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OPTM 737 > Test 1: Cataracts > Flashcards

Test 1: Cataracts Flashcards

1
Q

types of cataract surgery

A

couching
ICCE (intracapsular)
ECCE (extracapsular)

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2
Q

intraocular implants

A

iris fixated
anterior chamber
posterior chamber

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3
Q

iris fixated IOLs

A

can’t dilate
rare now
have to have iridectomy

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4
Q

suture techniques

A

interrupted sutures
continuous
no-stitich - clear corneal incision

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5
Q

incision techniques

A

limbal
scleral tunnel - 1-2 mm into sclera superiorly
self sealing
all done at a shallow tangential angle

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6
Q

anesthesia

A

general or local

local - retrobulbar & peribulbar

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7
Q

retrobulbar anesthesia

A

2% lidocaine short onset
0.75% marcaine long acting
epinephrine

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8
Q

general classification of cataract

A

first appear after ages 30-40 occurring in 90+% of people over age 70
generally progress at varying rates and result in decreased VA
typically classified as: location within the lens and stage of development

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9
Q

major types of cataracts include

A

nuclear
cortical
subcapsular

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10
Q

subdivisions of nuclear

A

early or advanced

brunescent, milky

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11
Q

subdivisions of cortical

A

early or incipient
immature or intumescent
mature
hypermature

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12
Q

subdivisions of sub capsular

A

early
moderate
advanced

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13
Q

nuclear cataract

A

normal lens nucleus hardens and pigments with age
known as nuclear sclerosis and only when advanced will it interfere with VA
color progresses from orange to dark brown
involves fetal nucleus which can appear darker than adult nucleus
can result in lenticular myopia or second sight
refraction become difficult in advanced stages
decreased VA from non-focused rays from above phenomenon
monocular diplopia may also be seen by patient with small nuclear change acting like prism

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14
Q

cortical cataract

A

most common opacity
early stage results in lens swelling and subsequent shallowing of anterior chamber
mature stage results from water and wast products exit the capsule

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15
Q

cortical cataract early stage reveals

A

water clefts - most common location is anterior cortex
lamellar separation - most common location is inferonasal anterior cortex
cuneiform opacity - most characteristic sign
clear vacuoles
senile punctate opacities - may be called snowflake cataract if in large numbers

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16
Q

further degeneration of cortical cataract can lead to

A

hyper mature cataract
shrunken, dry yellow lens
possible capsular folding
can appear as bag of milky fluid

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17
Q

morgagnian cataract

A

type of cortical cataract

brown nucleus which sinks to bottom of liquefied lens

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18
Q

christmas tree cataract

A

type of cortical cataract
formed by cholesterol crystals scattered throughout cortex
myotonic dystrophy

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19
Q

subcapsular cataract

A

chronic NSAIDs use
also known as cumuliform cataract because of its characteristic mature cup shape
typically occurs at earlier age than nuclear or cortical
posterior sub capsular much more common than anterior
consists of thin layer of granules beneath the capsule which may exhibit as small granular opacity
over time will enlarge to form round or irregular plaque
plaque consiste of vacuoles and crystals scattered between irregular granules
remainder of lens is clear outside of plaque
VA is affected greatly if develops in axial location, especially in glare situations

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20
Q

subcapsular cataract symptoms

A

excess glare while driving at night
trouble seeing in bright sunlight
reading difficulties with otherwise good reading lamp

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21
Q

promazine hydrochloride

A

med that can cause cataract

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22
Q

indications for surgery

A 
unhappy with VA (night glare)
phacoanaphylaxis 
phacomorphic glaucoma
phacolytic glaucoma 
dislocation of lens 
amblyopia in young patient 
to provide unobscured access for treatment of eye disease
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23
Q

indications for IOL implantation

A

IOL implantation is considered a routine procedure and si therefore performed in the majority of cases

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24
Q

contraindications for surgery

A 
visual reduction secondary to coexisting condition 
patient satisfied with current VA
poor systemic health 
patient doesn't desire surgery 
surgery won't improve visual function
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25
Q

complications of cataract surgery

A

post capsular opacification
CME
posterior capsular rupture
endophthalmitis

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26
Q

contraindications for IOL implantation

A

corneal endothelial disease
unilateral aphakia with spectacle correction
rubeosis irides and/or neovascular glaucoma
young patient

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27
Q

conditions which require additional evaluation before surgery

A 
monocular patients 
high myopia 
traumatic cataract
Fuch's dystrophy 
glaucoma 
history of lattice degeneration or retinal detachment 
chronic iritis/uveitis
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28
Q

eligibility for cataract surgery

A

snellen 20/40 or worse
reduction in VA of 2 lines under glare testing
2D of anise
have to have a functional complaint

