LE chronic primary angle closure glaucoma with PPM

1. CASE PRESENTATION
CHRONIC PACG
BY:- DR. SUDHANSHU SHEKHAR
1ST YR OPHTHAL PGT
MGM MEDICAL COLLEGE, KISHANGANJ

2. • NAME= Muzammil
• Age= 40yr male
• Address= Kishanganj
• Occupation= carpenter
• Came to our eye OPD on 22/01/2021
Chief complaint:
Left eye Diminution of vision since 4 months.

3. HISTORY OF PRESENT ILLNESS:-
• h/o Decrease vision of left eye 4month back associated with redness for which he
attended a local hospital at kishanganj and was prescribed with topical eye drops and
tablets. But he came to our hospital for better management.
• No h/o redness, watering of eye
• No h/o pain , nausea, vomiting
• No h/o headache

4. PAST OCULAR HISTORY:
• history of using spectacles.
RE: +1.00D sph LE: +1.00D sph
• h/o ocular trauma left eye with fist 4 month back
• No h/o ocular surgery
• No h/o DM/HTN/Asthma/Allergy or any other systemic illness
Ocular medications:
• E/d IOTIM Plus(timolol + pilocarpine) – twice daily
• Tab GLOEYE (bilberry extract + pine bark extract) – OD 20days

5. FAMILY HISTORY:-
• No significant family history.
• No h/o glaucoma case in family members.

6. GENERAL PHYSICAL EXAMINATION:-
• No h/o pallor
• No h/o icterus
• No h/o cyanosis
• No h/o clubbing
• No h/o lymphadenopathy
 vitals:- temp= 98.8*F , RR= 20
BP= 130/80mmhg, pulse= 70bpm

7. OCULAR EXAMINATION:-
Right eye Left eye
Visual acuity aided 6/6p 6/18p , not improved with pin
hole
Lids normal normal
conjunctiva clear Clear
cornea clear Clear
Ant chamber Normal depth shallow
Iris Normal pattern PPM , Post synechiae @4-5
o’clock
Pupil R/R/R Mid dilated pupil, brisk, fibrin
membrane with pigments
lens clear Iris pigments on lens
Extra-ocular movement full full
IOP on AT(1st visit) 22/01/2021 16 26
IOP on AT(2nd visit) 05/02/2021 16 36

8. LEFT EYE SLIT LAMP

9. FUNDOSCOPY
Right eye
Media clear,
CDR= 0.3
v/s= normal
FR= dull
Tessellated fundus
Left eye
Media clear,
CDR= 0.8-0.9 , pale disc,
laminar dot sign+nt,
bayoneting sign +nt
v/s= nasal shifting of vessels,
FR= dull
Tessellated fundus

10. INVESTIGATION:-
• GONIOSCOPY:-
SHAFFER grading
R/E grade 2
L/E grade 0 (360 degree PAS)

11. PROVISIONAL DIAGNOSIS
• LE chronic primary angle closure glaucoma with PPM

12. TREATMENT GIVEN:-
1st visit on 22nd jan 2021:-
• Advice: E/D pilocarpine(2%) 1 drop 3 times per day
E/D timolol(0.5%) 1 drop 2 times per day
• But patient didn’t took pilocarpine e/d.
2nd visit on 5th feb 2021:-
• Advice: Continue same previously prescribed eye drops.
Tab Diamox 250mg 1 tab TID for 7days.
Banana as potassium supplements advised
Plan for trabeculectomy LE.
Left eye