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OQ Review > BCSC 10. Glaucoma > Flashcards

BCSC 10. Glaucoma Flashcards

1
Q

Critical risk factors for progression of POAG

A

DECREASED PERFUSION PRESSURE, thin cornea, increasing age. Intracranial pressure not studied. Low ICP implicated in low-tension glaucoma.

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2
Q

Inheritance of axenfeld-rieger syndrome

A

AUTOSOMAL DOMINANT

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3
Q

Outflow facility is measured by

A

tonography

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4
Q

Measures aqueous humor formation rate

A

fluorophotometry

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5
Q

Measures episcleral venous pressure

A

venomanometry

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6
Q

Must be calculated using goldman equation and parameters IOP, aqueous humor flow rate, outflow facility, and episcleral venous pressure

A

Uveoscleral outflow rate

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7
Q

Rate of aqueous humor formation during sleep

A

decreases 50%. Normal 2-3uL/min

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8
Q

Tonometer uses Imbert-Fick principle for measurement of IOP

A

Goldmann and Perkins tonometer - use same measurement tip, balances surface tension of tear film with rigidity of cornea to approximate dry infinitely flexible thin walled sphere for eyes with corneal thickness of 520 um

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9
Q

Imbert-Fick principle

A

relates pressure inside a dry, thin-walled sphere to the force required to flatten a specific area

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10
Q

Force goldmann applanation tonometer measures

A

Force necessary to flatten an area of the cornea of 3.06 mm in diameter

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11
Q

How was a visual field defect defined on standard automated perimetry in the OHTS

A

presence of a Pattern Standard Deviation (PSD) with P < 5% or presence of a Glaucoma Hemifield Test (GHT) with a result outside normal limits. Had to be present in 3 consecutive visual field tests

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12
Q

Mutations in which gene are associated with pseudoexfoliation syndrome?

A

LOXL1 mutation at 15q24 (Scandanavians like lox)

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13
Q

Gene mutation in primary congenital glaucoma

A

CYP1B1

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14
Q

Gene mutation in iridogoniodysgenesis

A

FOXC1

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15
Q

Gene mutation in Rieger syndrome

A

PITX2

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16
Q

m/c cause of glaucoma associated with primary or metastatic tumors of the ciliary body

A

DIRECT INVASION of the anterior chamber angle

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17
Q

Glaucoma caused by leakage of lens protein through the capsule of a mature or hypermature cataract

A

Phacolytic glaucoma - phagocytizing macrophages obstruct TM

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18
Q

Glaucoma caused when lens cortex particles obstruct TM following disruption of lens capsule with cataract extraction or trauma

A

Lens particle glaucoma

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19
Q

Glaucoma caused by large intumescent lens induces angle-closure (ACG)

A

Phacomorphic glaucoma

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20
Q

Displacement of lens from its normal anatomical position

A

Ectopia lentis

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21
Q

WDR36

A

Adult POAG

22
Q

OPTN

A

NTG, adult POAG

23
Q

TIGR/MYOC

A

JOAG and adult POAG

24
Q

Inheritance of Congenital glaucoma

A

Recessive

25
Q

Goldmann equation

A 
Po = (F-U)/C+Pv
Po = IOP in mm Hg 
F = rate of aqueous formation in uL/min
U = rate of aqueous humor drainage through pressure insensitive uveoscleral pathway (uL/min)
C = outflow facility
Pv = episcleral venous pressure in mm Hg
26
Q

Resistance to outflow (R) is equal to

A

inverse of facility of outflow

27
Q

Aqueous humor composition

A

XS Hydrogen, chloride, ascorbate, deficit of bicarb, protein free (1/200-1/500).
GF, enzymes: carbonic anhydrase, lysozyme, diamine oxidase, plasminogen activator, dopamine beta-hydroxylase, phospholipase A2, prostaglandins, cyclic adenosine monophosphate, catecholamines, steroid hormones, hyaluronic acid

28
Q

Bilateral angle closure glaucoma in eyes with normal axial length

A

Uveal effusions due to systemic medication - m/c topiramate

29
Q

Laser iridotomy useful for

A

pupillary block (phacomorphic glaucoma)

30
Q

Patients with appositional angle closure or areas of peripheral anterior synechiae with relative pupillary block are at risk for chronic angle closure developing should have this treatment

A

laser iridotomy

31
Q

Elevation of IOP independent of pupillary block may occur despite a patent iridotomy

A

Plateau iris syndrome

32
Q

Type of glaucoma unlikely to resolve after cataract extraction

A

Eye with angle recession and phacodenesis after blunt trauma

33
Q

Abnormal spherical shape of lens induces pupillary block

A

microspherophakia

34
Q

Finding in congenital glaucoma can continue to change and indicate progression even though IOP appears to be controlled

A

AXIAL LENGTH

35
Q

After successful surgery for congenital glaucoma, how many years should child be monitored

A

Lifetime

36
Q

Post-op complications in congenital glaucoma

A

amblyopia, strabismus, corneal decompensation, cataracts

37
Q

Glaucoma medication contraindicated in toddlers

A

Brimonidine - systemic hypotension and apnea in children younger than 2 years old. Relative contraindication in older children

38
Q

Class of ocular hypotensive agents associated with the development of apnea in infants and young children

A

alpha 2-Selective adrenergic agonists reported to cause systemic hypotension, apnea, CNS depression, bradycardia. May cross blood-brain barrier. Avoid in nursing mothers.

39
Q

Only topical ocular hypotensive beta-blocker that is relatively beta-1 selective

A

Betaxolol

40
Q

Nonselective beta-adrenergic antagonists (beta-blockers) topical ocular hypotensive agents

A

Timolol, carteolol, levobunolol (may result in bronchospasm)

41
Q

Conditions associated with increased risk of suprachoroidal hemorrhagw

A

High myopia, aphakia or pseudophakia, hypotony, prior vitrectomy, advanced age, systemic hypertension, anticoagulant therapy, h/o suprachoroidal hemorrhage in fellow eye.

42
Q

Fluorouracil Filtering Surgery Study found that risk of suprachoroidal hemorrhage was strongly associated with

A

(1) level of preoperative IOP and (2) magnitude of IOP reduction. Reduce IOP as much as possible before filtering surgery and decreasing magnitude of immediate IOP reduction through releasable sutures or laser suture lysis can reduce risk.

43
Q

5 years after laser trabeculoplasty, what percentage of treated patients are expected to maintain lower IOP

A

50%

44
Q

Best candidate for a trabeculectomy with mitomycin C

A

Patient with previous failed trabeculectomy without antifibrotics

45
Q

Patient with neovascular glaucoma is candidate for which GL procedure

A

Tube shunt (trabeculectomy success rate lowered with inflammation)

46
Q

Patient with active uveitis or neovascular glaucoma is good candidate for which GL tx

A

Tube shunt (trabeculectomy success rate lowered with inflammation)

47
Q

Risk factor for bleb related infections

A

contact lens wear

48
Q

Patient with most success with laser trabeculoplasty (LTP)

A

IOP needs to be lowered but patient can’t tolerate multiple medications. Contraindicated in uveitic glaucoma.

49
Q

LTP less effective in which patients

A

Less effective in aphakic and pseudophakic than in phakic patients. Small central island of vision is at risk of vision loss if significant IOP spike

50
Q

Consider tube shunt in following clinical settings

A 
Failed trabeculectomy with antifibrotics
Active uveitis
Neovascular glaucoma
Inadequate conjunctiva
Aphakia
CL use

OQ Review (9 decks)

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