Dr. Assimellis Stuff In Dronka's Words

Question 1

Floaters

Answer 1

• aging vitreous-collagen fiber collapse-clumps/knots
• vitreous cortex (outer vitreous) peels from the retina-hole/break
• forward light scatter

Question 2

Predisposition for floaters

Answer 2

High axial myopia

Diabetes

Question 3

How many weeks to we have them back after we dilate them after the first time of floaters

Answer 3

6 weeks

This is when there is a the highest risk of RD/tears/holes after having floaters for the first time

Question 4

Removal of floaters

Answer 4

Nd:YAG 1064=vitreolysis
Vitrectomy

Vitrectomy is still the only proven method to remove floaters. Vitreolysis can create significant issues and the risks dont necessarily outweigh the benefits

Question 5

Cyclophotocoagulation procedure

Answer 5

• lowers IOP by decreasing production of AH. Ablated the CB epithelium.
• methods: transcleral, endoscopic

Question 6

Complications of cyclophotocoagulation

Answer 6

Excessively lowered IOP secondary to collateral damage

Can’t see through the sclera and can see how much CB is being ablated, end up creating too much IOP drop and having hypotony. Sometimes too effective

Question 7

Retinal laser therapy

Answer 7

Pan retinal photocoagulation

• Nd:YAH 532nm (or Argon)
• light is absorbed by the RPE-denatures protein via thermal burn-Cell death

Question 8

What is PRP used for

Answer 8

DR

Retinal ischemia/neo

Question 9

MOA of PRP

Answer 9

Light is absorbed by the RPE-denatures protein via thermal burn-cell death
-reduces the area of ischemic tissues-reduces total vascular endothelial growth factors (VEGF) production-reduces likelihood of neo

Question 10

Complications of PRP

Answer 10

Chorodial effusion
Exudative RD
Macular edema
VF defects from scar tissues. They dont notice a large spot because there are a lot of smaller spots

Question 11

Most commonl performed ophthalmic surgery

Answer 11

Cataract surgery

Question 12

What laser is used for cataract surgery

Answer 12

Femtosecond laser

Question 13

Femtosecond laser for cataract surgery

Answer 13

Nd:GLass 1053 (near infrared)
-creates plasma that rapidly expands, separating tissue by way of bubble formation

Pulse time < diffuse time

• significant reduction of heat affected zone
• more precise ablation

Question 14

Pros of femtosecond laser for cataract surgery

Answer 14

More accurate ablation of crystalline lens

Less truama to surrounding tissue

Less negative outcomes

Question 15

Refractive surgery

Answer 15

LTK
PRK
LASIK
LASEK
SMILE

Question 16

LASIK/LASEK/PRL: Myopia

Answer 16

We want

• less optical power
• decreased curvature (Center)

We can

• flatten the cornea
• remove central tissue

Question 17

LASIK/LASEK/SMILE: hyperopia

Answer 17

We want

• more optical power
• increased curvature (center)

We can

• steepen the cornea
• remove peripheral tissue

Question 18

Phototherapeutic Keratoplasty (PTK)

Answer 18

Indicated for ANTERIOR corneal pathology ONLY

• spheroidal degeneration
• salzmann nodular degeneration
• band keratopthy
• RCE
• bullous keratopathy
• anterior corneal dystrophies
• superficial scars
• keratitis

Question 19

Procedure for PTK

Answer 19

• Argon fluoride excimer laser (193nm)=photoablation
• by itself or in combination; before and/or after surgery
• reshapes the cornea which causes rapid re-epithelization

Question 20

Anteiror stromal puncture indication

Answer 20

RCE

• trauma: organic material
• anterior corneal dystrophy: Map dot, reis-bucklers

Question 21

Anterior stromal puncture procedure

Answer 21

Needle

• debride corneal epithelium
• puncture tissue to create hemidesmisome connections

Question 22

Anterior stromal puncture with a Nd:YAG 1064

Answer 22

• No corneal debridement necessary***
• focused at BM
• energy: 1.8-2.2mJ. Shots ~ 1/4mm apart within subepithelium or superficial stroma

Question 23

Signs of pigmentary dispersion

Answer 23

Kruckenberg spindle (endothelium)
Iris concavity
TI defects 
Scheie stripe (lens)
Double hump sign (using 4 mirror)
Excessive TTM pigment 
Sanpalosi line (Schwalbes)

Question 24

Why do we use pilo before LPI

Answer 24

Tension on scleral spur pulls TM open, increased outflow

Pulls iris tight for us to see crypts

Question 25

LPI setting ND;YAG 1064

Answer 25

Energy=3-6mJ
Spit size is fixed
Duration is fixed 
Pulses=1
Amount of burns=1-15, @ 11 or 1 oclock, 0.5-1mm in size (large enough to be patent)

Question 26

Iridoplasty setttings

Answer 26

Power=300-500mW
Spot size=300-500um
Duration=300-500ms

Question 27

Perfect candidate for YAG CAP

Answer 27

VA <20/30
Symptatomic
<3m post op cat sx