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Lasers_Final Flashcards

1
Q

Disadvantages for Intracapsular Cataract Extraction?

A
  • Requires a very large incision
  • Higher risk of vitreous loss
  • Higher risk of post-op complications
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2
Q

When is the special case for Intracapsular Cataract Extraction

A

Damaged zonules secondary to trauma.

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3
Q

What is the disadvantage for Extracapsular Cataract Extraction by nuclear expression?

A

Larger incision is required

More sutures.

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4
Q

What is the advantage of Extracapsular Cataract Extraction by phacoemulsification?

A

Maintains normal depth of A/C
Smaller incision
Less sutures

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5
Q

What is vital for post op care in Cataract surgery?

A

Wound stability
Restriction of PA
Do not rub eye for 2 weeks.

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6
Q

What drops do you give pt for post op care?

A

Antibiotic/Steroids QID

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7
Q

List the follow up Schedule?

A

1 day follow up
1-2 week follow up
4 week follow up
6 week follow up

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8
Q

When do you start antibiotic therapy?

A

3 days before Sx
Besivance, zymar, vigamox
Use until it runs out.

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9
Q

How to use steroid post op?

A

QID.

Taper after week one.

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10
Q

The types of post-operative coplications

A

Early Emergent
Early Less-Emergent
Intermediate to Late

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11
Q

List the types of Post-Op early emergent complications

A 
Ocular HTN: Closed or open angle mechanism
Wound leak with shallow or flat AC
Endophthalmitis
Iris prolapse or vitreous in the wound
Intraocular lens dislocation
Retinal Breack and Detachment
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12
Q

T/F?

It is safe to use PGA for an Oc HTN case that is open angle

A 
False. 
Use beta blockers
Alpha-agonists
CAIs
May use oral hyperosmotic agent
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13
Q

Define some things that constitute ENdophthalmitis?

A

Microbial invasion of Ant chamber at the time of sx

Microbial invasion of ant chamber through infected leaking wound

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14
Q

Onset for endo for days to weeks?

A

Gram Positive:
Staph Epi
Staph Aur

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15
Q

Onset for endo for 1-4days?

A

Strep species

Gram neg species

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16
Q

Onset for endo for weeks to months?

A

Propionibacterium acnes

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17
Q

When do you suspect endophthalmitis?

A

Suspect in any eye with pronounced inflammation

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18
Q

T/F?

Endophthalmitis is not a true ocular emergency

A

False
Can progress rapidly.
Inform the surgeon immediately
It is a true ocular emergency

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19
Q

What is the most common intraocular lens dislocation?

A

Sunset Syndrome: Inferior dislocation

Need to do retro son!!!

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20
Q

What is an increased risk for RB and Detachment?

A

Intraoperative capsular bag rupture –> Bitreous prolapse and loss
ICCE

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21
Q

T/F?

Retinal break and Detach is considered an ocular emergency?

A

True

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22
Q

List the types of Post-Op early Less emergent complications

A

Ptosis
Diplopia
Wound leak with well formed AC (normal configuration)
Acute Corneal Edema
Hyphema
Anterior Uveitis
Intraocular lens decentration/pupillary capture

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23
Q

What is the most common post-op early less emergent complication?

A

Ptosis

Happens within a few weeks.

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24
Q

What are some of the reasons that ptosis occurs?

A

Prolonged akinesia
Patching
Trauma from lid speculum
Myotoxicity

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25
Q

What is the differential diagnosis for hypotony?

A

Anterior Uveitis

Retinal Detachment

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26
Q

What are some signs for acute corneal edema?

A

Blurry Vision
FBS
Possible Pain

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27
Q

what are some signs for acute corneal edema?

A

Epithelial Microcysts or bullae
Stromal edema and thickening
Folds in Descemet’s membrane.

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28
Q

What do you do if you notice the presence of endocapsular hematoma during a hyphema?

A

Nd:YAG capsulotomy is required.

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29
Q

What do you need to rule out for an anterior uveitis occurrence?

A

Infection.

If disproportionate inflammation; you need to suspect endophthalmitis.

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30
Q

What is an IOL decentration/pupillary capture?

A

IOL is not symmetrically located within the pupil yet maintains most of tissue support.

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31
Q

How do you evaluate an IOL lens decentration/pupillary capture?

