General DataE.S. 55 y/o MaleMarriedFilipinoRoman Catholic

Chief ComplaintBlurring of vision

History of Present Illness2 mos PTA (+) blurring of vission

(-) headache or diziness

(+) consult done, advised surgery, schedule of operation after control of blood surger

History of Present Illness1 mon PTA (+) blurring of vision

(+) stable of blood sugar, Phacoemulsification w/ PLIOL OD was done (apr 22, 08) in AFPMC.

admission

History of Present Illness2 wks PTA Pt was retro-EVAC, schedule for

next OR hence admission

admission

Past Medical History(-) Hypertension, (-) Asthma (+) DM x 11 years

Metformin 850mg/tab TID after meal, Glimepiride 2mg/tab OD before breakfast

(+) food allergy to chicken but no known allergies to drugs

(+) S/P Phacoemulsification w/ PLIOL OD

Family History

Personal / Social History(+) smoker (5 pack years) ,Stopped feb,

2008Non alcoholic beverage drinker.

Review of Systems

(-) wt loss, (-) change of appetite(-) headache, (-) skin rashes(-)Chest pain, (-) palpitation(-) diarrhea

Physical ExaminationGENERAL: conscious, coherent, ambulatory, not in

cardiorespiratory distress.

BP = 130/80 mmHg CR = 81 bpm RR = 21 cpm T = 36.5°C

Skin: No jaundice, good skin turgorHEENT: Anicteric sclera, pink palpebral conjunctiva,

no nasoaural discharge, no tonsillopharyngeal congestion, no cervical lymphadenopathy, (+) blurring of vision of left eye

Chest & Lungs: Symmetrical chest expansion, no retractions, clear breath sounds

Physical ExaminationHeart: Adynamic precordium, NRRR, no murmur

Abdomen: Flat, normoactive bowel sounds, soft, non-tender

Extremities: grossly normal, full and equal pulses

DIFFERENTIAL DIAGNOSIS

ADMITTING IMPRESSIONPosterior Subcapsular Cataract OSDM type2, controlled

Course in the WardsOn admission to 15th hospital day

DM dietNo IVF

Therapeutic: Predrisolone (Pred forte) 10mg/ml 1 drop QID

to consumeMoxifloxacin (Vigamox) 5mg/ml 1 drop

TID to consumeNepafenac (Nevanac) 1mg/ml 1drop TID

to consumeMetformin 850mg/tab TID after mealGlimepiride 2mg/tab OD before

breakfast

Course in the WardsOn 16th to 18th hospital day

DM dietNo IVF

Therapeutic: Tobramycin dexamethasone 3mg/ml 1

drop QID to consumeMoxifloxacin (vigamox) 5mg/ml 1 drop

TID to consumeNepafenac (nevanac) 1mg/ml 1drop TID

to consumeMetformin 850mg/tab TID after mealGlimepiride 2mg/tab OD before

breakfast

Course in the WardsOn 19th to 22th hospital day

DM dietNo IVF

Therapeutic: Tobramycin dexamethasone 3mg/ml 1 drop

QID to consumeMetformin 850mg/tab TID after mealGlimepiride 2mg/tab OD before breakfast

Final DiagnosisPosterior Subcapsular Cataract OSDM type2, controlled

Daily BGM May 10, 08 137

May 13, 08 135

May 15, 08 141

May 16, 08 62

May 20, 08 95

May 21, 08 105

May , 08

May , 08

May , 08

May , 08

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What is a Cataract?A cloudy or opaque area (an area you cannot

see through) in the lens of the eye.

The human eye contains a translucent lens inside it.

This lens focuses the rays of light entering the eye on to the retina rather like rays of sunshine being focused by a magnifying glass.

The retina converts this light into neurological messages that are then transmitted to the brain by the optic nerve.

