Glaucoma Flashcards
(111 cards)
1
Q
What are the contraindications to prostaglandins?
A
• Active uveitis
• CME
• Herpetic keratitis
2
Q
What are the risk factors for failure of trabeculectomy?
A
• Young age
• Aphakia/pseudophakia
• Disturbance of conjunctiva
• African American
• Active inflammation
• Neovascularization
3
Q
What are the last portions of the visual field (VF) to be affected in end-stage glaucoma?
A
• Central VF
• Inferotemporal VF
4
Q
What are the functions of M cells?
A
• Motion vision
• Large diameter “Massive”
• Sensitive to light in scotopic conditions
5
Q
What is the function of P cells?
A
• Concentrated in macula
• Small diameter ”Petite”
• 80% of RGCs
• Responsible for color and fine detail
6
Q
What is the most common complication after filtering surgery?
A
• Visually significant cataract (20-40%)
7
Q
What is phacolytic glaucoma?
A
• Mature or hypermature cataract
• Increased concentration of high molecular weight lens protein
• Proteins released through MICROscopic openings in lens capsule
• Protein clogs trabecular meshwork
• Macrophages phagocytize large proteins clog trabecular meshwork
• Cytology of aqueous = lens laden macrophages
• LACK OF KERATIC PRECIPITATES
• OPEN angle
• Intact lens capsule
8
Q
What is phacoanaphylaxis (AKA phacoantigenic glaucoma)?
A
• Capsular bag violated (i.e. trauma, surgery)
• Leads to granulomatous inflammation
• Keratic precipitates
9
Q
What is phacomorphic glaucoma?
A
• Shallow anterior chamber
• Lens becomes large, thick → pushes iris forward and closes angle
• Treatment: cataract removal
10
Q
What is lens particle glaucoma?
A
• MACROscopic lens pieces in anterior chamber
11
Q
What is the differential diagnosis for shallow anterior chamber with patent PI?
A
• Aqueous misdirection, malignant glaucoma
• Choroidal effusion
• Suprachoriodal hemorrhage
12
Q
What is the treatment of aqueous misdirection, malignant glaucoma?
A
• Medical: intensive aqueous suppressant, cycloplegics, hyperosmotics. NEVER use miotics
• Surgical (disruption of anterior vitreous face): YAG laser through patent iridotomy or pars plana vitrectomy (definitive)
13
Q
What is the treatment for plateau iris?
A
• Laser iridoplasty
• Chronic cholinergics
14
Q
What types of renal stones are caused by systemic carbonic anhydrase inhibitors?
A
• Calcium oxalate
• Calcium phosphate
15
Q
What is the mechanism of action of latanoprostene bunod 0.024% (Vyzulta)?
A
• Latanoprost component reduces IOP by long term remodeling of extracellular matrices in ciliary body (via uveoscleral pathway, “nonconventional”)
• Nitric oxide component reduces IOP by “conventional” pathway via relaxation of trabecular meshwork and Schlemm’s canal
16
Q
What is the purpose of dynamic gonio?
A
Determines whether closed angle is due to appositional versus synechial closure
17
Q
Which gonio lenses can and cannot be used for dynamic gonio?
A
• Dynamic gonio: Zeiss, Posner, Sussman (posterior lens diameter < corneal diameter)
• Cannot do dynamic gonio: Goldmann lens (posterior lens diameter > corneal diameter)
18
Q
The TIGR/MYOC gene mutation leads to which conditions?
A
• Mutations produce protein myocilin
• Chromosome 1
• Seen in juvenile open angle glaucoma and adult onset POAG
19
Q
The OPTN gene mutation leads to which condition?
A
• Normal tension glaucoma
20
Q
Which genes are associated with congenital glaucoma?
A
• GLC3A gene mutation (most common)
• CYP1B1 gene mutation (more severe form)
21
Q
Which condition has a LOXL1 gene mutation?
A
• Pseudoexfoliation glaucoma
22
Q
What is the pathway of pressure sensitive trabecular outflow?
A
Uveal TM → corneoscleral TM → juxtacanalicular TM (most outflow resistance) → Schlemm canal → collector channels (25-30) → deep and midscleral venous plexi → episcleral veins → anterior ciliary and superior ophthalmic veins → cavernous sinus
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23
Q
What is the pathway of pressure insensitive trabecular outflow?
A
• Ciliary muscle → supraciliary and suprachoroidal spaces → intact sclera
• 45% of total aqueous outflow
• Increased by cycloplegia, adrenergic agents, prostaglandins
• Decreased by age, glaucoma, miotics
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24
Q
What is tilted disc syndrome?
