOAG ec
ocular inflammation
32 6/8/2021 Nari/ 60 Tahun 162780
(uveitis) on
treatment
ODS Secondary
Glaucomas ec
A. Hesti Musfira/ 23 Axenfield Rieger
34 9/8/2021 134257
Tahun Syndrome Post
Trabekulektomi + 5
FU
OD PAC post LPI +
Dry eye + KSI, OS
Post Implantasi
GDD + Post
Merry Rau/ 56
44 13/8/2021 143388 trabekulektomi + 5
Tahun
FU ec SOAG post
uveitis +
Pseudofakia +
keratopati
ODS Pseudofakia
+  Secondary
Syifa Permata H/ 8 pediatric glaucoma,
45 13/8/2021 102052
Tahun OD Post
Trabekulektomi +
5FU
ODS POAG, OD
48 18/8/2021 Darwis/ 36 Tahun 163663 post
Trabekulektomi
OD SACG without
pupillary block ec
Neovaskular
Glaucoma +
Abd. Ganing/ 65
50 18/8/2021 142746 Keratitis Pungtat
Tahun
OS Pseudofakia +
POAG Post
Trabekulektomi +
5FU
ODS PACG + OD
post
Trabekulektomi +
51 19/8/2021 Hasan K/ 74 Tahun 160396
5FU + ODS
keratitis + Katarak
senilis imatur
52 19/8/2021 Muh. Saleh Azis/ 53 161647 OD Pseudofakia;
Tahun OD PACG Acute
Attack post
Trabekulektomi + 5
FU + Sinekiolisis +
FAC (Flat anterior
Chamber) gr3 ec
overfiltrasi DD/ low
tension malignant
glaucoma, OS PAC

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Post LPI
OD PACG +
Pseudofakia,OS
53 24/8/2021 Muh Tahir/ 76 thn 160679 PACG Post
Trabekulektomi +
KSI
OD Secondary
Angle Closure
Glaukoma e.c
Waode Mariani / Fakomorfik
58 5/10/2021 166857
57th Glaukoma Post
Trabekulektomi + 5
FU; ODS Katarak
senilis
ODS PACG post
acute attack S/P
Trabekulektomi + 5
FU + Premature
66 8/10/2021 Murni / 77th 167201 Entry,OD severe
glaucoma, ODS
Inflamatory
glaucoma (SACG),
OS Ptisis Bulbi
OS PACG Post
72 11/10/2021 Hasnah / 63th 168566 Trabekulektomi +
5FU, OD PACG
OD Post
Trabekulektomi +
5FU, ODS PACG +
73 11/10/2021 Damaris Lisu / 52th 143698
Katarak Senilis
Imatur + severe dry
eye
OD ADVANCE
PACG post
Trabekulektomi +
74 11/10/2021 Nuraeni / 58th 100870 Pseudofakia, OS
APAC post
Trabekulektomi +
5FU
OD PACS post LPI
+ OS Acute
Primary Angle
75 13/10/2021 Rohana/ 64 thn 153230
Closure post
Trabekulektomi + 5
FU
OD pseudofakia +
S/P
Trabekulektomi et
cause PAC +
78 13/10/2021 Ristianto / 68th 164250 Phacormorphic
glaucoma; OS
PACS Post LPI;
ODS Severe dry
eye

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 ODS Primary
Congenital
Glaucoma late
onset, OD Post
84 18/10/2021 Muh. Al Gazalih / 5th 167591
Trabekulektomi +
trabekulotomi +
injeksi 5FU
subkonjungtiva

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 KEGIATAN TINDAKAN BEDAH LASER IRIDOTOMI
Nama :
Tahap :
Semester :
Periode Tanggal :
Subdivisi : GLAUKOMA

NO Tanggal Nama Pasien / umur No. RM Diagnosa / Tindakan Supervisor Kode

Portofolio
ODS SACG
without pupillary
block ec ocular
inflammation; OD
Pseudofakia,
anterior Uveitis
Post Surgical
Wa Ode Amuma/ 44 Iridektomi + LPI +
21 3/8/2021 159483
Tahun Susp. Irvine Gass
Syndrome ;
OS Panuveitis +
Retinal
Detachment + Post
Trabekulektomi +
5FU + Katarak
Komplikata
ODS PACG Kronik
Post LPI, Post
Surgical
56 16/9/2021 Idris Gaffar/ 54 thn 164423 Iridektomi , ODS
Katarak Senil
Imatur + Pterygium
Gr. II

