General Data

E.S.
55 y/o
Male
Married
Filipino
Roman Catholic
Chief Complaint
Blurring of vision
History of Present
Illness
2 mos PTA (+) blurring of vission
(-) headache or diziness
(+) consult done, advised
surgery, schedule of
operation after control of
blood surger
History of Present
Illness
1 mon PTA (+) blurring of vision
(+) stable of blood sugar,
Phacoemulsification w/ PLIOL
OD was done (apr 22, 08) in
AFPMC.

admission
History of Present
Illness
2 wks PTA Pt was retro-EVAC, schedule for
next OR hence admission

admission
Past Medical History
(-) Hypertension, (-) Asthma
(+) DM x 11 years
 Metformin 850mg/tab TID after meal,
 Glimepiride 2mg/tab OD before breakfast
(+) food allergy to chicken but no known allergies
to drugs
(+) S/P Phacoemulsification w/ PLIOL OD
Family History
Personal / Social
History
(+) smoker (5 pack years) ,Stopped feb,
2008
Non alcoholic beverage drinker.
Review of Systems
(-) wt loss, (-) change of appetite
(-) headache, (-) skin rashes
(-)Chest pain, (-) palpitation
(-) diarrhea
Physical Examination
GENERAL: conscious, coherent, ambulatory, not in
cardiorespiratory distress.
BP = 130/80 mmHg CR = 81 bpm
RR = 21 cpm T = 36.5°C

 Skin: No jaundice, good skin turgor

HEENT: Anicteric sclera, pink palpebral conjunctiva,
no nasoaural discharge, no tonsillopharyngeal
congestion, no cervical lymphadenopathy, (+) blurring
of vision of left eye
Chest & Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Physical Examination
Heart: Adynamic precordium, NRRR, no murmur

Abdomen: Flat, normoactive bowel sounds, soft,

non-tender

Extremities: grossly normal, full and equal

pulses
DIFFERENTIAL
DIAGNOSIS
ADMITTING IMPRESSION
Posterior Subcapsular Cataract OS
DM type2, controlled
Course in the Wards
On admission to 15th hospital day
DM diet
No IVF
Therapeutic:
Predrisolone (Pred forte) 10mg/ml 1 drop QID to
consume
Moxifloxacin (Vigamox) 5mg/ml 1 drop
TID to consume
Nepafenac (Nevanac) 1mg/ml 1drop TID
to consume
Metformin 850mg/tab TID after meal
Glimepiride 2mg/tab OD before
breakfast
Course in the Wards
On 16th to 18th hospital day
DM diet
No IVF
Therapeutic:
Tobramycin dexamethasone 3mg/ml 1
drop QID to consume
Moxifloxacin (vigamox) 5mg/ml 1 drop
TID to consume
Nepafenac (nevanac) 1mg/ml 1drop TID
to consume
Metformin 850mg/tab TID after meal
Glimepiride 2mg/tab OD before
breakfast
Course in the Wards
On 19th to 22th hospital day
DM diet
No IVF
Therapeutic:
 Tobramycin dexamethasone 3mg/ml 1 drop
QID to consume
Metformin 850mg/tab TID after meal
Glimepiride 2mg/tab OD before breakfast
Final Diagnosis
Posterior Subcapsular Cataract OS
DM type2, controlled
Daily BGM
May 10, 08 137 ↑