A
• Situs inversus (vessels go nasally before turning temporally)
• Superotemporal or bitemporal VF defects
• Associated with myopic astigmatism and X-linked congenital stationary night blindness
25
What is the mechanism of action of pilocarpine?
● Contraction of longitudinal ciliary muscle where it inserts into scleral spur and TM → improves outflow
● Reduces IOP 15% to 20%
● Associated with:
○ Angle closure (forward shift of lens-iris diaphragm); myopic shift secondary to ciliary muscle contraction; headache, brow ache (ciliary muscle spasm); cataract formation; RD; breakdown of blood-aqueous barrier; iris pigment epithelial cysts; epiphora (lacrimal stimulation and punctal stenosis); ocular surface changes (drug-induced pseudopemphigoid)
26
What virus is associated with Posner Schlosmann and Fuchs iridocyclitis?
• Posner Schlosmann: CMV
• Fuchs: Rubella & CMV
27
What is hypotony maculopathy?
• Common complication in young myopes (versus choroidal detachments which are more common in older pts)
• Complication of over filtration
• Fundus findings: optic disc edema, macular folds, CME
• Hypotony maculopathy and choroidal detachments do not occur together
28
What are examples of direct gonioscopy (used in the operating room)?
• Koeppe
• Barkan
• Wurst
• Swan-Jacob
• Richardson
29
What are examples of indirect gonioscopy?
• Zeiss
• Sussman
• Posner
• Goldmann (3 mirror)
30
What is the prognosis for primary congenital glaucoma?
• Best if diagnosed between 3 months to 12 months of age
• Worse when diagnosed within 1 month of life or >12 months of age
• >50% of patients with newborn PCG develop legal blindness
• Worse prognosis if corneal diameter >14 mm at diagnosis
31
What medications lower IOP and what is their mechanism of action?
• Topical beta blockers: reduce aqueous production, inhibit cAMP production
• Topical alpha agonists: reduce cAMP production by binding alpha 2 receptors. With long term use also increases uveoscleral outflow
• Topical CAI: reduce aqueous production by inhibiting carbonic anhydrase
• Topical pilocarpine, echothiophate, parasympathomimetics: increase outflow through TM by contraction of longitudinal ciliary muscle fibers
• Topical prostaglandins analogs: increase uveoscleral outflow, activates MMP which remodels tissues along this pathway
32
What are the side effects of IOP-lowering medications?
• Topical prostaglandins: conjunctival hyperemia, hypertrichosis, increased pigmentation of iris and periocular skin, CME, anterior uveitis, reactivation of herpes simplex virus keratitis. Rarely, flu-like symptoms and joint/muscle pains
• Topical CAI: bitter taste, corneal edema secondary to effecting corneal endothelium pump
• Topical beta blocker: decreased exercise tolerance. Use with caution in asthma and COPD
• Topical alpha agonists: dry mouth, follicular conjunctivitis, contraindicated in children and while breastfeeding, safest medication during pregnancy but stop after birth of baby due to causing systemic hypotension and apnea
33
What is topiramate-induced angle closure?
• Sulfamate-substituted monosaccharide medication
• Causes bilateral acute myopia and angle closure
• Ciliochoroidal swelling
• Anterior rotation of ciliary body
• First-line treatment: stop medication, start cycloplegia, hypotensive agents
• Refractory cases: laser iridoplasty
34
What are the focal signs of glaucomatous cups?
• Notching of rim
• Vertical elongation of cup
• Cupping to rim margin
• RNFL hemorrhage
• RNFL loss
35
What are less specific signs of glaucomatous cups?
• Exposed lamina cribrosa
• Nasal displacement of rim vessels
• Baring of circumlinear vessels
• Peripapillary atrophy
36
What is the classic triad of primary congenital glaucoma?
• Epiphora
• Photophobia
• Blepharospasm
37
What is automated static perimetry?
• Stimulus size constant
• Varies stimulus intensity
• Stationary stimulus at various locations
38
What is frequency doubling technology (FDT) perimetry?
• Low spatial frequency sinusoidal grating that undergoes rapid phase-reversal flicker
• Ability for patients to distinguish changes in contrast
• Only useful for detecting early glaucomatous loss
39
What is SWAP (short wavelength automated perimetry)?
