Quizzes and Cases
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Case 1:
75 year old man presents to you complaining of decrease vision with no pain or discomfort.
Question. What are the key clinical findings of relevance in the images?
Question:
What are the key clinical findings of relevance in the images?
Answer:
Subtle haze in the cornea affecting the visual axis (black arrow A) and (* B).
Black arrow (B)denotes corneal nerves but this is of no clinical relevance.
Generalised endothelial deposits (guttata) (B).
White arrow (C) shows oedematous stromal thickening. Patient is pseudophakic.
Question:
What is the Diagnosis?
Answer:
Findings are consistent with Fuchs endothelial dystrophy with focal cornea decompensation
Question:
What additional question would you ask in addition to the clinical examination?
Answer:
How long they have noticed a decline in vision and whether the vision is hazier in the morning. The main symptom of early corneal failure is morning haziness that shows some improvement during the day.In advanced cases then the vision will be hazy through out the day.
Question:
What would you tell the patient and what is your plan of action?
Answer:
If you are certain of the diagnosis, then explain that the cornea is hazy and requires assessment by a corneal specialist. Explain that this is a not uncommon condition and that treatment has a high success rate. If the patient asks what the treatment options are then it is important not to commit to one treatment.Explain that they need to be seen by a corneal specialist who will be able to discuss some of the options.
The main treatment would be a partial thickness corneal transplant which has a very high success rate however, there are some less invasive options available for selected cases and that the consultant will discuss with them. Routine referral to NHS/Private is adequate.
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