Glaucoma

Question 1

peripupillary TID

Answer 1

pseudoexfoliation

Question 2

midperipheral iris TID

Answer 2

PDS

Question 3

widened ciliary body band compared to fellow eye

Answer 3

angle recession

Question 4

Retinal procedure that carries the highest risk of secondary angle closure due to choroidal effusion and anterior rotation of ciliary body?

Answer 4

scleral buckle

Question 5

MOA of cyclophotocoagulation

Answer 5

reducing aqeuous production

Question 6

Symmetric scattered peripheral anterior synechiae

Answer 6

CACG

“creeping angle closure” because slow formation of PAS which advance circumferentially

Tx: LPI to prevent progressive PAS

Question 7

IOP in pregnancy

IOP in exercise

Answer 7

decreases in both

Question 8

hyperopic elderly Asian woman

Answer 8

angle-closure glaucoma

Question 9

Structure

Answer 9

anterior displaced schwalbe line

between Descemet membrane and TM

(posterior embryotoxon)

Question 10

Expected ON appearance with given defect?

Answer 10

HVF: dense superior arcuate defect OD

inferior notch

Question 11

Normal optic nerve head size

Answer 11

1.1 to 2.2 mm in diameter

Question 12

MC cause of primary angle closure

Answer 12

pupillary block

occurs when there is restricted movement through the pupil because of iris contract with the lens and is maximal when the pupil is in the mid-dilated position.

Question 13

AW increased risk of blindness in POAG

Answer 13

VF loss at diagnosis

Question 14

Blindness in AA compared to whites

Answer 14

4x higher in AA than whites

Question 15

Effect of applying posterior corneal pressure with a Goldmann-type, large-diameter gonioscopy lens?

Answer 15

This might indent the sclera and falsely narrow the angle

also reflux of blood into Schlemm canal

Question 16

Goldmann lenses

Answer 16

Vaulted gonioscopy lens requiring a coupling agent such as methylcellulose to fill the space between the cornea and lens to visualize the angle. Rim diameter is larger than cornea

Question 17

shallow chamber with double iris hump on gonioscopy indentation

Answer 17

plateau iris

Question 18

Answer 18

“double hump” sign

plateau iris

Question 19

frequently observed in what condition

Answer 19

low-tension glaucoma

(disc heme seen IT)

Question 20

Gene a/w JOAG

Answer 20

TIGR/MYOC

Question 21

Findings on gonio

Answer 21

dilated episcleral veins

blood in Schelmm canal

Question 22

DDx

Answer 22

Blood in Schlemm canal

increased episcleral venous pressure

thyroid ophthalmopathy

Arteriovenous malformations

Carotid cavernous fistulas

dural sinus fistulas

Question 23

How does SLT differ from ALT

Answer 23

SLT delivers less energly than ALT

Question 24

Risk factors for progression of POAG

Answer 24

decreased ocular perfusion pressure

thinner cornea

increasing age

Question 25

How does IV mannitorl reduce IOP

Answer 25

decreases water conent of vitreous

Question 26

Topical ocular hypotensive that should be avoided with history of herpetic keratitis.

Answer 26

**prostaglandins** **_can cause reactivation of herpetic keratitis_** latanoprost, travoprost, bimatoprost, tafluprost (4 available in the USA)

Question 27

Percentage of untreated patients progressed to glaucoma during a 5 year period

Answer 27

9.5%

Question 28

Laser trabeculoplasty is most likely to be effective in patient with what diagnosis

Answer 28

pseudoexfoliative glaucoma PXG, POAG, PDS

Question 29

Risk after cataract

Answer 29

(lens deposition of pseudoexfoliation) **accelerated PCO** intraoperative miosis vitreous loss floppy iris iris prolapse disolcated IOL from zonular dehiscence

Question 30

Tonometer uses imbert-fick principle for IOP

Answer 30

**Perkins tonometer** (applanation) Goldmann tonometer

Question 31

MC reason for poor visual outcome 2/2 primary congenital glaucoma after treatment with goniotomy

Answer 31

**amblyopia** ## Footnote note: cataract formation rare after goniotomy

Question 33

SE topical CAI that can decrease vision

Answer 33

**corneal edema** (carbonic anhydrase found in corneal endothelium)

Question 34

Tx for topiramate bilateral acute angle-closure glaucoma. Discontinue topiramate, give ocular hypotensive and this agent

Answer 34

**cycloplegia** ## Footnote **deepens the AC and relieve attack** systemic acetazolamide po or IV secondary angle closure resolves 24-48 and myopia resolves 1-2 weeks

Question 35

ciliochoroidal swelling with anterior rotation of ciliary body and recent sulfamate-substituted monosaccharide medication

Answer 35

idiosyncratic reaction to topiramate leading to bilateral acute myopia and angle closure

Question 36

Gonioscopic finding a/w pseudoexfoliation

Answer 36

**inability to visualize TM without compression** (narrow angle 2/2 anterior lens movement 2/2 zonular weakness or dialysis)

