Download - Giant retinal tear
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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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