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Shared Care and Ocular Therapeutics > Refractive Procedures > Flashcards

Refractive Procedures Flashcards

1
Q

What is Laser Vision Correction?

A
  • Reshaping the cornea via removal of corneal tissue to eliminate the need for spectacles or CLs
  • Is for ametropia
  • LASIK and LASEK are most commonly performed
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2
Q

LASIK Features

A
  • Quicker recovery
  • Particularly myopes will achieve 6/6 next day
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3
Q

LASEK Features

A
  • More uncomfortable for at least 3 days after
  • Performed if patient is unsuitable for LASIK
  • Will have bandage lens that needs removed 4 days after
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4
Q

What is Phakic Intraocular Lens?

A
  • Alternative when LVC is ruled out e.g. in high ametropia
  • Clear implantable lens placed around the iris without removal of natural lens
  • Is for Ametropia
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5
Q

What is Refractive Lens Exchange?

A
  • Removal of natural lens for an implant
  • Is for ametropia and presbyopia
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6
Q

Advice to Patient Following a Procedure

A
  1. Rest for 24 hours
  2. Do not rub eyes
  3. Wear eye mask during sleep for 1 week
  4. Dont drive until instructed by optometrist
  5. Do not wear makeup for 1 week
  6. Avoid getting soap/shampoo in eyes
  7. Do not intensely exercise for 1 week, swim for 2 weeks or play sports for 4 weeks
  8. Take painkillers if necessary
  9. Clean hands before handling eyedrops
  10. Contact out of hours if any issues
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7
Q

Side Effects Which Follow Surgery

A
  • Raised IOP
  • Dry eye
  • Diffuse lamellar keratitis
  • Glare and halos
  • Posterior subcapsular opacification
  • Macrostriae
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8
Q

Flap Complications

A
  • Diffuse lamellar keratitis
  • Striae
  • Dislodge flap
  • Epithelial ingrowth
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9
Q

LASEK Complications

A
  • Slow epithelial healing
  • Corneal oedema
  • Corneal haze
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10
Q

General Complications

A
  • Sterile infiltrates
  • Infectious keratitis
  • Ectasia
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11
Q

What is Diffuse Lamellar Keratitis

A
  • Inflammatory response
  • 24 to 48 hours after surgery
  • Is graded 1-4, grades 3 and 4 need surgeon’s attention
  • Symptoms include discomfort, lacrimation, photophobia or can be asymptomatic
  • Signs are white granular opacification that is confined to flat, no AC reaction and no epithelial defect
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12
Q

What are Striae and how are they managed?

A
  • Wrinkles in cornea
  • Occur 1 to 8 days after surgery
  • Reduces vision
  • Small striae are of small significance, larger striae are significant
  • Monitor, but if visually significant then surgeon will preform flap wash
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13
Q

Dislodged Flap

A
  • Disruption of flap
  • Can be due to non-compliance
  • Surgeon will need to replace flap and re-smooth it
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14
Q

Epithelial Ingrowth

A
  • Visible nest of cells on flap margin
  • Often asymptomatic but if progressive then will induce cyl
  • Management is to monitor, or routine/emnergency referral depending upon progression/demarcation
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15
Q

Slow Epithelial Healing

A
  • Slow healing in epithelium only in treatment area
  • Appears as a epithelial defect similar to an abrasion
  • Symptoms include discomfort, lacrimation, puffy lid and vision can be affected
  • Management is to inform surgeon, fit bandage CL, oftaquix qds with review in 48 hrs
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16
Q

Corneal Oedema

A
  • Usually occurs within first week
  • Located in central posterior corneal layers
  • Can present with descemets folds and criss-cross tracks
  • Vision can be affected
  • Inform surgeon and monitor as often resolves
17
Q

Corneal Haze

A
  • Onset 1-3 months after surgery
  • Associated with high myopia
  • Sub-epithelial plaque which may or may not affect vision, along with steepinging of K’s and shift to myopia
  • Inform surgeon, most resolve with time, but some require surgical intervention
18
Q

Sterile Infiltrates

A
  • Can occur at any time post surgery
  • Appears as multiple hazy patches in the periphery
  • There is no AC reaction, no discharge, no pain but can be photophobic
  • Requires urgent surgeon attention, treated with pred-forte or dexamethosone hourly if inflammatory
19
Q

Infectious Keratitis

A
  • Occurs within a week (in LASEK)
  • Affects cornea as an epithelial defect with AC reaction (hypopyon)
  • Symptoms are pain, redness, discharge, reduced vision
  • Remove bandage CL and emergency referral
20
Q

Ectasia

A
  • Can appear months or even years after surgery
  • Can cause reduced vision via induced cyl
  • Cornea often appears normal but could see cone shape in advanced cases
  • Urgent referral to surgeon for cross-linking
21
Q
A

Shared Care and Ocular Therapeutics (10 decks)

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