ophtha case report - copy
TRANSCRIPT
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C.R
57/MMarried
Patient Profile
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3 yrs PTC, px noted gradual blurring of vision of
the right eye
(-) eye pain
(-) redness
(-) tearing
(-) dicharge
CONSULT
History of Present Illness
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Past Medical History
HTN (Amlodipine, 2 yrs)
Past Ocular History
Unremarkable
Family History
Unremarkable
History of Present Illness
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SUDDEN GRADUAL TRANSIENT
PAINLESS PAINFUL
Ischemic Optic
Neuropathy Retinal
Artery/VeinOcclusion
Acute Angle
ClosureGlaucoma Corneal Ulcer Uveitis with
Complications
Cataract
Error ofRefraction Open Angle
Glaucoma DM
Retinopathy Age-related
MacularDegeneration
Subacute
AngleClosureGlaucoma
Uveitis Optic
Neuritis Uveitis
Papilledema
AmaurosisFugax
Differential Diagnosis
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Cataract57 y/oLeukocoria
Error of Refraction Not improved with pinhole
Open Angle Glaucoma Normal IOP
DM Retinopathy No DM
Age-related Macular Degeneration Central vision is not affected
Gradual, Painless
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Cataract Senile Mature, OD
Assesment
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Pathogenesis
not completely understood.
cataractous lensesprotein aggregates thatscatter light rays and reduce transparency.
Factors:
oxidative damage (from free radical reactions)
ultraviolet light damage
malnutrition
NO medical treatment to retard or reversecataract formation.
protective effect from dietary carotenoids (lutein)
Cataract
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Mature All of the lens protein is opaque Leukocoria
Immature Some transparent protein Black opacity against a red orange background
Intumescent Lens take up water
Hypermature
Cortical proteins have become liquidescapeshrunken lenswith wrinkled capsule
Morgagnian Hypermature cataract in which lens nucleus floats freely in the
capsular bag
Cataract
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Most common type
Age-related
Types
Nuclear
Cortical
Subcapsular
Senile Cataract
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Nuclear (Hard) Cataract
Hardening of the nucleus d/t compacting &
sclerosing of the lens fiber in the center of the lensyellow-brown pigments
Myopic shift in refraction
Early onset of BOV (Far vision)
Senile Cataract
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Cortical (Soft) Cataract
Hydration of the cortex with development of
subcapsular vacuoles which disrupts regulararrangement of lens fiber
Opacity begins at periphery (radial spoke-like
opacities)
Late onset of BOV
Senile Cataract
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Posterior Subcapsular Cataract
cortex near the central posterior capsule.
Posterior migration of lens epithelium
Near vision is affected early
Associated with DM, trauma, corticosteroid use
(topical or systemic), inflammation, or exposure to
ionizing radiation.
Senile Cataract
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Phacoemulsification
Latest method
Use of ultrasonic vibrator to
disintegrate nucleus Sutureless
Procedure:
Capsulorrhexis
Hydrodissection
Sculpting of the Nucleus Cracking of the Nucleus
Emulsification
Removal of Cortex
Insertion of IOL
Management of Cataract