• Isolates and tests the sensitivity of short-wavelength ganglion cells
• Detection of early glaucoma is higher with SWAP compared to standard automated perimetry
• VF defects predate same VF defects on standard automated perimetry
• Disadvantage = long testing time and more sensitive to media opacities
• SITA-SWAP = decrease in testing time
40
What is kinetic and tangent screen testing?
• Target moved into an area just until it is seen (automated or manual)
41
What are the reliability indices of visual fields?
• False positives(“trigger happy”): >15% is unreliable
• False negatives: does not respond when stimulus is present, indicates inattentiveness or seen in areas of damage (if high, do not throw out the test)
• Fixation loss: patient looks way from central target (“chasing lights”)
42
What is SLT and its efficacy compared to ALT?
• SLT: selective photothermolysis targeting pigmented cell
• Short, low-energy bursts absorbed selectively by pigmented trabecular meshwork
• Little damage to surrounding tissue
• Efficacy of SLT and ALT are equivalent
43
What is the process of aqueous production?
• Produced by inner non pigmented epithelial cells
• Ciliary process composed of outer pigmented and inner non-pigmented epithelial cells that face each other at their apical surface and joined by tight junctions
• Tight junctions are part of blood-brain barrier
• Inner non-pigmented epithelial cells have many mitochondria and microvilli
• Inner non-pigmented epithelial cells protrude into posterior chamber
44
What is a beta-1 selective topical beta blocker?
• Produced by inner non pigmented epithelial cells
• Ciliary process composed of outer pigmented and inner non-pigmented epithelial cells that face each other at their apical surface and joined by tight junctions
• Tight junctions are part of blood-brain barrier
• Inner non-pigmented epithelial cells have many mitochondria and microvilli
• Inner non-pigmented epithelial cells protrude into posterior chamber
45
What are the causes of falsely low IOP on applanation?
• Thin CCT
• BCL
• Corneal edema
• Corneal ectasia
• Not enough fluorescein (thin meyers)
46
What are the causes of falsely high IOP on applanation?
• Band keratopathy
• Thick CCT
• Corneal scar
• Too much fluorescein (thick meyers)
47
What is the age range for JOAG?
• Ages 4 to 35 years
48
Which anesthetics lower IOP?
• Sevoflurane
• Most others
49
Which anesthetics increase IOP?
• Ketamine
• Succinylcholine
50
Which anesthetic does not have an effect on IOP?
• Chloral hydrate
51
Which illicit drugs lower IOP?
• Heroin
• Marijuana
• Alcohol
52
What is an ideal time to check IOP in EUA?
• Immediately after induction of general anesthesia and before intubation
53
What are the risk factors for aphakic glaucoma?
● Cataract surgery in the first year of life
● Glaucoma develops in 15-50% of children who undergo surgery for congenital cataracts
● Small corneal diameters
● Post-op complications
● Aphakic patients are always at risk for developing glaucoma
○ Usually aphakic glaucoma develops within 3 years after cataract surgery
54
What are the relative contraindications to trabeculectomy?
• Prior conjunctival surgery
• Active anterior segment neovascularization
• Active uveitis or scleritis
• Younger age
• African American
55
What are the findings in Axenfeld-Rieger syndrome?
• Corectopia
• Polycoria
• Posterior embryotoxon
• Iris strands to Schwalbe line
• Iris hypoplasia
• Maldeveloped anterior chamber angle
• Craniofacial dysmorphism (maxillary hypoplasia, telecanthus, hypertelorism)
• Dental abnormalities (microdontia/oligodontia/hypodontia)
• Redundant umbilical skin
• Hypospadias
• Growth retardation
• Cardiac valve abnormalities
• Pituitary abnormalities
56
What is the aqueous humor formation rate?
• 2 to 3 μL/min during waking hours
• During sleep, 50% reduction in rate
• Total aqueous volume: 250 μL
• Turnover 1% per minute
57
What are the racial differences in risks in POAG?
• POAG prevalence 3-4 times higher in African descent and Hispanic ethnicity
• Blindness 4 times more common in Black patients; up to 15 times higher risk in older than 45 years
• More likely to be diagnosed at younger age and more advanced stage in Black patients
58
What is the Goldmann equation?
● Po = (F-U)/C + Pv
○ Po = IOP in mmHg
○ F = rate of aqueous formation
○ U = rate of aqueous drainage through pressure-insensitive uveoscleral pathway in μL/min → cannot be directly measured
○ C = facility of outflow through pressure-sensitive trabecular pathway in μL/min/mmHg
○ Pv = episcleral venous pressure in mmHg, normally 6-9 mmHg
59
What is the Imbert-Fick principle?
