Case Presentation

OD Traumatic Cataract

Baiq Denda Putria Ningsih

(H1A016012)

Supervisor:
dr. Monalisa Nasrul, Sp.M
OUTLINE

01 INTRODUCTION

02 CASE REPORT

03 DISCUSSION
AND
CLINICAL
REASONIN
INTRODUCTIO
N
Ocular injury is one of the main causes of visual disturbances.
BETT → open globe injury and closed globe injury

WHO → the global annual incidence of ocular trauma is about 55

million and blindness worldwide in 1.6 million people is caused by
ocular injury.

Traumatic cataract is a very common complication of eye injury.

>> childrens, male gender
Traumatic cataracts caused by 54.2% penetrating injury and 45.8%
blunt injury

Traumatic cataract
4
Case Report
Patient’s
Identity
▪ Name : AKA
▪ Age : 11 years old
▪ Sex : Male
▪ Job : Students
▪ Religion : Islam
▪ Address : Kasane Barat, Bima
▪ Date of : March 18th 2021
examinations
7
 Main
Complaint
There is a white patch in
the middle of the eye and
blurred vision on the right
eye
Timeline RS Bima (March 4th )

Disease RSUDP NTB (March 18th )

- Same problem and
- The patient's
diagnosis is cataract
-
same diagnosis
Pro cataract surgery
- Recommendation to 2021
RSUDP NTB
Ocular trauma
- Ocular trauma cause by White patch
traditional toys a white patch began to appear
-Red eyes, pain, blurred on the patient's eye lens, which 2021
vision and bleeding from grew wider over time
Other symptoms
the patient's eye - Blurred vision more progressive
- Blurred vision is felt both when
2020 looking far and near
October - vision is brighter at night
- photophobia

2020
November
Medical
History
Past Medical History Allergic History Family Medical History
- History of similar
- No similar problem
complaints (-) - No allergic history - Cataract (+) grandfather
- History of eye disease (-)
- Hypertension (-), DM (-)
MRS History (-)
- Operation history (-)
- Trauma History (+) 6
months ago
- Glasses usage history (-)

9
Medical
History
Treatment History Social History
- Biovision : ± 2
- The patient is a grade 6
days post trauma elementary school who is actively
- RS Bima → playing.
RSUDP NTB for
cataract surgery

Prenatal and Perinatal History

- born normal and weighed 3.2 kg at birth.
- Complaints of blurred vision or other complaints to the eye from birth were
denied.
- There is no problem with the mother's pregnancy and the consumption of drugs
during pregnancy is denied.
- Immunization complete 10
Ophthalmologic
Status OD OS
Visus
Natural visus 1/60 6/6
Pinhole Same Same
Ocular alignment
Hirschberg test Ortoforia Orthoforia
Cover-Uncover test Ortotropia Ortotropia
Extraocular motility

Normally Normally
Pain (-) Pain (-)
Diplopia binocular (+) Diplopia Binocular (+)

Visual fields

Same as the examiner Same as the examiner

11
Ophthalmologic
Status External Eye
Eyebrows

Color Black Black

Distribution Normal Normal
Inflammation (-) (-)
Superior And Inferior Palpebra

Edema (-) (-)

Hyperemia (-) (-)

Mass (-) (-)

Entropion (-) (-)
Extropion (-) (-)
Pain (-) (-) 12
Ophthalmologic
Status
External Eye
Superior And Inferior Silia
Normal Normal
Distribution

Secret (-) (-)

Inflammation (-) (-)

Lacrimal System

Lacrimal Punctum Normal Normal

Lacrimal Saccus Normal Normal

Lacrimal Glands Normal Normal

13
Ophthalmologic
Status External Eye
Bulbar Conjuctiva

Conjunctiva injection (-) (-)

Siliar injection (-) (-)

Mass (-) (-)

Edema (-) (-)
Refraction Media

Cornea

Shape Convex Convex

Transparancy Clear Clear

Surface Smooth Smooth

Foreign body (-) (-) 14

Ophthalmologic
Status
Refraction Media
COA
Defth Deep Deep
Hifema (-) (-)
Hipopion (-) (-)
Iris
Color Brown Brown

Shape Round, regular Round, regular

Pupil

Shape Round Round

Size ± 3 mm ± 3 mm

RCL (+) (+)

15
RCLT (+) (+) slow
Ophthalmologic
Status
Refraction Media
Lens
Tranparancy Cloudy Clear
Subluksasi (-) (-)
Luksasi (-) (-)
Afakia (-) (-)
TIO
Perpalpation Normal Normal

Funduscopy

Red reflex (-) (+)

16
Patient’s eye
19
Patient’s Right
20
Eye
Patient’s Right Eye
21
Discussion and
Clinical
Reasonin
g
Problem
Identification
Subjective
- Blurred vision in the right eye blurred when looking far or near ± 6 months ago
post trauma, the longer it is blurry. Vision is brighter at night
- ± 1 month post-trauma, white patches were seen in the eyes that were widening
- Patients also complain of glare when they see light

