Dronka's Review - Dronka Flashcards
Gonio
-insertion
—anteriorly
—posteriorly
Less CB
More CB
Gonio
-technique to help show more CB during (2)
Pt looks into the mirror
Tilt lens into quadrant of question (indentation gonio)
Grading Systems
-describes degree to which
—angle is closed
—angle is open
Closed = Scheie
Open = Shaffer
Grading System
-what is this an example of: B15b2+ptm
Spaeth
Plateau Iris Configuration vs Syndrome
- describe PIC
- describe PIS
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
Plateau Iris Configuration vs Syndrome
-which does an LPI work on
Configuration!
Gonio
-when to check for angle recession after trauma and why
4-6 weeks
Ensure no exacerbation of hyphema or inflammation
Gonio
-common findings for pigment dispersion (3)
Sanpolosi line
Scheie stripe
Excessive TM pigment
Iris process vs peripheral synechia
-which is pathological
Synechia
Peripheral Synechia
-causes (4)
Angle-closure glaucoma
NVG (scar tissue)
Uveitis (sticky tissue)
ICE
Laser Trabeculoplasty
-general MOA
Incr AH outflow
-esp thru TM
Laser Trabeculoplasty
-indications (5)
POAG OHTN NTG PDG PSG
Laser Trabeculoplasty
-positive predictors (3)
Age >40
TB pigment - want good amount/more
Corneal clarity
Thermal Relaxation Time
- define
- how long
- when would a burn occur
Time required by melanin to convert EM energy to thermal
1 microsecond
If >1 microsecond
Argon Laser Trabeculoplasty (ALT)
-mechanical or biological MOA
Both
Argon Laser Trabeculoplasty (ALT) -laser settings —power —spot size —duration —pulses —amount of burns
600 mW
50 microns
0.1 seconds
1 pulse
180 degrees
Pre-operative drops for ALT and SLT (2)
Alphagan
Proparacaine
Can you repeat ALT
Highly recommended not to
- incr complications
- 50% need surgery to lower IOP w/in 6 mo of repeated ALT
Selective Laser Trabeculoplasty (SLT)
-mechanical or biological MOA
Biological
Selective Laser Trabeculoplasty (SLT)
-cold or hot, why
Cold
Thermal relaxation time not met
Is SLT a safe/effective initial therapy
Yes - multiple studies
Selective Laser Trabeculoplasty (SLT) -laser settings —energy —spot size —duration —pulses —amount of burns
0.8-1.2 mJ
400 microns (fixed)
3 nanoseconds (cold)
1 pulse
~100 burns, 360*
Selective Laser Trabeculoplasty (SLT)
-which hemisphere do you perform first, why
Inferior
More pigment
Selective Laser Trabeculoplasty (SLT)
-post-op drops
Alphagan
Nothing or tylenol PRN
Selective Laser Trabeculoplasty (SLT)
-time frame for most success
12-60mo
80% at 1 year
50% at 5 years
Selective Laser Trabeculoplasty (SLT)
-will it be successful if the pt did not respond to PGA
No
Selective Laser Trabeculoplasty (SLT)
- should you perform on pts with pigmentary dispersion syndrome/glaucoma
Yes - be more cautious, do test spot and watch for spike
Selective Laser Trabeculoplasty (SLT)
-can you repeat
Yes - not as effective second time
