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Ocular Disease > Refractive surgery - Dr. Sharma > Flashcards

Refractive surgery - Dr. Sharma Flashcards

1
Q

What are the types of refractive surgeries?

A

Incisional, Thermal procedures, Excimer laser refractive surgery, INTACTS (Intracorneal) and Intraocular Surgery

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2
Q

During Incisional surgeries, which cuts would flatten the corneal more?

A

Larger incisions, central incision, deeper cuts and shorter tunnel cuts

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3
Q

What are the types of incisional refractive surgeries?

A 
Radial keratotomy (RK)
Astigmatic Keratotomy (AK)
Relaxing Incisions: Limbal (LRI) or Peripheral (PRI)
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4
Q

Radial Keratotomy was only used for _____ and _____ correction.

A

myopia, astigmatism

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5
Q

Where do the inrastromal corneal ring implant in the cornea?

A

deep stroma

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6
Q

How thick does the corneal has to be inorder to do intrastromal corneal ring implant?

A

450microns thick

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7
Q

INTACS Intrastromal corneal ring segment is to correct ______ and treat _______.

A

myopia. keratoconus

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8
Q

Laser Thermal Kertoplasty is used to treat _______, causes shrinkage ______ collagen.

A

hyperopia, stromal

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9
Q

In Conductive Keratoplasty, _____ waves heat/shrink collagen.

A

radio

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10
Q

What kind of gas laser is use in the excimer laser?

A

Argon-fluoride gas laser

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11
Q

Excimer laser is to correct _______ and _______.

A

refractive errors, higher order aberrations

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12
Q

Phtorefractive Kertectomy is mechanically removed ________ by using excimer laser photoablates ______ and ________.

A

corneal epithelium, bowman’s, anterior stroma

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13
Q

_________ may reduce risk haze development.

A

Mitomycin-C

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14
Q

What is used to loosen epithelium in Laser Subepithelial Keratectomy (LASEK)?

A

Alcohol

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15
Q

T/F LASEK is more discomfort than PRK.

A

False, less discomfort

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16
Q

LASIK uses a mechanical ______ or ______.

A

microkeratome (blade). Femtosecond laser/ INTRALASE (no blade)

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17
Q

Wavefront LASIK can take away ____ order aberration.

A

high

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18
Q

Larger diameter Flap and more ablation will cause ____ tissue loss per diopter and _____ glare.

A

more, less

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19
Q

Thicker corneas, Keloid formers and higher corrections > -6D is an indication for which refractive surgery?

A

LASIK

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20
Q

In LASIK complication, microK flap causes ____ microns, Femto lap _____ microns and Excimer _______ microns/diopter of corneal ectasia (fluids build up in corneal stroma).

A

160, 90-110, 14

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21
Q

What are some flap complications from LASIK surgery?

A

Button hole flap, epithelial ingrowth, striae, torn flap, “free” flap, lost flap, aborted flap, dry eye and diffuse lamellar keratitis (DLK).

22
Q

The indication for having phakic intraocular lens is ____D hyperopia, ____D myopia and ____D astigmatism?

A

20, 20, 7.5

23
Q

Is having a thin corneal or thick cornea an indication for phakic intraocular lens?

A

thin

24
Q

T/F Phakic intraocular lenses is irreversible.

A

False. reversible

25
Q

What are some general risks for phakic intraocular lenses?

A
  1. Endopthalmitis
  2. Risidual refractive error
  3. Glare
26
Q

What is the name for the anterior chamber lens?

A

Verisyse

27
Q

What is the name for the posterior chamber lens?

A

Visian

28
Q

What is the minimum depth the anterior chamber needs to be inorder to do the Verisyse (anterior chamber lens)?

A

3.2mm

29
Q

Anterior chamber lens can cause ___________ and posterior chamber lens can cause ___________.

a. cataract
b. glaucoma

A

glaucoma, cataract

30
Q

What are some refractive surgery pre-op evaluations you have to do?

