CASE PERSENTATION

Chronic Glaukoma and Senile

Cataract Immature ODS

Nadya Julaifa (H1A014049)

SUPERVISOR: dr. Siti Farida I.T. Santyowibowo, Sp.M(k)
 BACKGROUND

Glaucoma is a group of eye diseases characterized by da
mage to the optic nerve usually due to high intraocular 
pressure (IOP)

In Indonesia, 1993-1996 around 1.5% experienced

blindness with 0.20% cases caused by glaucoma. THE
cases of glaucoma at 2007 was around 0.46% with the
highest incidence in DKI Jakarta Province (1.85%) and
for the province of West Nusa Tenggara was 7th place
with 0.73% of cases.
 BACKGROUND

A cataract is a clouding of the lens of

the eye which leads to a decrease in vision.
There are many causes of cataract,
including aging, trauma, diabetes, and
other diseases.

 Aging is the most common cause of

cataracts.
 Indonesia Ministry of Health in 1993-
1996 showed that blindness in
Indonesia is 1.5% with the main cause
because of cataracts.
PATIENT’S IDENTITY

– Name : Mrs. F
– Age : 65 years old
– Gender : Female
– Address : Bima
– Religion : Moeslem
– Status : Married
– Occupation : -
– MR : 068695
– Date of Examination : 05 March 2020
ANAMNESIS
Main Complaint

Blurred vision in both of eye

History of current disease
• patient came to Polyclinic with the complaints of blurred vision
on her eyes.
• The patient claimed that the complaint was felt slowly and had
been around for about 2 years. The complaints of vision are
accompanied by watery eyes, painful in both eye, itching, and
headaches.

• The patient initially does not pay much attention to the

complaint, but over time her vision are increasingly blurred.
• The patient stated that she had previously came to the doctor in
Bima and was given an eye drops, because her complaints did
not improve she was referred to the hospital in Mataram.
History of Past Disease

• The patient claimed to have a history of hypertension since 5

months ago.
• There’s no history of similar complaints, diabetes, heart disease,
and kidney disease.
History of family Disease

• The patient said her sister were diagnosed with cataract.

• The history of similar complaints, hypertension, diabetes, heart
disease, and kidney disease in her family are denied
History of Previous Treatment

• This was the fourth time the patient came to polyclinic.

• Patients have used eye ointments given by doctor in Bima
History of Allergy

There is no history of any medication and food

allergies
Social History

Daily activity of the patient is housewife

GENERAL STATUS)

– General Condition : Moderate

– GCS : Compos mentis (E4V5M6)
– Blood Pressure : 140/90 mmHg
– Heart Rate : 80x/minute
– Respiratory Rate : 20 x/minute
– Temperature : 36,6 oC
 OPTHALMOLOGY STATUS
No EXAMINATION OD OS
1. Visual Acuity 6/12 1/300
   
2. Eyeball Position
Orthoforia
1. Hirschberg test
Orthotropia
2. Cover-uncover test
3. Eyeball Movement Good in all directions, smooth Good in all directions,
movement, full range, pain (-)  smooth movement,full
range, pain (-) 

Narrowing of the visual field

4. Lapang pandang Narrowing of the visual field on the on the nasal and inferior
nasal dextra section sinistra section

5. Superior Palpebra Edema (-) (-)

Hyperemia (-) (-)
Pseudoptosis (-) (-)
Entropion (-) (-)
Ectropion (-) (-)
6. Inferior Palpebra Edema (-) (-)
Hyperemia (-) (-)
Entropion (-) (-)
Ectropion (-) (-)
7. Superior Palpebral Conjunctiva Hyperemia (-) (-)
Scar (-) (-)

8. Inferior Palpebral Conjunctiva Hyperemia (-) (-)

Scar (-) (-)

9. Bulbar Conjunctiva Conjunctival injection (-) (-)

Cilarry injection (-) (-)

Mass (-) (-)

Edema (-) (-)

10. Cornea Shape/curvature Convex Convex
Transparency Clear Clear
Surface Smooth Smooth
Scar (-) (-)
Corpus alienum (-) (-)
11. COA Depth shalllow shallow

Hyphema (-) (-)

12. Iris Color Brown Brown

Shape Round and regular Round and regular

13. Pupil Shape Round Round

DLR (+) (+)

IDLR (+) (+)

14. Lens Transparency unclear unclear

Iris shadow (+) (+)

