Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

TORIC > Glaucoma laser > Flashcards

Glaucoma laser Flashcards

1
Q

Définition de l’abréviation LASER

A

Light Amplification by Stimulated Emission of Radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Propriétés d’un laser (x5)

A

Monochromatic
Coherence
Directionality
Polarization
Intensity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Interactions Laser-Tissue (x3)

A

PHOTOCOAGULATION : selective absorption of light energy and conversion of that energy to heat, with subsequent thermally included structural change in the target. Ex. ARGON

PHOTODISRUPTION : High-peak-power pulsed laser to ionize the target and rupture the surrounding tissue. Explosive disruption of tissue to create an excision. Ex. YAG

PHOTOABLATION : Break the chemical bonds that hold tissue together - vaporizing the tissue. Ex. EXCIMER LASER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Indications d’un iridotomie au laser (x3)

A

Pupil block angle closure
Narrow/occluable angles
Pigment dispersion syndrome/glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Contre-indications relatives de l’irodotomie au laser (x5)

A

Flat anterior chamber
Completely sealed angle
Angle-closure due to primary SYNECHIAL closure
Uncooperative patient
No view (corneal edema, corneal opacification)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Gouttes à administrer pré-iridotomie au laser

A

Pilocarpine 2% (4% si iris foncé)
Alphagan/Apraclonidine
Topical anesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Site(s) de l’iridotomie au laser

A

Iris crypt
Area of thinning (choisir l’endroit le plus mince possible)
Temporal > Nasal (En supérieur : Dysphotopsie)
Éviter 3h et 9h : entrée des nerfs ciliaires

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Laser(s) utilisés pour iridotomie

A

YAG laser : le PLUS commun
- Lower closure rate compared to Argon
- Less energy compared to Argon

Argon : can be used to PRE-treat thick iris prior to YAG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Post-operative care d’un glaucoma laser

A

IOP check 1-3 hours post-laser
Stéroïdes topiques : q2h x 2 jours, QID x 5 jours puis plus longtemps prn si persistance inflammation
Check IOP, AC reaction, patency 1-4 weeks after laser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications de l’iridotomie au laser

A

IOP spike (le plus fréquent)
- 30-40% > 10 mmHg within 1-3 hours post LPI
- Uncommon with alpha-2 agonist prophylaxis
- Risk : increased baseline IOP, PAS > 180°
Anterior uveitis
Diplopia and glare
Hemorrhage
- 50% avec YAG, rare avec Argon
- FdR : rubeosis, anticoagulants, uveitis
Corneal damage
Pupillary abnormalities
Posterior synechia
Lens opacities (progression of cataract)
Closure of iridotomy
Retinal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Types de Laser Trabeculopasty

A

Argon Laser Trabeculoplasty (AL)
Selective Laser Trabeculoplasty (SLT)
Micropulse Diode Laser Trabeculoplasty
Titanium Sapphire Laser Trabeculoplasty
Pattern Scan Laser (PASCAL) Trabeculoplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Indications de la trabeculoplasty

A

Open angles
Adjunctive or 1st line treatment
OHTN (ocular hypertension)
POAG (primary open angle glaucoma)
PXG/PXF (Pseudoexfoliative glaucoma)
PDG/PDS (Pigmentary Glaucoma/Pigment Dispersion Syndrome)
NTG
Steroid induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mécanisme d’action du ALT

A

Increased phagocytotic activity
Decreased resistance to outflow (increased DNA replication of cells + increased metallo-poteinase levels whitin trabecular meshwork)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Evidence of ALT

A

20-30% IOP reduction in 75-85%
Efficacy decreases by 50% over 5 years, and 32% over 10 years
Repeat ALT success rates : 21-70% with additional decreased success over time (DONC pas vrmt répétable)
Largest IOP reductions and earlier failures noted in PXG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Complications laser trabeculoplasty

A

IOP spike 30-50% (higher avec ALT, PDS/PDG)
Uveitis
Peripheral anterior synechia (PAS) formation (more common with ALT)
CME (rare)
Subretinal fluid (rare)
Choroidal effusion (rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mécanisme d’action du SLT

A

Selective photothermolysis with marked absorption by melanin pigment granules : avoid thermal damage to surrounding non-pigmented cells

Lower energy than ALT

(En pratique, on utilise plus SLT que ALT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Evidence of SLT

A

Succès rate over 70% achieved up to 30 months after treatment
Effective as using prostaglandins in first time treatment
REPEATABLE after prior SLT, even if initial response was limited
Pre-treatment with PGAs associated with decreased IOP-lowering response
Anti-inflammatory drops after SLT do not cause a significant reduction in inflammation or altered IOP lower efficacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Contre-indications de la laser trabeculoplasty

A

Uncooperative patient
Inadequate visualization
Complete angle closure

19
Q

Mécanismes d’action ALT versus SLT

A

ALT :
- Augmente phagocytose
- Decreased resistance outflow

SLT :
- Selective targeting of pigmented TM
- Moins d’É que ALT

20
Q

Evolution ALT versus SLT

A

ALT :
- Diminution 20-30% IOP in 75-85%
- Efficacy 50% over 5 years
- PXG largest IOP reduction and earlier failure

SLT :
- Diminution 25-30% in 70% up to 30 months
- Effective as PGAs in first line Tx
- Repeatable after prior SLT even if initial response limited

