poag case presentation
TRANSCRIPT
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Long case presentation
Dr.Syeda Fahmida Farzana Aziz
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Particulars of the patientName : XAge : 65 yearsSex : FemaleReligion : IslamOccupation : House wifeMarital status : MarriedAddress : Keraniganj, DhakaDate of examination : 26/01/2016
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Chief Complaints
• Total loss of vision in left eye for 3 months. • Gradual dimness of vision in both eye for about 2 years.
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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.
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History of Present Illness: Cont
• Difficulties in vision particularly in peripheral field & in near work.
• Frequent changes of spectacles for last 2 years.
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History of Present Illness Cont…
Her visual problems were associated with• Recurrent redness.•Watering.•Foreign body sensetion.•Mild headache.
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History of Present Illness Cont…
There is no history of •Image distortion•Nausea•Vomiting•Transient visual loss.•Trauma in the eye.
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History past ocular illness
• She was operated for cataract in left eye 1 year back in keraniganj.
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General medical History
• She has no history of • DM• Hypertension• Bronchial Asthma
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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.
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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.
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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
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Ocular Examination
Visual acuity R/E L/E• DistantUnaided 6/18 NPLWith PH NI ---• NearUnaided N/18 ---With PH NI ---
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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
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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
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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
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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
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Other System Examinations
Respiratory system
Cardiovascular system
Elementary system
Genitourinary system
Nervous system including all cranial nerves.
Nothing significant
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Provisional Diagnosis
• POAG with age related cataract (R/E)• Glaucomatous optic atrophy with pseudophakia (L/E)
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Differential Diagnosis
• PACG• Toxic optic neuropathy
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Investigations
Ocular investigations• CCT• Visual field analysis• OCT: RNFL & ONH analysis• CFP
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Investigations Cont…
Systemic Investigations
• CBC with ESR
• FBS & 2 hours after breakfast
• Fasting Lipid profile
Within Normal Limit
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Investigations Cont…
CCT• R/E: 442 micron• L/E: 443 micron
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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
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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
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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 .
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Thank You