CHAPTER III

CASE PRESENTATION
1. Patient identity
Name
Sex
Age
Address
Ethnic
Job
Religion

: Mrs. IR
: Female
: 47 years old
: Komyos Sudarso street, Muria Dalam alley, No. 20
: Madura
: Housewife
: Islam

Patient was examined and got history on September 15th, 2014

2. History
a. Main complaint
b. History of disease

: Blurred vision in both eyes

:

Patient complained that her vision in both eyes become blurry. Her right
eye blurred since 2 years ago and her left eye blurred since 9 months ago.
Her vision in both eyes decreased gradually. Patient felt that her right eye
is more blurry that her left eye. Patient didnt feel pain in both of her eyes.
Patient also said that she didnt feel itch in her eyes and didnt feel
headache.
c. Past clinical history :
Patient claimed that she never has this symptoms before. Patient said that
she has hypertesion and diabetes melitus history. She said that she already
consumed anti hypertension and anti diabetes melitus drugs. There is no
ocular trauma history in her eyes.
d. Family history: There is no one in her family have the same complaint.

3. General Physical Assessment

General condition
: Good
Awareness
: Compos Mentis
Vital Signs:
Heart Rate
: 80x/minute
Respiration freq.
: 24x/minute
Blood Pressure
: 110/80 mmHg

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4. Ophthalmological status
Visual acuity:
a. OD
: 1/300
b. OS
: 1/2/60
OD

Right eye
Ortho
ptosis (-), lagoftalmos
(-), edema (-)
Redness (-), discharge

OS

Eye ball position

Palpebra

Left eye
Ortho
ptosis (-), lagoftalmos (-),

Conjunctiva

edema(-)
Redness (-), discharge (-) ,

(-) , fibrovascular

fibrovascular growth (-)

growth (-)
Clear, edema (-), ulcer

Cornea

Clear, edema (-), ulcer (-),

(-), infiltrate (-)

clear, deep
Iris color : brown

COA
Iris and pupil

infiltrate (-)
clear, deep
Iris color : brown

Pupil: circular, 3mm,

Pupil: circular, 3mm,

isokor, reactive to light

Opaque
Cannot be described
Cannot be described

isokor, reactive to light

Half opaque
Cannot be described
Cannot be described

Lens
Vitreous
Fundus

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Eye ball movement

OD
+
+

OS
+

Shadow Test
-

OD : Negative
OS : Positive

5. Resume
A 47 years old women came to the ophtalmologist and complained that her
vision in both eyes become blurry. Her right eye blurred since 2 years ago and her
left eye blurred since 9 months ago. Her vision in both eyes decreased gradually.
Patient felt that her right eye is more blurry that her left eye. Patient didnt feel
pain in both of her eyes. Patient also said that she didnt feel itch in her eyes and
didnt feel headache.
Patient claimed that she never has this symptoms before. Patient said that she
has hypertesion and diabetes melitus history. She said that she already consumed
hypertension and diabetes melitus drugs. There is no ocular trauma history in this
patient.
Vital signs of this patient are in normal range. Visual acuity of OD is 1/300
with good projection, and OS is 1/2/60. Eyelids are normal. Cornea is normal. Iris,
pupil and anterior chamber are in the normal condition. Both of eyes have opaque
lens. Fundus examination cannot be done. Shadow test for the right eye is
negative and for the left eye is positive.

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6. Diagnose
Working Diagnose:

OD : Mature cataract
OS : Immature cataract

Differential Diagnose:

OD : Diabetic Cataract
OS : Diabetic Cataract

7. Plan for examination:

a. Slit lamp
b. Laboratorium
5. Treatment:
OD : ECCE Surgery
Non medicamentous: Education for the patient to control her blood pressure
and blood sugar with diet and do the exercise regularly
6. Prognosis:
a. OD
Ad vitam
: bonam
Ad functionam : dubia ad bonam
Ad sanactionam : dubia ad bonam
b. OD
Ad vitam
: bonam
Ad functionam : dubia ad bonam
Ad sanactionam : dubia ad bonam