A

Examine with and w/o dilation. Don’t dilate an iris-fixated IOL.

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32
Q

What gives you an increase risk of Retinal detachment for a choroidal detachment?

A

Kissing choroidals

Need to immetiately consult with the operating surgeon.

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33
Q

What is another name for thermal effect?

A

Photocoagulation

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34
Q

Describe the characteristics of thermal effect?

A

Denaturation of proteins
Coagulation of blood (no bleeding)
Moderate inflammation –> Creates scarring and adhesion

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35
Q

What is another name for photodisruptive effect?

A

Wave-acoustic Shock

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36
Q

Describe the characteristics of photodisruptive effect?

A

Causes tissue to be reduced to plasma
Majority of energy is back towards the physician
Does not coag the blood thus bleeding possible.

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37
Q

Which laser is tissue dependent?

A

Photocoagulation or Thermal effect

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38
Q

Name the two categories for Laser Trabeculoplasty?

A

Argon Laser Trabeculoplasty.

Selective Laser Trabeculoplasty.

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39
Q

Which of the two Laser Trabeculoplasty methods have a better success rate?

A

SLT

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40
Q

Describe ALT?

A

Burn and contract

Scarring of the TM leads to mech contraction of TM tissue leads to opening up in adjacent tissues.

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41
Q

Describe SLT?

A

Biological activation of inflammatory mediators –> Cleans up the TM
Selective for pigmented TM cells, no structural or photocoagulative damage to TM

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42
Q

T/F?

Both forms of laser trabeculoplasty leads to an increase of aqueous outflow

A

True

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43
Q

When do you utilize Argon laser peripheral iridoplasty?

A

To treat plateau iris syndrome.

To open up the angle for ALT/SLT

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44
Q

How do you diagnose Plateau iris syndrome?

A

When LPI fails.

A residual angle closure results.

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45
Q

Who’s at risk for plateau iris syndrome?

A

20-50 y.o caucasian females.

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46
Q

What characteristics is needed for plateau iris syndrome?

A

Narrow angles
Deep AC
Flat iris

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47
Q

MOA for ALPI?

A

Scars peripheral iris causing it to shrink and pull away/out of the angle
20-25 burns in a circular fashion around peripheral iris

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48
Q

Which of the Nd:YAG requires pigment?

A

Nd:YAG 532nm (green)
Nd:YAG SLT
Thus it is a thermal effect

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49
Q

Which of the Nd:YAG does not require pigment?

A

Nd:YAG 1064 nm (infrared)

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50
Q

What is the Laser:Power density formula?

A

W/cm^2

J/s divided by cm^2

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51
Q

What is energy (J)

A

The number of photons

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52
Q

What is Power (W)

A

The transfer of a number of photons per second (J/s)

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53
Q

What is power density (W/cm^2)?

A

Transfer of a number of photons per second to a given area

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54
Q

What happens to the power density if you have a smaller area (cm^2)

A

Higher power density

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55
Q

What happens to the power density if you have a shorter pulse(s)?

A

Higher power density

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56
Q

What happens to the power density if you have higher energy (J)

A

Higher power density

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57
Q

What is Q-switching?

A

Extremely brief pulse of the beam.

Remember that with a shorter pulse, you get higher power density.

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58
Q

What are the two different types of spot sizes?

A

Fixed spot size

Adjustable spot size

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59
Q

Which laser are you able to virtually adjust anything?

A

Most photocoagulation Systems 532 nm

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60
Q

Which laser are you fixed in?

A

Photodisruptive Systems 1064nm

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61
Q

T/F?

Risk of complications increases proportionately to cumulative energy?

A

True

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62
Q

What is the rule of thumb when dealing with lasers?

A

Use the lowest energy setting, the least number of shots, and lowest duration possible to accomplish desired effect

63
Q

Where should the focus point be for YAG Capsulotomy?

A

Just deep to the capsule.

The laser is usually infrared

64
Q

What is the most common complicatons for ANt Seg Laser Energy?

A

IOP spike

Inflammation

65
Q

What should you treat an IOP spike with

A

1 drop alphagan pre-op and post-op

66
Q

What should you treat inflammation with?

A

Pred Forte QID x 1 week. Except for SLT

67
Q

What do you absolutely need for SLT to work?

