Case Report

ODS Immature Senile Cataract

Presented By:
Devi Indah Permatasari
111 2016 2137
Supervisor:
dr. Marliyanti N. Akib, Sp.M (K), M.Kes
OPTHALMOLOGY DEPARTMENT FACULTY OF MEDICINE
UNIVERSITAS MUSLIM INDONESIA
MAKASSAR
2018
 Patient Identity
Name : Mr. D
Sex : Male
Age : 70 y.o
Address : Bantaeng
Religion : Islam
Ethnic / Nation : Makassar / Indonesia
Occupation : Unemployed
No Medical Record : 12.83.70
Date of Examination : November 28th, 2018
 History taking
Main Complaint : Blurred vision in both eyes
Guided history :
A 70 years-old male patient came to the BKMM with blurred vision in both eyes, which occured s
lowly since 2 years ago and get worse in the past 3 months. Besides blurrey, the patient also fee
ls there were glares in both eyes, but not feeling of itchy and pain. There were no history of red a
nd watery eyes, no dirt found in both eyes. The patient felt a little of discomfort both eyes. No his
tory of treatment, glasses and trauma. There were no history of DM and hypertension.
Ophthalmology Examination
Overview
 Inspection
OD OS
Palpebral Margo Oedema (-) Hyperemia (-), Crusta (-) Oedema (-) Hyperemia (-), Crusta (-)
Cilia Secret (-), Madarosis (-) Secret (-), Madarosis (-)
Lacrimal Apparatus Lacrimation (-) Lacrimation (-)

Conjunctiva Hyperemia (-) Hyperemia (-)

Eyeball Normal Normal

Eyeball Movement Full Full
Cornea Clear Clear
Anterior Chamber Normal Depth Normal Depth
Iris Brown Brown
Pupil Round, Central Round, Central
Lens Opacity Opacity
 Palpation
OD OS
Ocular pressure Tn Tn
Tumor/Mass (-) (-)
Pre Auriculer Not palpable Not palpable
gland
 Examination of visual acuity
OD Visus OS

20/150 Uncorrected visual acuity 20/200

- Correction -

- Best corrected visual acuity -

- Near visual acuity -

- Correction -

- Best corrected near visual acuity -

 Slit Lamp
• SLOD: Conjuctival Hyperemia (-), Opacity of cornea (-), anterior chamber normal, br
own iris, visible crypt, round and central pupil, positive light reflex, iris shadow (+)
• SLOS: Conjuctival Hyperemia (-), Opacity of cornea (-), anterior chamber normal, br
own iris, visible crypt, round and central pupil, positive light reflex, iris shadow (+).
 Intraocular Pressure : NCT Tonometry
• OD : 10 mmHg
• OS : 11 mmHg
 Diagnosis
ODS Immature Senile Cataract

Differential Diagnosis
Mature Senile Cataract
Hypermature Senile Cataract
Treatment
• Surgery planning: Phacoemulsification + Intraocular Lens Implantation
 Prognosis

• Quad Ad vitam : Bonam

• Quad Ad Sanam : Bonam
• Quad Ad Visam : Bonam
• Quad Ad Cosmetican : Bonam
DISCUSSION
 Explanation
Cataract is defined as the loss of lens transpar
ency because of opacification of the lens. Age- related
cataract is the most prevalent type in adults, with the o
nset between age 45 to 50 years, while in children her
editary and metabolic causes are most common.
Anatomy
Anatomy
Mechanism of loss of transparency
Definition
• Cataract is defined as the loss of lens transparency because of o
pacification of the lens. Based on the causes, cataract can be cla
ssified into age- related cataract, pediatric cataract, and cataract
due to other cause.
 Epidemiology

Cross- sectional studies place th

e prevalence of cataract at 50% i
Age related cataract is a n individuals aged 65-74, the pre
common cause of visual valence increase to about 70% fo
impairment. r those over 75.
Etiology
Hereditery

