CASE REPORT FORM

Comparison of Effectiveness of post-operative topical steroids after uneventful phacoemulsification

for two weeks to two months

Case No. ________________________________ Date:_________________

Name: ________________________________________ Age/Sex:______________
Reg. No:________________________________________
Occupation: ____________ Phone No:______________
Address:_______________________________________________________________
Comorbid Conditions:_____________________________________________________
Group: A/B:________________
Section 1: Preoperative Assessment
a. Visual Acuity:_____________________________________________
b. IOP:____________________________________________________
c. Examination findings on slit lamp biomicroscopy:________________
d. Fundus Examination findings:________________________________
e. Inflammation:____________________________________________
f. AC reaction:_____________________________________________

Section 2: Postoperative Ocular Assessment

Outcome 1 week 2 weeks 1 month 2 months
Measure
Inflammation
(redness,
dilation of
vessels, pain)
AC Reaction
Visual Acuity
Hypopyon
Posterior
Synechie
formation
Visual Analogue
Results