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CHAPTER IV
DISCUSSION
A 47 years old women came to the ophtalmologist and complained that her
vision in both eyes become blurry. Her right eye blurred since 2 years ago and her
left eye blurred since 9 months ago. Her vision in both eyes decreased gradually.
Patient felt that her right eye is more blurry than her left eye. Patient didnt feel
pain in both of her eyes. Patient also said that she didnt feel itch in her eyes and
didnt feel headache.
The crystalline lens is a transparent structure. Its transparency may be
disturbed due to degenerative process leading to opacification of lens fibres. Loss
of lens transparency results in blurred vision (without pain) for both near and
distance.
Patient claimed that she never has this symptoms before. Patient said that she
has hypertension and diabetes melitus history. She said that she already consumed
anti hypertension and anti diabetes drugs. There is no ocular trauma history in this
patient. Vital signs of this patient are in normal range. Visual acuity of OD is
1/300 with good projection, and OS is 1/2/60. Shadow test for the right eye is
negative and for the left eye is positive.
Aging is the most common cause of cataract, but many other factors can be
involved, including trauma, toxins, systemic disease (such as diabetes), smoking,
and heredity. Age-related cataract is a common cause of visual impairment. Crosssectional studies place the prevalence of cataracts at 50% in individuals aged 6574; the prevalence increases to about 70% for those over 75.
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A mature cataract is one of the classification of cataract where all of the lens
protein is opaque; the immature cataract has some transparent protein. Age-related
cataract is usually slowly progressive over years. The patients right eye is mature
cataract because the lens is diffusely white, and the shadow test is negative. The
left eye is still immature cataract because the opacity only in a half of the lens, the
shadow test is positive although she has loss her vision.
Bilateral cataracts may occur in association with the following systemic
disorders: diabetes mellitus, hypocalcemia (of any cause), myotonic dystrophy,
atopic dermatitis, galactosemia, and Lowe's, Werner's, and Down's syndromes.
Diabetic cataract progresses rapidly. These cataracts usually also occur two to
three years earlier. Uncontrolled diabetus mellitus make the patient develop into
cataract earlier. During hyperglycemia extracellular glucose diffuse into the lens,
which can leads to the post-translational modification. Cataract progress forms the
synthesis and accumulation of excessive sorbitol in the lens fibre and consequent
osmotic stress. Sorbitol is synthesis from aldose reductase utilising the NADPH
and does not cross the cell membranes; it can accumulate in the cells and can
cause cell damage due to disturbing osmotic homeostasis.
Cataract depending on severity is a condition of the eye that by interfering
with vision can simultaneously interfere with certain activities in life. It is
generally agreed that surgical intervention is indicated when there is functional
visual impairment. In this patient, her right eye has a blurred vision for 2 year, and
the visual acuity is 1/300 with good projection.It means patient can differ hand
movements and know the direction where the movement start. This condition
decreasing her quality of life.
The definitive management for mature cataract is lens extraction through
surgery. The type of the surgery that I recommend for this patient is extracapsular
cataract extraction (ECCE). I tend to choose this type rather than intracapsular
cataract extraction (ECCE) because extracapsular cataract extraction maintains the
integrity of the anterior and posterior chambers of the eye, and the vitreous body
cannot prolapse anteriorly as after intracapsular cataract extraction. At 0.1 0.2
%, the incidence of retinal detachment after extracapsular cataract extraction is

23

about ten times less than after intracapsular cataract extraction, which has an
incidence of 2 3 %.

CHAPTER V
CONCLUSION

The diagnosis of this patient is mature cataract of the ocular dextra and
immature for ocular sinistra. The therapy is Extracapsular cataract extraction with
an implantation of posterior chamber intraoculer lens for ocular dextra.

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Lang GK. Ophtalmology: A Short Textbook. Newyork: Stuttgart; 2000.
Yanoff M, Duker JS. Yanoff & Duker Ophthalmology. 3 rd Edition. Philadelphia:

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Mosby, An Imprint of Elsevier; 2009.

Khurana AK. Comprehensive Ophthalmology. 4th Edition. New Delhi: New age

5.

International; 2007.
Galloway NR, Amoaku WMK, Galloway PH, Browing AC. Common Eye
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