Ultraviolet irraditio
ns
Dietary Factors

Dehydrational crisis
Smooking
Etiology
• Hereditery
Age of onset and maturation is seen as a genetic tait

• Ultraviolet Irradiations
More exposure to UV irradiation from sunlight have been implicated
for early onset and maturation of senile cataract in many epidemiological s
tudies
Etiology
• Dehydrational crisis
Diarrehoea, cholera

• Smoking
Smoking causes accumulation of pigmented molecules—3 hydroxykynurinine an
d chromophores, which lead to yellowing. Cyanates in smoke causes carbamylati
on and protein denaturation.
Classification

Classification

Maturity of
Age of onset Morpholgy
cataract
Classification Age of onset

Classification age of onset

a. Congenital Cataract
b.Juvenile cataract
c. Age related / senile cataract

Name Here
Blepharitis Anterior Programmer
Classification of cataract morphology

Blepharitis Posterior
Maturity of cataract Senil
Insipient

In this stage, oppacification progresses further. The cuneiform or

cupuliform pattern can be recognised till the advanced stage of
ISC when opacification becomes more diffuse and irreguler. The
lens appears greyish white. But clear cortex is still present and so
iris shadow is visible.

Insipient Name Here

Programmer
Maturity of cataract Senil
• Immature

In this stage, oppacification progresses further. The cuneiform or

cupuliform pattern can be recognised till the advanced stage of
ISC when opacification becomes more diffuse and irreguler. The
lens appears greyish white. But clear cortex is still present and so
iris shadow is visible.

Immature Name Here

Programmer
Classification
• Mature

• In this stage, opacification becomes complete, whole of the cortex

is involved. Lens becomes pearly white in color. Such as cataract
is also labelled as “ripe cataract”

Mature
Name Here
Programmer
Classification blepharitis - Etiology
• Hipermature

• Lysis of cortex result in shrinkage, seen clinically as wrinkling

of the capsule.

Hipermature Name Here

Programmer
Classification Cataract senil

Name Here
Programmer
Diagnosis
• History taking
Glare, uniocular polyopia, coloured halos, black spot in front of
eyes, image blur, loss of vision

• Physical Examination
Visual acuity testing, Oblique illumination, test for iris shadow,
slit lamp
Physical Examination

Oblique illumination Slit lamp

Treatment
Surgical Management
• Intracapsular Cataract Extraction (ICCE)
• Extracapsular Cataract Extraction (ECCE)
• Small Incision Cataract Extraction (SICS)
• Phacoemulsification
• Intracapsular Cataract Extraction (ICCE)
• Extracapsular Cataract Extraction (ECCE)
Small Incision Cataract Extraction (SICS)
Phacoemulsification
Complication
• Preoperative complications
• Intraoperative complication
• Early postoperative complications
• Delayed (late) postoperative complications
• IOL – Related complications
Prognosis
Overall, the prognosis for patients with cataract is good.
Bibliography
1. Ilyas S, Yulianti SR. 2013. Ilmu Penyakit Mata. 5th edition. Jakarta: Badan Penerbit FKUI
: EGC. Hal.

2. Abdulrahman. Cataracts Pathophysiology and Managements, Updated November 14, 2017.

Available at : http://egyptianjournal.xyz/701_26.pdf. Accessed November 25,2018

3. Khurana AK, editor. Comprehensive Ophthalmology. In: Diseases of the lens. 4th Edition.
New Delhi: New Age International; 2015.page 167-201.

4. Riordan P, Witcher J. 2016. Vaughan & Asbury’s General Ophtalmology. 16th Edition. Lond
on: Lange; p.

5. Andrews Nartey. The Pathophysiology of cataract and Major Interventions to Retarding Its
Progression, Updated February 22, 2017. Available at https://medcraveonline.com/AOVS/
AOVS-06-00178

6. Alastair, Philip I. Murray. Oxford Handbook of Ophthalmology. 3th Edition. P.304-305

Bibliography