Case Discussion: Mrs. Enriqueta Sumibcay

1. Case Discussion:Mrs. EnriquetaSumibcay OPHTHALMOLOGY CLERKSHIP ROTATION Quirino memorial medical center Matthew S. Parco July 30, 2011

2. Background and Chief Complaint • Patient is a 58 y/o female, married, who came with the Chief Complaint of “umuulapnapaningin”, or cloudiness of vision, OD. • Birthdate: July 15, 1952

3. History of Present Illness • 5 years PTC, patient noticed cloudiness with blurring of vision. Associated symptoms include glare and periorbitalpain with ocular movements, graded 5/10. Progressive cloudiness and blurring occurred from onset of symptoms, hence this consult.

4. Past Medical History, Family History, and Social History • PMH • Diabetes Mellitus, type II • Glibenclamide 5g/tablet, OD • Metformin 90g/tablet, TID • Hypertension • Amlodipine 100mg/tablet, OD • FH • Hypertension (maternal side) • SH • Currently married. Has strong family support. • Housewife.

5. Physical Examination • Gross Eye Examination • Lids and lashes • No tearing, matting of lashes, or masses • Eyeball • Anictericsclerae • Pink palpebral conjunctiva • Clear cornea • Visual Acuity • OD • SC – 20/400 • PH – 20/70 -1 • Near Vision – J10 • OS • SC – 20/20 -1 • PH – not done • Near Vision – J4 • Extraocular Muscle Movements - Intact

6. Physical Examination (con't). • Pupils • OD • 2-3 mm, brisk and reactive, RAPD • OS • 2-3 mm, brisk and reactive, RAPD • Digital Tonometry • Both soft • Ophthalmoscopy • Positive ROR • Clear media • Distinct borders • Cup-disk ratio is 0.3. • AV ratio is 2:3 • No hemorrhages or exudates. • Good foveal reflexes.

7. Assessment and Plan • Assessment • Senile Mature Cataract, OD • Plan • Phacoemulsification with Posterior Chamber Lens Implantation

8. Course in the Wards • July 27 • 1:00 PM • Admitted to Ophthalmology Department ward • Given prophylactic Moxifloxacin drops 1 gtts every 4 hours. • Blood pressure and other vitals taken every 4 hours. • July 28 • 12: 00 AM • Patient put on NPO. • 5:00 AM • Pre-operative checks done. • 10:00 AM • Patient transferred to Operation Room for surgery. • 11:00 AM • Post-operation. Transferred back to the Ward. • July 29 • 8:00 AM • Discharged

9. Post-Operation • Pupils • OD • 2-3 mm, brisk and reactive, RAPD • OS • 2-3 mm, brisk and reactive, RAPD • Digital Tonometry • Both soft • Ophthalmoscopy • Positive ROR • Clear media • Distinct borders • Cup-disk ratio is 0.3. • AV ratio is 2:3 • No hemorrhages or exudates. • Good foveal reflexes. • Patient noted minimal pain afterward (4/10). • Gross Eye Examination • Lids and lashes • No tearing, matting of lashes, or masses • Eyeball • Anictericsclerae • Pink palpebral conjunctiva • Clear cornea • Visual Acuity • OD • SC – ~20/200 • PH – not done. • Near Vision – J4 • OS • SC – 20/20 -1 • PH – not done • Near Vision – J4 • Extraocular Muscle Movements– Intact

10. Discussion: Etiology • Senile Mature Cataracts are often caused by oxidative damage to the proteins of the lens, which often overpower antioxidants as one ages. • Increased exposure to light, such as living in equatorial or high altitude regions, as well as certain occupations, make some people more prone to developing cataracts.

11. Discussion: Treatment • The most effective and common treatment is Extracapsular Cataract Extraction (ECCE), in which the majority of the lens capsule is left intact. • High frequency sound waves (phacoemulsification) are often used in order to break the lens prior to extraction.

12. Discussion: Prognosis • Many patients who underwent ECCE/Phacoemulsification usually gain 2 lines in the Snellen chart. • However, risk factors for development of after-cataracts do exist among patients with Diabetes Mellitus.