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KMK Ocular Disease > 11 - Lens/Cataract/IOL > Flashcards

11 - Lens/Cataract/IOL Flashcards

1
Q

Cataracts

-nuclear sclerosis

A

Most common aging

MYOPIC SHIFT in elderly pts - report of “second sight” due to improved ability to read without specs

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2
Q

Cataracts

-cortical

A

Radial spokes

HYPEROPIC SHIFT

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3
Q

Cataracts

-anterior subcapsular

A

Directly underneath anterior lens capsule

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4
Q

Cataracts

-posterior subcapsular

A

Directly in front of posterior lens capsule
AFFECTS NEAR VISION > distance
Commonly results from systemic/topical steroids
-high myopes
-late stages RP
-mild PSCs can cause significant reduction in acuity, typically assoc with worse glare than other cts

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5
Q

Cataracts

-infant

A

Assoc with GALACTOSEMIA + RUBELLA
Most common type is lamellar/zonular: lens opacity surrounding embryonic nucleus

Cerulean is a type of congenital that rarely affects VA, app as tiny dot-like or flake-like white or bluish-green opacities

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6
Q

Cataracts

-presenile

A 
“Mr. Wilson is MAD about his early cataracts”
-Wilson’s dz
-myotonic dystrophy: PSC christmas tree
-atopic dermatitis
-diabetes mellitus
And ANY CHANGES IN CALCIUM
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7
Q

Cataracts

-traumatic

A

aka Rosette

Look for vossius ring

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8
Q

Cataracts

-toxic

A

ASC:

  • chlorpromazine = stellate
  • amiodarone = deposits
  • miotics = vacuoles
  • gold salts = gold deposits

PSC: corticosteroids

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9
Q

Cataracts

-secondary

A

Common causes:

  • chronic anterior uveitis (e.g. Fuchs)
  • high myopia (esp PSC, NS)
  • RP (PSC)
  • gyrate atrophy
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10
Q 
Cataracts
-testing
—PAM
—BAT
—axial length
—B-scan
A

PAM: incr VA

BAT: glare disability = decr VA

AL: A-scan or IOL master, helps calc appropriate IOL power

  • avg 24mm
  • 1mm error = 3D error in calc IOL power

B-scan: post seg abnorm

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11
Q

Cataract surgeries

-intracapsular cataract exctraction

A

ICCE - think “ice age”, not done anymore

Entire lens + capsule removed -> aphakia -> need for 2nd surgery for IOL

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12
Q

Cataract surgeries

-extracapsular cataract extraction

A

ECCE

Lens removed, capsule remains
-large incision (9-11mm, lens taken out as whole)

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13
Q

Cataract surgeries

-phacoemulsification

A

Form of ECCE with smaller incision (1-3mm)

  • lens is fragmented with ultrasound
  • no suture as AH will push against flap to close it
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14
Q

Cataract surgeries

-femtosecond laser

A

Used for corneal incisions, ant capsulorhexis, lens fragmentation

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15
Q

Cataract surgeries
-post-op complications
—frequency
—corneal edema + folds in Descemet’s

A

5%

Striate keratopathy

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16
Q

Cataract surgeries
-post-op complications
—acute post-op bacterial endophthalmitis

A

Rare
With tx 50% go blind
Symptoms in 2-4 days
-signs: significant AC rxn, hypopyon, etc.
70% gram(+) from normal flora
-most common STAPH EPIDERMIDIS (cat+, coag-)
-also Staph aureus

17
Q

Cataract surgeries
-post-op complications
—delayed post-op bacterial endophthalmitis
—toxic anterior seg syndrome

A

Delayed:

  • symp in 1wk-1mo
  • insidious vision loss, pain
  • fungal also common

TASS:

  • STERILE INFLAMMATORY rxn -> damage to ant seg structures
  • due to chemical exposure during sx
18
Q

Cataract surgeries
-post-op complications
—lens subluxation

A

Rare - common in PXF, Marfan’s*
-also Ehlers-Danlos*, Weill-Marchesani, homocysteinuria
*ME in t-dome
Due to pupillary capture and poor capsular support

19
Q

Cataract surgeries
-post-op complications
—posterior capsular opacfication
—cystoid macular edema

A

PCO: #1 post-op complication

  • equatorial epi cells -> post capsule (2-6mo)
  • elschnig pearls = kids

CME:

  • surgical trauma -> inflammation, release of PGs + disruption of lens-vitreous interface
  • ct sx is most common cause of CME; Irvine-Gass
  • develops in OPL/Henle’s
  • peak 6-10wks, most resolve with tx in 6mo
20
Q

Cataract surgeries
-post-op complications
—corneal edema: low vs high IOP

A

Low -> Descemet’s folds

High -> microcystic edema

21
Q

Cataract surgeries
-post-op complications
—assoc with anterior chamber IOLs

A

UGH: uveitis, glaucoma, hyphema syndrome

KMK Ocular Disease (17 decks)

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