Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

14: Eye > Chapter 125 Emergency Ophtho Surgery > Flashcards

Chapter 125 Emergency Ophtho Surgery Flashcards

1
Q

Look at this diagram and learn the muscles…

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the four layers of the eyelid

How are lacerations closed?

A

Skin, muscular, fibrous, conjunctiva

2 layer closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is best predictor of perfect post-op eyelid function following laceration?

A

Meticulous marginal apposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When doing a figure of 8 suture to align eyelid margins, what should be used to determine appropriate eyelid margin exit point

A

Opening of meibomian glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When shoudl figure of 8 clusure not be used for eyelid apposition

A 
At lateral (or presumably medial) canthus
Just do simple interrupted and tie suture ends into mosre lateral sutures so they dont poke into the eye
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is severed NL duct treated

A

Thread 2/0 Monofilament along duct and affix end away from eye and nose.
Repair any other damage

Leave suture inplace for 2-4 months!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List 3 broad surgical techniques for management of corneal ulcer (and subcategories where necessary)

A
  • Autografts
    • ​Bulbar conjunctival graft aka Gunderson’s graft
    • Corneoconjunctival transposition
  • Corneal allografts
    • ​Penetrating keratoplasty (full thickness)
    • Lamellar keratoplasty (partial thickness)
  • Extracellular matrix grafts
    • ​Porcine SIS
    • Porcine urinary bladder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List 4 variations of a conjuntival graft

A

A, Pedicle graft.

B, Bridge graft.

C and D, Island graft.

E, 360-degree graft.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a key step in harvesting conjunctival graft and why

A

Removal of Tenon’s capsule

To reduce tension on graft and reduce post op contracture by Tenon’s fibroblasts (both risk factors for graft dehisence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What non-sx steps shoudl be performed before conjunctival graft

A

Ulcer sampling for cytology and culture + susceptibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is size of pedicle graft relative to ulcer?

A

3mm wider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe condition

A

Axially located descemetocele in a dog. Notice the deep stromal walls that stain positively with fluorescein and the lucent, glistening Descemet’s membrane that does not stain positively.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where is conjunctival graft harvest started, relative to limbus

A

1mm lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What step is performed prior to conjunctival graft suturing

A

Prep of ulcer bed

  • bed swabbed with cellulose or edge of beaver blader to remove any epithelail cells (want graft to heal TO epithelium, not epithelium healing under graft)

If edges melting resect cornea back to healther tossie to allow suture holding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What suture is used to suture corneal graft

A

8/0 Vicryl (polyglactin 910)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What steps are performed afer cinjunctival graft suturing

A

Suture scleral donor site and consider temprrary tarsorrhaphy

17
Q

How long is conjunctival graft left in place

How is remaing scar minimised

A

6-8 weeks

Short course topical roids

18
Q

What is rule of thumb re conjunctival pedical graft arm angle

A

Shouldnt exceed 45º from vertical to minimise shear stress form blinking (risk for dehisence)

19
Q

List 3 rosk factors for conjunctival graft dehisence

A
  • Tenons capsuel tension
  • Fibrosis from tenons capsule fibroblasts
  • Angle >45º from vertical –> shear forces from blinking
20
Q

What procedure has been performed

A

Corneoconjunctival transposition immediately after surgery. Notice that the limbus has been shifted toward the corneal axis in the area of the graft.

21
Q

What is benefit of corneoconjunctival transposition over conjunctival graft

A

Allows for clear corneal axis

22
Q

What is sixelimitation for performing conrenoconjunctival transposition

A

5mm and must be axial

23
Q

At what stromal level is conrneoconjunctival transposition performed/

A

Half stomal

24
Q

What corneal lesions are particularly suited to corneal allograft?

A

>6mm

or

Already perforated

N.B. corneal allografts and biosynthetic grafts can be covered with a conjunctival graft after if necessary, just NB

25
Q

What counts as a freshly harvested corneal graft?

What si the advantage?

A

Fresh if <35d old and stored at 4ºC in storage medium

More likely to remain clear

26
Q

Transplanted corneal tissure canbe either full or partial thickness - whatare the names for these procedures?

A
  • Partial thickness = lemellar keratoplasty
  • Full thickness = penetrating keratoplasty
27
Q

What IOP has to be reached to cause corneal/scleral tear?

A

7000 mm Hg

28
Q

Where do dog and cat globes tend to ruputre

A

At posterior pole or near optic nerve

29
Q

What si it called when sclera tears but conjunctiva remains intact

What is a clue to its presence

A

OCCULT SCLERAL RUPTURES

Haemorrhagic chemosis and hyphema and low IOP in globe thats experienced blunt trauma

30
Q

What 2 factors in corneal laceration –> worse progosis

A
  • From blunt trauma (vs sharp)
  • If lesion extends beyond limbus (i.e. liekly damage for uveal/retinal tissue)
31
Q

Name a technique to create corneal ‘seal’ if tissues too macerated to hold more sutures

A

Deliberately instill some airbubbles –> surface tension provides seal for 1-2d while fibrinous seal forms

32
Q

WHAT IS TIME LIMIT FOR BEING ABLE TO PRESERVE HERNIATED IRIS TISSUE?

A

<12 HOURS

33
Q

What is problem with anterior lens lux

A

Anterior uveitis, secondary glaucoma, retinal detachment

34
Q

List 2 management options for anterior lens lux

A
  • Lens extraction
  • “Couched” into position behind lens + latanoprost to keep iris consticted
35
Q

List 3 methods to extract an anteriorly luxated lens

A
  • Phacoemulsification
  • Use of lens loop
  • 1mm nitrous oxide probe tip to freeze lens to probe whiel being extracted

(extraction via dorsal inscision (09.30 - 02.30)

36
Q

What addidonal procedure might be performed after extraction of luxated lens?

A

Placement of artificial lens (placement of pseudophakos)

37
Q

What are the two methods for securing psuedophakos?

A

Ab interno suturing

Ab externo suturing

38
Q

How is proptosed globe managed?

A

Assess for rupture/laceration

Clean + lubricate

Reducue by pre-placign temporary tarrshoraphy sutures, then use sutures + handle end of scalpel blade behind sutures to reduce globe (can do lateral canthotomy if nec)

Maintain tarrshorraphy for 3 weeks

39
Q

Describe an emergency way to manage galcuoma if medical tx not wokign

A

Temporary keratostomy

  • i.e. 30G needle instered into anterior chamber, allwoed to leak out until IOP 10 - 15 mmHg
  • When done withdraw needle half way through corneal (to allow interior part to seal, wait 5 seconds, then withdrawl fully

14: Eye (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions