neovascular glaucoma.pptx.....................

neovascular glaucoma case presentation diagnosis treatment given........................................................................................................................................................................................................................................................................................

1. Presenter Dr. Shagun Gaur Junior Resident Case Presentation Moderator Dr. Amit Singh Ass istant Professor

2. PATIENT PARTICULARS Lalan Prasad Barnwal , 61 years old male Resident of Gopalganj , Bihar Occupation – Shopkeeper Socioeconomic status- lower middle class

3. C hief complaints Pain in Right eye since 1 month. Diminution of vision in left eye since 1month.

4. H istory of presenting illness The patient was apparently asymptomatic 7-8 years back , when he developed diminution of vision in right eye which was insidious in onset, painless and gradually progressive in nature. Patient is now complaining of pain in right eye associated with watering. Patient also complains of diminution of vision in left eye which is gradual, painless and progressive in nature. Patient was using spectacles for near vision for 7-8 years (Previous glass prescription was 1-2 months back). Patient consulted a nearby practitioner and he was prescribed topical medication for both eyes.

5. E/D Dorzolamide TDS (BE) E/D Brimonidine + timolol BD (BE) E/D Bimatoprost OD (RE) Previous treatment history :

6. P ast History No history of T2DM, HTN No h/o ocular trauma or ocular surgery.

7. PERSONAL HISTORY Takes mixed diet. N o H/o any addiction Bowel and bladder habits are normal. Sleep habit is normal.

8. FAMILY HISTORY No history of similar illness in the family.

9. GENERAL PHYSICAL EXAMINATION Patient is of average built. Conscious, oriented to time , place and person PR = 86/min, taken in right radial artery which is regular in rhythm, good volume and character and no radio-radial or radio-femoral delay. BP : 1 34/69 mm Hg measured in right arm in supine position. General physical examination- WNL Normal head posture and ocular alignment maintained.

10. Ocular E xamination RE LE Visual Acuity (with glass) PL negative 6/12P Intraocular pressure Non Contact tonometry Goldmann Applanation tonometry 45.3 mm Hg 44 mm Hg 9.4 mm Hg 12 mm Hg

11. RE LE Eyelids and adnexa Normal in shape and size Normal in shape and size Extraocular movements Full and free Full and free Direction Orthophoric Orthophoric Palpebral fissure height 10 mm 10 mm Palpebral fissure width 32 mm 32 mm Drainage system Normal ROPLAS negative Normal ROPLAS negative

12. RE LE Conjunctiva Circumcorneal congestion NAD Sclera NAD NAD CORNEA Shape Normal Normal Size Normal B /E symmetrical in vertical and horizontal diameter Transparency Corneal microcystic epithelial edema C lear

13. RE LE Anterior chamber VH-3 Normal depth Iris Florid neovascularization of iris Normal color and pattern Pupil mid dilated and fixed Direct and consensual reflex present, pupil - 3 mm , central in position Lens IMSC nuclear sclerosis grade 2 IMSC nuclear sclerosis grade 2 Fundus Media hazy due to cataract , disc round, medium in size, total cupping , well defined margins resolved retinal hemorrhages seen in all quadrants . FR dull Media hazy due to cataract , disc round, medium in size, CDR 0.6 :1, thinning of neuro retinal rim inferiorly , well defined margins. A:V ratio – 2:3, background normal. FR dull Gonioscopy NVA NVA NVA NVA PTM PTM PTM PTM

14. Treatment Medical management Inj. mannitol 300cc under strict vital monitoring was given. Post mannitol IOP- 35.9mm hg in right eye 8.0 mm hg in left eye Patient was advised following for 7 days and to be reviewed after 7 days. 1. Tab Acetazolamide 250 mg BD 2. E/D Brimonidine tartrate + Timolol Maleate BD (RE) 3. E/D B imatoprost 0.01% HS (BE) 4. E/D Carboxymethylcellu lose QID

15. P rovisional diagnosis Right eye Neovascular glaucoma (?f/b CRVO) with IMSC NS 2 Left eye I MSC NS 2 with ? POAG

16. THANK YOU !