Grand round case. Developmental cataract.

Grand Round Case    Dated:27/12/12                                                                                                                                                       Patient’s Name – Reshu, 6yrs./ Male, R/o Luchnow
Chief Complaints – Diminution of vision with whitish discolouration of central clear part of BE’s noticed 2 months back
History of present illness- History is given by the patient’s father and seems to be reliable. According to him the child was apparently asymptomatic 2 mths back when he accidentally collided with a wall following which they noticed diminution of vision and whitish discoloration of central clear part of both eyes. The next day parents took the patient to a Govt. hospital in Lucknow where he was prescribed some topical medications and was advised surgery. The parents refused surgery at that time due to economic problems.
In the meantime, there has been no progression in diminution of vision or the whitish discoloration.
2 days back, the patient came to KGMU and has been admitted for further management.
No H/o pain, redness, watering
No H/o photophobia
No H/o trauma
No H/o any drug intake by the patient
No H/o fever, diarrhea, any systemic illness
No significant family history
Birth history- No H/o any drug intake by mother during antenatal period
No H/o fever or rash during antenatal period
No significant perinatal historyFull term normal vaginal delivery in hospital
Normal cry after delivery

Examination
Patient is conscious, co-operative and well oriented to time, place and person.
General Examination                                           
Temperature : Afebrile        Pulse: 88/min.       Resp. rate: 16/min.        BP: 1100/70 mm of Hg
Local Examination     

Slit Lamp Examinaion

  
Retinosopy
RE- No glow                   LE- No glow
Fundus examination
RE- Not visible              LE- Not visible

InvestigationsHb – 13 gm% , TLC- 6800/cumm,  DLC- N70 L26 E01 M03 B00,  Platelet count- 2.8 lakhs/cumm,  RBS- 82 mg/dl
HIV-NR, HBsAg- NR, HCV-NR
B-Scan:
  Cataract both eyes. Rest WNL.

Chronic blepharoconjuntivits causing chalazia in both the eye lids

Posterior capsular opacification

Elschnig's pearls type of PCO.

Conjunctival nevus

An innocuous pigmented lesion on conjunctiva right eye of this young female.
Apart from cosmetic blemish it is hardly of any clinical significance.

Orbital cysticercus.

An eleven year old male child presented with this painful firm to hard tender swelling in superio-medial aspect of right orbit.
Patient has responded to treatment including Albendazole, and systemic steroids.
These are pre and post treatment photos of the patient one week apart.

Perforated Mooren's ulcer

Management of perforated peripheral corneal ulcer with full thickness patch graft.

Lower lid laceration.

Lower lid laceration, repaired.
The lid margin has some over riding of the temporal flap.

Acute idiopathic iridocyclitis.

Unaided photo of a female patient taken from my phone camera.
Note the minimal hypopyon, which was missed by a student even on slit lamp.

Eye injury due to spontaneous explosion of soft drink bottle.

This young male suffered injury in his left eye as he was handling a cold drink bottle kept in hot environment. The pressure inside the bottle was so high that some agitation caused by movement caused explosion of the bottle resulting in severe eye injury.
Presenting vision was PL present with hand movement perception.
 The corneal laceration was repaired with repositioning of the prolapsed tissue. The cataract caused by the injury would be managed later when inflammation subsides.

Artificial customized eye prosthesis in a child with enucleated left eye for retinoblastoma.

Pre and post prosthesis fitting pictures of this child cured of retinoblastoma.
The left eye was enucleated for retinoblastoma about 6 months back and timely placement of prosthesis will ensure that the socket remains adequate and acceptable cosmetic result is maintained.

Phacoemulsification in an albino patient. These patients have lack of pigment in the eyes, hairs and skin, abnormal eye movements and subnormal vision since childhood, but with the development of cataract, later in life they have increase in the symptoms of glare, intolerance to bright light and further reduction in vision.

Cataract surgery is very rewarding in these cases when indicated for the above mentioned symptoms. This patient was very satisfied and and engineer by profession, was able to resume his full working abilities.

MSICS under topical Anesthesia.

Convergent squint in a young girl corrected by surgery.

These are preoperative and final photos of a young girl suffering from convergent squint since agree of 5 years.
The child underwent successful Squint corrective surgery.

Sutural cataract.

Photo of Sutural cataract using my phone camera on slit lamp.

Posterior sub capsular cataract.

Using my cellphone camera through a slit lamp, photo of a post traumatic rosette cataract.

Keyser Flescher ring in a patient of Wilson's disease.

Photograph taken from my cellphone camera using slit lamp.

Non accommodative squint, treated by surgery. Pre surgery and post surgery photos.

This young boy had a long standing convergent squint, with hyper metropia.
He underwent squint correction surgery, the pre surgery and post surgery photos are presented.

Severe IOL pitting due to Nd-YAG laser.

Photo taken from my cellphone camera using slit lamp optic. The IOL and the cracks are well seen.

Advanced pterygium in an elderly patient treated by excision and limbal auto graft.

Pre-operative and post operative photo graphs of the patient treated successfully for pterygium in right eye. The corneal haze at the tip of pterygium remains but one can appreciate the normal appearance of the limbal area, which ensures that recurrance will not take place.

Final Post surgery picture 

Pre Surgery Photograph

Developmental cataract, zonular type, in a child aged 16 months.

squamous cell carcinoma at limbus.

Photo of Squamous cell carcinoma snapped using my cellphone.
There are numerous advantages of using cellphone camera for recording your clinical images.
1. The cellphone is always with you, camera is an additional payload.
2. A smartphone has so many connectivity options and so you can upload the photo, send by mail, sync to PC, share using social networking, thus the photo is never lost.
3. Significant editing can be done on phone itself.

I will be posting more amazing clinical photos using my cellphone.

Reverse cutlur beard surgery for squamous cell carcinoma, successfully treated.

These are photos of a patient operated for an eye lid cancer. The lower lid which had cancer has been cut and part of upper lid is used to reconstruct the deficiency in the lower lid. The last photo shows excellent final outcome.

Just installed a new router/ repeater at my home.

I needed to have a system which could let me share the contents of my external hdd without keeping my PC on and also download torrents independently. I got myself a multi mode router from Asus, RT-N13 U B1.
I had to do some research to install it as a repeater as I already had wifi router at my home and wanted to cover some dead spots. Now in the repeater mode with hdd connected it serves me three functions.
1. Allows all my gadgets, including computer, laptop, android tablet, and phone to access my hdd contents.
2. Download torrents independently without keeping my PC on.
3. Save the torrents to the hdd and so that there are no duplicates and all can share the contents.
However the download manager provided of not good, the download speeds are not updated Realtime and the downloads are slow.
यह उम्मीद के मुताबिक तो नहीं है मगर थोड़े सॉफ्टवेर बेहतरी से अच्छा काम कर सकता है।

About me

I am Dr. Sanjiv Kumar Gupta, Associate Professor in the department of Ophthalmology, CSMMU, Lucknow, Uttar Pradesh, India.