1. Consultant Rounds
Ophthalmology Block 10A

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

3. 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.

4. 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

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

6. Ophthalmologic EvaluationOD
20/200
PH: 20/70 OS
20/100 +1
PH: 20/50
VISUAL ACUITY

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

8. Full EOM on duction and version, (-) limitations

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

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

11. DIFFERENTIAL DIAGNOSES?

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

13. 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

14. Working Diagnosis
Keratoconus

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

16. Slit lamp biomicroscopy Rigid gas permeable contact lens application
Biopsy

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

18. Management

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

20. 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

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

22. 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

23. 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

24. 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.

25. The Bioethics of the Cornea

26. 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.