Catarac

Long Case Presentation
Dr. Shabnam Sultana Shova

Resident (Phase A)
Dept. of Community Ophthalmology
BSMMU
Particulars of the patient
Name : Md. Shahadat Hossain

Age : 60 years
Sex : Male
Occupation : Security guard
Address : Rupganj, Narayanganj
Religion : Islam
Date of : 28/04/2024
examination
Presenting complaints
Blurring of vision in right eye for 1 year.

History of present illness
According to patient statement, He was

reasonably well one year back. Then he noticed
blurring of vision in right eye. It is gradual in
onset & progressive in nature which is affecting
distant vision more than near vision & day light
than night.
History of present illness (cont…)
It is not associated with headache, pain, watering,

redness, discharge, diplopia, color halos or black spot.
He has no history of trauma to any eyes or use of any
drug other than CCB&ARB for hypertension.
History of present illness (cont…)
He is hypertensive for last 5years, non diabetic,

non asthmatic. With these complaints he came
to department of community ophthalmology
OPD, BSMMU for better management.
History of past ocular surgery
He had cataract surgery (Phacoemulsification

with PCIOL implantation) in left eye one year
back
Drug history
Tab. CCB & ARB 5/20 (Bizoran 5/20)

Family history
None of his family member suffering from this

kind of disease.
Personal history
He is non smoker & non alcoholic.

Socio economic history
He lives in a tin-shed building house, drinks

arsenic free tube-well water & uses sanitary
latrine.
Immunization history
He is immunized as per schedule.

General Examination
Appearance- ill looking

Body built- average
Co-operation- co-operative
Pulse- 80 beats /min
BP- 130/80 mm hg
Temperature- 98.4 degree F
Anemia- absent
Jaundice- absent
General Examination(cont…)
Edema- absent
Dehydration- absent
Clubbing- absent
Koilonychia- absent
Leukonychia- absent
Respiratory rate- 18 breaths/ min
Thyroid gland- not enlarged
Lymph node- not palpable
Cardiovascular system
Audible 1st and 2nd heart sound. No added sound

present.
All peripheral pulses are palpable with no delay
Respiratory system
o Respiratory rate- 18 breaths/min

o Respiratory movement- symmetrical
o No chest wall deformity
o No local tenderness
o Vesicular breath sound present
o No added sound
Alimentary system
o Mouth and oral cavity normal

o Abdomen- scaphoid shape , umbilicus
centrally placed , no visible peristalsis
o No superficial or deep tenderness
o No palpable mass
o Bowel sound- present
Genitourinary system
No abnormality detected
Musculo-skeletal system
o Gait: Normal
o No movement restrictions in upper or lower limbs
o Spine: Normal
o No joint deformity or tenderness
o Muscle power and deep tendon reflexes: No

abnormality detected
Nervous system
o Higher mental function- intact

o Cranial nerves- intact
o Signs of meningeal irritation- Absent
o Motor response- normal
o Sensory system - intact
Ocular Examination
Trait Right Eye Left Eye
Distant
6/24 6/ 12
Unaided
With Pinhole 6/ 24 6/9

Visual Acuity Near Vision N 24 N 10
6/24 with +0.25D

6/9 with +0.25D spherical & N-
BCVA spherical & N-10 with
6 with +2.50D Spherical
+2.50D Spherical
Pupillary Direct Brisk Brisk

Light Reflex Consensual Present Present
RAPD Absent Absent

Hirschberg Reflex Central Central
Ocular Motility Test Full In All Gaze Full In All Gaze
Color Vision Test Trichromatic Trichromatic
Slit-lamp examination
Traits Right eye Left eye
Eyelid Normal Normal
Eyelash Normal normal
Conjunctiva Not congested Not congested
Cornea Transparent Transparent
Normal depth both center &
Anterior chamber Normal depth both center & periphery periphery
Normal pattern in all quadrant

