CASE PRESENTATION I

“OD MATURE SENILE CATARACT & OS IMMATURE SENILE

CATARACT”

Pembimbing : dr. Siti Farida I.T. Santyowibowo, Sp.M (K)

Ni Kadek Ariani
CASE PRESENTATION 1 :
H1A015050
BACKGROUND
Cataract defined as opacity in lens, leading cause decreased visual acuity and
contrast sensitivity.

 Cataracts are caused by multifactorials, the aging process is the main cause. Systemic
diseases such as diabetes mellitus, hypertension and the use of steroid-containing drugs are
associated with the acceleration of cataracts.
 Cataracts that caused by the aging process are called senile cataracts, which are divided
into 4 stages of maturity  Insipien, immature, mature, hypermature
PATIENT’S IDENTITY
Name : Mr. E
Age : 53 years old
Sex : Male
Education : Senior High School
Address : Pagutan, Mataram
Job : Wiraswasta
Religion : Moeslem
Date of examinations : April 20, 2019
Main complaint  foggy blurred vision on the both eyes

Present medical history :

Patient came to the ophthalmology clinic at RSUDP NTB with
complaints of foggy blurred vision in both eyes since 2 years
ago. First occured in the right eye, then 1 year later in the
left eye. In addition, patient also said that he felt the vision
was more clearly when seing at night than during the day
and glare when seen the light. Other complaints such as
pain, nausea and vomiting were denied.
 PAST MEDICAL HISTORY
History of ophthalmology diseases:
• Similiar complaints, wearing glasses, infection in the eyes were denied
• Patient had experienced trauma to the eyes, 10 years ago. The trauma
occured due to being hit by airgun splinters when shooting bird. That make the
red eyes and he treated just by cold water compress
History of systemic diseases:
• Patient has hypertension and diabetic mellitus history since 4 years ago. The
patient routinely seek treatment for the first years since they have been known,
but after that, he never took a medication again.
•Hearth diseases (-) and asthma (-)
•Anemia (-)
Family medical history : his brother has DM

Allergic history : -

Medication history :
• Antihypertension
• Antidiabetic

Social history :
• Consumed 1 pack cigarettes per day since 25 years ago
PHYSICAL EXAMINATION

General condition: well

Consciousness/GCS : Compos mentis / E4V5M6
Vital sign
Blood pressure : 150/90 mmHg
Rr : 20x/menit
Hr : 88x/menit
 No OD OS

Visus
1
STATUS -. Sc
1/300 5/60
LOCALIS - Pinhole:
No Improvement No Improvement
Eye
2 ball position
Ortoforia Ortoforia
.
Hirschbeg
Ortotropia Ortotropia
Cover Uncover Test
Eye
3 Movement Good in all direction, smooth Good in all direction, smooth
movement, full range, pain (-)
. movement, full range, pain (-)

Convergence test Insufficiency Normal convergence

 No OD OS

1
Visual fields
STATUS .
LOCALIS
OPHTHALMOLOGY

± 20o towards superior, ±50° towards superior,

±40o towards nasal, ±50o ±40o towards nasal, ±70°
towards inferior, dan ±40o towards inferior, dan ±80o
towards temporal. towards temporal

Palpebra
5 Superior Edema (-) (-)
. Hyperemi (-) (-)

Entropion (-) (-)

Ekcropion (-) (-)

Ptosis (-) (-)

Lagoftalmus (-) (-)

 Palpebra
6 Inferior Edema (-) (-)
. Hyperemi (-) (-)
STATUS Mass (-) (-)
LOCALIS
Sikatrik (-) (-)
Entropion (-) (-)
Ektropion (-) (-)
Conjunctiva
7 superior Hyeremi (-) (-)
. Palpebra Cobble stone (-) (-)
Sikatrik (-) (-)
Corpus alienum (-) (-)

Conjuctiva
8 Inferior Hyperemi (-) (-)
. Palbebra Cobble stone (-) (-)
Sikatrik (-) (-)
Corpus Alienum (-) (-)
 9 Bulbar conjuctiva Conjuctival and (-) (-)
. siliar injection
STATUS
LOCALIS Subconjuctival (-) (-)
bleeding
Mass (-) (-)
Edema (-) (-)
1 Kornea Shape Convex Convex
0 Transparancy Clear Clear
. Surface Smooth Smooth
Scar (-) (-)
Corpus Alienum (-) (-)
Presipitat ceratic (-) (-)

1 COA Depth deep deep

1 Hifema (-) (-)
 Iris color brown brown
Shape Round and regular Round and regular
Sinekia (-) (-)
Pupil shape Round, 4 mm Round, 4 mm
RCL (+) (+)
RCTL (+) (+)
STATUS
LOCALIS
Lens Transparancy Total cloudy Partially cloudy

Iris Shadow (-) (+)

Subluxatio (-) (-)
Luxtatio (-) (-)
TIO Palpation Normal Normal
 Funduskopi
1 Reflex Refleks Refleks fundus (+)
6 fundus (-)
STATUS Fundus
LOCALIS .