• Used for Goldmann tonometer and Perkins tonometer
• Assumes CCT = 520 μm
• 3.06 mm tip diameter
60
What are the causes of increased episcleral venous pressure?
• Sturge Weber
• Carotid-cavernous fistula
• Cavernous sinus thrombosis
• TED
61
What are the contraindications and adverse effects of hyperosmotic agents?
• Contraindication: renal failure
• Adverse effects: headache, mental confusion, backache, acute CHF, myocardial infarct, subarachnoid/subdural hemorrhage
62
What anatomical changes are found in angle recession?
• Tear between longitudinal and circular muscle fibers of ciliary body
63
What anatomical changes are found in cyclodialysis?
• Separation of ciliary body from scleral spur
• Causes hypotony
64
What anatomical changes are found in iridodialysis?
• Disinsertion of iris root from ciliary body
65
What are the trabecular meshwork tear findings on gonio?
• Small trabecular cleft on gonio
66
What are the risks for suprachoroidal hemorrhage after trabeculectomy?
• High myopia
• Aphakia
• Pseudophakia
• Hypotony
• Prior vitrectomy
• Advanced age
• Systemic hypertension
• Anticoagulant therapy
• History of suprachoroidal hemorrhage in fellow eye
• Large magnitude of IOP reduction from pre-op to post-op
67
Which glaucoma medication is category B in pregnancy?
• Brimonidine
68
Which glaucoma medications are category C in pregnancy?
• Prostaglandins (PGF 2a) → affects uterine smooth muscle and induces contraction/labor
• Carbonic anhydrase inhibitors
• Beta blockers
69
What are the preservative free (BAK free) glaucoma drops?
• Tafluprost
• Cosopt -PF
• Timolol -PF
• Travatan Z
• Alphagan P
70
What are the optic nerve lengths in various locations?
• Intraocular: 1 mm
• Intraorbital: 25 mm
• Intracanalicular: 10 mm
• Intracranial: 10 mm
71
What are the number of axons in the optic nerve?
• 1.2 -1.5 million axons
72
What are the risk factors for primary angle closure glaucoma?
• Race: Inuit (20-40 times higher than whites) or East Asian
• Small AC/short axial lengths
• >40 years
• Women > men
• Positive family history
• Hyperopes
73
Which topical steroids cause IOP elevation, ranked by decreasing severity?
Decreasing order of effect on IOP elevation
• Difluprednate (most)
• Prednisolone
• Rimexolone
• Fluorometholone (FML)
• Loteprednol
74
What are optic drusen?
• Abnormal axonal metabolism → mitochondrial calcification and drusen formation
• Histology: discrete basophilic zones of calcifications
75
What are the different secondary glaucomas and the respective cell types involved in blocking trabecular meshwork?
• Hemolytic glaucoma → hemosiderin-laden macrophages
• Ghost cell glaucoma → rigid hemolyzed erythrocytes
• Uveal melanomas → pigmented epithelioid melanocytes
• Phacolytic glaucoma → eosinophilic protein-laden macrophages
76
What is implicated in the excessive proliferation of tenon capsule fibroblasts?
• Seen with scarring of glaucoma filtration bleb
• Transforming growth factor beta and platelet-derived growth factor are implicated
77
What is this finding?
• Haab striae
78
What were the findings in the Ocular Hypertension Treatment Study (OHTS)?
● Determined the effectiveness of typical ocular hypotensive in preventing or delaying onset of glaucoma in patients with ocular HTN
● Risk factors for progression of POAG
○ Elevated IOP (for each mmHg above baseline IOP → risk of progression increased by 10%)
○ Advanced age (22% increased relative risk per decade)
○ Thin CCT (81% increase in relative risk for every 40 μm thinner CCT)
○ Large C/D ratio (for each 0.1 vertical CD ratio increase → risk of progression increased by 32%)
○ Worse pattern standard deviation on standard automated perimetry (22% increase in relative risk per 0.2 dB increase)
● Treated group: 22.5% IOP reduction; 4.4% developed optic nerve or VF damage over 5 years
● Untreated group: 4% IOP reduction; 9.5% developed optic nerve or VF damage in 5 years
● Patients with CCT > 588 had very low rates of conversation to OAG at 5 years
79
What was a shared conclusion of the Collaborative Normal Tension Glaucoma study (CNTGS) and the Early Manifest Glaucoma Trial (EMGT)?