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 RESUME PORTO FOLIO SUBDIVISI

GLAUKOMA
Nama :
Subdivisi : GLAUKOMA

NO Tanggal Nama Pasien / umur No. RM Diagnosa / Tindakan Supervisor Kode

Portofolio
ODS POAG Post
trabekulektomi+
5FU + Keratitis
Pungtat; OD Post
Irigasi Aspirasi
Suud Awad/ 62
26 4/8/2021 148439 Sisa Korteks +
Tahun
Bleb Needling +
Injeksi 5 FU
OD Pseudofakia +
OS Katarak Senilis
Imatur
OD PACG +
chorioretinopathy
sup. High myopia
post trabekulektomi
+ releasable
Muhammad Nasir/
27 6/8/2021 160821 suture.
44Tahun
OS SACG with
pupillary block ec.
phacomorphic
glaucoma post
trabekulektomi
OD SOAG post
Retinal surgery
28 6/8/2021 Tandi/ 41 Tahun 145118 OS SACG without
pupillary block ec
NVG end-stage
OD SACG Without
pupillary block ec
Syarifuddin Dg. Vitreoretinal
29 6/8/2021 39846
Naba/ 45 Tahun Surgery S/P
Implantasi GDD +
Needling + 5 FU
OD PACG post LPI
+ OS PACG Post
30 6/8/2021 M. Tahir/ 68 Tahun 154954
Trabekulektomi +
5FU

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 OD Ptisis Bulbi +
OS Pseudofakia +
PACG Kronik +
Post
Poppy Mariyanti S/
31 6/8/2021 153704 trabekulektomi +
66 Tahun
5FU + Post Injeksi
5FU
Subkonjungtiva OD
Ptisis Bulbi
OS SOAG ec
ocular inflammation
32 6/8/2021 Nari/ 60 Tahun 162780
(uveitis) on
treatment
OD Glaukoma
sekunder +
Glakukoma
33 7/8/2021 Bahtiar B/70 tahun 143637
absolute; OS
Plateau Iris
Syndrome
ODS Secondary
Glaucomas ec
A. Hesti Musfira/ 23 Axenfield Rieger
34 9/8/2021 134257
Tahun Syndrome Post
Trabekulektomi + 5
FU
OD Afakia +
Aniridia + OD
Secondary
Pediatric
Glaucoma post
Zhafran Khairy R/ 7 eksplantasi Virna
35 9/8/2021 144995
Tahun GDD + Ablatio
retina, OS
Secondary
Pediatric
Glaucoma +
Aniridia
OS Afakia +
iridodialisis post
repair kornea +
Akram Dzaki/ 10
36 9/8/2021 157940 SACG without
Tahun
pupillary block post
needling 5 FU +
Repair bleb
Suspect ODS
Ocular
Yanti Sadikun/ 38
37 9/8/2021 162992 Hypertension +
Tahun
ODS Keratitis
Exposure
ODS PDR + NVG
post laser PRP +
38 10/8/2021 Jusman/ 42 thn 162515
Injeksi avastin
intravitreal
39 10/8/2021 Anzar/ 39 Tahun 163106 OD Secondary

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 angle closure
glaucoma without
pupillary block ec
Uveitis , OS PACS
+ Dry Eye
OD SACG without
pupillary block ec
NVG Post
A. Syamsir AT/ 56
40 10/8/2021 163109 paracentesis +
Tahun
Injeksi anti VEGF
intravitreal, OS
POAG
OD Pseudofakia +
Secondary Angle
Closure without
pupillary block post
Muhammad Ikbal implan GDD dan
41 12/8/2021 156997
Umar/ 8 tahun Removing Rip
Cord + Post
pupiloplasti +
Ekstraksi Katarak +
IOL
ODS  Pseudofakia
42 12/8/2021 Jumriani/ 27 tahun 160922 + NTG, OS Brown
Syndrome
ODS PACG+ ODS
43 12/8/2021 Masnur/ 47 Tahun 163265 Dry eye + Keratitis
Punctata
OD PAC post LPI +
Dry eye + KSI, OS
Post Implantasi
GDD + Post
Merry Rau/ 56
44 13/8/2021 143388 trabekulektomi + 5
Tahun
FU ec SOAG post
uveitis +
Pseudofakia +
keratopati
ODS Pseudofakia
+  Secondary
Syifa Permata H/ 8 pediatric glaucoma,
45 13/8/2021 102052
Tahun OD Post
Trabekulektomi +
5FU
OD NVG suspek
46 14/8/2021 Wa ode arsida 146761
post Uveitis
47 18/8/2021 Fitriyani/ 34 Tahun 148779 OD Pseudofakia +
retinal attached
post VPP + FAE+
EL + SO 5000; OD
secondary Open
angle glaucoma
post retinal
surgery; OS
Katarak senil

