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PACG.pptx
- 1. CASE PRESENTATION DR . MALIHA NAWAR RESIDENT(Phase –B) Community Ophthalmology Bangabandhu Sheikh Mujib Medical University
- 3. Particulars of the patient: Name: Monowara Age: 65years Sex: Female Religion: Islam Address: Demra, Dhaka Date of examination: 6/12/2023
- 4. Case Summary : Mrs.Monowara, 65 years old female, hailing from Demra,Dhaka came to Ophthalmology OPD,BSMMU with the complaints of gradual reduction of vision in both eyes, more in right eye for last 3 months and seeing of rainbow haloes around light occasionally for last 1year.
- 5. Cont. She also complained of eye ache, vomiting and headache for last 1 years which increased severely in last 3 months. She gave no history of discharge, watering, double vision, seeing of broken image, bumping into surrounding objects, ocular trauma or surgery. She has no history of using spectacles.
- 6. Cont. She has no history of taking any eye drops, steroids or any other systemic medications. She is hypertensive, non-diabetic and non-asthmatic.There is no history of such disease in her family.
- 7. General Examination: Appearance- Normal Co operation-Co-operative Body built- Average Nutrition-Good Decubitus- On choice Anaemia- Absent Jaundice-Absent Cyanosis- Absent Oedema-Absent
- 8. Cont.: Dehydration: Absent Clubbing-Absent Neck vein-Not engorged Lymph node –Not enlarged Thyroid gland-Not enlarged Pulse -76 beats/minute BP-120/80 mm of Hg Respiratory rate- 16 breaths/min Temperature-98.6 degree F
- 9. Ocular Examination: R/E L/E Visual acuity: (unaided) Distant Near Pinhole 6/36 N14 6/12 6/36 N14 6/12 BCVA 6/12,+1.50Ds*+1.00Dcyl@ 90˚ N8 +2.50D sph 6/12,+1.00Ds*+1.00Dcyl@ 180˚ N8 +2.50D sph Pupillary light reflex Direct Consensual Sluggish Present Brisk Present RAPD Absent Absent Ocular motility Full in all gazes Full in all gazes Color vision Trichromatic Trichromatic Confrontation test Restricted in peripheral field Intact
- 10. Slit lamp Examination: OD OS Eyelid and eyelashes Normal Normal Conjunctiva Not congested Not congested Cornea Transparent Transparent Anterior chamber Shallow in center and periphery(Van Herick grade 1), Quiet . Shallow in center and periphery (Van Herick grade 1),Quiet. Iris Sectoral iris atrophy( 7’ t0 1 o’clock position), Normal in color, pattern. Pupil Irregular, mid dilated and slowly reacting Round, regular and reacting Lens Nuclear sclerosis grade II+cortical Nuclear sclerosis grade II+cortical IOP(GAT on 6/12/2023@ 11.10am) mmHg 30 18
- 11. OD OS
- 12. OD OS
- 13. OD OS
- 15. Fundus Examinations: OD OS Media Clear Clear Optic disc C:D= 0.7:1 Pink Margin well defined. C:D= 0.5:1 Pink Margin well defined. Blood vessel Number of blood vessels normal. Number of blood vessels normal. NRR Healthy Healthy Macula Healthy Healthy Background Normal Normal
- 18. Provisional Diagnosis: Primary Angle closure glaucoma with age related cataract in right eye and primary angle closure suspect in left eye.
- 20. Investigations: HumphreyVisual field analysis B/E OCT Optic nerve head and RNFL B/E Color Fundus Photography B/E ECG RBS HBsAg
- 22. OCTOptic nerve head and RNFL
- 23. Management: Counselling of the patient. Medical treatment for reduction of raised IOP in R/E : 1.Tab. Acetazolamide(250mg) 1 tab 4 times daily 2.Tab.potassium chloride 1 tab 4 times daily 2. Pilocarpine 2% eye drop , 1 drop 4times daily R/E ,1 drop 3 times daily L/E 3.Timolol maleate 0.5%eye drop,1drop 2 times daily R/E 4.Dexamethason E/D 1 drop 4 times daily R/E
- 24. Surgical management: Combined cataract extraction with trabeculectomy under local anaesthesia (R/E) Laser PI (L/E)
- 25. Follow up on 1st POD(R/E): VA ‹6/9 Conjunctive: mildly congested Cornea: mildly edematous AC: 2+cells, formed(air) Pupil: round,regular,reacting to light IOL in bag Bleb formed Broad PI present
- 37. Management of Acute Primary Angle Closure