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29
Q

pre-surgical care ocular evaluation

A 
keratometry 
potential acuity assessment 
BAT
contrast sensitivity 
endothelial cell cunt 
A scan 
B scan 
medications 
patient edu
30
Q

pre-surgical medical evaluation

A

detailed history - cardiovascular, respiratory, hepatic, neuro/musculoskeletal, renal/metabolic, social, misc.
physical assessment - cardiovascular, chest/lungs, abdomen, extremities, neurological, mental status

31
Q

pre-surgical lab testing

A

CBC with differential
ECG
urinalysis
electrolytes

32
Q

post surgical care examination procedures performed at each visit

A

case history including amount of discomfort and quality of vision
VA
keratometry
refraction
biomicroscope - cornea, AC reaction and depth, iris and pupil, intraocular lens, capsule
wound - no-stitch surgery, suture type and placement, integrity with Seidel test
tonometry
posterior pole evaluation, vitreous, ONH, macula, surrounding retina

33
Q

schedule of visits

A 
one day
one week (evaluate fellow eye at 1 week)
3-6 weeks
2 months
three months 
six months 
12 months
34
Q

medications

A 
topical corticosteroids 
topical borad spectrum antibiotics 
combo steroid/antibiotic 
anti glaucoma meds
lubricants
35
Q

patient instructions

A

avoid activities which are associated with risk of trauma or toxic and infectious exposure
check vision every day for significant change
use meds as directed
metal shield at bedtime for 3 days
sunglasses and/or glasses for protection
avoid lifting heavy objects or bending over for long periods

36
Q

suture removal

A

the amount of post-op suture induced astigmatism is based upon the type of surgery performed
larger incisions show higher amounts and no stitch show very little
incisions of 3-4 mm show ~1-2D of refractive astigmatism, 5-8 mm usually 2-3 D
this, of course is based on the surgeon and how tight the suture is tied

37
Q

interrupted sutures

A

can be removed as soon as 1 week post-op
remove suture in steep K meridian
if refraction shows -2.00 -4.00 x 010 remove the suture at axis 100

38
Q

continuous sutures

A

should not be removed for ~6 weeks post op
technique consists of cutting the suture nearest the inferior insertion into the eye
forceps are used to grab long free end of suture and gently pull the suture through

39
Q

refractive cataract surgery

A

used in cases of preexisting or induced high corneal astigmatism
can be performed as an adjunct technique at the time of surgery or post op behind the slit lamp
one or two corneal incisions are made along the limbus at the steepest corneal meridian
no stitch scleral incision made at the steepest corneal meridian

40
Q

posterior capsulotomy

A

initial complaint of clouding or film decreasing VA
posterior capsule reveals significant haze
typically performed with nd YAG laser
photo disruptive laser designed to disrupt or separate tissue
opening usually 3-4 mm and is usually performed 6-8 weeks post-op

41
Q

surgical eligibility for posterior capsulotomy

A

patient has decreased ability to carry out activities of DL including but not limited to reading, TV, etc.
pt has BCVA in which glare testing decreases VA by 2 lines
pt has determined that he or she is no longer able to function adequately with the current level of visual function
other eye diseases have been excluded as the primary cause of visual functional disability, except for instance in which significant visual debility
physician concurrence with significant pt defined improvement in visual function an be expected as a result of surgery
pt has been edu on risks and benefits

42
Q

eyelid complications

A

bruising
ptosis
edema and erythema

43
Q

conjunctiva complications

A

subconjunctival hemorrhage
chemosis
localized GPC

44
Q

cornea complications

A

astigmatism
edema
bulls keratopathy
descemet’s membrane detachment

45
Q

anterior chamber complications

A 
hypopyon 
hyphema 
shallow chamber
wound leak 
epithelial downgrowth 
increased IOP
46
Q

iris complications

A

iritis

iris prolapse into wound

47
Q

pupil complications

A

pupillary distortion (peaked pupil)
pupillary capture
atonic pupil

48
Q

lens, capsule, and IOL complications

A 
torn posterior capsule 
retained cortex
posterior capsule opacification 
anterior capsular contraction 
dislocated IOL
49
Q

complications involving anterior chamber lenses

A 
UGH syndrome 
partial or total erosion through angle
anterior synechia 
dislocation 
pupillary capture 
reverse pupillary block
50
Q

contraindications of anterior chamber IOL’s include

A

chronic open angle glaucoma
extensive peripheral anterior synechia
recurrent uveitis
low endothelial cell count

51
Q

complications involving posterior chamber lenses

A 
malposition of IOL - sunset syndrome, sunrise syndrome, horizontal decantation, windshield wiper syndrome 
pupil capture 
posterior synechiae 
posterior chafing syndrome 
erosion of ciliary body 
loop perforation through peripheral iridectomy 
posterior capsular opacification 
vitreous 
retina and choroid
52
Q

sunset syndrome

A

optic displaced toward 6:00
can be caused by inferior haptic in sulcus and superior haptic in capsular bag
disturbs patient from aphakic/pseudophakic correction
minor displacements corrected with pilo
surgical intervention may be necessary