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 imatur + Post laser
PRP
ODS POAG, OD
48 18/8/2021 Darwis/ 36 Tahun 163663 post
Trabekulektomi
OD ulkus kornea +
Descematocele +
SOAG without
pupillary block ec
Rahmatia / 36 NVG post injeksi
49 18/8/2021 96848
Tahun Intrastromal,
Tractional retinal
detachment, OS
POAG post Laser
PRP, DM Tipe II
OD SACG without
pupillary block ec
Neovaskular
Glaucoma +
Abd. Ganing/ 65
50 18/8/2021 142746 Keratitis Pungtat
Tahun
OS Pseudofakia +
POAG Post
Trabekulektomi +
5FU
ODS PACG + OD
post
Trabekulektomi +
51 19/8/2021 Hasan K/ 74 Tahun 160396
5FU + ODS
keratitis + Katarak
senilis imatur
OD Pseudofakia;
OD PACG Acute
Attack post
Trabekulektomi + 5
FU + Sinekiolisis +
Muh. Saleh Azis/ 53
52 19/8/2021 161647 FAC (Flat anterior
Tahun
Chamber) gr3 ec
overfiltrasi DD/ low
tension malignant
glaucoma, OS PAC
Post LPI
OD PACG +
Pseudofakia,OS
53 24/8/2021 Muh Tahir/ 76 thn 160679 PACG Post
Trabekulektomi +
KSI
OD suspect PDR
dd/ NPDR, OS
54 30/8/2021 Nurham/ 56 thn 164865
Pseudofakia +
SOAG
ODS Ocular
55 6/9/2021 Darwis fadli/ 15 thn 165619 Hypertension DD/
JOAG
56 16/9/2021 Idris Gaffar/ 54 thn 164423 ODS PACG Kronik

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Post LPI, Post
Surgical
Iridektomi , ODS
Katarak Senil
Imatur + Pterygium
Gr. II
Oculus Dextra
Inflammatory
glaucoma dd/
Steroid +
skleromalaise +
57 5/10/2021 A Reski / 19th 165742 sikatrik kornea post
uveitis ; Oculus
Sinistra PAC +
keratokonjungtivitis
Flikten + uveitis
posterior ?
OD Secondary
Angle Closure
Glaukoma e.c
Waode Mariani / Fakomorfik
58 5/10/2021 166857
57th Glaukoma Post
Trabekulektomi + 5
FU; ODS Katarak
senilis
OD post
penetrating
keratoplasti ec
59 6/10/2021 Nurul Aulia / 23th 157955 Leukoma Kornea
ec Ulkus Kornea +
OHT, OS Stafiloma
Kornea
OD Secondary
60 6/10/2021 Suardi / 28th 167570 Open Angle
Glaucoma
OD PAC, OS
61 6/10/2021 Kasma / 64th 167667 PACG post acute
attack, ODS KSI
OD Secondary
Angle Closure
Glaucoma e.c.
62 6/10/2021 Jamaluddin / 59th 167868
Subluksasi lensa
Post Surgical
Iridectomy 2 site
63 7/10/2021 Muhammad 150924 OS Secondary
Fachrul / 15th Angle Closure +
Retinal Attached
Post VPP + FAE +
EL + SO 1300 +
Optic Capture Post
VPP + Evakuasi
IOL Drop +
Implantasi IOL
Sekunder, ODS

