Patients Identity

Name : Mr. DAW

Age : 23 yo

Address : Wonosobo

Occupation : Student

MR : 01.67.24.01

Date of visit : December 13th 2016

 CHIEF COMPLAINT

Blurred Vision on his both eye

History of Present Illness

His both eye still blurred, then he came to

SGH
 History of RELATED ILLNESS

Ocular Surgery : (+)

Rheumatoid Arthritis : (+)
Steroid Consumption : (+)
Ocular Trauma : (-)
Diabetes Mellitus : (-)
Hypertension : (-)
 HISTORY OF FAMILY ILLNESS

Blindness : (-)
Eye diseases : (-)
 GENERAL EXAMINATION

General condition: Good

Consciousness : Alert
Nutritional state : Good
Vital signs :
BP : 110/72 mmHg
HR : 88 x/minute
RR : 12 x/minute
T : Afebrile
PATIENTS PHOTOGRAPH
RE OPHTALMOLOGICAL STATUS
RE Fundus Photograph
LE OPHTALMOLOGICAL STATUS
 LE Fundus Photograph

Difficult to be Assessed
 GONIOSCOPY
RIGHT EYE- Open LEFT EYE- difficult to
Angle be assesed
I S N T

SL + + + +
TM + + + +
SS - - - -
IR - - - -
PIQ - - - -
PAS - - - -
HOURS - - - -
NEOVASC - - - -

ETC - - - -
OCT ONH RIGHT EYE
RNFL
 OCT ONH and RNFL LEFT EYE

Couldnt Be assesed
 USG
OD

OS
 VISUAL FIELD

RE: Double Arcuate defect

LE : Temporal Central Remnant Very Severe General
Very severe General Depression
Depression
 DIAGNOSIS

LE Steroid Induced Glaucoma

LE Posterior Sub capsular Cataract
RE Pseudophacos
RE Atrophy papil susp preptisis bulbi
RLE Dry Eye
 MANAGEMENT

Medicamentosa :
Timol ED 1 drop/12 hours (LE)
Lyteers ED 1 drop/6 hours (RLE)
Acetazolamide (Glaucon) 3 x 125 mg per oral
KCl 1 x 125 mg per oral

Surgery:
LE Trabeculectomy
 PLAN

Education about the disease and prognosis

Consult to Uvea Lens subdivision for further
management of cataract
 PROGNOSIS

Ad visam : malam
Ad sanam : malam
Ad vitam : bonam
Ad cosmeticam : dubia ad malam (RE)
bonam (LE)
GLAUKOMA STEROID INDUCED
 PATOFISIOLOGI

Enzim hyaluronidase berikatan dengan

glycosaminoglycans di trabecular meshwork
keadaan glycosaminoglycans dalam bentuk
polimer edema steroid menyetabilkan
keadaan edema peningkatan resistensi aquos
humor peningkatan tekanan intra okular.
Gejala yang muncul akibat keadaan tersebut
mirip dengan keadaan glaukoma sudut terbuka :
1.Peningkatan TIO
2.Nyeri periokular minimal
3.Hilangnya lapang pandang
 PATOFISIOLOGI

Terbentuknya katarak akibat terapi

kortikosteroid ini karena reaksi spesifik dengan
asam amino dari lensa sehingga menyebabkan
agregasi protein dan kekeruhan lensa.
Katarak subkapsular posterior khas terbentuk
pada katarak akibat kortikosteroid, hal ini
disebabkan oleh migrasi abnormal dari sel
epitel lensa. Aktivasi reseptor glukokortikoid
pada sel epitel lensa yang berakibat proliferasi
sel, penurunan apoptosis, dan menghambat
diferensiasi sel.