Objective
- Naturalist vision OD 1/60 (pinhole no changed)
- The OS indirect light reflex (RCTL) slows down
- Lens OD cloudy
- Fundus reflex OD (-)

21
Traumatic agent
Discussion
Cataract is a clouding condition of the lens that causes a decrease in the quality of
vision function. Traumatic cataracts are cataracts caused by trauma to the eye

BETT
Traumatic cataracts are found in 27-65% of cases
of eye trauma or occur in 3.45 per 100 000
population per year or 4.6 per 10000 outpatient
79% 21%
visits

Male Female

45,8%
54,2%

Penetrating trauma Blunt trauma

- Generally occurs in - Generally occurs in
patients aged> 15
patients aged <15
years %
years
Symptom and
Sign Symptom
• Decrease or blurring in the vision
• Diplopia
• Colored halos around the light
• Sensitivity to glare
• Increased frequency to change
refractive glasses
Sign
- Decreases of vision
- Cloudy lens
Traumatic - White color in pupil
cataract - Shadow test
- Funduscopy

Rossete cataract 26
 Treatment
Surgical removal of cloudy/opaque lens and replacement with a synthetic
intraocular lens is the only available treatment for cataract.
Phacoemulsification, extracapsular cataract extraction and intracapsular
cataract extraction are the major surgical procedures employed for cataract
treatment throughout the world.

A study shows that satisfactory visuals in the

majority of patients with traumatic cataracts
can be achieved after cataract removal and
intraocular lens implantation.

27
Assesmen
t
Diagnosis : OD Traumatic Cataract
Differential
diagnosis
Congenital Congenital cataracts are cataracts that start before
Cataracts or shortly after birth and the baby is less than 1 year
old. To find out the cause of congenital cataracts, it
is necessary to examine the prenatal history of
maternal infection and drug use during pregnancy
and congenital cataracts are often found in
premature babies.

28
Plannin
g
Diagnostic:
- In this case, no investigations for cataract are needed but slit lamp can be used
- USG-B Scan

Therapy
- Planing Phacoemulsification Cataract Extraction and IOL on OD

29
Educatio
n
▪ Explain to the patient in simple term about the diagnosis (cataract)
▪ Inform to the patient and her family that the main therapy for cataract is surgery.
▪ Inform the patient about complications if surgery is not performed, possible
complications during surgery, and the patient's disease prognosis

30
Prognosti
c
▪ Ad vitam : Bonam
▪ Ad functionam : Dubia ad
Bonam
▪ Ad
sanationam : Dubia ad
Bonam

31
CONCLUSIO
N
Conclusion

Male patient, 11 years old with white patches and blurred vision in the right eye
that was felt ± 6 months ago. Complaints were felt after the patient was
traumatized by a toy made of bamboo cuttings. Complaints of blurred vision are
felt increasingly blurred, and vision is felt brighter at night. White patches began
to appear ± 1 month after trauma, the longer they widened. In addition, patients
also complain of glare when they see light. Based on the physical examination of
the eye, it was found that vision OD 1/60 with fixed pinhole, indirect light reflex
(RCLT) OS slows down, OD lens is cloudy, and fundus reflex is OD (-). The patient
diagnosed the patient with traumatic cataract OD. The patient's treatment plan
was to perform ECCE (Extracapsular Cataract Extraction) surgery with
phacoemulsification by placing IOL (Intraocular Lens) on the right oculi.

33
SOURCE
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presenting to the department of ophthalmology at Hawassa University: Retrospective study. PloS one , 14
(3), e0213893. https://doi.org/10.1371/journal.pone.0213893
2) Adlina, AR, Chong, YJ, & Shatriah, I. (2014). Clinical profile and visual outcome of traumatic pediatric
cataract in suburban Malaysia: a ten-year experience. Singapore medical journal , 55 (5), 253–256.
https://doi.org/10.11622/smedj.2014067
3) Sharma, AK, Aslami, AN, Srivastava, JP, & Iqbal, J. (2016). Visual Outcome of Traumatic Cataract at a Tertiary
Eye Care Center in North India: A Prospective Study. Journal of clinical and diagnostic research: JCDR , 10
(1), NC05 – NC8. https://doi.org/10.7860/JCDR/2016/17216.7049
4) Khun, F, Witherspoon, CD, and Morris, RE. 2015. Birmingham Eye Trauma Terminology System (BETT).
Journal Franciais d Ophtalmologie. 15 (2), 139-43.
5) Nadeem, Sana. (2016). Traumatic Cataract: Our experience. Ophthalmology Update.
6) Tabatabaei, SA, Rajabi, MB, Tabatabaei, SM, Soleimani, M., Rahimi, F., & Yaseri, M. (2017). Operasi katarak
traumatis awal versus akhir dan implantasi lensa intraokular. Eye (London, Inggris) , 31 (8), 1199–1204.
https://doi.org/10.1038/eye.2017.57
7) Ilyas S, Yulianti SR. 2018. Ilmu Penyakit Mata. Ed 5. Jakarta: FKUI, 2018; Hal 64-81
8) Nizami AA, Gulani AC. Cataract. [Updated 2020 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539699/
Thank
You
 Cincin soemering
Mutiara elschnig