Consultant Rounds Ophthalmology Block 10A

General Data 27/M L.T. Baguio City Chief Complaint Blurring of Vision, OU

History of Present Illness 11 yrs PTC Progressive BOV, bilateral, solitary symptom Corrective lenses improved vision 9 years PTC Repeated corrections were done over time Consult at BGHkeratoconus 7 months PTC Consulted at SLU hospital Referred to PGH for co-management 11 years PTC Patient noted progressive BOV OU, with no other ocular symptoms. Corrective lens was used with improvement of vision. However, due to progressiveness of the BOV, patient had multiple attempts in obtaining optimum spectacle correction. 9 years PTC Consulted BGH, he was diagnosed with keratoconus, no medication was given, and patient was not advised RGP use. 7 months PTC He consulted at SLU hospital, still due to BOV, he was then referred to PGH for management.

ROS (-) tearing (-) redness (-) discharges (-) photopsias (-) floaters (-) metmorphopsias Medical History (-) previous surgeries, hospitalizations (-) Asthma, Goiter, cancer, DM, HPN Family History (+) DM type 2 (-)Similar condition in the family Asthma, Goiter, cancer, DM, HPN P/S: occasional alcohol drinker, non-smoker, denies illicit drug use

Physical Exam Stable vital signs No gross deformities or abnormalities Otherwise unremarkable

Ophthalmologic Evaluation OD 20/200 PH: 20/70 OS 20/100 +1 PH: 20/50 VISUAL ACUITY

Gross Eye Exam Coning of the cornea (+) Munson sign L>R (+) Rizzuti’s Sign OS

Full EOM on duction and version, (-) limitations

Tonometry Fundoscopy OD Soft OS Soft OD (+) ROR, CM, IDB, AVR: 2:3, (-) H/E OS (+) ROR, CM, IDB, AVR: 2:3, (-) H/E

SLIT LAMP (+) Fleisher’s Ring, OS Striae, OU (+) Vogt’ s

DIFFERENTIAL DIAGNOSES?

Error of Refraction Rule in (-) other occular symptoms BOV Rule out Progressive BOV (+) gross corneal deformity Repeated Refractions

Vogt's lines, Fleischer's ring Keratoconus Rule in Vogt's lines, Fleischer's ring Munson’s sign Cone shape cornea ProgressiveBOV Rule out Cannot rule out

Working Diagnosis Keratoconus

Computer-assisted Videokeratography Diagnostics Careful refraction Keratometry Computer-assisted Videokeratography

Slit lamp biomicroscopy Rigid gas permeable contact lens application Biopsy

This will be my part. Bukas ko na gawin What is Keratoconus?

Management

Eyeglasses/soft contact lenses Rigid gas permeable (RGP) contact lenses Intracorneal rings Corneal cross-linking Corneal transplant

Eyeglasses/soft contact lenses Early stage KC Mild astigmatism/myopia Have a limited role in improving vision the front surface of the lens assumes the same irregular surface as the cornea without trapping a fluid reservoir so the effective refracting surface is no improvement over the original corneal surface

Rigid gas permeable (RGP) contact lenses primary option for correcting KC vision masks the underlying irregular cornea functions as the new refractive surface

Intracorneal rings Semi-circular rings inserted into the mid layer of the cornea Flatten the cornea  change the shape and location of the cone Eliminates some or all of the irregularities caused by keratoconus Glasses or contact lenses may still be needed

Corneal cross-linking Not a cure but prevents progression of KC Glasses or contact lenses may still be needed custom-made riboflavin drops saturate the cornea, then activated by ultraviolet light. This process has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea

Corneal transplant May be indicated Dangerously thin cornea VA not achieved by contact lens steepening of the cornea scarring lens intolerance warranted when the cornea becomes dangerously thin or when sufficient visual acuity to meet the individual’s needs can no longer be achieved by contact lenses due to steepening of the cornea, scaring or lens intolerance. Lens intolerance occurs when the steepened, irregular cornea can no longer be fitted with a contact lens, or the patient cannot tolerate the lens.

The Bioethics of the Cornea

Corneal Transplantation I WILL UPLOAD THE REST TOMORROW HEHE NAHIRAPAN AKO PANO TO MASIMPLIFY NA PART BUT WORKING ON IT. SENSYA JV MADELAY NANG KONTI ANG PART MO.