C/D ratio Not observed Difficult to observe

Blood vessel Not observed Difficult to observe

Retina Not observed Difficult to observe

Macula Not observed Difficult to observe

RIGHT EYE
LEFT EYE
PROBLEM IDENTIFICATION
Subjective
• Complaint of foggy blurred vision in both eyes since 2 years ago. First in right eye, 1 year later in left
eye
• Feel more clearly when seeing at night than during the day.
• Glare when see light
• History of hypertension and DM

Objective
 BP : 150/90 mmHg
 Decrease visual acuity ( OD 1/300 OS 5/60)
 Visual field loss (nasal OS; nasal, temporal, superior, and inferior OD)
 Convergence test : insufficiency OD
 Totally cloudy lens OD (iris shadow (-), partially cloudy OS (iris shadow (+))
 Fundus reflex OD (-), OS (+) not full round
 CASE ANALYSIS
• Clarity of refractive media/
Blurred vision visual axis
• N. Opticus pathway
• Central nervous system

Anamnesis & Eye examination :

• 54 years old
• Complaint of foggy blurred vision in both eyes since 2 years ago,
first in right eyes, 1 year later in left eye. Senile Cataract
• Feel more clearly when seeing at night than during the day
• Glare when see light
• Visus  VOD: 1/300, VOS: 5/60
• Pinhole  no improvement
• inspection of OS lens  partially cloudy (iris shadow(+)) Immature Senile Cataract
• Inspection of OD lens  Totally cloudy (iris shadow (-))
Mature Senile Cataract
 CASE ANALYSIS

This patient:
• 54 years old Cloudy in lens
• Tumor/edema in palpebra (-)
• Corpus alineum in conjuctiva (-),
Pterygium (-)
• History of neurologic disease (-)
Visual field Loss

Convergence test : Disruption on M. Rectus

insufficiency Medialis
CASE ANALYSIS
In a meta-analysis study by Xiaoning et al, it was
History of hypertension found that there was a relationship between
hypertension and an increased risk of cataracts

Many studies suggest that hypertension increasing the risk of

cataracts associated with the anti-hypertensive medication, for
example:
• Potassium-sparing diuretics can interfere the electrolyte balance
in the membrane fiber lens
• beta blockers can increase intracellular cyclic adenosine
monophosphate which can cause modification of lens proteins
CASE ANALYSIS
Diabetes mellitus can affect lens clarity, as
History of DM
well as the refractive index and
accommodative amplitude of the lens

Blood glucose level ↑ glucose content in the aqueous humor ↑ 

glucose from the aqueous enters the lens by diffusion  glucose
content in the lens↑.
Some of the glucose is converted to sorbitol metabolized slowly
by the lens and accumulates in the lens cell cytoplasm increase in
osmotic pressure may cause an influx of water, which leads to
swelling of the lens fibers.
CASE ANALYSIS
Consumed 1 pack cigarettes per day since 25
Social History years ago

In numerous studies, smoking has consistently

been associated with an increase in the
frequency of nuclear opacities
Assesment

Diagnosis:
• OD Matur Senile Cataract + OS Immatur Senile Cataract

Differential diagnosis:
• ODS Complicata Cataract
Planning

Diagnostic:
• Slitlamp, blood test, USG ocular

Therapy
• BP control and blood glucose control (referral to internist), phacoemulsification
with IOL

Monitoring
• Lens
• BP and blood glucose
 EDUCATION

 Patients are given information about the condition of their illness

 Patients are given information that cataracts can only be treated with surgery
 Provide information about the procedure, risk, benefits, complications, and results
obtained after undergoing surgery
PROGNOSIS
Sight Prognosis (ad visum)
Ad bonam.
Life Prognosis (ad vitam)
Ad bonam
REFERENCES
Widyawati, S. Katarak. Dalam: Sitorus, R.S., et al. Buku Ajar Oftalmologi Edisi Pertama.
Jakarta: Badan Penerbit FK UI. 2017; hal 195-204.
Kementerian Kesehatan RI. Situasi Gangguan Penglihatan dan Kebutaan. [pdf] 2014.
Available at:
<http://www.depkes.go.id/download.php?file=download/pusdatin/infodatin/infodatin-
penglihatan.pdf> [Accessed 21 April 2019].
Bowling B. Kanski’s Clinical Ophthalmology. 8th Edition. New York: Elsevier
Inc.; 2016.
Vaughan Daniel G., Asbury T. Oftalmologi Umum, Edisi 17 (Alih Bahasa: Waliban dan Bondan
Hariono); Jakarta :Widya Medika; 2015.
Budiono, S., dkk. Buku Ajar Ilmu Kesehatan Mata. Airlangga University Press; 2013.
American Academy of Ophthalmology. Lens and Cataract 2011-2012. San Fransisco: Basic
and Clinical Science Course; 2011.
TERIMA KASIH