A

Inflammation
THus don’t use a steroid. Use steroid, Nsaids or meds with caution. It is better to use a NSAID instead of str8 up steroid.

68
Q

When do you use dilating drops for pre-op?

A

Only for YAG capsulotomy

69
Q

When do you use Pilocarpine 1%

A

ALPI

Optional for SLT/ALT: to help see TM. LPI: stretches the iris, making it thinner and easier to treat.

70
Q

List some procedures you can do with Nd:YAG 1064 nm

A

YAG capsulotomy
YAG iridotomy
this is pigment independent

71
Q

List some procedures you can do with argon or frequency doubled Nd:YAG 532nm

A 
Argon Iridotomy
ALT
ALPI
Corneal suture lysis
(this is pigment dependent)
72
Q

List some procedures you can do with Frequency doubled YAG 532 nm

A

SLT

(this is pigment dependent

73
Q

Describe some key features for Nd: YAG 1064nm

A

Spot size fixed
Duration of burn fixed
Energy Variable.

74
Q

What is the energy for an ALT procedure?

A

600 mW

75
Q

What is the energy for SLT?

A

0.6 to 0.8mJ

76
Q

What is the diff b/w SLT vs ALT?

A 
Both use 532nm
SLT uses a Q-switched system.
Shorter pulse duration:
3 nanosec for SLT. ALT is 0.1 sec
Spot Sizes: ALT = 50 microns. SLT = 400 microns.
77
Q

What is the thermal relaxation time of melanin?

A

1 microsec.

78
Q

Describe ALPI

A

Long pulse duration: 0.5 sec
Large spot size: 500 microns
Low energy 200mW
We do not desire to make a hole.

79
Q

List some postoperative care of intermediate to late complications

A 
Ptosis
Diplopia
Oc HTN/Glaucoma
Chronic corneal edema/Corneal decompensation
Late Hyphema
Chronic ANt Uveitis
Posterior Capsular Opacity
Pseudophakic Cystoid Macular Edema.
80
Q

What are some causes of postoperative care of intermediate to late complications: glacuoma/HTN?

A

Steroids
IOL irritation
Synechial angle closure

81
Q

What is Uveitis-Glaucoma-Hyphema syndrome?

A

Classic presentation of IOL irritation.

Hyphema + AC inflammation = obstruction of TM with inflammatory and hemorrhagic debris which leads to IOP elevation.

82
Q

Which IOL poses the greatest risk for Synechial angle closure?

A

AC-IOL poses the greatest risk.

If do gonio–> May reveal “Cocconing”

83
Q

How do u trt inflammation from synechial angle closure?

A

topical steroids

84
Q

How do u trt IOP elevation from synechial angle closure?

A

aqueous suppressants.

85
Q

What is white out syndrome?

A

Associated with Late hyphema.
Pt experiences episodes of white-outs that may last from hours to days.
Caused by RBCs being released into the AC.

86
Q

Trt for late hyphema?

A

Low concentration miotics may stabilize pupillary motion but may increase inflammation.

87
Q

What do u suspect with a chornic anterior uveitis?

A

Endopthalmitis

88
Q

Posterior Capsular Opacity

A

One of the most common sequelae of cataract sx.

89
Q

Trt of pseudophakic CME?

A

NSAIDs
Steroids
Injections

90
Q

What is one of the most common causes of vision loss in pts with Diabetes?

A

Diabetic macular edema

91
Q

Define microangiopathy?

A

Damage to the retinal capillaries.

92
Q

What does mild NPDR have only?

A

Microaneurysms

93
Q

What does severe NPDR have?

A

Intraretinal hem
Venous beading
IRMA

94
Q

How do you systemically trt DR?

A

Hemoglobin A1C to less than 6@
BP to less than 130/80
Total cholesterol to less than 240 mg/dl and TG to less than 200 mg/dl

95
Q

How do you trt DR ocularly?

A

PRP

Pan-retinal photocoag.

96
Q

Purpose of PRP?

A

Improved oxygen supply to previously deprived cells due to decreased number of cells in the areas of burns.
Less viable hypoxic cells producing VEGF
Regression of Neo

97
Q

When do you consider PRP?

A

Severe NPDR and

PDR

98
Q

What is the definition of Diabetic macular edema?

A

Retinal thickening within 2DD of the fovea.

