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Z Lasers - Final > 4 - Review > Flashcards

4 - Review Flashcards

1
Q

Floaters

  • how they form
  • how hole/break forms
  • predisposition
  • light scatter
  • when to see pt back
A

Aging vitreous -> collagen fiber collapse -> clumps/knots

Vitreous cortex peels from retina -> hole/break

High axial myopia
DM

Forward light scatter

6 weeks after initial dilation - highest risk of hole/tear

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2
Q

Floaters

-removal

A

Vitrectomy only proven method

Nd:YAG 1064 vitreolysis
-RD risk of ~50%

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3
Q

Cryptocoagulation

  • procedure
  • methods
  • complications
A

Lowers IOP by decr AH production via CB epithelium ablation

Transscleral
Endoscopic

Excessively lowered IOP secondary to collateral damage

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4
Q

PRP

  • laser
  • when to perform
  • pathophys of procedure
A

Nd:YAG 532 (FD) or Argon

Diabetic ret
Retinal ischemia/NV

Light absorbed by RPE -> denatures protein via thermal burn -> cell death

Reduces area of ischemic tissue -> reduces VEGF production -> reduces likelihood of NV

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5
Q

PRP

-complications (4)

A

Choroidal effusion
Exudative RD
Macular edema
VF defects

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6
Q

Cataract surgery
-femtosecond laser
—laser properties

A

Nd:Glass 1053 (near IR)

Creates plasma that rapidly expands, separating tissue via bubble formation

Pulse time < diffusion time

  • significant reduction of heat-affected zone
  • more precise ablation
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7
Q

Cataract surgery
-femtosecond laser
—why use it

A

More accurate ablation of lens

Less trauma to surrounding tissue

Less negative outcomes

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8
Q 
Phototherapeutic keratoplasy (PTK)
-indications
A

Anterior corneal pathology ONLY

-esp. RCE (most common)

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9
Q 
Phototherapeutic keratoplasy (PTK)
-procedure
A

Argon fluoride excimer laser 193nm = photoablation

By itself or in combo - before and/or after surgery

Reshapes the K -> rapid re-epithelialization

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10
Q

Anterior stromal puncture

-indication

A

RCE - trauma, anterior K dystrophy (map-dot, Reis-Buckler)

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11
Q

Anterior stromal puncture

-procedure (2)

A

Needle
-debride K epithelium, puncture tissue to create hemidesmosome connections

Nd:YAG 1064

  • no debridement necessary
  • focused at BM
  • 1.8-2.2mJ
  • shots .25mm apart within subepithelium or superficial stroma
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12
Q

Pupillary block

  • definition
  • relative vs absolute
A

Restricts AH outflow from PC to AC

R: functional/partial/intermittent, most common

A: post synechia completely binds down iris

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13
Q

LPI

-indications (5)

A 
AACG
Malignant glauc
PDS/PDG
Phacomorphic glauc
Occludable angles
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14
Q

AACG

  • signs/symptoms
  • diagnosis
A

SS: temporal pain/HA, nausea/vomiting, eye pain, blurred vision, fixed dilated pupil, etc.

D: high IOP, K edema, shallow AC, gonio

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15
Q

Malignant glaucoma

A

After any type of surgery for ACG

AH flow forced backwards (into vitreous) by CB apposition to lens

Everything is pushed forward

LPI doesn’t work - already been done

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16
Q

Pigmentary dispersion

  • syndrome
  • glaucoma
  • tx
  • signs, locations
A

Syndrome = pigmentary chnages, OHT (-) glaucomatous nerve damage

Glaucoma = with nerve damage

SLT 10 degrees at a time to avoid spike
Can do LPI first as well

Krukenberg spindle = endothelium
Sheie stripe = lens
Double hump = indentation gonio (4 mirror)
Sanpalosi line
Transillumination
Excessive TM pigment
17
Q

LPI

-why pre-op pilo + MOA

A

Contracts ciliary muscle -> incr tension on SS -> opens TM -> outflow -> decr pressure

Tightens iris to visualize crypts

18
Q

LPI

-why use a lens

A 
Magnifies, good DOF
Concentrate laser energy
Speculum
Control eye
Focuses laser -> less energy to retina
19
Q

LPI

-laser settings

A 
Nd:YAG 1064
3-6mJ
Fixed spot size, duration
1 pulse
1-15 shots @ 11 or 1:00

Thermal/Argon
600mW
Can pretreat LPI (cauterizes bleeding)

20
Q

LPI

-placement (conventional vs paradigm shift)

A

C: 11/1:00 - visual disturbances/dysphotopsia

P: 3/9:00 - pain/cosmetic concerns
-long posterior ciliary nerve

21
Q

LPI

-complications and tx (5)

A

IOP - ocular hypotensives

Hemorrhage - pressure

Uveitis - pred forte

Diplopia/glare - tints

Closure - repeat procedure

22
Q

Iridoplasty

-purpose

A

Low energy laser burns in peripheral iris to widen the angle

Break PAS

Pulls away from the TM

23
Q

Iridoplasty

-when to perform (4)

A

Plateau iris syndrome (most useful)

Nanophthalmos/microphthalmos

ACG

PAS

24
Q

Iridoplasty

-laser settings

A

Power: 300-500mW

Spot size: 300-500um

Duration: 300-500ms

6-8 shots/quadrant (24-32 total)

25
Q

Capsular opacification

-cause

A

Growth and proliferation of lens epi cells from original ct that migrate

Most common complication of ct sx

26
Q

Capsular opacification

-anterior capsular opacification

A

Occurs w/in first 6 mo post-op

Complications:

  • decentered IOL (#1)
  • lens tilt
27
Q

Capsular opacification

-soemmering’s ring

A

Only in APHAKIC pts

  • congenital
  • Lowe syndrome
  • Hallermann-Streiff-Francois syndrome
28
Q

Capsular opacification
-posterior capsular opacification
—types

A

Fibrosis

  • tough = more energy to break
  • white opacities, fine folds, wrinkles

Proliferation/pearl
-circular opacification

Linear
-striae/channels

29
Q

Capsular opacification
-posterior capsular opacification
—effects (3)

A

Forward light scatter

Contrast sensitivity

VA

30
Q

YAG CAP
-contraindications
—absolute (2)
—relative (4)

A

Corneal haze
Unstable

Glass IOL
Active inflamm
CME
High risk RD

31
Q

YAG CAP

-complications

A 
IOP spike 
Inflammation
Floaters
Stromal haze/edema
CSME
IOL pitting*
RD
-overall 1% after ct sx
-incr to 2% after YAG CAP
32
Q

YAG CAP

-reduction in complications

A

Pick pt

  • VA <20/30
  • symptomatic
  • more than 3 mo post-op ct

Decr total energy

33
Q

If pt RTC for decr vison which tests do you run (7)

A 
VA
Pupils
AG
IOP
OCT
HVF
DFE

Z Lasers - Final (4 decks)

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