Question 37

Process seen after blunt trauma

Answer 37

**separation of the ciliary body from the scleral spur** cyclodialysis cleft resulting in prolonged hypotony

Question 38

Only condition after trauma that cna cause hypotony

Answer 38

**cyclodialysis cleft** - separation of the ciliary body from the scleral spur - providing direct access of aqueous to the suprachoroidal space

Question 39

parameter of the Goldmann equation that cannot be directly measured

Answer 39

uveoscleral flow rate

Question 40

measures outflow facility

Answer 40

tonography

Question 41

measures aqueous humor formation rate

Answer 41

fluorophotometry

Question 42

measures episcleral venous pressure

Answer 42

venomanometry

Question 43

How does pilocarpine reduce IOP

Answer 43

**increases TRABECULAR outflow** ## Footnote contracts the longitudinal ciliary muscle fibers that insert into the scleral spur and TM

Question 44

SE pilocarpine

Answer 44

induced myopia difficulty seeing in dim light - miosis paradoxical angle closure (forward shift of lens-iris diaphragm) RD breakdown of blood-aqueous barrier

Question 45

migration of (abnormal endothelial cells) membrane causing high peripheral anterior synechiae and secondary angle closure. Condition fails to respond to medications. Next step

Answer 45

surgical bypass of angle obstruction: Trabeculectomy or GDI

Question 46

powerful predictor of developing glaucoma in OHTS study

Answer 46

CCT - 81% increase in RR for every 40 um thinner CCT Other RF C:D baseline Age Higher IOP higher PSD on perimetry

Question 47

optic disc characteristic most specific for glaucoma

Answer 47

focal notching of the rim

Question 48

acute bilateral angle closure with normal axial length. What additional evaluation is necessary to reach an accurate diagnosis

Answer 48

Take a medication history (presentation suggests uveal effusions due to systemic medication - topiramate)

Question 49

MC cause for decreased VA in surgical arm of CIGTS study

Answer 49

**cataract formation** CIGTS - initial surgical therapy achieves better IOP control than initial medical therapy (did not translate to better VF stabilization because of cataracts long term)

Question 50

perform IOP at this time during EUA

Answer 50

immediately after induction of general anesthesia and before intubation

Question 51

Complication of cyclodestruction unique to endoscopic cyclophotocoagulation

Answer 51

**endophthalmitis** ## Footnote all other forms can cause CME, hypotony, pain, RD, intraocular hemorrhage

Question 52

Class of medication to cause this

Answer 52

**alpha-2 selective agnoists** (ocular allergic symptoms in 10%-15%) toxic follicular conjunctivitis

Question 53

Instrument most accurate in measuring IOP in setting of corneal scarring

Answer 53

Tono-Pen tonometer

Question 54

CYP1B1

Answer 54

primary congenital glaucoma

Question 55

FOXC1

Answer 55

iridogoniodysgenesis

Question 56

PITX2

Answer 56

Rieger syndrome

Question 57

corneal optical wedge

Answer 57

termination of descemet membrane (most anterior structure)

Question 58

interventions compared in the Early Manifest Glaucoma Trial

Answer 58

**medication and laser trabeculoplasty versus observation** first trial with adequate power that showed treatment delayed progression in glaucoma betaxolol + laser trabeculoplasty

Question 59

Condition a/w higher risk of developing aqueous misdirection following trabeculectomy

Answer 59

**angle closure**

Question 60

Aqueous humor formation sleep versus waking hours

Answer 60

decreased by 50% during sleep | (normal 2-3 uL/min)

Question 61

Young myopic patient undergoes trabeculectomy with MMC. 1 month later IOP normal but VA falls from 20/30 to 20/400. Mechanism?

Answer 61

choroidal folds in macula **hypotony maculopathy** bleb leak (acute: wound closure or conj buttonhole, late: use of antifibrotic drugs)

Question 62

After trab: decreased vision, hypotony, optic nerve edema, retinal edema, radial folds in macula

Answer 62

hypotony maculopathy

Question 63

Limits use of alpha agonists in infants

Answer 63

**bradycardia** apnea, systempic hypotension

Question 64

Tx of choice for phacomorphic glaucoma

Answer 64

LPI

Question 65

Tx for dry eye that can raise IOP

Answer 65

loteprednol etabonate (Lotemax) (any steroid even weak - FML, lotemax, loteprednol)

Question 66

PCG has best prognosis when diagnosed at which age?

Answer 66

**between 3 and 12 months**

Question 67

Worse prognosis for PCG

Answer 67

**within 1 month of life** or if K diameter \>14mm at diagnosis \>50% legal blindness

Question 68

red painful eye + elevated IOP + prominent cell and flare + (-) KP + intact lens capsule + mature cataract + wrinkling lens capsule

Answer 68

phacolytic glaucoma

Question 69

First test to get

Answer 69

IOP!