Cataract Care

Question 1

Pts need to have a ______ _______

Answer 1

Lifestyle Complaint

Question 2

Visual “requirements”

Answer 2

Worse than 20/40 or better but with glare complaints

Question 3

Name two glare tests

Answer 3

1. BAT
2. Penlight test (poor man’s)

Question 4

What needs to be considered regarding refractive error before surgery

Answer 4

1. cyl
2. some myopes like being myopes
3. pts profession and hobbies
4. pts personality

Question 5

What are the expectations for amblyopia?

Answer 5

This surgery won’t bring back the lost vision because its cortical (not ocular)

Question 6

Name three concomitant procedures that can be done

Answer 6

1. Endocyclophotocoagulation (glaucoma)
2. iStent (glaucoma)
3. LASIK

Question 7

Name five different IOL options

Answer 7

1. Monovision
2. MF
3. Accommodating (not used much anymore)
4. Toric
5. Light adjustable

Question 8

What is special about the Light adjustable IOL? Who is it used for?

Answer 8

Used for pts with unpredictable outcomes and the refractice error can be adjusted post-op using UV light

Question 9

Tx for Blepharitis

Answer 9

First line: WCP and lid scrubs

Question 10

Name three topical txs for Blepharitis

Answer 10

1. Azyithromycin (Azasite)
2. Erythromycin ung
3. Tobradex ung

Question 11

How do you Rx Azasite for Blepharitis pre-op?

Answer 11

1 gtt BID x 1 day then daily until run out

Question 12

PO tx for Blepharitis

Answer 12

Doxycycline - 100mg

Question 13

Why is it important to point out things to pt before surgery? (ptosis, entropion/ectropion)

Answer 13

Because after surgery, pts will pay more attention to their eyes and think prior issues are a SE of surgery

Question 14

Name three potential causes of poor dilation

Answer 14

1. Meds (pilocarpine)
2. PXE
3. DM

Question 15

What does the pt lose during surgery?

Answer 15

Endothelial cells

Question 16

If the endothelial cell count is _____ or there is _______ edema then able to do _______ surgery

Answer 16

> 650
microcyctic
combined (corneal transplant and cat surgery)

Question 17

Normal endothelial cell count in adults? Infants?

Answer 17

Adults:1500 - 2000
Infants: 3500 - 4000

Question 18

Why is it important to ask about previous herpetic infections pre-op?

Answer 18

Because surgery can cause a “flare up”

Question 19

If the pt has a hx of herpetic infections, what can be done pre-op?

Answer 19

Pre-tx with PO anti-virals several days or a week before surgery

Question 20

Name four things to consider/watch for with PXE?

Answer 20

1. WEAK ZONULES - fragile surgery
2. Smaller pupils
3. Glaucoma association - watch post-op IOP
4. Phacodonesis: sunset IOL post-op (even years later)

Question 21

What is IFIS? What is the triad?

Answer 21

Intraocular floppy iris syndrome:
1. Floppy iris during surgery
2. Progressive pupillary constriction
3. Iris prolapse to wound sites

Question 22

What med can cause IFIS?

Answer 22

Flomax: Tamsulosin
Systemic alpha agonist for BPH
(also Cardura and Hytrin)

Question 23

IFIS is associated with what herbal supplement?

Answer 23

Saw Palmetto

Question 24

Name seven IFIS secondary complications

Answer 24

1. Focal iris atrophy
2. Post-op IOP
3. Iris trauma
4. Post capsular break
5. Vitreal loss
6. Zonular dehiscence
7. CME

Question 25

Name three reasons why the zonules would be weak or absent

Answer 25

1. Trauma 2. PXE 3. genetic disease (Marfan's)

Question 26

When would you use ultrasound in pre-op exam?

Answer 26

When you have a poor view or no view of the back of the eye

Question 27

Name three considerations regarding DM post-op

Answer 27

1. Longer recovery/slower healing 2. More prone to macular edema 3. May exacerbate retinopathy

Question 28

At what axial should peripheral retinal be prophylactically tx'd?

Answer 28

>25mm