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Anterior Segment Disease > Refractive Surgery > Flashcards

Refractive Surgery Flashcards

1
Q

Radial Keratotomy

RK

A

uses diamond blade to make radial cuts deep into cornea to flatten it

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2
Q

RK was used to treat….

A

myopia

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3
Q

Problems with RK

A 
permanently weakened cornea
unpredictable results
vision fluctuation
starbursts
not used
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4
Q

Astigmatic Keratotomy

AK

A

arcing parallel cuts in periphery- steepen flatter and flatten steeper
often done during cataract surgery

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5
Q

AK is used to treat….

A

high post-keratoplasty astigmatism

small degrees of pre-existing astigmatism

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6
Q

Non- Contact Holmium uses…..

A

YAG laser

induces heat

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7
Q

Non- Contact Holmium

A

places shrinkage spots outside visual axis to steepen cornea

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8
Q

Non- Contact Holmium was used to treat….

A

hyperopia

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9
Q

Problems with Non- Contact Holmium

A

induces astigmatism
high regression rate
not used anymore

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10
Q

Conductive Keratoplasty

CK

A

radio frequency delivered to stroma by probe

predictable, safe, cheap

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11
Q

Conductive Keratoplasty Use

A

low levels of hyperopia and presbyopia

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12
Q

Contraindications for CK

A

pacemakers

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13
Q

CK and Monovision

A

used on one eye so one for distance and one for near

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14
Q

Laser Photoablation uses….

A

argon- fluoride gas

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15
Q

Photorefractive Keratectomy

PRK

A

corneal epithelium removed

excimer laser photoablates anterior stroma to flatten or steepen cornea

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16
Q

Indications of PRK

A

+3 to -6; -8 w/ mitomycin C
cornea too thin for LASIK
residual refractive error after cataract or refractive surgery
epithelial irregularities, EBMD, K scars

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17
Q

Problems with PRK

A

significant postop discomfort- 2-3 days
slow vision recovery
subepithelial haze-more permanent with higher powers

18
Q

Mitomycin C

A

helps decrease haze in PRK

can cause corneal toxicity

19
Q

Laser in situ Keratomileusis

LASIK

A

flap created with microkeratome blade or femtosecond laser
photoablation in deep stroma
flap repositioned over ablated area

20
Q

Benefits of LASIK

A 
deep stromal ablation results in less haze
no pain (epithelium intact) and almost instant vision
21
Q

Indications for LASIK

A

those prone to haze- -6D or more; significant astig
wanting immediate visual recovery
cant handle pain

22
Q

Problems with LASIK

A

loud clicking and burning smell from gas (not burning)
flap complications
epithelial growth under flap
corneal ectasia if cut too thin

23
Q

Contraindications of LASIK

A

epithelial irregularities- EBMD and scars

24
Q

Thickness required for LASIK

A

250 micrometers remaining of stroma
100 for flap
12 x each D
added cannot be greater than central corneal thickness

25
Q

Laser Subepithelial Keratectomy

LASEK

A

alcohol loosens epithelium, which is folded back for photoablation and rolled back after
like PRK but faster recovery and less discomfort

26
Q

Epithelium in LASEK

A

most dies as a result of alcohol

27
Q

Epithelial Laser in situ Keratomileusis

epi-LASIK

A

like LASEK but flap made with microeratome- less epithelial toxicity and more viable

28
Q

Best refractive surgery for <6D of myopia

29
Q

Best refractive surgery for 6 - 10D of myopia

A

LASIK

less risk of haze

30
Q

Phakic Intraocular Lenses

A

artifcial lenses inserted into eye to correct higher refractive error
placed in anterior or posterior chamber

31
Q

Artisan Lenses

A

pIOL clipped on to front of iris

32
Q

Advantages of pIOL

A

> 20D of hyperopia or myopia
7.5D of astigmatism
reversible
maintains accommodation

33
Q

Disadvantages of pIOL

A

min AC depth of 3.2mm- rules out most hyperopes
endothelial cell loss or cataract formation from rubbing
potential for glaucoma

34
Q

Refractive Lens Exchange

A

replaces actual lens with fake one to correct refractive error

35
Q

Advantages of RLE

A

spherical corrections +20 to -30D
available in toric, multifocal, accommodating
no need for later cataract surgery

36
Q

Disadvantages of RLE

A

loss of accommodation

high myopes at risk of RD

37
Q

pIOL vs RLE

A

pIOL safer and better for non-presbyopes

RLE better for high hyperopes w/ shallow AC and those needing cataract surgery soon

38
Q

CK Post-Op Presentation

A

FB sensation and tearing
functional vision next day, can go back to work
astigmatism worse in 1st month
effects regress 1D every 2-3 yrs

39
Q

Mx PRK

A

repithelialization takes ~3 days- discomfort and lack of functional vision, wear BCL
vision fluctuates until about 6 months

40
Q

LASIK Post-Op Presentation

A

no discomfort, good vision in 24 hours
vision stabilizes after 3 months
watch for flap complications

Anterior Segment Disease (19 decks)

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