giant retinal tear

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Case presentation Dr.Prathibha.M.Chachadi 06/09/2022 1

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case presentation ophthalmology

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Page 1: Giant retinal tear

04/11/2023 1

Case presentation

Dr.Prathibha.M.Chachadi

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Sanjay M (op no: 725436) 18 years /male StudentBangalore; 20/11/12 at emergency

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• h/o fall by tripping on a pipe • Sustained injury with a stone in his right eye• c/o pain and swelling around the right eye with

blurring of vision• h/o poor vision in right eye since childhood• Using glasses and contact lenses (occasionally) since

2 years yearly disposable soft contact lenses.• No h/o epistaxis; nausea or vomiting/loss of

consciousness• Was started treatment and followed up closely• 0n 28/11/12 he came with c/o sudden painless

decrease of vision-1 day

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• Treatment history: o/e right eye had periorbital edema with echymosis- lower lid No e/o orbital wall # Extraocular movement were full and normal Subconjunctival haemorrhage was seen temporally cornea –clear Anterior chamber- +4 cells with grade 1 hyphaema+ Pupil- Round regular and reactive;iridodenesis+ Lens- Normal Vision: with previous glasses right eye- cf- 1mt left eye 6/6;N6 IOP- digitally normal

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• On follow up- 21/11/12• IOP – 17 mmhg –RE 15 mmhg – LE• Vision Status quo• Gonioscopy- • RE LE

360 deg angle recession

Grade 4

Grade 4

Grade 4Grade 4

Grade 4

Grade 3

Grade 3

Grade 3

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• Retinal examination – • BE- Myopic fundus with tessellated back

ground \periphery- no treatable lesions• Ocular medications:• RE- oflacin Dx- 12 t/d• RE-Ocupol –d e/o- at bed time• RE- homide – e/d- 3 t/d• Tab combiflam 1-0-1 for 5 days

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• Personal history• Family history• General physical examination: Height : 5 feet 4 inches ; Weight : 58 kgs Arm span= height Cardiac and respiratory system : Normal

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Ocular examination

• Head posture: normal• Facial symmetry: normal• Ocular symmetry: normal

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Right Eye Left Eye

Lids and adnexaLacrimal Sac area

normal normal

Conjunctiva:Bulbar Forniceal

Subconjuctival haemorrhage

Cornea: SizeShapeTransparencySensation EpitheliumStromaEndothelium

Clearnormal

Clear normal

Anterior chamberDepthContent

DeepAC +2 cells; flare+Vitreous pigment

normal

Iris: ColorSurface

Iridodenesis+ normal

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Right Eye Left Eye

Pupil:SizeNumberMarginCentrationLight reflex: Direct Indirect

Pharmacologically dilated Round regular reactive

Lens:TransparencyPositionZonules

Inferior early cortical cataract changes seenPhacodonesis+ Inferior zonules weakness+

Normal

Extra ocular movementsDuctionsVersionsConvergence

Full and normal

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Right Eye

Left eye

Anterior Chamber depth

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Angle recession

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Right Eye Left Eye

Vision :Unaided/pinholeDistanceNear

Hand movement+NIL

Cf 3meter 6/18N6

Refraction Media hazy

(-5-1)Tropicamide plus1 meter

Subjective refraction No improvement -4.25 sphere diopters6/6; n6

Contact lens power: -3.75 Sphere OU

-6.00

-6.00

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Fundoscopy78 D lens Right Eye Left eye

Media hazy clear

Disc: size ShapeColorMarginBlood vessels on discCup disc ratio

Pigment in anterior vitreous

Normal0.4

Posterior pole:Blood vessels A:V ratioFoveal reflex

Details not made out Normal 1:3Fr+

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Indirect ophthalmoscopy:Right eye

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Indirect ophthalmoscopy:Left eye

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Diagnosis

• Right Eye:• High myopia with anisometropic amblyopia• Blunt injury(contusion) with early cortical

cataract(inferior zonular weakness);traumatic iritis;angle recession

• Superior giant retinal tear with total retinal detachment with early proliferative vitreoretinopathy changes (grade b)

• Left eye: Simple myopia

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Management

• Right Eye:Phaco+/-CTR +/- IOL implantation band+PPV+removal of PVR membranes+PFCL

for eversion of GRT flap+EL(barrage)+silicone oil injection – GVP-under local+sedation

• Left eye: Simple myopia(glasses/ CL)

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• RE- Phaco+ctr+IOL+PPV+membrane removal+FAE+EL+Silicone oil injection

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