Authors: Mathilde Gallant & Eliana-Ruobing Zhang
A 72-year-old woman presents with progressive blurry vision and glare in her right eye. She has a history of hypertension but no known ocular disease. Visual acuity is 20/60 right eye and 20/40 left eye. Intraocular pressures are 26 mmHg right and 18 mmHg left. The pupil in the right eye dilates poorly despite maximal mydriasis. Slit-lamp examination reveals patchy, irregular, grayish deposits on the anterior lens capsule and mild iris transillumination defects. Gonioscopy shows an open angle with dense trabecular pigmentation.
I thank for giving this questions
I thank for giving this questions
I enjoy solving the quiz, its a good way to refresh knowledge .
Deferential Diagnosis
1. Pseudoexfoliation syndrome: Patchy pigments on the anterior lens capsule, High IOP, decreased vision
2. Pigmentary Glaucoma
I would say slit a lamp exam and gonioscopy are part of the clinical exam and not really tests or investigation.
Good very Nice
Completely disagree!
If a 72-year-old woman presents with progressive blurry vision and glare in her right eye and there is significant cataract, then the most appropriate initial management in the affected eye is careful cataract surgery, not topical intraocular pressure-lowering medications.
It was good for knowledge seek refreshing
Very educative
nice one
Nicely made qns
Very informative
Thank you Sir for explaining the condition, i didn’t get the right answer ,but i have the knowledge now.
Thank you Sir for explaining the condition, i didn’t get the right answer ,but i have the knowledge now.
its very informative, well described
I believe observation might also be a feasible option at this stage, especially if there is minimal or no optic nerve damage. Washing out the angles during cataract surgery is probably more valuable (and better QoL) to this 72-year-old patient than starting drops or other glaucoma treatment. Treatment can always be started if optic nerve damage pregresses. A cardiovasular workup is also advisable.
Nice one
Kudos
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Interesting case
I am very happy to attend this quiz. It was an excellent knowledge-enhancing platform that helped me learn and improve my understanding. The quiz was informative, engaging, and well organized. Thank you for this wonderful opportunity and experience.
Thanks for your sharing to me this Quiz
Thanks for the update
It is very important lesson with clear explanation of the findings and questions.
Thank you
Getenet Shumet
Lecturer, Department optometry
University of Gondar, Ethiopia
Very educative
The appropriate treatment would be cataract surgery despite the risk of zonular dialysis.
Thanks.
Great one
Great questions. Enjoyed…
Pseudoexfoliation syndrome. Closed-angle glaucoma. Complicated swelling cataract
Ahimed mehamed
It was a great experience
It was a great experience
Good reminder
The primary challenges associated with pseudoexfoliation syndrome are poor pupil dilation and weakened lens zonules, which can result in lens instability, lens dislocation, capsular tears, and other complications. These factors significantly increase the risk of intraoperative complications during cataract surgery. Therefore, it is essential that the surgeon identifies the presence of pseudoexfoliation syndrome before surgery so that appropriate precautions and surgical strategies can be planned. For this reason, cataract surgery in patients with pseudoexfoliation syndrome is generally recommended to be performed by an experienced cataract surgeon, preferably the most senior surgeon available.
Very helpful, thank you
Thank
Sir as in given scenario the IOP is 18,is it needed IOP lowering on this stage?
Very informative case.
interesting Case
Exfoliation syndrome
Nice & attractive
Nice quiz
I have learng
The gonioscopy and slit lamp examination were already described and initio and they do not “assess” the risk of glaucoma. The IOP and fundus information (neuro-retinal rim and nerve fiber layer) are the critical clinical details needed for glaucoma risk assessment at this stage.
Due to the capsule-zonular weakness,the Cataract Surgery in such cases can be complicated .
I Dr Krishna Choudhary has been received many more knowledge in field of Opthalmology.
Thank you, keep me involved
Excellent details about PXS
This patchy grayish deposit are according to PEX syndrome (pseudo exfoliation syndrome)
That increase with age(72 in this case) and occur more in females(woman in this case), and most importantly results in secondary open angle glaucoma (which explains high iop in this case and low vision), and lead to small pupil due to effect to iris dilator muscle, and in addition it cause challenges in cataract surgery like weak capsule and dialysis also.
Thank you
Thank you cybersight to give me knowledge. I learned everyone you send me emails you motivated me , Now I know that LOXL1is the most strongly associated with pseudoexfloliation syndrome
Just ok
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