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Clinical Cases

What you should carry. To examine ophthalmic clinical case you need:1. Good torch light (essential)2. A pin hole (essential)3. Magnification aid, Binocular or uniocular loupe (desirable) . Case of Cataract. Evaluation of cataract cases. HistoryIn a case of cataract, in our circumstances the usual history is:a. Gradual painless diminution of visionb. Change of spectacle number frequentlyc. Diplopia, polyopiad. Reddish tint of objects seen .

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Clinical Cases

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    1. Clinical Cases

    2. What you should carry To examine ophthalmic clinical case you need: 1. Good torch light (essential) 2. A pin hole (essential) 3. Magnification aid, Binocular or uniocular loupe (desirable)

    3. Case of Cataract

    4. Evaluation of cataract cases History In a case of cataract, in our circumstances the usual history is: a. Gradual painless diminution of vision b. Change of spectacle number frequently c. Diplopia, polyopia d. Reddish tint of objects seen

    5. Evaluation e. Diminution of vision more marked in bright light , in cases of central lenticular opacity and diminution of vision, more marked in dim illumination, in cases of peripheral spoke like lenticular opacity.

    6. Evaluation 2. History of local complaints like history of redness , blurring of vision, particularly in young patients to rule out complicated cataract 3. Systemic history of diabetes and other metabolic disorders, particularly when patient is relatively ‘young’ to exclude pre-senile cataract due to metabolic factors

    7. Evaluation 4. From point of view of treatment – ask for history of hypertension, diabetes, cardio-vascular disorders, chronic obstructive air way disease, other disorders, history to exclude systemic septic focus etc. 5. History of previous refractive error, ocular disease/ surgery etc

    8. Ocular examination Visual acuity: Without and with pin hole for distance Note any abnormality of lids, lacrimal sac, conjunctiva, cornea, anterior chamber and iris. Note carefully pupillary reactions

    9. Ocular Examination 4. Examination of lens – note for lenticular opacity (differentiate it from gray reflex normally seen in elderly patients by correlating lenticular opacity with visual acuity), Iris shadow is important sign for differentiating immature and mature cataract, note position of lens, any deposits on anterior surface of lens.

    10. Ocular Examination 5. Intra-ocular tension (IOT) by digital tonometry (in case of suspected high IOT suggest Schiotz tonometry)

    11. How to differentiate Immature and Mature Cataract IMMATURE CATARACT Visual acuity is better (Snellens line or count finger at some distance) Lens is opaque (Gray white opacity) lens is not fully opaque, there are transparent fibres between opaque nucleus/cortex and anterior capsule. MATURE CATARACT Visual acuity is PL or HM only Lens is uniformly opaque upto anterior capsule (usually milky white like pearl, exception black and brown cataract)

    12. Mature Cataract

    13. Immature Cataract

    14. How to differentiate Immature and Mature Cataract IMMATURE CATARACT 3. There is presence of iris shadow 4. Fundus details may be visible (for UG students it is theoretical point) MATURE CATARACT 3 No iris shadow 4. No fundus glow visible

    15. Investigations Before taking patient for surgery: Retinal function test: macular function test with Maddox rod test or two pin hole test. Projection of light rays Entoptic view of fundus Recording of IOT with tonometer Fundus examination of eye to be treated and of fellow eye, if possible.

    16. Investigations Rule out hypertension, if it is present – should be controlled before operation Rule out diabetes, if it is present – should be controlled before operation Septic focus should be ruled out by careful history taking Other systemic disease(s) to be ruled out by careful history taking

    17. Investigations IOL power calculation by taking keratometric readings and recording axial length and application of one of the (appropriate) IOL power calculation formulas

    18. Indication for cataract surgery Cataract surgery is indicated when patient has difficulty in performing routine work due to reduced vision due to cataract

    19. Treatment ECCE with PC IOL Methods of ECCE withy PC IOL 1. Phocoemulsification with PC IOL in the bag 2. SICS with PC IOL in the bag / sulcus fixated 3. Conventional ECCE with PC IOL in the bag / sulcus fixated

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