If this ocular lens becomes cloudy or hazy it is called a cataract. The light focused on the retina is then no longer sharply focused, and the patient's vision becomes blurred in this eye

CAUSESAdvancing AgeRadiation exposureLong term exposure to ultraviolet radiationDiabetesHypertensionEye injury / Physical TraumaDrugs (Corticosteroids)Congenital (e.g. congenital cataract)

EPIDEMIOLOGYLeading cause of blindness in the worldStatistics:

42% of those between the ages of 52 to 64, 60% of those between the ages 65 and 74, and 91% of those between the ages of 75 and 85.Increased risk for those with diabetes,

hypertension, and few are related with long term corticosteroid therapy

SIGNS AND SYMPTOMSBlurry vision Glare from car headlights especially at night. Sunlight or indoor overhead lighting may

seem to be seem too bright or cause glare. Bright colors may appear dulled. Sometime cataracts can cause double vision, Frequently changing contact or eyeglasses

prescriptions.

TYPES OF CATARACTSCLASSIFIED BY ETIOLOGY

Congenital CataractAge relatedSecondary cataract ( drug induced cataract)Traumatic Cataract

TYPES OF CATARACTCLASSIFIED BY LOCATION OF OPACITY

WITHIN LENS STRUCTURENuclear Posterior cortical cataract Posterior polar cataract (importance lies in

higher risk of complication - posterior capsular tears during surgery)

Posterior subcapsular cataract Anterior cortical cataract Anterior polar cataract Anterior subcapsular cataract

Top LeftThis is a posterior subcapsular cataract. Such cataracts often cause difficulty in reading, and a disabling glare in bright light.

Top RightCortical cataract as seen against the reflection of the retina. This is a very common type of cataract causing glare and blurring of vision.

Bottom LeftNuclear cataract is another common type. This is an opacity in the central nucleus of the lens which tends to cause refractive changes and blurring of vision.

Bottom RightA mature cataract. These are now rare in developed countries.

Clinical features: Symptoms: glare and decreased visual acuity

especially during bright sunlight, but see well in dim illumination.

Signs: granular opacities in the posterior pole of cortex adjacent to the posterior capsule.

May be age-related or occur as a complication of other conditions such as intraocular inflammation (e.g. chronic uveitis), steroid administration, vitreoretinal surgery and trauma.

May also be related to irradiation and systemic conditions such as diabetes mellitus.

View of a person with Cataract

POSERIOR SUBCAPSULAR CATARACCT

No-stitch/small incision surgery are techniques used to restore vision loss due to cataracts.

The cloudy lens is removed and replaced with a plastic lens (IOL) implant.

Ultrasound technology (phacoemulsification) is often used to remove the cataract.

A special lens can then be implanted through a smaller incision than is required in traditional cataract surgery.

What is Phacoemulsification?Phacoemulsification (phaco) is a surgical technique which uses

ultrasound technology. In “phaco” or small incision surgery, a small probe is inserted

into the capsular membrane which surrounds the cloudy lens. Ultrasound is used to gently break-up (or emulsify) the cloudy

lens into tiny pieces which can be removed through the tip of the probe.

In comparison, traditional surgery techniques require the lens to be removed in one piece through a relatively large incision.

Traditional cataract surgery requires an incision that spans a third of the circumference of the cornea and needs as many as eight stitches to close.

In contrast, the phaco technique allows the cloudy lens to be removed through as incision as small as 1/6 of an inch wide.

What are the Advantages of this procedure?Faster recovery of good vision Faster return to normal activities Good vision in a matter of days instead of

weeks or even months Return home within hours of the procedure No need for an overnight hospital stay Reduces the chance of surgically induced

astigmatism or ruptured sutures

Phacoemulsification

INSERTION OF INTRAOCULAR LENS

BEFORE AND AFTER SURGERY

PREVENTIONcontrolling diseases that increase the risk of

a cataract, and avoiding exposure to factors known to promote cataract formation.

Wearing sunglasses when you are outside during the day can reduce the amount of UV light your eyes are exposed to.

Some sunglasses do not filter out the harmful UV. An optician should be able to tell you which sunglasses filter out the most UV.

For patients who smoke cigarettes, QUIT while you’re still young

THANK YOU!!!!