4 - Review Flashcards
Floaters
- how they form
- how hole/break forms
- predisposition
- light scatter
- when to see pt back
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
Floaters
-removal
Vitrectomy only proven method
Nd:YAG 1064 vitreolysis
-RD risk of ~50%
Cryptocoagulation
- procedure
- methods
- complications
Lowers IOP by decr AH production via CB epithelium ablation
Transscleral
Endoscopic
Excessively lowered IOP secondary to collateral damage
PRP
- laser
- when to perform
- pathophys of procedure
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
PRP
-complications (4)
Choroidal effusion
Exudative RD
Macular edema
VF defects
Cataract surgery
-femtosecond laser
—laser properties
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
Cataract surgery
-femtosecond laser
—why use it
More accurate ablation of lens
Less trauma to surrounding tissue
Less negative outcomes
Phototherapeutic keratoplasy (PTK) -indications
Anterior corneal pathology ONLY
-esp. RCE (most common)
Phototherapeutic keratoplasy (PTK) -procedure
Argon fluoride excimer laser 193nm = photoablation
By itself or in combo - before and/or after surgery
Reshapes the K -> rapid re-epithelialization
Anterior stromal puncture
-indication
RCE - trauma, anterior K dystrophy (map-dot, Reis-Buckler)
Anterior stromal puncture
-procedure (2)
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
Pupillary block
- definition
- relative vs absolute
Restricts AH outflow from PC to AC
R: functional/partial/intermittent, most common
A: post synechia completely binds down iris
LPI
-indications (5)
AACG Malignant glauc PDS/PDG Phacomorphic glauc Occludable angles
AACG
- signs/symptoms
- diagnosis
SS: temporal pain/HA, nausea/vomiting, eye pain, blurred vision, fixed dilated pupil, etc.
D: high IOP, K edema, shallow AC, gonio
Malignant glaucoma
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
Pigmentary dispersion
- syndrome
- glaucoma
- tx
- signs, locations
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
LPI
-why pre-op pilo + MOA
Contracts ciliary muscle -> incr tension on SS -> opens TM -> outflow -> decr pressure
Tightens iris to visualize crypts
LPI
-why use a lens
Magnifies, good DOF Concentrate laser energy Speculum Control eye Focuses laser -> less energy to retina
LPI
-laser settings
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)
LPI
-placement (conventional vs paradigm shift)
C: 11/1:00 - visual disturbances/dysphotopsia
P: 3/9:00 - pain/cosmetic concerns
-long posterior ciliary nerve
LPI
-complications and tx (5)
IOP - ocular hypotensives
Hemorrhage - pressure
Uveitis - pred forte
Diplopia/glare - tints
Closure - repeat procedure
Iridoplasty
-purpose
Low energy laser burns in peripheral iris to widen the angle
Break PAS
Pulls away from the TM
Iridoplasty
-when to perform (4)
Plateau iris syndrome (most useful)
Nanophthalmos/microphthalmos
ACG
PAS
Iridoplasty
-laser settings
Power: 300-500mW
Spot size: 300-500um
Duration: 300-500ms
6-8 shots/quadrant (24-32 total)
Capsular opacification
-cause
Growth and proliferation of lens epi cells from original ct that migrate
Most common complication of ct sx
Capsular opacification
-anterior capsular opacification
Occurs w/in first 6 mo post-op
Complications:
- decentered IOL (#1)
- lens tilt
Capsular opacification
-soemmering’s ring
Only in APHAKIC pts
- congenital
- Lowe syndrome
- Hallermann-Streiff-Francois syndrome
Capsular opacification
-posterior capsular opacification
—types
Fibrosis
- tough = more energy to break
- white opacities, fine folds, wrinkles
Proliferation/pearl
-circular opacification
Linear
-striae/channels
Capsular opacification
-posterior capsular opacification
—effects (3)
Forward light scatter
Contrast sensitivity
VA
YAG CAP
-contraindications
—absolute (2)
—relative (4)
Corneal haze
Unstable
Glass IOL
Active inflamm
CME
High risk RD
YAG CAP
-complications
IOP spike Inflammation Floaters Stromal haze/edema CSME IOL pitting* RD -overall 1% after ct sx -incr to 2% after YAG CAP
YAG CAP
-reduction in complications
Pick pt
- VA <20/30
- symptomatic
- more than 3 mo post-op ct
Decr total energy
If pt RTC for decr vison which tests do you run (7)
VA Pupils AG IOP OCT HVF DFE
