Dronka's Review - Dronka

Question 1

Gonio
-insertion
—anteriorly
—posteriorly

Answer 1

Less CB

More CB

Question 2

Gonio

-technique to help show more CB during (2)

Answer 2

Pt looks into the mirror

Tilt lens into quadrant of question (indentation gonio)

Question 3

Grading Systems
-describes degree to which
—angle is closed
—angle is open

Answer 3

Closed = Scheie

Open = Shaffer

Question 4

Grading System

-what is this an example of: B15b2+ptm

Answer 4

Spaeth

Question 5

Plateau Iris Configuration vs Syndrome

• describe PIC
• describe PIS

Answer 5

PIC (preoperative)

• planar
• depth of AC is normal
• vs typical angle closure - more crowding in the AC due to shorter eye/hyperopia
• confirm narrow angle with gonio

PIS (postoperative)

• patent LPI has eliminated pupillary block, but angle closure persists w/o shallowing of AC
• abnormal CB position -> alters position of peripheral iris in relation to TM -> obstruction of AH outflow

Question 6

Plateau Iris Configuration vs Syndrome

-which does an LPI work on

Answer 6

Configuration!

Question 7

Gonio

-when to check for angle recession after trauma and why

Answer 7

4-6 weeks

Ensure no exacerbation of hyphema or inflammation

Question 8

Gonio

-common findings for pigment dispersion (3)

Answer 8

Sanpolosi line
Scheie stripe
Excessive TM pigment

Question 9

Iris process vs peripheral synechia

-which is pathological

Answer 9

Synechia

Question 10

Peripheral Synechia

-causes (4)

Answer 10

Angle-closure glaucoma
NVG (scar tissue)
Uveitis (sticky tissue)
ICE

Question 11

Laser Trabeculoplasty

-general MOA

Answer 11

Incr AH outflow

-esp thru TM

Question 12

Laser Trabeculoplasty

-indications (5)

Answer 12

POAG
OHTN
NTG
PDG
PSG

Question 13

Laser Trabeculoplasty

-positive predictors (3)

Answer 13

Age >40

TB pigment - want good amount/more

Corneal clarity

Question 14

Thermal Relaxation Time

• define
• how long
• when would a burn occur

Answer 14

Time required by melanin to convert EM energy to thermal

1 microsecond

If >1 microsecond

Question 15

Argon Laser Trabeculoplasty (ALT)

-mechanical or biological MOA

Answer 15

Both

Question 16

Argon Laser Trabeculoplasty (ALT)
-laser settings
—power
—spot size
—duration
—pulses
—amount of burns

Answer 16

600 mW

50 microns

0.1 seconds

1 pulse

180 degrees

Question 17

Pre-operative drops for ALT and SLT (2)

Answer 17

Alphagan

Proparacaine

Question 18

Can you repeat ALT

Answer 18

Highly recommended not to

• incr complications
• 50% need surgery to lower IOP w/in 6 mo of repeated ALT

Question 19

Selective Laser Trabeculoplasty (SLT)

-mechanical or biological MOA

Answer 19

Biological

Question 20

Selective Laser Trabeculoplasty (SLT)

-cold or hot, why

Answer 20

Cold

Thermal relaxation time not met

Question 21

Is SLT a safe/effective initial therapy

Answer 21

Yes - multiple studies

Question 22

Selective Laser Trabeculoplasty (SLT)
-laser settings
—energy
—spot size
—duration
—pulses
—amount of burns

Answer 22

0.8-1.2 mJ

400 microns (fixed)

3 nanoseconds (cold)

1 pulse

~100 burns, 360*

Question 23

Selective Laser Trabeculoplasty (SLT)

-which hemisphere do you perform first, why

Answer 23

Inferior

More pigment

Question 24

Selective Laser Trabeculoplasty (SLT)

-post-op drops

Answer 24

Alphagan

Nothing or tylenol PRN

Question 25

Selective Laser Trabeculoplasty (SLT)

-time frame for most success

Answer 25

12-60mo

80% at 1 year
50% at 5 years

Question 26

Selective Laser Trabeculoplasty (SLT)

-will it be successful if the pt did not respond to PGA

Answer 26

No

Question 27

Selective Laser Trabeculoplasty (SLT)

- should you perform on pts with pigmentary dispersion syndrome/glaucoma

Answer 27

Yes - be more cautious, do test spot and watch for spike

Question 28

Selective Laser Trabeculoplasty (SLT)

-can you repeat

Answer 28

Yes - not as effective second time