Glaucoma 2 Flashcards

1
Q

What glaucoma medication class should be avoided in a patient with HSV, CME, or uveitis?

A

Prostaglandins

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2
Q

What is the most common stimulus size in automated perimetry?

A

4mm squared (size III)

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3
Q

How much does SITA standard (not fast) reduce test taking time compared to full thresholding strategy?

A

50%

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4
Q

According to OHTS, how much of an increased risk for glaucomatous field progression do you have for each millimeter mmercury above baseline IOP?

A

10% for each millimeter mercury

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5
Q

What are some characteristics of glaucomatocyclitic crisis (Posner-Schlossman syndrome)?

A

NAME?

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6
Q

What are some characteristics of Fuchs heterochromic iridocylitis?

A

NAME?

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7
Q

What class of glaucoma medications should be avoided in someone with PACG?

A

Non-selective alpha agonists or alpha 1 agonist as they may cause decreased blood flow (worsen ischemia) and may dilate

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8
Q

Why are 2 laser iridotomies indicated in a patient with ectopia lentis (prior to lensectomy)?

A

To relieve/prevent pupillary block. The lens loose lens can block a single iridotomy but not two iridotomies 180 degrees apart

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9
Q

What is the most common cause of ectopia lentis?

A

PDX is followed by trauma. Weil-Marchesani, Marfans, and homocystinuria are actually lower on the list.

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10
Q

What is the most common ICE variant?

A

Chandlers

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11
Q

PAS superiorly is more suspicious for chronic angle closure glaucoma or inflammatory glaucoma?

A

chronic angle closure glaucoma

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12
Q

What distinguishes acute angle glaucoma from aqueous misdirection syndrome on exam?

A

AC is flat peripherally and centrally in aqueous misdirection syndrome; in acute angle glaucoma the AC is flat peripherally but not centrally

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13
Q

What is the inheritance pattern of most cases of JOAG?

A

AD

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14
Q

What is the inheritance pattern of aniridia?

A

2/3 AD, 1/3 sporadic

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15
Q

The prognosis of primary congenital glaucoma diagnosed between what time frame?

A

3 months and 1 year

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16
Q

Axenfeld-Rieger is what type of inheritance pattern?

A

AD, some sporadic

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17
Q

Work-up for renal cell carcinoma should be obtained in aniridia inherited AD or sporadically?

A

sporadically

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18
Q

What glaucoma drug can cause apnea, hypotension, bradycardia, hypotonia, hypothermia and somnolence in children less than 3 and is thus contraindicated?

A

Alpha 2 agonist such as alphagan

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19
Q

What prostaglandin analogs are pro-drugs?

A

Latanoprost (XALATAN) and Travoprost (TRAVATAN). They are activated by corneal esterase and need only once daily dosing

20
Q

A scleral buckle with cause IOP’s to be artificially high or low with goldmann applanation?

A

Artificially low

21
Q

Which of the classes of glaucoma medications has the strongest IOP lower effects?

A

Prostaglandins

22
Q

What would be the most common advantage for using methazolamide over acetozolamide?

A

If someone has kidney failure. Acetazolamide is metabolized by the kidneys and methazolamide by the liver

23
Q

What is an advantage of brinzolamide (azopt) compared to dorsolamide (trusopt) as far as side effect profile is concerned?

A

brinzolamide does not sting as much as dorzolamide

24
Q

What is the benefit to a gel form of timolol?

A

It reduces systemic absorption

25
Which glaucoma medication has the most alpha 1 agonist activity?
apraclonidine although it has more alpha 2 function. It is used for Horner's testing
26
Both apraclonidine and brimonidine lower IOP by decreasing aqueous outflow. Each have an additional way that they lower IOP, what are they?
1. Apraclonidine: decrease EVP2. Brimonidine: Increase uveoscleral outflow
27
How does LTP (including ALT and SLT work)?
thermal energy causes release of local chemical mediators that increase facility outflow
28
How much is laser trabeculoplasty thought to lower IOP?
About the same as a glaucoma med...20-25%
29
the 50 micron spot size in ALT is applied where?
The Anterior TM posterior TM junction
30
How many spots are generally applied in ALT and over how much of the angle?
40-50 over 180 degrees (can do 360 too)
31
What is the spot size for SLT?
400 microns
32
What is the 10 year success rate of laser trabeculoplasty?
30%
33
Young patients with myopia undergoing trabeculectomy have an increased risk of hypotony maculopathy when what adjuvant medication is used during surgery?
MMC or 5FU
34
How does 5FU work?
It interferes with DNA synthesis with its action on thymidylate synthetase
35
How is 5FU applied?
Like MMC. Postoperatively it can also be injected subconj away from the scleral flap so that it does not get in the eye.
36
How does MMC work?
It is a DNA alkylating agent causing DNA crosslinking
37
What type of laser is used for laser suture lysis?
Argon green or red
38
Does antifibrotic agents increase the risk of endophthalmitis?
yes
39
A patient needs glaucoma surgery which is progressing causing vision loss. They also need cataract surgery, although no risk for permanent vision loss from that. Should the surgeon do a combined glaucoma/CE or just glaucoma surgery?
Just glaucoma, combined has poorer outcomes.
40
Which glaucoma draining device is valved?
Ahmed valve; molteno and baerveldt are non-valved
41
In the tube vs trab study, which did better?
tube
42
In the study comparing Baerveldt vs Ahmed, which had lower post-op complications? Which had better decrease in IOP?
Ahmed and fewer complications but high slightly higher IOP
43
Indications for glaucoma drainage device include failed trab with antifibrotics, active uveitis, NVG, and inadequate conj. What are two other indications that may not be as intuitive?
Aphakia (trab success rate is late in aphkia) and need to wear contact lens (bleb will not interfere with corneal/scleral surface)
44
How many degrees of cyclophotocoagulation is normally performed?
270 degrees
45
What mechanism might a patient with tuberous sclerosis get glaucoma?
#NAME?
46
What is the laser setting for ALT?
50um spot size; 0.1 sec duration; 300-1000mW
47
What is the laser setting for SLT?
Uses Nd:YAG; 400um spot size; 3 ns duration and 0.4-1.0mj energy