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BCSCSAP Review > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

peripupillary TID

A

pseudoexfoliation

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2
Q

midperipheral iris TID

A

PDS

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3
Q

widened ciliary body band compared to fellow eye

A

angle recession

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4
Q

Retinal procedure that carries the highest risk of secondary angle closure due to choroidal effusion and anterior rotation of ciliary body?

A

scleral buckle

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5
Q

MOA of cyclophotocoagulation

A

reducing aqeuous production

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6
Q

Symmetric scattered peripheral anterior synechiae

A

CACG

“creeping angle closure” because slow formation of PAS which advance circumferentially

Tx: LPI to prevent progressive PAS

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7
Q

IOP in pregnancy

IOP in exercise

A

decreases in both

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8
Q

hyperopic elderly Asian woman

A

angle-closure glaucoma

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9
Q

Structure

A

anterior displaced schwalbe line

between Descemet membrane and TM

(posterior embryotoxon)

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10
Q

Expected ON appearance with given defect?

A

HVF: dense superior arcuate defect OD

inferior notch

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11
Q

Normal optic nerve head size

A

1.1 to 2.2 mm in diameter

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12
Q

MC cause of primary angle closure

A

pupillary block

occurs when there is restricted movement through the pupil because of iris contract with the lens and is maximal when the pupil is in the mid-dilated position.

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13
Q

AW increased risk of blindness in POAG

A

VF loss at diagnosis

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14
Q

Blindness in AA compared to whites

A

4x higher in AA than whites

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15
Q

Effect of applying posterior corneal pressure with a Goldmann-type, large-diameter gonioscopy lens?

A

This might indent the sclera and falsely narrow the angle

also reflux of blood into Schlemm canal

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16
Q

Goldmann lenses

A

Vaulted gonioscopy lens requiring a coupling agent such as methylcellulose to fill the space between the cornea and lens to visualize the angle. Rim diameter is larger than cornea

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17
Q

shallow chamber with double iris hump on gonioscopy indentation

A

plateau iris

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18
Q
A

“double hump” sign

plateau iris

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19
Q

frequently observed in what condition

A

low-tension glaucoma

(disc heme seen IT)

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20
Q

Gene a/w JOAG

A

TIGR/MYOC

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21
Q

Findings on gonio

A

dilated episcleral veins

blood in Schelmm canal

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22
Q

DDx

A

Blood in Schlemm canal

increased episcleral venous pressure

thyroid ophthalmopathy

Arteriovenous malformations

Carotid cavernous fistulas

dural sinus fistulas

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23
Q

How does SLT differ from ALT

A

SLT delivers less energly than ALT

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24
Q

Risk factors for progression of POAG

A

decreased ocular perfusion pressure

thinner cornea

increasing age

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25
Q

How does IV mannitorl reduce IOP

A

decreases water conent of vitreous

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26
Q

Topical ocular hypotensive that should be avoided with history of herpetic keratitis.

A

prostaglandins

can cause reactivation of herpetic keratitis

latanoprost, travoprost, bimatoprost, tafluprost (4 available in the USA)

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27
Q

Percentage of untreated patients progressed to glaucoma during a 5 year period

A

9.5%

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28
Q

Laser trabeculoplasty is most likely to be effective in patient with what diagnosis

A

pseudoexfoliative glaucoma

PXG, POAG, PDS

29
Q

Risk after cataract

A

(lens deposition of pseudoexfoliation)

accelerated PCO

intraoperative miosis

vitreous loss

floppy iris

iris prolapse

disolcated IOL from zonular dehiscence

30
Q

Tonometer uses imbert-fick principle for IOP

A

Perkins tonometer (applanation)

Goldmann tonometer

31
Q

MC reason for poor visual outcome 2/2 primary congenital glaucoma after treatment with goniotomy

A

amblyopia

note: cataract formation rare after goniotomy

32
Q
A
33
Q

SE topical CAI that can decrease vision

A

corneal edema

(carbonic anhydrase found in corneal endothelium)

34
Q

Tx for topiramate bilateral acute angle-closure glaucoma. Discontinue topiramate, give ocular hypotensive and this agent

A

cycloplegia

deepens the AC and relieve attack

systemic acetazolamide po or IV

secondary angle closure resolves 24-48 and myopia resolves 1-2 weeks

35
Q

ciliochoroidal swelling with anterior rotation of ciliary body and recent sulfamate-substituted monosaccharide medication

A

idiosyncratic reaction to topiramate leading to bilateral acute myopia and angle closure

36
Q

Gonioscopic finding a/w pseudoexfoliation

A

inability to visualize TM without compression

(narrow angle 2/2 anterior lens movement 2/2 zonular weakness or dialysis)