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Pseudofakia
OD PACG post
acute attack dd/
Muhammad Mujib /
64 7/10/2021 168273 sub acute angle
32th
closure glaucoma,
OS PACG
OS Secondary
Angle Closure
Glaucoma susp
65 7/10/2021 Hamsina/ 52 Tahun 168313 inflammatory
glaucoma +
suspect TON + HT
grade II
8/10/2021 Murni / 77th 167201 ODS PACG post
acute attack S/P
Trabekulektomi + 5
FU + Premature
66 Entry,OD severe
glaucoma, ODS
Inflamatory
glaucoma (SACG),
OS Ptisis Bulbi
OS post implantasi
GDD ec NVG
suspek iskemik
67 8/10/2021 Liling / 71th 165688 posterior ; OD
retinopathy
hipertensi grade II;
ODS KSI
OD PAC Post LPI,
OS PACG post
68 8/10/2021 Ny. Kasma / 59th 167494
acute Attack, ODS
KSI
OS post implantasi
La Ode Pribadi Minu
69 8/10/2021 144252 GDD ec NVG ;
/ 45th
ODS PDR + DME
OS Phacomorfic
Glaucoma ec
70 11/10/2021 Habo / 64th 168567
Subluksai Lensa ec
Trauma
OS SOAG + Post
Evakuasi Silicon
71 11/10/2021 Basman / 38th 142539
Oil + ODS
Pseudofakia
OS PACG Post
72 11/10/2021 Hasnah / 63th 168566 Trabekulektomi +
5FU, OD PACG
OD Post
Trabekulektomi +
5FU, ODS PACG +
73 11/10/2021 Damaris Lisu / 52th 143698
Katarak Senilis
Imatur + severe dry
eye
74 11/10/2021 Nuraeni / 58th 100870 OD ADVANCE

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 PACG post
Trabekulektomi +
Pseudofakia, OS
APAC post
Trabekulektomi +
5FU
OD PACS post LPI
+ OS Acute
Primary Angle
75 13/10/2021 Rohana/ 64 thn 153230
Closure post
Trabekulektomi + 5
FU
suspect NTG dd/
76 13/10/2021 Rahmat Kurniawan / 168730
JOAG
OD NTG dd
77 13/10/2021 Budiman Tjaru / 65th 168814
POAG, OS PACG
OD pseudofakia +
S/P
Trabekulektomi et
cause PAC +
78 13/10/2021 Ristianto / 68th 164250 Phacormorphic
glaucoma; OS
PACS Post LPI;
ODS Severe dry
eye
Computer vision
Lilis Ambarwati / syndrome +
79 14/10/2021 168904
28th Convergence
Insuficiensy
ODS Normotension
80 14/10/2021 Kalma / 56th 168588
Glaukoma Suspect
OD PEX
syndrome, OS
SACG et causa
81 14/10/2021 Hinara Masua / 80th 168915 PEX glaucoma +
Suspek subluklasi
Lensa + Bullous
Keratopathy
ODS Post
Syamsuddin/ 66 Trabeculectomy +
82 15/10/2021 83503
Tahun 5FU+ Re-needling
ec POAG
OS SACG et causa
83 15/10/2021 Hadawiah / 50th 168983 Suspek drug
induced glaucoma
ODS Primary
Congenital
Glaucoma late
onset, OD Post
84 18/10/2021 Muh. Al Gazalih / 5th 167591
Trabekulektomi +
trabekulotomi +
injeksi 5FU
subkonjungtiva
85 18/10/2021 Muh. Akmal Wahyu / 165996 OS Pseudofakia

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 post Lensektomi +
Sinekiolisis +
Implantasi IOL +
29th
Injeksi Intrakameral
+ Neovaskular
Glaukoma.
OD PACG Post
86 18/10/2021 Yohanis Agul / 52th 158452 Acute Attack ,OS
PAC
Oculus Sinistra
Amir Syam/ 69
87 19/10/2021 69638 Normotension
Tahun
Glaucoma

EVALUASI FORMAL SUBDIVISI

Nama : ........................................................................................................................

Tahap : ........................................................................................................................

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
 Subdivisi : GLAUKOMA

NILAI
NO JENIS UJIAN TANGGAL UJIAN UJIAN UJIAN
BULAN I BULAN II BULAN III
PENGETAHUAN DASAR
1 (Anatomi, Fisiologi, dan
pemeriksaan mata pada
anak dan stabismus)

2 UJIAN TEORI

UJIAN KETERAMPILAN
3 (Diagnostik dan Bedah)

4 SIKAP

Skala Nilai :
A : > 90
A- : 85 – 90
B : 80 – 84
B- : 75 – 79
C : 70 – 74
D : 1 – 69

Berdasarkan hasil evaluasi subdivisi, maka residen/PPDS diatas :

Dinyatakan LULUS, dan boleh pindah ke Subdivisi berikutnya

Dinyatakan TIDAK LULUS, dan belum dapat pindah ke Subdivisi berikutnya

Dinyatakan LULUS BERSYARAT, dan boleh pindah ke Subdivisi berikutnya DENGAN CATATAN;

....................................................................................................................................................

....................................................................................................................................................
Makassar, ............................
Pembimbing / Supervisor
Subdivisi Glaukoma

NIP :

VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION
VITREO-RETINA
REFRAKSI, KONTAK LENSA, DAN LOW VISION