final

Question 1

most common yag complications

Answer 1

inflammation (CME- treat with anti-inflammatory drugs, floaters, hyphema- can also be in vitreous, corneal issues, vitreous prolapse)

IOP pike - why give brominidine before and after procedure)

pitting

1% patients can get RD

Question 2

what does pitting do? What materials does it occur most in?

Answer 2

damages the IOL
affects contrast sensitivity

occurs in silicone>acrylic> PMMA

Question 3

ALT/ SLT complications

Answer 3

Post op IOP spike (occurs within 90 mins and resolves 1-3 days)
- NOTE: continue to take normal glaucoma drops if on them and may need to add others

permanent IOP spikes -> treat with a trabeculectomy , prevent by lasering 50 spots max/18- degrees at min level

trabeculitis -> treated with topical steroids and NSAIDS, prevent by avoid too much treatment, good focus, and don’t treat ATM

Question 4

JAMA SLT study

Answer 4

misleading study with a small sample size. said OD had more risk of repeat sessions vs OMD.

can do LTP in 2 sessions

Question 5

TOSRP study

Answer 5

said that OD’s untrained/ can’t perform lasers, but nothing involved lasers in actual study

Question 6

LPI complications

Answer 6

I ULTRA-CHIC PB
I - Iris non-preforation
U- uveitis
L- linear dysphotopsia
T - transient IOP spikes
R - retinal damage
A - anterior chamber debris
C - corneal damage
H- hyphema
I - iridotomy closure
C - focal cataracts
P - pupillary distortion
b - bleeding at the margin

Question 7

iris non-perforation in LPI

Answer 7

most common complication

just not breaking though the iris -> risk nonpatent

prevent with ie. decrease the patency with miotics

use a short burn and look for pigment plume

Question 8

iridotomy closure in LPI

Answer 8

occurs within 3 weeks

more likely to closer in smaller iridotomies (<150 um)

reopen with YAG
most iridotomies are 200-1000 microns

Question 9

anterior chamber debris in LPI

Answer 9

transient mild->mod blur X 1-3 days

see pigment, cells/fare - check for glaucoma and RD RISK - ie. monitor floaters

Question 10

uveitis in LPI

Answer 10

usually mild
treat with steroids NSAIDS for synechiae

taper off once controlled!!

Question 11

transient IOP spikes in LPI

Answer 11

elevations >10 = dangerous!
document after 1 hr and after 24 hours

NOTE: most spikes occur 1-3 hours post LPI and resolve 24-48 hours after LPI

may need surgical intervention if doesn’t decrease with meds

Question 12

how do you avoid pupillary distortion in LPI

Answer 12

laser outer 1/3 of the iris- occurs if hit eye muscle

usually consequence is only cosmetic

Question 13

hyphema in LPI

Answer 13

usually only micohyphema that resolves spontaneously

more common in YAG, rubeosis, uveitis, anti-coagulants

Question 14

corneal damage in LPI

Answer 14

can look like cracked glass and can lead to gradual haze if endothelial damage occurred

use the lens to avoid - more precise

Question 15

linear dystphotopsia in LPI

Answer 15

do LPI at 3 or 9 o clock to decrease risk

can lead to diplopia

Question 16

retinal damage in LPi

Answer 16

usually occurs in the periphery - not concerning because CNVM with form there

Question 17

what are general complications that occur with lasers and how to treat them?

Answer 17

High IOP usually 1-3 hours after procedure, goes away 1-2 days
- risk factor = POAG
- treat with aqueous suppressants ( CAS, apraclonidine, beta blockers)

Iritis, synechiae (PAS/PS)

Uveitis - treat is > 10 cells or if aqueous flare/haze seen
- treat with topical steroids and NSAIDS q4 hours

CME: if blurry vision after procedure + confirm with OCT/FA

Question 18

general rules to avoid laser complications

Answer 18

educate patients that ALL lasers have complications, risk factors, etc

Not every case is a laser case, patients may need surgery

use minimal energy and take the lowest number of shots for successful treatment

typically toxicities are mild, don’t last long, and are insignificant

Question 19

bleeding at the margin during LPi procedure

Answer 19

more common in yag LPI

Question 20

cumulative energy

Answer 20

total laser shots fired + number of pulses per shot + energy per pulse

the more energy - the more damage and more inflammation and higher chance for IOP spike

Question 21

risk factors for complications

Answer 21

DM
high myopia
retinal health
glaucoma
OHTN
immunocompromised

Question 22

what can optometrists not do?

Answer 22

retinal laser (focal PRP), lassie, cosmetic surgery

Question 23

inclusive law

Answer 23

tells OD can do

Question 24

exclusive law

Answer 24

tells what OD can’t do

Question 25

safety signs

Answer 25

3A lasers need caution sign

3B or 4 lasers need a danger sign

Question 26

how can someone claim negligence?

Answer 26

a close relationship must exist

actual loss or injury to patient caused by you.