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Advanced Clinical Topics > MT1 > Flashcards

MT1 Flashcards

1
Q

where are most retinal holes? what type are they most commonly?

A
  • atrophic

- in the periphery

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2
Q

where are flap tears

A

at the equator

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3
Q

what type of holes have a less chance to cause an RD

A

free operculated holes

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4
Q

most breaks are in what quadrant of the retina

A

superior temporal

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5
Q

prevalence of RDs over lifetime

A

0.7%

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6
Q

incidence of retinal breaks in the population

A

5-7%

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7
Q

what % of holes are associated w/lattice?

A

80%

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8
Q

what are 3 goals of RD surgery

A
  • put retina break back in apposition to the RPE/choroid in region of the breaks
  • create chorioretinal adhesion around the breaks
  • offset all vitreoretinal traction
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9
Q

in uncomplicated RD in the presence of a flap tear, what procedure had the lowest failure rate?

A

scleral buckle

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10
Q

what is the failure of vitrectomy vs. victrectomy +buckle in complicated RD

A

vitrectomy had lower failure than vit+buckle

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11
Q

definition of cryotherapy in RD

A

transconjunctival application of a freezing probe to form a chorioretinal adhesion

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12
Q

how does cyrotherapy work (molecular level)

A

expansion of high pressure nitrous oxide into end of a probe which generates temperatures of -89 degrees Celcius

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13
Q

when do you use cyrotherapy?

A
  • retinal breaks

- can be used in conjunction with scleral buckling and pneumatic retinoplexy

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14
Q

advantages of cyrotherapy over laser photocoagulation

A
  • treatment of anterior lesions
  • treatment through media opacities, vitreous heme
  • delivered upon lesions requiring scleral depression
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15
Q

post-procedure on cyrotherapy includes:

A
  • patch eye for 4 hours
  • chemosis is common
  • refrain from strenuous physical activity for 1 week
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16
Q

complications of cyrotherapy

A
  • inadvertent tissue freezing (ex: muscles causing transient diplopia, and adjacent tissue)
  • dispersion of RPE cells
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17
Q

goals of scleral buckling therapy

A
  • close retinal breaks by placing the sensory retina next to the RPE
  • reduce the dynamic vitreo-retinal traction at sites of adhesion
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18
Q

indication for scleral buckling surgery

A

-routine rhegmatogenous retinal detachments

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19
Q

what are contraindications for scleral buckling surgery

A
  • posterior retinal breaks

- proliferative vitreoretinopathy

20
Q

what are the 3 types of explants for scleral buckling

A
  • radial
  • segmental circumferential
  • encircling
21
Q

radial explants for scleral buckling are for:

A
  • breaks that extend more posterior

- large U-shaped tears

22
Q

segmental circumferential explants for buckling are for:

A
  • multiple breaks in more than one or two quadrants

- anterior breaks or wide breaks (dialysis)

23
Q

encircling explants for buckling are for:

A
  • breaks involving 3 or more quadrants
  • extensive RD without detectable breaks
  • moderate proliferative vitreoretinopathy
  • lattice degeneration involving 3 or more quadrants
24
Q

4 factors that affect buckle height

A
  • diameter of explant
  • separation of sutures
  • tautness of sutures
  • intraocular pressure
25
Q

what causes increase buckle height?

A
  • greater the explant diameter
  • greater the separation of sutures
  • tighter the sutures
  • lower the IOP
26
Q

steps of scleral buckling

A
  1. prep (dilation, sterilization, anesthesia)
  2. peritomy: resection of conjunctiva and Tenon’s capsule
  3. bridle sutures around EOMs
  4. localization of breaks
  5. cyrotherapy around retinal break
  6. application of scleral explant
  7. suture conjunctiva and Tenon’s
27
Q

post-op management medications for scleral buckling

A

cycloplegic, antibiotic-steroid drops, pain meds

28
Q

what are some surgical complications from scleral buckling

A
  • buckle may be inadequate size, position, and indentation
  • missed breaks
  • fishmouthing
29
Q

what will happen if buckle is too tight?

A
  • radial retinal folds

- anterior segment ischemia

30
Q

what are some causes of late failure of buckling

A
  • proliferative vitreoretinopathy
  • migration or extrusion of explant
  • extraocular muscle imbalance
31
Q

describe pneumatic retinopexy

A

-flotation force and surface tension of an intraocular gas bubble utilized in reattachment and closure of retinal breaks against the eye wall

32
Q

indications for pneumatic retinopexy

A
  • RD with posterior breaks
  • RD w/ 1 or more breaks no larger than 1 clock hour
  • breaks in superior retina (upper 8 clock hours)
33
Q

contraindications of pneumatic retinpexy

A
  • breaks larger than 1 clock hr or multiple breaks extending over 1 clock hour
  • breaks in the inferior retina
  • presence of proliferative vitreoretinopathy
  • cloudy media which disallows full assessment of the retina
  • severe or uncontrolled glaucoma
  • physical limitations which limit ability to maintain post-op positioning
34
Q

advantages of pneumatic retinopexy over scleral buckling

A
  • outpatient setting
  • no incisions required
  • visual results are better
  • lower incidence of cataracts (1/4th)
  • morbidity of the eye is lower (pain, diplopia, nausea, psuedoptosis)
35
Q

types of gas in pneumatic retinopexy

A
  • air
  • sulfur hexafluroride (SF6)
  • perfluoroethane (C2F6)
  • perfluoropropane (C3F8)
36
Q

you want an intraocular bubble the size of ____ for pneumatic retinopexy

A

-1-1.5

37
Q

laser photocoagulation or cyrotherapy?

-performed prior to gas injection

A

cyrotherapy

38
Q

laser photocoagulation or cyrotherapy?

-better for posterior breaks and vitreous traction

A

-laser photocoagulation

39
Q

laser photocoagulation or cyrotherapy?

-adhesion is much quizker and more form

A

laser photocoag.

40
Q

how long does resorption of subretinal fluid take with the bubble in place against the break

A

24-48 hours

41
Q

complications of pneumatic retinopexy

A
  • fluid is not reabsorbing
  • fish eggs
  • trapped bubble
  • subretinal gas
  • increased IOP
  • cataract formation
  • new retinal breaks (7-23%)
42
Q

treatment success w/initial pneumatic retinopexy treatment

A

63-84% success

43
Q

advantages of vitrectomy

A
  • direct relief of vitreous traction
  • proliferative ret. can be removed w/membrane peeling
  • combine w/scleral buckling
  • complete reattachment at the time of surgery
  • success rate 85-90%
44
Q

contraindications for vitrectomy

A

-active neo of the iris (prognosis for the eye is poor)

45
Q

vitrectomy studies in type I diabetics showed

A

non-clearing vit. heme should be operated on within 6 months

46
Q

vitrectomy studies in type II diabetics showed

A

no difference in surgeries performed at 6 months or 1 year

Advanced Clinical Topics (1 decks)

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