Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Summer Final: Glaucoma > Laser Surgery And Glaucoma > Flashcards

Laser Surgery And Glaucoma Flashcards

1
Q

Historically, how are lasers viewed for glaucoma

A

Drops until failure, then laser, then invasive surgery

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

Advantages of glaucoma drops

A
  • choices
  • effective
  • familiar to patients and well received
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Disadvantage of glaucoma drops

A
  • compliance
  • cost
  • side effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Glaucoma laser trial (GLT)

A

Timolol-ALT for newly diagnosed POAG

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

SLT/Med study

A

SLT is a variable first line treatment for POAG

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

UpToDate

A

We recommend pharmocologic laser therapy as first line treatment

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

Academy of ophthalmology and laser for glaucoma

A

Lasers can be considered as initial therapy in selected patients

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

OD role in laser surgery for glaucoma

A
  • initial diagnosis
  • intimate drops
  • perform laser
  • decision to refer for surgery (educate patient on expectations, outcomes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Information for the referral for surgery

A
  • max IOP
  • IOP on current treatment
  • current meds and any that were previously ineffective or not tolerated
  • baseline and current VF
  • baseline and correct OCT
  • gonio findings
  • eye surgery/injury history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Laser variables that’s influence interaction

A
  • wavelength
  • spot size
  • pulse duration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tissue variables that’s influence interaction

A

Transparency

Pigment

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

Laser variables

A

Wavelength

  • varies by laser (YAG vs ARGON)
  • determines which tissue is impacted

Spot size
-smaller=higher density

Pulse duration
-sometimes variable (argon); sometimes fixed (YAG)

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

Tissue variables

A

Transparency
-depends on wavelength

Pigment

  • argon: pigment absorbed laser light and converted energy to heat
  • more pigment=better absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Selective laser trabeculoplasty (SLT)

A
  • wavelength output is 532nm green

- burn time is 3ns

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

Thermal relaxation time of SLT

A

Amount of time it takes melanin to convert light energy to heat

1micro second

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

SLT pulse duration is

A

3 nanoseconds

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

Thermal damage of SLT

A

No thermal damage, “cold laser”

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

What does SLT target

A

Intracellualr melanin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Effect on adjacent non melanin containg cells in SLT

A

No effect. “Selective”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Proposed mechanism of SLT

A
  • targetcels activate cytokines, which activate macrophages
  • macrophages clean area, decreasing outflow resistance
  • no mechanical damage/scars (unlike ALT). Potentially repeatable
21
Q

Trabeculoplasty recommendations

A
  • POAG
  • OHTN
  • NTG
  • pigment dispersion glaucoma
  • PXG
22
Q

Predicting SLT success

A

Looked at

-pre treatment IOP, current meds, phakic status, level of pigmentation, steroid use, age, gender

23
Q

MIGS

A

Minimally invasive glaucoma surgery

-mild-mod glaucoma

24
Q

Conventional surgery

A

More invasive

Moderate-sever glaucoma

25
What is MIGS
- minimal truama/disruption to normal anatomy - Ab interno, micro incisional approach - modest IOP reduction - safe - often combined with cataract surgery (and sometimes multiple MIGS prcoredures) - rapid post op recovery - first FDA approval in 2012 - now 15 different techniques
26
iStent
MIGS - inserted from AC into schlemms canal. Creates channel from AC to schlemms - increases aqueous outflow by bypassing the TM
27
Trabectome
- MIGS - electrocautery device used to perform partial trabeculotomy - TM and interior wall of schlemms canal are cauterized and eliminated
28
Endocyclophotocoagulation (ECP)
- MIGS | - a laser probe is used to destroy the anterior ciliary processes
29
Transscleral cyclophotocoagulation (CPC)
- MIGS | - laser energy is delivered at he limbus through the sclera and to the ciliary process
30
ECP and CPC both do what
Decrease aqueous production
31
Xen gel stent
- 6mm tube - inserted from AC, through schlemms canal, into subconjunctival space - creates a bleb
32
Difference between ALT and SLT
ALT has a longer burn time and causes burn damage to the TM. Not repeatable SLT actually causes macrophages to come in and act like drane-o without burn damage. Repeatable
33
Incisional surgery
- more invasive than MIGS - historically, the only surgical options - tubes (aqueous tube shunt) and trabs (trabeculectomy)
34
Tube shunts
- divert aqueous humor to an external reservoir - baerveldt vs Ahmed - external incision through conjunctiva and tenons capsule - implant is placed subconjunctivally with the tube entering the anteiror chamber
35
-otomy
Cutting into, putting a hole in
36
Ectomy
Removing tissue
37
Endo
Camera used for surgeon to see tissue
38
Cyclo
CB
39
Photo
Laser or light energy
40
Bleb
Between sclera and conjunctiva for aqueous to collect
41
Filtering blebs
Xen gel stent
42
Trabeculectomy
- the most establishes (oldest) of these procedures - surgeon creates an opening into the AC from underneath a scleral flap - aq flows into the subconjunctival space and creates a filtering bleb - no tube is placed. Mitomycin C (MMC): antimetabolite; prevents fibrosis and grab failure
43
Tubes vs trabs
TVT study; similar IOP reduction -trabs have higher failure rate (complications, need for more surgery, NLP vision) Increasing usage of tubes over past 20 years
44
Post op care of MIGS
- similar to cataract surgery - 1 day, 1 week, 1 month - check for inflammation and infection - judge IOP repsosne at 1 month. Consider reducing meds
45
Post op care of icisional surgery
The ideal bleb - low lying - minimal vascualrity - IOP in teens - well formed AC - negative Seidel sign
46
Bleb complications
Hypotony - IOP less than 5mmHg - no visible bleb Bleb leak -positive Seidel test Blebitis - milky white bleb - pain, blurry vision - if AC and or vitreous involved-endopthalmitis
47
Tube complications
Same a bleb complications Also diplopia -tube plate is placed near EOMs
48
Micropulse diode laser trabeculoplasty(mDLT)
- delivers small, repetitive micropiulses rather than one continuous pulse - cooling periods between micropulses reduces tissue damage
49
Annual low-power SLT for OHTN
- repeatedly yearly, regardless of IOP level - followed 3-10 years - mean treated IOP similar to transitional SLT - fewer patients needed medications to control IOP vs traditional SLT

Summer Final: Glaucoma (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions