2 Flashcards
(25 cards)
A post-cataract patient with a small axial length presents with high IOP and shallow anterior chamber depth both centrally and peripherally. What is the likely diagnosis and how can it be treated?
Dx-> Aquesous Misdirection Tx-> Three different options 1-Cycloplege ( The patient typically would be for the cataract surgery it self) 2-YAG laser to Anterior Hyaloid 3-Pars plana vitrectomy
SMILE, a refractive surgery that uses Femtosecond laser to make an intrastromal Laser Cut, that has a similar outcome to LASIK. What is one benefit of SMILE compared to LASIK and why ?
Less risk of dry eye symptoms, the incision takes place within the cornea without the need for a larger corneal flap resulting in less damage to corneal nerves.
Regarding a patient with Fuch’s Endothelial Dystrophy who shows prominent bullae, what surgical procedure should be performed as soon as possible?
DMEK = Descemet Membrane Endothelial Keratoplasty
What is the difference between a posterior polar cataract and PSC?
Posterior polar have sharply demarcated borders
Why should you never polish a posterior polar cataract?
The capsule can rupture
What corneal procedure has the highest rejection rate in the first 2 years: PK, DALK, DSAEK, or DMEK?
PK, has the highest rejection rate in the first 2 years, with 18%.
DALK is 4%, DSEAK is 5-12%, and DMEK is 1%.
In terms of corneal transplant methods, which method does not lead to corneal astigmatism?
Descemet Membrane Endothelial Keratoplasty (DMEK)
Descemet Membrane Endothelial Keratoplasty (DMEK)
Epithelialization is the first stage and takes 1 day to 2 weeks to occur. Patients run the risk of rejection and endophthalmitis.
Stromal healing is the second stage and takes 1 year. Patients do run the risk of infection from loose sutures and rejection.
Which corneal transplant procedure is MOST useful for a case of granular dystrophy that compromises a patient’s VA?
Given the granular dystrophy is a stromal dystrophy, a penetrating keratoplasty would be indicated.
When you have a patient with a flat anterior chamber and a high IOP what are two diagnosis that should be suspected?
Untreated angle closure or malignant Glaucoma
What is the official treatment for malignant glaucoma?
Pars Plana Vitrectomy
What 3 tests are required at the initial post op visit within the first 3 days after cataract surgery?
Visual acuity, IOP, slit lamp exam
DALK and PK have similar stages and treatment. However, what are some of the slight differences with DALK?
DALK has :
- less risk of rejection
- can taper steroids earlier and remove sutures earlier
- less blunt trauma risk
What is the typical schedule of antibiotic, steroid, and NSAID drops following cataract surgery?
Antibiotic: q1h first day, then TID x 3 more days
Steroid: QID tapered 1 gt per week
NSAID: Dose depends on type
A 45 year old patient with Fuchs presents in your office confluent corneal guttata. What are possible tx options?
DMEK. If they choose to defer surgery, monitor every 6 months, or sooner if symptoms worsen.
A patient reports for a post-op surgery with an epithelial defect. The surgical note states that TriMoxi was used during the procedure. In addition to BSCL, what type medication do you need to prescribe?
Antibiotic
You have a patient that comes in after cataract surgery. On examination you find their pressures to be 60 mmHg OU. You recheck pressures after a couple minutes and once again find it to be 62 mmHg OU. Would you want to burp the wound? Why?
Yes. You would want to burp the wound and recheck pressures after 30 minutes. If pressures are still high, burp again and repeat every 30 minutes until pressure stops rebounding.
When would you want to burp for post-op cataract surgery”
Depending on what the pressure is before you begin burping you will need to continue doing so until you reach a desired IOP.
What does the burping technique consist of?
Numbing, betadine, antibiotic drops, lid speculum, then calmly press the sclera adjacent to the wound to release pressure. Then give IOP drops
With PK/DALK, what can be used to erase high astigmatism once healed and is referred to as the “silver bullet”?
Toric IOL once healed is your silver bullet.
How often do you burp a patient’s eye with IOP of 60 mmHg?
As often as needed every 30-40 minutes until IOP is consistently within normal limits.
Which topical IOP drop should try to be avoided in patients with corneal edema?
Cosopt
What is a concern of prolonged inflammation after cataract surgery?
CME
What is a sign of endophthalmitis?
Vitreous cells