53
Q

sunrise syndrome

A

optic displaced toward 12:00
can be caused by superior haptic in sulcus and inferior haptic in capsular bag
disturbs patient from aphakic/pseudophakic correction
minor displacements corrected with pilo
surgical intervention may be necessary

54
Q

horizontal decentration

A

optic displaced horizontally
can be caused by one haptic in sulcus and another haptic in capsular bag
disturbs patient from aphakic/pseudophakic correction
minor displacements corrected with pilo
surgical intervention may be necessary

55
Q

windshield wiper syndrome

A

implant too small and not placed within capsular bag
most common in myopic eyes
found out common with sulcus-fixated lenses placed in a vertical position
superior loop rotates to the left and right head movement

56
Q

pupil capture

A

lens falls forward and iris closes around lens
creates irregular pupil
may cause inflammation
may have to be repaired by dilating pupil and pushing lens posteriors
long standing pupillary capture does not require treatment
all sulcus lenses

57
Q

posterior synechiae

A

results from chronic inflammation

related to the following: IOL equator with pigment epithelium of iris, IOL with pigment epithelium of iris

58
Q

posterior chafing syndrome

A

can occur in two forms
first form reveals iris transillumination defects and microhyphemas and is characterized by the following: associated with intermittent blurring known as white out attacks, typically occurs in sulcus-fixated lenses which liberates WBCs
second form caused by pigment dispersion resulting in glaucoma

59
Q

erosion of ciliary body

A

seen in ciliary sulcus supported IOLs
erosion and perforation can be seen through the ciliary body
haptic can also erode through pars plicata, muscular

60
Q

loop perforation through peripheral iridectomy

A

seen in sulcus-fixated lenses

may need surgical repair

61
Q

posterior capsular opacification

A

misnomer since opacification occurs secondary to lens epithelial cells that cover capsule
collagen production of lens epithelial cells results in white fibrotic opacification
lens epi cells migrate from anterior capsule to posterior capsule
lens epi cells can form dense clusters known as Elschnig’s pearls
opacification and Elschnig’s pearls best seen through retro illumination
opacification advancement occurs more rapidly in younger patients
treatment consists of a YAG laser capsulotomy which opens the capsule

62
Q

vitreous

A

vitreal hemorrhage
vitreal attachment to wound
vitreal touch

63
Q

retina and choroid

A

choroidal detachment
retinal detachment
cystoid macular edema

64
Q

medications that causes anterior capsule cataracts

A

amiodarone
mercury, gold, silver
phenothiazines

65
Q

medications that cause anterior sub capsular cataracts

A

allopurinol

miotics

66
Q

medications that cause cortical cataracts

A

hydrocarbons

67
Q

medications that cause posterior subcapsular cataracts

A

corticosteroids
systemic antimetabolites or chemotherapy
hydroxychloroquine

68
Q

conditions associated with nuclear sclerotic cataracts

A

acquired: drugs, radiation, trauma
age related: yes
congenital/genetic: down’s syndrome, norris disease, X-linked ichthyosis
inflammatory or vascular: ocular ischemia
intraocular diseases: angle closure glaucoma, chronic uveitis, high myopia, pseudoexfoliation, stickler syndrome
metabolic: chronic malnutrition or dehydration, diabetes mellitus

69
Q

conditions associated with cortical cataracts

A

acquired: chemical injury, siderosis, trauma
age related: yes
congenital/genetic: alport syndrome, down’s syndrome, lowe syndrome, myotonic dystrophy, osteogenesis imperfecta
inflammatory or vascular: eczema or atopic dermatitis
intraocular diseases: angle closure glaucoma, chronic uveitis, fuch’s heterochromic iridocyclitis, high myopia, stickler syndrome
metabolic: diabetes mellitus, galactosemia, hypocalcemia, pseudohypoparathyroidism, wilson’s disease or chalcosis
radiation: infrared or thermal, ionizing

70
Q

conditions associated with subcapsular cataracts

A

acquired: electric shock, trauma, vitreoretinal surgery
age related: yes
congenital/genetic: fabry’s disease, hyperornithinermia or gyrate atrophy, myotonic dystrophy, refsum’s disease, RP or Usher’s disease, werner’s syndrome
inflammatory or vascular: ocular ischemia
intraocular diseases: aniridia, chronic uveitis, high myopia, iridocorneal endothelial syndromes, persistent hyperplastic primary vitreous, peter’s anomaly
metabolic: diabetes mellitus, mannosidosis, neonatal hypoglycemia
radiation: ionizing, ultraviolet
neoplastic: neurofibromatosis type II, retinoblastoma, uveal melanoma

OPTM 737 (6 decks)

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