21
Q

Indications Laser Peripheral Iridoplasty

A

Medically unbreakable attack of ACG
Plateau iris syndrome
Nanophtalmos
Preparation for laser trabeculoplaty when iriocorneal angle is narrow
Phacomorphic angle closure

22
Q

Contre-indications Laser Peripheral Iridoplasty

A

Flat anterior chamber
Advanced corneal edema or opacification

23
Q

Gouttes pré-Tx Laser Peripheral Iridoplasty

A

Pilocarpine 2% (4% si iris foncé)
Alphagan/Apraclonidine
Topical anesthetic

24
Q

Site Selection of Laser Peripheral Iridoplasty

A

Peripheral location

25
Q

Laser utilisé pour Laser Peripheral Iridoplasty

A

Argon

85-90% angles remained open for up to 10 years in plateau iris after 1 session

26
Q

Post-operative management of Laser Peripheral Iridoplasty

A

IOP check 1-3 hours after
Topical steroids (q2h x 2 jours, QID x 5 jours et plus longtemps prn)

27
Q

Complications of Laser Peripheral Iridoplasty

A

IOP spike
Anterior uveitis
Iridolenticular or angles synchiaes
Iris atrophy
Atonic pupil
Corneal endothelial burns
Urrets-Zavalia syndrome - prolonged mydriasis unresponsive to pilocarpine (usually resolves spontaneously within 1 year)

28
Q

Indication d’une cyclophotocoagulation transsclérale

A

High risk of failure with filtering surgery or GDD
- Failed filtering surgery/GDD
- NVG (glaucome néovx)
- Post traumatic glaucoma
- Post PKP
- Post chemical/thermal burn
- Silicone oil
- Aphakic glaucoma
- Uveitic glaucoma
Poor VA potential
No visual potential
Refusing surgery

29
Q

Operative considerations with cyclophotocoagulation transsclérale

A

Retro/peribulbar block (car très douloureux)
Retro-luminate globe to determine position of ciliary body
Setting : SPARE 3 & 9 o’oclock

30
Q

Post-operative management of cyclophotocoagulation transsclérale

A

Stéroïdes ++ : Pred q2h x 1-2 weeks with taper (slow taper sur des mois)
Atropine 1% BID
Continue all glaucoma medications, except miotics
Can retreat at 1 month

31
Q

Complications du cyclophotocoagulation transsclérale

A

Higher energy = increased risk of complications
Mild :
- Iritis
- Conjunctival edema
- Transient pain
Severe:
- Phthisis bulbi
- Permanent hypotony
- Anterior segment hemorrhages
- Decreased vision
- Sympathetic ophtalmia –> 007%

32
Q

Différence entre la cyclophotocoagulation transsclérale MICROPULSE versus transsclérale?

A

MICROPULSE :
Similar effectiveness as cyclophotocoagulation transsclérale with LESS side effects
No hypotony or visual loss reported

33
Q

Types de cyclophotocoagulation

A

Transsscleral cyclophotocoagulation
Micropulse
Cyclocryotherapy
Endoscopic cyclophotocoagulation

34
Q

Quel cyclophotocoagulation affects nerves of cornea? Quel est l’avantage?

A

Cyclocryotherapy : affects sensory nerves of cornea benefit in painful eye

35
Q

Quel est l’avantage de la cyclophotocoagulation endoscopique?

A

Decreases risk of overtreatment and phthisis bulbi compared to trans-scleral technique
Applied diode laser energy directly to the ciliary processes via fibre optic endoscope
Can be combined with CEIOL (cataract extraction & IOL) : showed decrease in IOP at all time points after 35 months
Can be used to mechanically rotate ciliary processes to open angle further in plateau iris

36
Q

Complications de la cyclophotocoagulation endoscopique?

A

IOP spike
Inflammation
CME
Hypotony
Phthisis
Choroidal hemorrhage
Retinal detachment
Fibrin deposition in AC

37
Q

Quel laser utilise-t-on pour une lyse des sutures de nylon?

A

Argon : lysis of nylon sutures in trabeculectomy to titrate filtration

38
Q

Complications de la lyse de sutures au laser dans un contexte de trabeculectomy?

A

Over-filtration with flat AC
Conjunctival perforation

39
Q

Indication de l’anterior hyaloid disruption?

A

Treatment of malignant glaucoma
Phakic eyes : Argon
Pseudophakic/Aphakic : YAG

40
Q

Indication et fonctionnement du Laser Goniopuncture

A

Adjunctive procedure for non-filtering glaucoma surgery : deep sclerectomy, viscocanalostomy, canaloplasty

Creates holes in the trabeculo-desmet window to allow for greater IOP lowering

Achieve 20% IOP reduction and stable for a least 2 year in about 50% of cases

41
Q

Complications du Laser Goniopuncture

A

Complications (low) :
Hyphema
Iritis
Peripheral synechiae
Iris incarceration
Hypotony
Late bleb leak

42
Q

Objectif du Laser Assisted Deep Sclerectomy

A

Aim to simplify the manual deep sclerectomy procedure

Technique :
Manual creation of superficial flap
Repeated laser applications to cause progressive ablation of the thin layers of deep scleral tissue until aqueous percolation is achieved

43
Q

Autres types d’utilisation de laser

A

Pupilloplasty
Photomydriasis
Sphincterotomy
Goniophotocoagulation
Cyclodialysis cleft
Epithelial down growth
Shrinkage of conjunctival blebs

TORIC (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions