Treatment

Question 1

DME involving the center of the macula

Answer 1

3-4 months evaluation if patient refuses treatment .

2-4 months if DME not involving CSME

Question 2

What are the four evidence based therapies for DME

Answer 2

Focal and grid laser,
Intravitreal anti-VEGF,
Intravitreal steroid injection.
Implant 
Surgical intervention 

Last Photocoagulation prior to panrerinal treatment reduces risk of progression of DME

Question 3

Intravitreal steroid injection

Answer 3

Peribulbar or intravitreal
Triamcinolone
Fluocinolone acetonide

For one month duration

Question 4

Intraocular steroid implant

Answer 4

Iluvien (fluocinolone)effective up to 3 years

Ozurdex ( dexamethasone) effective up to 6 months

Question 5

Surgical Treatment of DME with vitreoretinal traction

Answer 5

Pars plana vitrectomy with or without membrane peel

Question 6

Avoid prescribing NSAID

Answer 6

If patient has infiltrate and is in pain. NSAID will make the infiltrate turn to ulcer.
Any possible infection to eye.

Question 7

Congenital symptomatic NLDO

Answer 7

Often 1-2 months spontaneous opening. If no response

• Digital downward massage 2-4x/day , if no response by 13 months,
• Nasolacrimal duct probing. If no response,
• Dacryocystorhinostomy ( DCR)

Question 8

SLK treatment

Answer 8

Doesn’t respond to steroids.

• Silver nitrate 0.5-1% for 10-20 sec
• Thermocauterization or surgical resection
• Acetylcysteine 10% ( Mucomyst) 3-5x/day for filamentary keratitis

Question 9

Salzmann’s nodular degeneration

Answer 9

Artificial tears
Protection against ultraviolet damage
If sympathetic; Superficial keratectomy(SK) or excimer laser photherapeutic keretectomy ( PTK) or lamellar keratoplasty.

Question 10

Treating RCE with Viroptic can lead to

Answer 10

Toxicity due to preservative thimerosal resulting in decrease corneal regeneration and healing.

Question 11

Marginal keratitis

Answer 11

• Without treatment resolution occurs in 3–4 weeks. Sometimes there may be residual superficial scarring and slight thinning with mild pannus.
• weak topical steroid such as prednisolone 0.5% q.i.d. for 1 week, sometimes combined (often in a fixed combination) with a topical antibiotic. An extended course of an oral tetracycline (erythromycin in children) may rarely be required for troublesome recurrent disease.

Question 12

Adverse reaction during FA testing

Answer 12

• allergic anaphylaxis
• local tissue necrosis
• nausea
• vomiting
• GI distress
• Cardiopulmonary reaction
• headaches
• convulsion and thrombophlebitis at the injection site

Question 13

Spectral domain (SD) OCT benefits

Answer 13

• quantify volume and thickness
• image hard exudates
• image intraretinal blood within retinal layers
• define vitreomacular traction.

Question 14

Swept source (SS) OCT

Answer 14

• provides better visualization of the choroid and choroidal scleral interface.
• beneficial in evaluating the vitreretinal interface in patience with DME

Question 15

OCT-angiography

Answer 15

• identifies the depth of the retina and choroid
• detects capillary dilation or truncation.
• detect increased foveal avascular zones and capillary drop out or non-perfusion to retinal
• identify location of micro aneurisms adjacent to retinal fluid.

Question 16

Older pt with CRAO without acutely elevated IOP or visible Embolus

Answer 16

Order ESR CNC CRP to rule out GCA

Question 17

Retinal Embuli and/or CRAO BRAO

Answer 17

Evaluate with carotid droppler 
Cardiac studies ( EKG, Echo)

Question 18

Pars Plana vitrectomy

Answer 18

• non clearing diabetic vit hemorrhage
• DME with vitreoretinal traction
• diffuse DME with presence of subretinal fluid

Question 19

CSR treatment

Answer 19

Improve without treatment in 1-3 months

Laser photocoagulation

Question 20

Cytomegalovirus treatment

Answer 20

IV Ganciclovir, foscarnet, cidofovir

Question 21

Toxoplasmosis treatment

Answer 21

Small peripheral lesions, observed or treated with Bactrim.

• oral pyrimethamine and oral sulfadiazine
• Folinic acid
• Sulfadiazine or Clindamycin or azithromycin

Question 22

Ocular MG

Answer 22

Pyridostigmine

Question 23

Extensive treatment from PRP

Answer 23

extensive treatment (generally over 1,000 spots for a single session) may induce suprachoroidal effusion, anterior rotation of the ciliary body, and acute angle closure.
Therefore treatment sessions are decided.