Long case presentation

Dr.Syeda Fahmida Farzana Aziz

Particulars of the patientName : XAge : 65 yearsSex : FemaleReligion : IslamOccupation : House wifeMarital status : MarriedAddress : Keraniganj, DhakaDate of examination : 26/01/2016

Chief Complaints

• Total loss of vision in left eye for 3 months. • Gradual dimness of vision in both eye for about 2 years.

History of Present Illness

She was reasonably alright 2 years back. She gave the history of

• Total loss of vision in left eye for 3 months.• Gradual dimness of vision in both eye for about

2 years.

History of Present Illness: Cont

• Difficulties in vision particularly in peripheral field & in near work.

• Frequent changes of spectacles for last 2 years.

History of Present Illness Cont…

Her visual problems were associated with• Recurrent redness.•Watering.•Foreign body sensetion.•Mild headache.

History of Present Illness Cont…

There is no history of •Image distortion•Nausea•Vomiting•Transient visual loss.•Trauma in the eye.

History past ocular illness

• She was operated for cataract in left eye 1 year back in keraniganj.

General medical History

• She has no history of • DM• Hypertension• Bronchial Asthma

General surgical history• She has no significant general surgical history.

Drug History• No significant history of taking medication.

Allergy History• No significant history of systemic , ocular or drug allergy.

Personal history• Take betel leaf for 25years.

Family history• Her father had a history of low vision.• She has 2 sons and 1 daughter, all are in good health.

Socio Economic History • She comes from a middle class family.

General Examination

• Appearance : Normal• Body built : Average• Co operation: Co- operative• Anemia : Absent• Jaundice : Absent• Cyanosis : Absent• Edema : Absent

• Blood pressure : 130/ 80 mmHg• Pulse : 74 beats per minutes• Respiratory rate: 18 breathes per minutes• Temperature : 98°F

Ocular Examination

Visual acuity R/E L/E• DistantUnaided 6/18 NPLWith PH NI ---• NearUnaided N/18 ---With PH NI ---

Ocular ExaminationR/E L/E

Color vision Trichromatic ---Hirschberg reflex Central CentralLight reflex Brisk SluggishRAPD PresentField of vision Superior & Inferior

field constriction---

EOM Full in all gaze Full in all gaze

Slit Lamp Examination

R/E L/EEye lid ,Lash Normal NormalConjunctiva Normal NormalCornea Normal NormalA/C Depth Normal NormalIris Normal NormalPupil Round, Regular,

ReactingRound, Regular

Slit Lamp Examination

R/E L/ELens PSC with

cortical cataract with NS Grade 2

Pseudophakic

IOP at 10 A.M by GAT

25 26

Gonioscopy

3

33

3

33 3

3

Slit Lamp ExaminationR/E L/E

Fundus:Media Hazy ClearC/D Ratio 0.8:1 GOAColor of disc Mild pallor Severe pallorNRR Inferior &superior

thinningGeneralized thinning

Blood vessels Nasal shifting Nasal shifting Macula Normal Normal

Other System Examinations

Respiratory system

Cardiovascular system

Elementary system

Genitourinary system

Nervous system including all cranial nerves.

Nothing significant

Provisional Diagnosis

• POAG with age related cataract (R/E)• Glaucomatous optic atrophy with pseudophakia (L/E)

Differential Diagnosis

• PACG• Toxic optic neuropathy

Investigations

Ocular investigations• CCT• Visual field analysis• OCT: RNFL & ONH analysis• CFP

Investigations Cont…

Systemic Investigations

• CBC with ESR

• FBS & 2 hours after breakfast

• Fasting Lipid profile

Within Normal Limit

Investigations Cont…

CCT• R/E: 442 micron• L/E: 443 micron

Management

• Medical therapy.

– Combet E/D 1 drop 2 times

– Travest E/D 1 drop at night

– Tab. Acemox 1+1+1

– Tab Electroe ½+½+½

1st Follow up

IOP @ 11.45AM • Right eye: 06 mm of Hg• Left eye : 06 mm of Hg

Contineu treatment• Combet E/D 1 drop 2 times• Travest E/D 1 drop at night

2nd Follow up

IOP @ 10.15AM • Right eye: 12 mm of Hg• Left eye : 12 mm of Hg

Plan of treatment• Trabeculectomy + Phacoemulcification/SICS with PCIOL under

L/A .

Thank You