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Retina and Vitreous > Lasers, Vitreoretinal Surgery, and Injections > Flashcards

Lasers, Vitreoretinal Surgery, and Injections Flashcards

1
Q

effect of photocoagulation on tissues

A

thermal damage via protein denaturation and coagulative necrosis

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2
Q

color wavelength of choice for retinal vascular lesions and CNV

A

green (514 nm)

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3
Q

color wavelength best for penetrating vitreous heme? for nuclear sclerotic cataracts?

A

both red (647 nm)

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4
Q

which color laser causes deeper burns and more discomfort

A

red (647 nm)

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5
Q

absorption curve of hemoglobin?

A

two peak: blue, and then green-yellow. minimal absorption of red

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6
Q

absorption curve of xanthophyl?

A

one peak at blue. minimal absorption of other wavelengths

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7
Q

which laser color has minimal scatter through NSC, low xanthophyl absorption, and little potential for photochemical damaged

A

yellow (570)

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8
Q

contrast negative-power planoconcave v high plus-power lenses for laser photocoagulation

A
  • negative-power planoconcave: upright image, good resolution, narrow view. favored for macular treatments
  • high plus-power lenses : inverted image, worse resolution, wider view. favored for PRP
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9
Q

guidelines for macular laser treatment

A

not within 500 um of fovea center. small spot size, (100-200 um) short duration (

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10
Q

PRP laser spot size and duration

A

200-500 um, 0.05 - 0.2 s

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11
Q

three laser parameters that increase risk of Bruch’s membrane rupture

A

small spot size, high power, short duration

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12
Q

next step when subretinal heme develops during laser photocoagulation of CNV?

A

increase digital pressure on contact lens and continue lasering

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13
Q

what type of photic damage is produced by PDT?

A

photochemical

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14
Q

how long to stay out of sun after verteporfin?

A

2-5 days

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15
Q

advantages of indirect and of direct visualization systems for vitrectomy?

A

indirect: wider view, better view through media opacities, gas tamponades, and miotic pupils
direct: better mag, better stereopsis

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16
Q

ICG is used in vitreoretinal surgery to stain which structure?

A

ILM

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17
Q

lifespan of SF6 and C3F8 inside the eye at nonexpansile concentrations?

A

2 and 8 weeks, respectively

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18
Q

main advantage of small gauge vitrectomy

A

no need to suture wounds

19
Q

indications and outcomes of PPV w/ membrane peel for ERM

A

indicated for reduced vision or visual distortion interfering with binocularity, generally 20/40-20/60 or worse. 2/3 of patients will have 2-line improvement but may take 6-12 months to fully improve

20
Q

indications for surgery for macular hole? steps to surgery? dyes and stains used?

A

stage 2 or greater (50% stage 1 spontaneously resolve). PPV + membrane peel + air or gas tamponade and face-down positioning. ICG, brilliant blue G, tryptan blue and, triamcinolone are used to identify ILM and vitreous

21
Q

use of vitrectomy for submacular hemorrhage?

A

early studies showed no benefit. newer techniques may improve outcomes but are still controversial

22
Q

when should pre-op anti-VEGF be given prior to PPV for vit heme?

A

10 days pre-op

23
Q

indications for vitrectomy in tractional RDs?

A

involving or threatening the macula, or if combined RRD/tractional RD

24
Q

types of and most common causes of post-op endophthalmitis

A
  • acute-onset ( 6 weeks): P. acnes, coag-neg staph, fungi

- bleb-related (often months to years post-op) - Strep spp. and Haemophilus

25
Q

conclusion from endophthalmitis vitrectomy study

A

LP: vitrectomy

HM or better: tap and inject

26
Q

presentation and management of P. acnes endophthalmitis

A
  • chronic post-op endophthalmitis (however not always after 6 weeks) with peripheral white plaque in capsular bag
  • PPV w/ injection of vanc next to or in capsular bag. if recurs, should consider subtotal or total capsulectomy with IOL exchange
27
Q

management of blebitis and blebitis with endophthalmitis

A

w/o endophth: topical or subconj abx

w/ endophth: intravitreal abx +/- PPV

28
Q

nuclear v cortical retained lens material

A

cortical often absorbed w/o inflammation. nuclear remnants usually cause chronic inflammation

29
Q

risk factors for suprachoroidal hemorrhage

A 
"Too Much Alcohol Gives A Heart Attack"
Tachycardia
Myopia
Advanced age
Glaucoma
Aphakia
Hypertension
Atherosclerotic disease
30
Q

management of intraoperative suprachoroidal hemorrhage

A

immediate closure of all wounds with removal of any incarcerated vitreous. then observe for 7-14 days

31
Q

risk factors for needle penetration of globe

A

high axial myopia, posterior staphyloma, previous scleral buckle, poor patient cooperation, inexperience of surgeon

32
Q

risk factors for post-phaco RRD

A

younger age, male sex, longer axial length

33
Q

name the classic indications for pneumatic retinopexy

A
  1. confidence that all breaks have been found
  2. clear media
  3. all breaks in superior 8 clock hours
  4. no grade C or D PVR
  5. single break or multiple breaks w/in 1.5 clock hors
  6. cooperative patient
34
Q

findings of Silicone Study

A

tamponade with SF6 inferior to silicone or C3F8. silicone with lower rates of hypotony than C3F8

35
Q

percent of reattachment of RD:

  1. at initial surgery
  2. at second surgery
  3. final outcome after any number of surgeries
A
  1. 80-90%
  2. 70%
  3. 90-100%
36
Q

protective factors and risk factors for success or RD repair

A

protective: demarcation lines, RDs caused by dialysis or small holes

RF: aphakia, pseudophakia, giant retinal tear, PVR, uveitis, choroidal detachment, posterior breaks 2/2 trauma

37
Q

visual acuity outcomes for RD

A

mac-on: 85-90% regain pre-RD acuity
mac-off: 1/3-1/2 regain 20/50 or better
–mac off 1 week: 50% 20/70 or better

38
Q

most common complication of vitrectomy? prevalence? other relatively common important complication?

A
  • nuclear sclerotic cataract
  • 90% older than 50 will get visually sign NSC by 3-6 months
  • open angle glaucoma
39
Q

type of cataract that silicone oil leads to

A

PSC

40
Q

rate of endophthalmitis from intravitreal injection

A

0.02 - 0.2%

41
Q

presumed source site of endophthalmitis from intravitreal injection

A

patient’s conjunctiva

42
Q

organism with proportionally higher frequency in endophthalmitis from intravitreal injection compared to intraocular surgery

A

Strep viridans (oral flora)

43
Q

proven measures to decrease risk of endophthalmitis from intravitreal injection?

A

none are proven, however consensus is to use povidone-iodine 5% to ocular surface for 60-90s prior to injection

Retina and Vitreous (6 decks)

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