• Optic disc hemorrhage is a risk factor for glaucoma progression
80
What were the conclusions from the Collaborative Initial Glaucoma Treatment Study (CIGTS)?
• Confirmed initial surgical (trab) therapy achieves better IOP than does initial medical therapy
• Results do not translate to better visual field stabilization secondary to cataracts
81
What were the conclusions of the Early Manifest Glaucoma Trial (EMGT)?
• Examined betaxolol plus laser trabeculoplasty or observation
• Treated: 45% progressed at 6 years. Reduced IOP by 25%
• Untreated: 62% progressed at 6 years
82
What are the different neuroradiologic findings in optic nerve glioma versus optic nerve meningioma?
• Optic nerve glioma: fusiform lesion
• Optic nerve meningioma: tram-track lesion; fusiform can also occur. Optic nerve should appear as lucency on imaging
83
What is congenital glaucoma?
• Increased resistance to outflow through trabecular secondary to dysgenesis of neural crest cell derived angle structures
• Males > females
• Bilateral (70%)
• 2% chance of having offspring with disease
• Deep anterior chamber with high, flat anterior iris insertion
• Hypoplastic peripheral iris
84
What are the findings in plateau iris?
• Anteriorly rotated ciliary process
• Anterior chamber deep central, narrow peripheral
• Gonio: narrow angle, indentation shows peripheral hump where iris is draped over anteriorly placed ciliary process
85
What are the types of secondary lens-related open-angle glaucoma and their findings?
• Phacolytic: leakage of high molecular weight lens protein through microscopic openings in capsule of hypermature cataract; wrinkling of capsule; lack KPs or synechiae; pseudohypopyon; lens-engorged macrophages settle in inferior trabecular meshwork
• Phacoantigenic: after surgery or trauma; granulomatous inflammation; sensitized to their own lens protein; KPs; low grade vitrifies, posterior synechiae, PAS, residual lens material
• Lens particle: due to fragments of cortical lens obstructing trabecular meshwork
86
What is the etiology of secondary lens-related closed angle glaucoma?
• Phacomorphic: enlarging, intumescent cataract grows in anterior-posterior dimension → pushes iris forward
87
What are the anterior angle structures (posterior to anterior)?
• Iris
• Ciliary body
• Scleral spur
• Trabecular meshwork
• Schwalbe's line
88
What is the significance of the corneal optical wedge?
• Posterior termination of Descemet membrane and corneal endothelium
89
What is the differential diagnosis for ectopia lentis?
• Marfans
• Weill-Marchesani
• Homocystinuria
• Hyperlysinemia
• Sulfite oxidase deficiency
90
What systemic abnormalities are associated with aniridia?
● WAGR complex: Wilms tumor, aniridia, GU malformations, mental retardation
○ Common in sporadic aniridia (PAX6 mutation; chromosome 11p13)
● Gillespie syndrome: aniridia, cerebellar ataxia, hypotonia, mental deficiency
91
What ocular anomalies are associated with aniridia?
• Cataract
• Corneal pannus
• Foveal hypoplasia
• Limbal stem cell deficiency
• Glaucoma
• Nystagmus
• Optic nerve coloboma
• Optic nerve hypoplasia
• Refractive errors
• Ptosis
92
What fatal conditions are associated with albinism?
• Chediak-Higashi
• Hermansky-Pudlak
93
What is Chediak-Higashi syndrome?
• Autosomal recessive
• Mutation in lysosomal trafficking regulator protein that renders inadequate phagocytosis
• Recurrent pyogenic infection
• Patients rarely survive past 10 years of age, die from infection
94
What is Hermansky-Pudlak syndrome?
● Autosomal recessive
● Associated with:
○ Low platelets
○ Interstitial lung disease
○ Granulomatous colitis
● Common among Swiss or Puerto Rican descent
95
What is the treatment for congenital glaucoma?
• Topical IOP lowering medications until surgery
• Surgery is definitive treatment
• If cornea is clear → goniotomy
• If cornea is cloudy → trabeculotomy
96
What are the clinical findings in pigmentary dispersion syndrome?
• Krukenberg spindle: narrow or round pigment on corneal endothelium. Present in 90% of patients
• Midperipheral transillumination defects of iris → iris with concave contour, rubs against zonules → pigment release. Present in 90% of patients
• Scheie’s line or Zentmayer’s line: pigment on anterior surface along zonule and posterior surface
• Gonioscopy: open angle, trabecular meshwork densely pigments and pigment on Schwalbe’s line (Sampaolesi line)
97
What are the risk factors for pigmentary dispersion syndrome?