A
  1. Medical history
  2. Ocular history
  3. Contact lens history
  4. Refractive data (with and without cycloplegic), EOM, Pupil size, Keratometry and Pachymetry, Keratoconus Topographic Index (take avg diopter power of rings 2,3 and 4 from placido’s disc. more than or equals to 47.20D suggestive keratoconus) and I-S value
31
Q

What is the Pentacam measure?

A
  1. Topography front/rear cornea limbus to limbus
  2. Pachymetry from limbus to limbus
  3. Anterior chamber angle volume and depth
  4. Densitometry crystalline lens
32
Q

What kind of image is the Pentacam?

A

Scheimpflug images

33
Q

What are some risk factors for dry eye?

A

Gender (female more than male), Age (>50), Race (Asian), Rx ( > -6, any +), Medicine, Cigarette smoking.

34
Q

______ is the most common side-effect of LASER procedure.

A

dry eye

35
Q

Before the LASIK surgery, what should you check on the patient’s eye?

A

make sure there’s no corneal staining, TBUT greater than 10secs, Stable refraction, stable aberrometry and no symptoms

36
Q

What are the kind of dry eye evaluations you can perform on your patients before LASIK?

A
  1. Schirmer Test
  2. Phenol Red Test
  3. Tear Osmolarity
  4. Evaluation Tear Meniscus
37
Q

What dyes can you use to check the corneal integraties before LASIK?

A
  1. Fluorescein staining to check corneal integrity for any ruptured epithelial surface. check TBUT as well.
  2. Lisamine Green stain devitalized cells. highlights dryness of bulbar conjunctiva
  3. Rose Bengal/Lisamine Green stain damaged cells and assess conjunctival surface disease
38
Q

What are some risk factors of ectasia in LASIK surgery?

A
  1. abnormal topography
  2. residual stromal bed thickness
  3. Age
  4. Preoperative corneal thickness
  5. Refractive error
39
Q

What does a bowtie topography tells us about the patient’s cornea?

A

keratoconus

40
Q

What are some contraindications for LASIK?

A
  1. Under 18
  2. Pregnant or nursing
  3. Dx. w/collagen vascular disease, autoimmune or immunodeficiency disease
  4. Taking Accutane and/or Amiodarone
  5. Keratoconus
41
Q

Why is taking Accutane contraindicate for LASIK?

A

it causes dry eye. it’s also an side effect of LASIK surgery

42
Q

Why is take Amiodarone contraindicate for LASIK?

A

Amiodarone has many ocular side effects, which includes photosenisitivity, corneal microdeposits, hazy vision, glare and colored haloes around lights.

43
Q

What diseases affect wound healing after LASIK?

A

Diabetes, Connective tissue and/or atopic disease, Immunocompromised status, history of herpes simplex/zoster, keratitis sicca and glaucoma

44
Q

Why is glaucoma contraindication with LASIK?

A

LASIK thins the cornea and thin cornea can cause glaucoma.

45
Q

What are the pre-op medications/treatments for LASIK?

A

Omega 3, Doxycycline (antibiotics), Restasis, artificial tear lubrication, Lid massage and punctal occlusion

46
Q

In what findings during day one after LASIK your patient has to go back to the center?

A
  1. dislodged flap
  2. flap striae
  3. infection
47
Q

Regression toward the pre-LASIK refractive state in ________ and _______ corrections and is correlated with _______.

A

higher myopic, hyperopic, dry eye

48
Q

What are some indications for post LASIK ectasia.

A
  1. delayed acquired astigmatism
  2. loss of BCVA
  3. Elevation Topography
  4. Aberrometry - elevated vertical coma
49
Q

What is the treatment for ectasia after LASIK?

A
  1. glasses
  2. contact lenses (soft toric, RGP, Hybrid)
    Others:
  3. Intra-corneal Ring Segment (INTACT)
  4. collagen Cross-linking
  5. Keratoplasty
50
Q

T/F Microkeratome(blade lasik) losses more corneal sensation than PRK (mechanically scrape off cornea).

A

True

51
Q

Patients with contrast sensitivity of 12 cycles/degree return to pre-surgical levels in _______.

A

3 months

52
Q

Patients with contrast sensitivity of 18 cycles/degree return to pre-surgical levels in _______.

A

1 month

Ocular Disease (12 decks)

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