15. IOP Palpation Normal Normal

16. Funduscopy Fundus reflex (-) (-)

funduscopy Cant’t evaluated Can’t evaluated
ODS
OD OS
The photo’s fundus

OS OD
PROBLEM IDENTIFICATION

– Subjective: the complaint was felt slowly and had been around for about 2 years. The
complaints of vision are accompanied by watery eyes, painful in both eye, itching, and
headaches.
– Objective:
 Visus natural OD 6/12 and OS 1/300
 Lens ODS partially unclear (+), iris shadow ODS (+)
 COA ODS is shallow (+)
 The results of NCT at February 17th, 2020 was OD 31,2 mmHg, OS 47,2 mmHg and at
March 9th, 2020 OD 17,0 mmHg, OS 18,5 mmHg
 Reflex fundus ODS (-)
PROBLEM ANALYZE

– Based on the anamnesis and examination status ophthalmology of the patient's

the diagnosis are ODS Chronic Glaucoma and Senile Cataract Immature.
– The patient complained of blurred vision of her both eye. The patient claimed
that the complaint was felt slowly and had been around for about 2 years. The
complaints of vision are accompanied by watery eyes, painful in both eye, itching,
and headaches.
– From the anamnesis it was found that the patient experienced a slow decline in
vision. So from the anamnesis we can arrange a differential diagnosis among
others that is chronic glaucoma, cataracts, refractive disorders, diabetic
retinopathy, hypertension retinopathy.
– Examination of the eyes function showed that the left eye vision is 1/300 and
the right eye vision is 6/12 which did not progress with pinhole. So that the
possibility of patient complaints is not a refractive disorders.
– In the visual field examination there is a narrowing of the visual field in the
nasal dextra oculi and for oculi sinistra the region at the nasal and inferior.
– In the both eye there were found clouding in the lens, iris shadow (+), and
reflexes fundus (-) and shallow at COA.
– Examination of IOP of the oculi sinistra and dextra is normal, for The results of
NCT of the patient at February 17th, 2020 was OD 31,2 mmHg, OS 47,2 mmHg
and at March 9th, 2020 OD 17,0 mmHg, OS 18,5 mmHg.
– The results examination of the the patient's are ODS Chronic Glaucoma and
Senile Cataract Immature.
Assessment

ODS Chronic Glaucoma and Senile Cataract Immature

PLANNING

– Planning diagnosis : Slit lamp and Perimetri

– Medikamentosa : Timolol Timolol 0,5% 2x for ODS, Glaupen 0,1 % 2x for
ODS
– Therapy surgical : Fakoemulsifikasi
– Education : Provide education about the disease and explain to patients
that current treatment of catarct is only surgical and if not treated with the
right time can lead to more severe disease.
Prognosis

– ad sanationam : dubia ad malam

– ad functionam : dubia ad malam
– ad vitam : dubia ad bonam
CONCLUSION

– A 65-year-old female patient came to the polyclinic with the main complaint of
blurred vision in both eye.
– The patient claimed that the complaint was felt slowly and had been around for
about 2 years. The complaints of vision are accompanied by watery eyes, painful in
both eye, itching, and headaches. because the patient's complaints did not improve
the patient was referred to Hospita in Mataram. On physical examination of the
visus in the OD 6/12 and OS 1/300.
– The patient was diagnosed with chronic ODS glaucoma and Senile Cataract
Immature
– The therapeutic plan for patients is operative management.
REFERENCES

– Ariesti, A dan Herriadi, D. 2018. Profile of Glaucoma at The Dr.M.Djamil Hospital Padang,
West Sumatera. Available at: http://jurnal.fk.unand.ac.id
– Salmon JF. Glaukoma. dalam: Eva PR dan Whitcher JP. 2008. Vaughan & Asbury
Oftalmologi Umum. Edisi ke-17. Jakarta : EGC
– Kementerian Kesehatan RI, 2015. Pusat Data dan Informasi Kementerian Kesehatan RI:
Situasi dan Analisis Glaukoma.
– Sitorus, R.S, dkk. Buku Ajar Oftalmologi Edisi Pertama. Jakarta: FKUI
– Budiono, S., Saleh, T.T., Moestidjab, dan Eddyanto. Buku Ajar Ilmu Kesehatan Mata.
Surabaya: Airlangga University Press (AUP)
– Kementerian Kesehatan. 2016. Katarak sebabkan 50% Kebutaan 1st Ed.
Thank You