May 13, 08 135 ↑

May 15, 08 141 ↑

May 16, 08 62
May 20, 08 95
May 21, 08 105
May , 08
May , 08
May , 08
May , 08
What is a Cataract?
A cloudy or opaque area (an area you cannot
see through) in the lens of the eye.
The human eye
contains a translucent
lens inside it.
This lens focuses the
rays of light entering
the eye on to the
retina rather like rays
of sunshine being
focused by a
magnifying glass.
The retina converts
this light into
neurological messages
that are then
If this ocular lens becomes cloudy or hazy it is
called a cataract. The light focused on the retina
is then no longer sharply focused, and the
patient's vision becomes blurred in this eye
CAUSES
Advancing Age
Radiation exposure
Long term exposure to ultraviolet radiation
Diabetes
Hypertension
Eye injury / Physical Trauma
Drugs (Corticosteroids)
Congenital (e.g. congenital cataract)
EPIDEMIOLOGY
Leading cause of blindness in the world
Statistics:
42% of those between the ages of 52 to 64,
60% of those between the ages 65 and 74, and
91% of those between the ages of 75 and 85.
Increased risk for those with diabetes,
hypertension, and few are related with long
term corticosteroid therapy
SIGNS AND SYMPTOMS
Blurry vision
Glare from car headlights especially at night.
Sunlight or indoor overhead lighting may
seem to be seem too bright or cause glare.
Bright colors may appear dulled.
Sometime cataracts can cause double vision,
Frequently changing contact or eyeglasses
prescriptions.
TYPES OF CATARACTS
CLASSIFIED BY ETIOLOGY
Congenital Cataract
Age related
Secondary cataract ( drug induced cataract)
Traumatic Cataract
TYPES OF CATARACT
CLASSIFIED BY LOCATION OF OPACITY WITHIN
LENS STRUCTURE
Nuclear
Posterior cortical cataract
Posterior polar cataract (importance lies in
higher risk of complication - posterior capsular
tears during surgery)
Posterior subcapsular cataract
Anterior cortical cataract
Anterior polar cataract
Anterior subcapsular cataract
Top Left Top Right
This is a posterior subcapsular cataract. Such Cortical cataract as seen against the reflection of
cataracts often cause difficulty in reading, and a the retina. This is a very common type of
disabling glare in bright light. cataract causing glare and blurring of vision.
Bottom Left
Nuclear cataract is another common type. This Bottom Right
is an opacity in the central nucleus of the lens A mature cataract. These are now rare in
which tends to cause refractive changes and developed countries.
blurring of vision.
Clinical features:
Symptoms: glare and decreased visual acuity
especially during bright sunlight, but see well in
dim illumination.
Signs: granular opacities in the posterior pole of
cortex adjacent to the posterior capsule.
May be age-related or occur as a complication
of other conditions such as intraocular
inflammation (e.g. chronic uveitis), steroid
administration, vitreoretinal surgery and
trauma.
May also be related to irradiation and
systemic conditions such as diabetes mellitus.
View of a person with
Cataract
POSERIOR SUBCAPSULAR
CATARACCT
No-stitch/small incision surgery are
techniques used to restore vision loss
due to cataracts.
The cloudy lens is removed and
replaced with a plastic lens (IOL)
implant.
Ultrasound technology
(phacoemulsification) is often used to
remove the cataract.
A special lens can then be implanted
through a smaller incision than is
required in traditional cataract
What is
Phacoemulsification?
 Phacoemulsification (phaco) is a surgical technique which
uses ultrasound technology.
 In “phaco” or small incision surgery, a small probe is
inserted into the capsular membrane which surrounds the
cloudy lens.
 Ultrasound is used to gently break-up (or emulsify) the
cloudy lens into tiny pieces which can be removed through
the tip of the probe.
 In comparison, traditional surgery techniques require the
lens to be removed in one piece through a relatively large
incision.
 Traditional cataract surgery requires an incision that spans a
third of the circumference of the cornea and needs as many
as eight stitches to close.
 In contrast, the phaco technique allows the cloudy lens to
What are the Advantages
of this procedure?
Faster recovery of good vision
Faster return to normal activities
Good vision in a matter of days instead of
weeks or even months
Return home within hours of the procedure
No need for an overnight hospital stay
Reduces the chance of surgically induced
astigmatism or ruptured sutures
Phacoemulsification
INSERTION OF INTRAOCULAR LENS
BEFORE AND AFTER
SURGERY
PREVENTION
controlling diseases that increase the risk of a
cataract, and avoiding exposure to factors
known to promote cataract formation.
Wearing sunglasses when you are outside
during the day can reduce the amount of UV
light your eyes are exposed to.
Some sunglasses do not filter out the harmful
UV. An optician should be able to tell you
which sunglasses filter out the most UV.
For patients who smoke cigarettes, QUIT while
you’re still young
THANK YOU!!!!