Iris Normal pattern in all quadrant
Round , regular & reacting to light

pupil Round , regular & reacting to light
PSC + CC + NS-1 (posterior subcapsular

Pseudophakia
Lens cataract with cortical cataract with nuclear
sclerosis grade-ii)
IOP (GAT) on
14 mm hg 14 mm hg
28/04/24 @11.00am
Diffuse illumination
Right Eye Left Eye

Oblique illumination
NS1 & CC in right eye Pseudophakia in left eye

Retro illumination
Showing PSC in right eye

Fundoscopic examination
Traits Right eye Left eye
Media Hazy partially Clear
Size: normal
Size: normal
Color : pink
Color : pink
Optic disc Shape : round
Shape : round
Margin: well defined
Margin: well defined
C:D 0.4 0.4
NRR Healthy Healthy
Blood vessel normal in Blood vessel normal in

Blood vessels number, pattern & number, pattern &
distribution distribution
Macula Healthy Healthy
Peripheral retina Normal Normal

Salient feature
Md. Sahadat hossain, 60 years old, hypertensive,

nondiabetic, non asthmatic, from rupganj, narayanganj
came to community ophthalmology OPD of BSMMUwith
complaints of blurring of vision in right eye for one year.
It is gradual in onset & progressive in nature & more
prominent in distant vision than near vision and day light
than night.
Salient feature
 On ocular examination, Best corrected visual acuity

(BCVA) is 6/24 with +0.25D spherical & N-10 with
+2.50D spherical in right eye and 6/9 with +0.25D
spherical and N-6 with +2.50D spherical in left eye.
Salient feature
 On slit lamp bio microscopy, posterior sub

capsular cataract with cortical cataract with
nuclear sclerosis grade-1 in right eye and
pseudophakia in left eye.
 On Fundoscopy, posterior segment found
normal in both eyes.
Provisional diagnosis
Cortical cataract with nuclear sclerosis grade-II

& posterior sub capsular cataract in right eye &
pseudophakia in left eye with hypertension.
Differential diagnosis
Secondary cataract in right eye.

Investigations for surgery
RBS
ECG
HBsAg
Biometry
Plan of management
Counselling of the patient.

Phacoemulsification with PCIOL implantation
in right eye.
THANK YOU ALL

Catarac

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Long Case Presentation

Dr. Shabnam Sultana Shova

Name : Md. Shahadat Hossain

Blurring of vision in right eye for 1 year.

According to patient statement, He was

It is not associated with headache, pain, watering,

He is hypertensive for last 5years, non diabetic,

He had cataract surgery (Phacoemulsification

Tab. CCB & ARB 5/20 (Bizoran 5/20)

None of his family member suffering from this

He is non smoker & non alcoholic.

He lives in a tin-shed building house, drinks

He is immunized as per schedule.

Appearance- ill looking

Audible 1st and 2nd heart sound. No added sound

o Respiratory rate- 18 breaths/min

o Mouth and oral cavity normal

o No movement restrictions in upper or lower limbs

o No joint deformity or tenderness

o Muscle power and deep tendon reflexes: No

o Higher mental function- intact

With Pinhole 6/ 24 6/9

6/24 with +0.25D

Pupillary Direct Brisk Brisk

RAPD Absent Absent

Normal pattern in all quadrant

Round , regular & reacting to light

PSC + CC + NS-1 (posterior subcapsular

Right Eye Left Eye

NS1 & CC in right eye Pseudophakia in left eye

Showing PSC in right eye

C:D 0.4 0.4

NRR Healthy Healthy

Blood vessel normal in Blood vessel normal in

Macula Healthy Healthy

Peripheral retina Normal Normal

Md. Sahadat hossain, 60 years old, hypertensive,

 On ocular examination, Best corrected visual acuity

 On slit lamp bio microscopy, posterior sub

Cortical cataract with nuclear sclerosis grade-II

Secondary cataract in right eye.

Counselling of the patient.

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