final Flashcards
most common yag complications
inflammation (CME- treat with anti-inflammatory drugs, floaters, hyphema- can also be in vitreous, corneal issues, vitreous prolapse)
IOP pike - why give brominidine before and after procedure)
pitting
1% patients can get RD
what does pitting do? What materials does it occur most in?
damages the IOL
affects contrast sensitivity
occurs in silicone>acrylic> PMMA
ALT/ SLT complications
Post op IOP spike (occurs within 90 mins and resolves 1-3 days)
- NOTE: continue to take normal glaucoma drops if on them and may need to add others
permanent IOP spikes -> treat with a trabeculectomy , prevent by lasering 50 spots max/18- degrees at min level
trabeculitis -> treated with topical steroids and NSAIDS, prevent by avoid too much treatment, good focus, and don’t treat ATM
JAMA SLT study
misleading study with a small sample size. said OD had more risk of repeat sessions vs OMD.
can do LTP in 2 sessions
TOSRP study
said that OD’s untrained/ can’t perform lasers, but nothing involved lasers in actual study
LPI complications
I ULTRA-CHIC PB
I - Iris non-preforation
U- uveitis
L- linear dysphotopsia
T - transient IOP spikes
R - retinal damage
A - anterior chamber debris
C - corneal damage
H- hyphema
I - iridotomy closure
C - focal cataracts
P - pupillary distortion
b - bleeding at the margin
iris non-perforation in LPI
most common complication
just not breaking though the iris -> risk nonpatent
prevent with ie. decrease the patency with miotics
use a short burn and look for pigment plume
iridotomy closure in LPI
occurs within 3 weeks
more likely to closer in smaller iridotomies (<150 um)
reopen with YAG
most iridotomies are 200-1000 microns
anterior chamber debris in LPI
transient mild->mod blur X 1-3 days
see pigment, cells/fare - check for glaucoma and RD RISK - ie. monitor floaters
uveitis in LPI
usually mild
treat with steroids NSAIDS for synechiae
taper off once controlled!!
transient IOP spikes in LPI
elevations >10 = dangerous!
document after 1 hr and after 24 hours
NOTE: most spikes occur 1-3 hours post LPI and resolve 24-48 hours after LPI
may need surgical intervention if doesn’t decrease with meds
how do you avoid pupillary distortion in LPI
laser outer 1/3 of the iris- occurs if hit eye muscle
usually consequence is only cosmetic
hyphema in LPI
usually only micohyphema that resolves spontaneously
more common in YAG, rubeosis, uveitis, anti-coagulants
corneal damage in LPI
can look like cracked glass and can lead to gradual haze if endothelial damage occurred
use the lens to avoid - more precise
linear dystphotopsia in LPI
do LPI at 3 or 9 o clock to decrease risk
can lead to diplopia
retinal damage in LPi
usually occurs in the periphery - not concerning because CNVM with form there
what are general complications that occur with lasers and how to treat them?
High IOP usually 1-3 hours after procedure, goes away 1-2 days
- risk factor = POAG
- treat with aqueous suppressants ( CAS, apraclonidine, beta blockers)
Iritis, synechiae (PAS/PS)
Uveitis - treat is > 10 cells or if aqueous flare/haze seen
- treat with topical steroids and NSAIDS q4 hours
CME: if blurry vision after procedure + confirm with OCT/FA
general rules to avoid laser complications
educate patients that ALL lasers have complications, risk factors, etc
Not every case is a laser case, patients may need surgery
use minimal energy and take the lowest number of shots for successful treatment
typically toxicities are mild, don’t last long, and are insignificant
bleeding at the margin during LPi procedure
more common in yag LPI
cumulative energy
total laser shots fired + number of pulses per shot + energy per pulse
the more energy - the more damage and more inflammation and higher chance for IOP spike
risk factors for complications
DM
high myopia
retinal health
glaucoma
OHTN
immunocompromised
what can optometrists not do?
retinal laser (focal PRP), lassie, cosmetic surgery
inclusive law
tells OD can do
exclusive law
tells what OD can’t do
safety signs
3A lasers need caution sign
3B or 4 lasers need a danger sign
how can someone claim negligence?
a close relationship must exist
actual loss or injury to patient caused by you.