37
Q

Process seen after blunt trauma

A

separation of the ciliary body from the scleral spur

cyclodialysis cleft resulting in prolonged hypotony

38
Q

Only condition after trauma that cna cause hypotony

A

cyclodialysis cleft - separation of the ciliary body from the scleral spur - providing direct access of aqueous to the suprachoroidal space

39
Q

parameter of the Goldmann equation that cannot be directly measured

A

uveoscleral flow rate

40
Q

measures outflow facility

A

tonography

41
Q

measures aqueous humor formation rate

A

fluorophotometry

42
Q

measures episcleral venous pressure

A

venomanometry

43
Q

How does pilocarpine reduce IOP

A

increases TRABECULAR outflow

contracts the longitudinal ciliary muscle fibers that insert into the scleral spur and TM

44
Q

SE pilocarpine

A

induced myopia

difficulty seeing in dim light - miosis

paradoxical angle closure (forward shift of lens-iris diaphragm)

RD

breakdown of blood-aqueous barrier

45
Q

migration of (abnormal endothelial cells) membrane causing high peripheral anterior synechiae and secondary angle closure. Condition fails to respond to medications. Next step

A

surgical bypass of angle obstruction: Trabeculectomy or GDI

46
Q

powerful predictor of developing glaucoma in OHTS study

A

CCT - 81% increase in RR for every 40 um thinner CCT

Other RF

C:D baseline

Age

Higher IOP

higher PSD on perimetry

47
Q

optic disc characteristic most specific for glaucoma

A

focal notching of the rim

48
Q

acute bilateral angle closure with normal axial length. What additional evaluation is necessary to reach an accurate diagnosis

A

Take a medication history

(presentation suggests uveal effusions due to systemic medication - topiramate)

49
Q

MC cause for decreased VA in surgical arm of CIGTS study

A

cataract formation

CIGTS - initial surgical therapy achieves better IOP control than initial medical therapy (did not translate to better VF stabilization because of cataracts long term)

50
Q

perform IOP at this time during EUA

A

immediately after induction of general anesthesia and before intubation

51
Q

Complication of cyclodestruction unique to endoscopic cyclophotocoagulation

A

endophthalmitis

all other forms can cause CME, hypotony, pain, RD, intraocular hemorrhage

52
Q

Class of medication to cause this

A

alpha-2 selective agnoists

(ocular allergic symptoms in 10%-15%)

toxic follicular conjunctivitis

53
Q

Instrument most accurate in measuring IOP in setting of corneal scarring

A

Tono-Pen tonometer

54
Q

CYP1B1

A

primary congenital glaucoma

55
Q

FOXC1

A

iridogoniodysgenesis

56
Q

PITX2

A

Rieger syndrome

57
Q

corneal optical wedge

A

termination of descemet membrane (most anterior structure)

58
Q

interventions compared in the Early Manifest Glaucoma Trial

A

medication and laser trabeculoplasty versus observation

first trial with adequate power that showed treatment delayed progression in glaucoma

betaxolol + laser trabeculoplasty

59
Q

Condition a/w higher risk of developing aqueous misdirection following trabeculectomy

A

angle closure

60
Q

Aqueous humor formation sleep versus waking hours

A

decreased by 50% during sleep

(normal 2-3 uL/min)

61
Q

Young myopic patient undergoes trabeculectomy with MMC. 1 month later IOP normal but VA falls from 20/30 to 20/400. Mechanism?

A

choroidal folds in macula

hypotony maculopathy

bleb leak (acute: wound closure or conj buttonhole, late: use of antifibrotic drugs)

62
Q

After trab: decreased vision, hypotony, optic nerve edema, retinal edema, radial folds in macula

A

hypotony maculopathy

63
Q

Limits use of alpha agonists in infants

A

bradycardia

apnea, systempic hypotension

64
Q

Tx of choice for phacomorphic glaucoma

A

LPI

65
Q

Tx for dry eye that can raise IOP

A

loteprednol etabonate (Lotemax)

(any steroid even weak - FML, lotemax, loteprednol)

66
Q

PCG has best prognosis when diagnosed at which age?

A

between 3 and 12 months

67
Q

Worse prognosis for PCG

A

within 1 month of life or if K diameter >14mm at diagnosis

>50% legal blindness

68
Q

red painful eye + elevated IOP + prominent cell and flare + (-) KP + intact lens capsule + mature cataract + wrinkling lens capsule

A

phacolytic glaucoma

69
Q

First test to get

A

IOP!

BCSCSAP Review (13 decks)

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