POST KERATOPLASTY CASE PRESENTATION.PPTX

Post keratoplasty case

1. CASE PRESENTATION Presenter: Dr. Sharath Ram V (Post Graduate) Moderator: Dr. Mamatha M Asst. Professor Department of Ophthalmology MVJ MC & RH

2. PATIENT DETAILS: Name: Rajasekhar 0P/IP No. 202304270289 Age: 42 Years Gender: Male Occupation: Real Estate Dealer CHIEF COMPLAINTS: Redness in left eye since 1 day. Pain in left eye since 1 day.

3. HISTORY OF PRESENTING ILLNESS: Patient was apparently normal , since 1 day patient developed redness in left eye which was insidious in onset, gradually progressive. Associated with pain in left eye pricking type of pain, localised to left eye. No history of discharge, watering No history of blurring of vision No history of trauma to both eyes No history of fever, URTI/LRTI

4. PAST HISTORY: History of trauma to left eye by a stick later was referred to higher centre. For which keratoplasty was done to left eye 3 years back at Prabha Eye Hospital, Bengaluru. Following which patient was apparently normal. Known case of systemic hypertension since 11 years, is on regular medications. Not a case of Diabetes mellitus, Tuberculosis, Asthma. No history of burns, radiation exposure. No history suggestive of herpes simplex/herpes zoster. No history suggestive of Steven-Johnson syndrome, neuroparalytic diseases. No history of previous corneal graft failure.

5. PAST HISTORY: No history of spectacle use/ contact lens use. PAST MEDICAL HISTORY: On oral anti-hypertensive medications since 11 years. 3 years back following keratoplasty procedure patient was on topical eye drops and was on oral medications(drug name not known) Family History- Not significant.

6. PERSONAL HISTORY: Diet – mixed Appetite – normal Bowel and bladder – Regular Sleep – Sound No ill habits. GENERAL PHYSICAL EXAMINATION : A male patient aged 47 years old, moderately built & nourished. Well oriented to time place and person. Pulse – 82 beats / min BP : 130/100 mm of Hg No pallor, icterus, cyanosis, clubbing and lymphadenopathy

7. SYSTEMIC EXAMINATION- CVS- S1,S2 heard RS- normal vesicular breath sounds heard P/A- soft & non tender CNS- Higher mental functions intact

8. OCULAR EXAMINATION: RIGHT EYE LEFT EYE Visual acuity 6/6 6/60 Pin Hole ---- 6/36 Near Vision N10 N18 Auto Refractometry +1.50DS; -O.75DC @ 176° CAT BCVA Plano Not accepting BCNV +1.25DS(N6) Not accepting

9. OCULAR EXAMINATION: Head posture – Normal Forehead – Normal Facial symmetry – Symmetrical Ocular posture – Orthophoric Extra ocular movements – BE -Normal

10. OCULAR EXAMINATION: RIGHT EYE LEFT EYE Lids MGD+ MGD+ Conjunctiva Nasal pterygium+ Normal Cornea Nebular corneal opacity present, ̴1×1mm in the paracentral zone at 5óclock position , 4mm away from limbus Superficial punctate keratitis+ Opacified graft tissue present Graft size ̴ 6mm Graft in place. Suture tracts present+ Descemet́s membrane folds+ on graft, superficial vascularization present in inferior quadrant, Corneal abrasion3×2mm in peripheral zone, graft host junction is normal.

11. OCULAR EXAMINATION: RIGHT EYE LEFT EYE Anterior chamber Normal in depth & contents Normal in depth & contents Iris Normal in pattern & colour Normal in pattern & colour Pupil Round regular reactive to light Reactive to light Lens SIMC SIMC Lacrimal apparatus Normal Normal IOP Perkins @ 11:30 AM 12 mmHg 14 mmHg

12. Patient wants to get dilated fundoscopy in the next visit as patient came alone. RIGHT EYE LEFT EYE B Scan Within normal limits Within normal limits

13. RIGHT EYE LEFT EYE

14. PROVISIONAL DIAGNOSIS: RE- Superficial punctate keratitis with corneal opacity LE- S/P Keratoplasty with graft failure , abrasions over cornea Both eyes – Senile immature cataract

15. THANK YOU