• Male
• Age (usually 30’s)
• Myopia
• Concave iris and posterior iris insertion
• Flat corneas
• Family history
98
What is the alcohol content of alcohol wipes?
• 70% isopropyl alcohol
99
What is the site of presumed damage to the optic nerve in glaucoma?
• Lamina cribrosa
100
What is Lowe syndrome?
• Oculocerebrorenal syndrome
• X-linked recessive; mutation of OCRL gene
• Poor visual prognosis
• Bilateral cataracts
• Glaucoma -50% of patients
• Nystagmus
• Keloids -corneal or conjunctival
• Hypotonia
• Fanconi syndrome/chronic renal failure
101
What are the ocular findings in albinism?
• Foveal hypoplasia (poor vision and poor prognosis)
• Nystagmus due to poor vision from foveal hypoplasia
• Over-decussation of optic nerve fiber, 90% fiber decussates to contralateral side (normally 53%)
• Loss of stereopsis due abnormal decussation
• Transillumination defects of iris
• Strabismus
• Photophobia
• Refractive errors
102
What is aniridia?
• Iris hypoplasia, various degrees
Genetic etiology:
• PAX6 mutation; chromosome 11p13
• Autosomal dominant (⅔) or sporadic (⅓)
• Autosomal recessive in 2% -seen with Gillespie syndrome
Management:
• Obtain renal ultrasound in sporadic aniridia to rule out WAGR
103
What is neurofibromatosis type 1?
• Autosomal dominant
• Chromosome 17
• AKA von Recklinghausen disease
• Associated with with cafe au lait spots, iris Lisch nodules (hamartoma), neurofibromas, plexiform neurofibromas (increased risk of glaucoma; described as “bag of worms,” S shaped eyelid), optic nerve gliomas, sphenoid wing dysplasia
104
What is tuberous sclerosis?
• Autosomal dominant
• Mutation of TSC1 (hamartin; more common for retinal lesions) and TSC2 (tuberin)
• Chromosome 9, 16
• AKA Bourneville-Pringle disease
• Triad: facial sebaceous adenomas (angiofibromas), mental deficiency, seizures (intracranial calcified astrocytic hamartomas)
• Other findings, ungual fibromas, hypomelanotic macules, Shagreen patch, multiple retinal hamartomas
105
What is von Hippel-Lindau Disease?
• Autosomal dominant
• Chromosome 3
• Tumor suppressor gene mutation
• AKA cerebello-retinal-angiomatosis
• Associated with retinal capillary hemangioblastomas; angiomatous lesions of CNS; cerebellar hemangioblastoma; pancreatic cysts; renal cell carcinoma; pheochromocytoma
106
What is ataxia telangiectasia?
• Autosomal recessive
• AT gene mutation → DNA damage repair
• Chromosome 11
• AKA Louis Bar syndrome
• Ocular manifestations include conjunctival telangiectasias, nystagmus, oculomotor apraxia, convergence and accommodation abnormalities, strabismus
• Increased risk of cancer and immunodeficiency
107
What are the laser settings for diode cyclophotocoagulation?
• Power: 750 mW to 2000 mW
• Duration: 2 to 4 seconds
• Avoid 3 o’clock and 9 o’clock positions (ciliary nerves)
• 6 spots per quadrant
• Total of 18 spots (recommend 3 quadrants to avoid anterior segment necrosis)
108
What medication has shown to decrease secondary hemorrhage in hyphema patients?
• Aminocaproic acid
109
What is the medical management of traumatic hyphema?
• If sickle cell screen positive: beta blockers and alpha-2 agonists; avoid systemic and topical CAI’s
• If sickle cell screen negative: beta blockers, alpha-2 agonists, and CAI’s (topical and systemic)
110
What are surgical indications for traumatic hyphema?
• If sickle cell screen positive: corneal blood staining; IOP > 25 for 24 hours; recurrent IOP spike > 30
• If sickle cell screen negative: corneal blood staining; IOP > 60 for 48 hours; IOP > 50 x 5 days; IOP > 25 for 6 days, hyphema > 50% after 8 days
111
What are mechanisms of action of Mitomycin C (MMC) and 5-fluorouracil (5-FU)?
• Both are chemotherapeutic agents
• MMC: DNA crosslinker
• 5-FU: inhibits thymidylate synthase, ultimately inhibits DNA synthesis and repair. Cell cycle specific (G1)
