1. ADMISSIONS CONFERENCE: “ULAP” CASE PRESENTATION, 23 July 2011

2. Identifying Information Rosita Catama 69 year old, female Filipino Married, with 3 children

3. Chief Complaint Blurring of vision on the left eye of 1 year’s duration

4. History of the Present Illness “parang may ulap” Gradual; lasting throughout the day Uncorrected by prescription lenses (+) glare, (+) improvement of vision at night/ darker environments (+) floaters, (+) tearing (-) headache, (-) dizziness, (-) ocular pain, (-) itchiness, (-) metamorphosia

5. Review of Systems (-) weight gain/loss, changes in appetite (-) skin rashes, itching (-) dyspnea, hempotysis, cough (+) palpitations (-) polyuria (-) excess thirst

6. Ocular History Wears corrective lenses with unrecalled grade ◦ Most recent eye refraction in March 2011 (-) ocular trauma, (-) visual problems in childhood No ocular medications, i.e. eye drops, ointments No previous eye surgery

7. General Medical/Surgical History Hypertension (May 2011) ◦ Unrecalled medication with unrecalled dose, 2x/day Pneumonia (June 2011) ◦ CXR: Lobar pneumonia, right lower lung field ◦ Azithromycin, Ampisulbactan, NAC (-) DM, (-) asthma, (-) atopic dermatitis (-) Allergies to food or drugs

8. Family History (-) Hypertension (-) DM (-) Asthma (-) Ocular disease

9. Personal and Social History Retired Has 3 children Never smoked (-) alcoholic beverage drinking (-) illicit drug use

10. General Physical Examination Alert, coherent and not in cardiorespiratory distress BP= 140/90 mmHg HR= 68 beats/ minute RR= 16 breaths/ minute VAS= 0/10 (no pain)

11. Visual Acuity ODOS SC20/8010/400 PH20/60No improvement

12. Gross Examination (+) drooping eyelids, both eyes (-) matting, crusting of eyelashes Anicteric sclerae, pink palpebral conjuctivae (+) symmetric eyes (corneal light reflex) (+) good and equal EOM movements on both eyes ODOS

13. Gross Examination Dirty sclerae, (+) arcus senilis, (-) conjunctival hyperemia, clear cornea, well pigmented iris, round pupils dilated to 2-3 mm, (-) visible lens opacity Dirty sclerae, (-) conjunctival hyperemia, clear cornea, well pigmented iris, round pupils dilated to 8-9 mm, (-) visible lens opacity

14. Palpation/Digital Tonometry (+) firm eyeballs

15. Fundoscopy (+) ROR on right, (-) ROR on left

16. Slit Lamp Examination

17. Assessment Senile mature cataract, OS ◦ LOCS III Classification: NO3 NC5 C3 P5

18. Plan Phacoemulsification with PCIOL implantation, OS

19. 1 st hospital day (7/18) Diet as tolerated  NPO post-midnight IV Fluids D5LR (KVO) Moxifloxacin eyedrops (Vigamox), 1 drop every 4 hours Monitor vital signs

20. 2 nd hospital day (Pre-Op) IV Fluids KVO Moxifloxacin eyedrops (Vigamox) ◦ 1 drop ever 4 hours Ranitidine 50 mg IV ◦ 2 hours prior to operation Tropicamide + Phenylephrine (Sanmyd)

21. 2 nd hospital day: Post-op Discontinue IV fluids Remove eye patch only when applying meds Moxifloxacin eyedrops (Vigamox) Prednisolone acetate (Pred Forte) ◦ 1 drop every 2 hours Patient advised Monitor VS

22. 3 rd hospital day S > (-) ocular pain,(-) headache, (-) dizziness O > 130/70 mmHg, 64 bpm, 16/min, 35.2C

23. 3 rd hospital day ODOS (s/p Phacoemulsification w/ PCIOL implantation) VA20/8020/60 Lashes(-) matting ScleraDirty CorneaClear, (-) opacity ROR(-) ROR(+) ROR PupilsOval, smooth edges, 3-4 mm Round, smooth edges, 4-5 mm Lens(-) opacityIOL in place

24. Assessment S/P Phacoemulsification with PCIOL implantation, Day 2

25. Plan Patient may go home Home medications ◦ Moxifloxacin eyedrops ◦ Prednisolone acetate eyedrops Advise patient and family members Follow-up after 1 week