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Ophthalomolgy > Cataract > Flashcards

Cataract Flashcards

1
Q

Risk factors of PCT

A
  1. Difficult Cat(brunescent, Morgagnian, PXF, Post polar)
  2. Glaucoma
  3. High myopia
  4. Vitreous pressure in anaesthesia
  5. Small pupils
  6. Small CCC
  7. HPT
  8. Chronic lung d/s
  9. Obese
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2
Q

Signs of PCR

A 
Prescience of ring reflex in PC
Outline of PCR seen
Pupil snap sign
Peaked pupil
Inability to aspirate
Fragments disappear from view
Sudden deepening of AC
Vitreous in AC
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3
Q

PCR op checklist

A
  1. Obvious vitreous at pupil borders
  2. Injection miotic agent - round pupil observed
  3. Traction at wound edge e wreck sponge - peaking of pupil (Marionette sign)
  4. Injections air bubble
  5. Sweep iris - movement in AC
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4
Q

PCR post op complications

A
  1. Endophthalmitis
  2. Glaucoma
  3. Inflammation
  4. Bulbous K
  5. Suprachoroidal haemorrhage
  6. CME
  7. RD
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5
Q

Post Cataract endophthalmitis

A

0.1%

  • S. Epidermidis(70%), S. aureus
  • Streptococcus
  • Gram negative
  • Propionibacterium species

Onset 1-14 days

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6
Q

Post op glaucoma

A

1%

  • Streptococcus
  • H. influenzae

Onset early to late

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7
Q

Factors that determine the management of glaucoma and Cataract

A
  1. Severity and progression of glaucoma IOP level (most important factor)
    Optic nerve head changes
    Visual field changes
    Ocular risk factors (CRVO, Fuchs endothelial dystrophy, retinitis pigmentosa)
  2. Severity and progression of cataract VA and visual requirements
  3. Patient factors Age
    Race (blacks have higher rate of glaucoma progression) Family history of blindness from glaucoma
    Fellow eye blinded from glaucoma
    Concomitant risk factors for glaucoma (DM, HPT, myopia, other vascular diseases)
    Compliance to follow-up and medication use
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8
Q

Combined cataract extraction and trabeculectomy Advatages

A
  1. One operation
  2. Faster visual rehabilitation
  3. Patient may be taken off all glaucoma medications
  4. No subsequent cataract operation needed (lower risk of bleb failure)
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9
Q

Disadvantage of combined

A

1.More manipulation during the combined operation
(higher risk of bleb failure)
2.Vitreous loss during cataract surgery (higher risk of bleb failure)
3.Larger wounds created (higher risk of wound leakage and shallow AC)

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10
Q

What is Ectopia lentis

A

Displacement of lens from it’s normal position
Maybe congenital, developmental or acquired

Sublimated lens - partial displacement of lens from its normal position but remains in pupillary area

Dislocated lens - completely displaced from pupil implying separation of all zonular attachment

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11
Q

Classification of ectopia lentis

A

Primary

  1. Idiopathic
  2. Familial ectopia lentis
  3. Ectopia lentis et pupillae

Secondary

  1. Systemic d/s - Marfan
    - Stickler, WM$,ED$
    - Homocysteinuria, Hlysinemia
  2. O developmental- big eye, cornea
    - anitidia, u coloboma, correctopia
  3. O d/s or acquire - UTI HA
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12
Q

Symptoms of sublimated lens

A
  1. Fluctuations in vision
  2. Difficulty in accommodations
  3. Monocular diplopia
  4. Monocular Astigmatisms
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13
Q

Signs of ectopia lentis

A
  1. Uneven Ac
  2. Uneven shadowing of iris on lens
  3. Phacodonesis
  4. Iridodonesis
  5. Sup or inf border of lens zonules seen
  6. Acute ACG
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14
Q

Complications of ectopia lentis

A
  1. Cataract
  2. Glaucoma
  3. Uveitis (lens induced)
  4. Refractive error
  5. Amblyopia
  6. RD, CMO
  7. Displacement of lens into AC or Vitreous
    • pupillary block and ACG, corneal decompensation
    • no advance sequels if capsule is intact
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15
Q

Subluxated lens management

A
  • Refractive error Mx
  • Surgical removal
    1. Cataract
    2. Glaucoma
    3. Persistent uveitis
    4. Severe optical distortion
    5. Corneal decompensation
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16
Q

Dislocated lens into Vitreous Mx

A

Into AC - o emergency, immediate removal
Into Vitreous- capsule intact

Sx technique- 4 EC/pha, IC, IC+Avi, PPV
IOL choice - 6 Ap, AC, CTR, Sul, Scl, Iris

17
Q

Types of CTR

A
  1. Standard CTR
  2. Modified conni type 1 L
  3. Conni type 2 L
  4. Armed capsular tension segment
18
Q

Standard CTR advantages

A
  1. Improve control
    - maintains capsule contour
    - centering mildly subluxated lens, prev dislocation and decentration
    - reduces risk of capsular tear
    - allow in the bag PC IOL
  2. Post op
    - prev capsular phimosis
    - limit PCO
  3. Allow YAG capsulotomy
19
Q

Complications of CTR

A
  1. Hyphaema
  2. Capsular entanglement
  3. Capsular bag tear
  4. Iatrogenic zonule damage
  5. Poor capsular centeration
  6. Result from capsular bag shrinkage , fibrosis

Ophthalomolgy (11 decks)

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