Treatment Flashcards
DME involving the center of the macula
3-4 months evaluation if patient refuses treatment .
2-4 months if DME not involving CSME
What are the four evidence based therapies for DME
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
Intravitreal steroid injection
Peribulbar or intravitreal
Triamcinolone
Fluocinolone acetonide
For one month duration
Intraocular steroid implant
Iluvien (fluocinolone)effective up to 3 years
Ozurdex ( dexamethasone) effective up to 6 months
Surgical Treatment of DME with vitreoretinal traction
Pars plana vitrectomy with or without membrane peel
Avoid prescribing NSAID
If patient has infiltrate and is in pain. NSAID will make the infiltrate turn to ulcer.
Any possible infection to eye.
Congenital symptomatic NLDO
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)
SLK treatment
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
Salzmann’s nodular degeneration
Artificial tears
Protection against ultraviolet damage
If sympathetic; Superficial keratectomy(SK) or excimer laser photherapeutic keretectomy ( PTK) or lamellar keratoplasty.
Treating RCE with Viroptic can lead to
Toxicity due to preservative thimerosal resulting in decrease corneal regeneration and healing.
Marginal keratitis
- 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.
Adverse reaction during FA testing
- allergic anaphylaxis
- local tissue necrosis
- nausea
- vomiting
- GI distress
- Cardiopulmonary reaction
- headaches
- convulsion and thrombophlebitis at the injection site
Spectral domain (SD) OCT benefits
- quantify volume and thickness
- image hard exudates
- image intraretinal blood within retinal layers
- define vitreomacular traction.
Swept source (SS) OCT
- provides better visualization of the choroid and choroidal scleral interface.
- beneficial in evaluating the vitreretinal interface in patience with DME
OCT-angiography
- 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.
Older pt with CRAO without acutely elevated IOP or visible Embolus
Order ESR CNC CRP to rule out GCA
Retinal Embuli and/or CRAO BRAO
Evaluate with carotid droppler Cardiac studies ( EKG, Echo)
Pars Plana vitrectomy
- non clearing diabetic vit hemorrhage
- DME with vitreoretinal traction
- diffuse DME with presence of subretinal fluid
CSR treatment
Improve without treatment in 1-3 months
Laser photocoagulation
Cytomegalovirus treatment
IV Ganciclovir, foscarnet, cidofovir
Toxoplasmosis treatment
Small peripheral lesions, observed or treated with Bactrim.
- oral pyrimethamine and oral sulfadiazine
- Folinic acid
- Sulfadiazine or Clindamycin or azithromycin
Ocular MG
Pyridostigmine
Extensive treatment from PRP
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.
