Ophthalmology


        

Case Discussion

self experience of CRVO by an ophthalmologist   Posted By R S Chauhan    Date : 09-May-03   01:05 PM     Reply

CASE SUMMARY

23.1.2003 39 years old, ophthalmologist all of a sudden observed dark scotoma inferiorly with horizontal leveling, painless. It disappeared off & on many times over a period of 2 hours. He consulted vitreoretinal surgeons. The findings were as under: Examination was done at 3 P.M. on 28.1.2003 General Physical Examination: Blood Pressure = 120/80 Pulse = 84/min Ocular Examination: Vision both eyes was 6/6 except appearance of scotoma. Left eye off & on. Right Eye was completely normal. Anterior segment Left Eye was normal. Fundus examination did not reveal anything. Intraocular pressure was 18.9mm by applanation. HFA 30-2 SITA fast fields were normal both eyes. Repeat examination done after 2 hours (28.1.03 at 5 P.M.) * Vn Left eye 6/6 except off & on scotoma * Intraocular pressure 18.9 mmHg * Slit lamp 90D examination revealed 2 haemorrhagic spot near macula. * Rest of fundus by Indirect Ophthalmoscopy was normal. * Diagnosis of non ischaemic CRVO (L/E) was made. * Fundus photograph recorded - Ist day * Treatment - 2 Tab. Diamox Stat. - Adv. Cardiologist opinion. On investigation: - Lipid profile was normal - Blood sugar fasting 90 mg% Postprandial 100mg% - Rest investigations were normal - Blood pressure was 120/80 mmHg - Cardiologist advised Tab. Ecosprin 75mg OD. 1.2.2003: Repeat Examination done after one week Fundus findings were recorded after 7 days i.e. 1.2.2003. Vn Both Eye was maintained 6/6 without any further symptoms. A routine follow up ocular examination was done after 3 months i.e. 1.5.2003.

01-05-03 Follow up examination done after 3 month Ocular Examination: Vn Both Eye 6/6 Fundus Right Eye revealed fresh haemorrhage near disc and along with superotemporal vessels. Three exudate seen 2DD away from disc along superotemporal vessel. The old haemorrhage had disappeared . Disc margin was blurred nasally. A diagnosis of Papillophlebitis was made and Tab. Wysolone 80mg OD along with Tab. Rantac 150 mg BD started on 1.5.2003. IOP was recorded in left Eye 23 mmHg and Right Eye 21mmHg by air puff tonometer. Repeat IOP (Air puff) done after dialation of Pupil showed 29 mmHg Left and 27mmHg Right Eye. Fundus disc C:D 0.5. HRT was done and found borderline. US patchymetry of cornea is 716 699 Right Eye 650 – 566 – 684 , Left Eye 619—576--703 680 685

Routine repeat examination on 5.5.2003 after starting Tab Wysolone. General Physical Examination – Blood Pressure 120/84, Pulse 84/min Investigation: Echo – Within normal limits Complete haemogram Hb 12.4 gm%, TLC 7500, DLC P 73 L 22 M 3 E2 Platelets Normal,ESR 4mm/Ist hour.

Lipid Profile S. Triglyceride 70mg%, S. cholesterol 184mg% HDL cholesterol 47mg% LDL cholesterol 123 mg% VLDL cholesterol 14mg% Blood sugar : Fasting – 60mg%; Postprandial – 141 mg% Blood urea 24 mg% Serum creatinine 1.0mg% SGOT/PT 95/137 I.U. LFT – Serum bilirubin 0.8 mg% Serum protein – 7.6 gm (6-8) Ocular Examination – Anterior segment Both Eye – Within normal limits. Fundus Examination Left eye : Disc : Hyperemic, nasal margin blurred, venous pulsation on pressure, C:D 0.4, hemorrhage over disc and peripapillary area. Background: Arteries narrow and attenuated. Veins dilated and tortuous and engorged. A: V ratio 1.5: 4. A-V crossing shows nipping, obscuration and banking phenomena. Haemorrhage all over the fundus especially move on central part and around the veins. Macula – Foveal reflux is normal. Impresion: Left CRVO Fundus Right Eye: Disc – Within normal limits. Background: Arteriolar attenuation with A-V ratio 1.5:3, A-V crossing, nipping and banking phenomena seen. No haemo, no exudates seen. Macula: Within normal limits. Important: Arteriosclerotic changes.





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