BLue 1-4

Question 1

Difference between PACS, PAC and PACG

Answer 1

PACS
>= 2 quadrants of iridotrabecular contact,
Elevated IOP +/- peripheral anterior synechiae
No glaucomatous optic neuropathy

PAC
>= 2 quadrants of iridotrabecualr contact
Elevated IOP +- PAS
No gluacomatous optic neuropathy

PACG
>= 2 quadrants of iridotrabecular contact
Elevated IOP +/- PAS
Glaucomatous optic neuropathy

Question 2

Fucntion of PGA in glaucoma

Answer 2

Increased uveoslceral outflos

Question 3

Beta blocker MOA in gluacoma

Answer 3

Reduces aqueoud production

Question 4

CAI MOA in gluacoma

Answer 4

Reduced aqueous production

Question 5

Alpha agonist MOA in gluacoma

Answer 5

Increase uveosclearl outflow
REduced acquoeous production

Question 6

What does pilocarpine do in gluacoma

Answer 6

Increased conventional outflow.

Question 7

What hsould OHT be reviewed if no COAG, no control of IOP

Answer 7

1-4 months

Question 8

OHT uncertain COAG, Control of IOP

Answer 8

6-12 months review

Question 9

OHT No converstion

Answer 9

Control of IOP
12-18 month review

Question 10

What happens in aqueous misdirection

Answer 10

Aqueous drainage into the vitreous cavity reuslting in anteiror displacement of the vitreous, ciliary body and lens with subsequent secondary angle closure

Myopic shift
Raised IOP
Shallow/flat AC in abscence of pupil block

Question 11

Management of aqueous misdirection

Answer 11

Avoid miotics

Atropine can encourage posterior rotation of ciliary body

YAG anteiror hyaloidotomy though extisting PI

Question 12

What is lens particle glaucoma?

Answer 12

Secondary open angle glaucoma caused by inflammation of lens particles after breach in lens capsule form surgery or traum

Question 13

What is phacomorphic glaucoma

Answer 13

Secondary angle closure glaucoma caused by large cataractous lens with narrowing and blockage of AC angle

Question 14

What is phacolytic glaucoma

Answer 14

Secondary open angle glaucoma caused by leakage of soluble lens proteins of hypermature cataract into AC causing trabecular obstruction (no trauma or surgery)

Question 15

What is phacoanaphylactic glaucoma

Answer 15

Secondary open angle glaucoma caused by granulomatous inflammatory reaction to lens antigen after trauma or post op lens retention

Question 16

What is Irvine Gass syndrome? Riskf factors

Answer 16

Post operative CMO

Diabetes
RVO
ERM
Macular hole
Uveitis

Question 17

How should power of lens be adjusted for sulcus placement

Answer 17

Reduce power by 0.5-1D

If optic capture, can use same power

Question 18

What are causes of myopic refractive surprise?

Answer 18

Previous hyperopic laser
Higher A constant
Retained visco behind IOL

Poor biometry, incorrect IOL calculation, poor wound construction
Incorrect IOL positioning

Question 19

What are causes of hypermetropic refractive surprise

Answer 19

Myopic laser
Lower A constant
Undiagnosed staphyloma

Poor biometry, incorrect IOL calculation, poor wound construction
Incorrect IOL positioning

Question 20

What lens changes occur in homocystinuria?

Answer 20

Autosomal recessive metabolic disorder of methionine

Abnormal accumulation of homocysteine

Defeiceincy of cysthionine b-synthase

Inferonasal lens subluxation wtih no trauma

Avoid GA due to increased risk of thrombosis

Question 21

What is lens change in MArfans

Answer 21

Ectopia lentis
Superotemporally

Question 22

Sign in WHO checklist

Answer 22

Identity
Site marked
Anaesthesia
Allergy
Airway
Postiioning/draping
Warfarin
Tamsolusin/alphablocker

Pre op VTE

Question 23

Time out WHO checklist

Answer 23

Team members introduced
NAme
Procedure
Which eye
Refractive outocme
Lens model and power
Correct lens implant present
Any special equipment
Any variation to standard procedure
Spare lens
Patient concerns anaesthetic
ASA grade
Special monitoring
Sterility confirmed
Equipment issues or concerns

Question 24

Sign out

Answer 24

Name and side of procedure recorded
Instruments, swabs, sharps counts complete and correct
Any equipment problems
Variations to standard recovery and discharge protocol

Question 25

PXF angles

Answer 25

Narrower

Question 26

When is CTR effective in managing zonular dehiscence

Answer 26

LEss than 3 clock hours

Question 27

What can PXF cause during cataract surgery

Answer 27

Poor pupil dilation Zonular instability

Question 28

What management for PXF before cataract surgery

Answer 28

Extensive discussion with patient pre-op to be aware of issues Pupil manipulation Adequate hydrodissection - minimise torsional forces on zonules during lens rotation Minimal phaco energy CTR if zonular dehiscence VR team if phacodonesis at slit lamp Gentle slow movement of instruments

Question 29

Who is reverse pupil block more common in? How do you resolve this?

Answer 29

Myopes Second instrument to lift iris anteriorly relieving the pupil block

Question 30

What reduces risk of PCO

Answer 30

Square edge design IOL optic Haptics with flexible arms and posterior flexion Complete overlapping of anterior capsulorrhexis and anterior surface of IOL optic Acryllic hydrophobic lens

Question 31

Effect of silicone oil in pseudophakic eyes? Phakic? Aphakic?

Answer 31

Pseudophakic and phakic - Silicone oil fills vitreous cavity and concavity of the anteiror part at interface with posteiror lens render eye more HYPERMETROPIC (concave lens) IN aphakic Convexity of lens at anteiror part of silicone oil acts as convex lens making eye less hypermetropic

Question 32

What is Toxic Anterior Segment Syndrome

Answer 32

Sterile post op inflammatory reaction caused by non-infectious substances that enter through anteiror segment resulting in ifnlammatoin and toxic damage to intraocualr tissue Starts within 24 hours (compared to 3-7 days fo POE) Severe ey epain SEvere AC ifnlammation Diffuse corneal oedema NEgative micro Improves with topical steroids

Question 33

What is associated with Fabry's diseasae

Answer 33

X linked lysosomal disease Cortex keratopathy PSC Tortuous conj/retinal vessels

Question 34

What is seen in Alports disease

Answer 34

Anteiror lenticonus (protrustion of anterior lens capusle) Nephritic haematuria Deafness

Question 35

FLACS vs standard

Answer 35

Same in VA, AC/PC tears, Post op CMO, IOP, patient reported outcomes and cost effectiveness