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Z Lasers - Final > 2 - Caudill > Flashcards

2 - Caudill Flashcards

1
Q

LPI

-main indication

A

Any form of angle-closure glaucoma that has a pupillary block component

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2
Q

LPI
-iris bombe
-pupillary block
—2 classifications

A

Bowing forward of iris -> closed angle
-iris has not moved, but is bulged forward (compared to malignant glaucoma)

Restriction of aqueous flow from PC to AC

PB classifications

  • relative = functional/partial restriction, most common
  • absolute = post synechia completely binds iris
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3
Q

LPI

-conditions that are indications (5)

A

Acute angle closure glaucoma (AACG)

Malignant glaucoma

PDS and PDG
-G if nerve damage/optic neuropathy

Phacomorphic glaucoma = change in the shape of the lens - concavity incr -> iris bombe, etc.

Eyes with occludable angles

  • “occludable” = narrow enough that it’s most likely occludable -> LPI
  • “narrow” = not necessarily enough for LPI to be needed
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4
Q

Acute angle closure glaucoma (AACG)

-describe

A

Urgent, uncommon, dramatic symptomatic event

Blurring of vision, painful red eye, HA, nausea, vomiting

High IOP, corneal edema, shallow AC, closed angle on gonio

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5
Q

Acute angle closure glaucoma (AACG)

-hx and exam

A

HA, nausea, vomiting, reduced VA, red eye, extreme IOP, corneal edema

Risk factors (hyperopia, thick cataractous lens, etc.)
Halos
Aching eye/brow pain
Engorged conj vessels
Fixed dilated pupils
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6
Q

Occludable angles

  • describe narrow angle
  • probable vs likely
A

May watch and consider other risk factors for development of glaucoma

  • intermittent IOP spikes -> HA/brow ache
  • intermittent eye pain

Probable <20 degrees
Likely <10 degrees

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7
Q

Malignant glaucoma

-describe

A

After ANY type of surgery

AC becomes shallow/flattened and IOP elevated

AH is forced backward into vitrous by CB apposition to lens and/or vitreous

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8
Q

Malignant glaucoma

-treatment

A

Vitrectomy

  • LPI is unsuccessful
  • ant seg OCT is very valuable
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9
Q

Plateau iris configuration/syndrome

-difference

A

IOP

  • C = anatomical
  • S = incr IOP
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10
Q

Plateau iris

-sign to look for during exam

A

Double hump pattern on indentation gonio
-anteriorly displaced CB
-use 4 mirror = small contact surface
—do not use 3 mirror

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11
Q

Plateau iris

-PDS and PDG are indicative of what tx

A

LPI - if iris bowing is present
-iris is bowed backwards (opposite of bombe) and rubbing against the lens, but LPI will still equalize the pressure in AC/PC

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12
Q

Gonio angle grading systems

-describe Shaffer

A

Degrees

-e.g. 20 degrees is narrow, 45 is wide open

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13
Q

Gonio angle grading systems

-Spaeth includes (4)

A

Location of insertion of iris (A thru E)

Angle formed with Schwalbe’s (cornea)

Iris configuration (e.g. F = flat, B = bowed forward, etc.)

Pigment level (1 thru 4)

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14
Q

LPI procedure

  • work-up (3)
  • pre-op (7)
A

Comprehensive exam, dx, DFE

VA, IOP, med/allergy check, vitals
Alphagan (Brimonidine) 
-iopidine is an older, more expensive drug
Pilocarpine 1%
Informed consent
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15
Q

LPI procedure

  • vitals (4)
  • laser lens options
A

BP, temp, pulse, oximetry

Abraham 66D most common
Wise 103D also used, easy to get lost

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16
Q

LPI procedure

-why use a lens (6)

A

Magnifies with good depth of field

Concentrates energy

Speculum

Heat sink to minimize K damage

Control eye

Focus energy = less to retina

17
Q

LPI procedure

-lasers (2)

A

Nd:YAG 1064
-initial setting 3-6mJ

Argon or green diode

  • initial setting 600mW
  • green = thermal
18
Q

LPI procedure

-thermal or YAG or both

A

Thermal = argon, green diode

  • reduces risk of bleeding
  • may require more energy

YAG
-generally most accepted method, esp for light eyes

Some advocate pre-tx with thermal, finish with YAG
-esp for dark irides

19
Q 
LPI procedure
-tx locations
—conventional wisdom
—paradigm shift
—none here
—size
A

11 or 1 o’clock

3 or 9 o’clock
-trying to reduce stray light

12 o’clock
-bubbles

~1.5mm

20
Q 
LPI procedure
-complications
—hemorrhages - what do you do
—IOP spike - when most occur, what to do
—transient uveitis
A

Push - gentle pressure for a few seconds to tamponade

IOP spikes: 25% of cases in first 3 hours of >10mmHg
-most are transient, respond to topical meds

Mild uveitis occurs in virtually 100% of pts, responds well to topical steroids

21
Q

LPI procedure
-complications
—diplopia/glare
—iridotomy closure

A

Placement crucial
Specialty contacts with opaque periphery in very rare cases

Confirmation of patency can be challenging
-important to see plume when performing sx

22
Q

LPI procedure

-post-op care (3)

A

Check IOP ~1 hr after

Topical pred acetate 1% QID

Recheck 5-7 days (global period 10 days)

23
Q

Iridoplasty

-describe

A

Uses thermal (green) laser to pull iris away from TM

Rarely performed

Most useful in plateau iris

Multiple burns placed concentrically close to iris insertion
-more burns = more contraction

Z Lasers - Final (4 decks)

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