99
Q

T/F?

DME can occur at any stage?

A

True

100
Q

When is trt recommoned for diabetic mac edema?

A

When it is SCME

101
Q

What is treatment of diabetic macular edema?

A

Focal/Grid photocoagulation

102
Q

What is focal photocoagulation?

A

Direct ablation of microaneurysms to areas of thickening
Reduces the risk of mod visual loss by 50%
Benefit is indep of initial VA

103
Q

How long must pass before considering additional trt for CSME?

A

3-6 months.

104
Q

When do u consider PRP for CSME?

A

When concurrent PDR or severe NPDR exist.

105
Q

What may happen if you zap to close to fovea with focal photocoag?

A

Initial decrease in VA
Paracentral scotoma
Permanent central scotoma

106
Q

Name some adjunct therapy for Diabetic Macular edema?

A

Anti-VEGF therapies
Intravitreal Steroids
COmbo therapy: macular laser + pharmacotherapy.

107
Q

Name the four types of RD?

A

Rhegmatogenous
Exudative
Tractional
Tractional-Rhegmatogenous

108
Q

What are the three pre-reqs for RRD?

A
  1. Liquefaction of the vitreous
  2. Tractional forces that produce a retinal break
  3. RB through which fluid gains into subret space
109
Q

What are some risk factors for RRD?

A 
High myopia
Cataract Sx
Lattice Degen (big time)
Ocular infections
Glaucoma
110
Q

What is the most imp periph retinal degeneration that predisposes to RRD?

A

Lattice Degen

111
Q

List some peripheral retinal degenerations that are at high risk for developing an RD?

A

LD
Retinoschisis
Cystic Retinal Tuft
Zonular Traction Tuft

112
Q

When would u consider prophylactic trt for LD?

A

If H/O RRD in the fellow eye
If pt does not have or has minimal access to ophthalmic care
If pt might have difficulty recognizing sx of PVD.

113
Q

what do u do w/ a pt with retinoschisis?

A

Monitor periodically

Pt education to RTC STAT if s/sx occur

114
Q

Do u recommend prophylact trt for a pt with cystic retinal tuft?

A

Nope.

The risk is low.

115
Q

Refer to page 10 for prophlyactic trt for RRD

A

Yes ma’am

116
Q

What is the one thing u must pick up when suspect RRD?

A

Retinal break.

May not always be detectable tho.

117
Q

What is the trt of RRD?

A

Surgical
Requires closure of RB
Nead to close then seal hole

118
Q

What is closing and sealing hole

A

Closing: apposition of Retina & underlyine RPE
Sealing: Creation of permanent adhesion b/w retina and underlying tissue.

119
Q

Trt options for RRD?

A

Scleral buckle
Tamponade
Cryotherapy laser

120
Q

Tamponade gas

A

BLocks retinal hole by surface tension

Prevents fluid flow

121
Q

What is Cryotherapy/laser

A

Creates tissue injury

-Chorioretinal adhesion 5-10 days later.

122
Q

What are the signs of PVD?

A

Light flashes

Floaters

123
Q

T/F

Retinal tears and detachment are always found in pts who have PVD w/o VH?

A

False

124
Q

T/F?

Retinal tears and detachments are found in 2/3 of pts who have PVD w/ VH

A

True

Up to 50% of those patients have more than one tear.

125
Q

What are the symptoms for PVD?

A

Flashes/FLoaters

126
Q

What are the symptoms for RD?

A

VF loss

Decreased VA

127
Q

Tobacca dust can be found in patients with RD?

A

True

128
Q

Advantages for Scleral buckling?

A

SRF drainage is not necessary

Eliminates vitreous traction

129
Q

Contraindications for Scleral Buckling?

A

Media opacities (diff to localize all RBs)
Giant retinal tears
Posterior tears
Multiple tears in diff meridians

130
Q

What is the most imp thing during scleral buckling?

A

Isolation of rectus muscles.

131
Q

Post op disadvantages of scleral buckling?

A 
Prolonged recoverty time
Pain
Increased myopia
Floaters
Ocular motility disorders - most common, but temporary
132
Q

What is the most common cause of failurs for Sceral buckling?

A

Proliferative Vitreoretinopathy

133
Q

How do you prevent proliefrative Viteroretinopathy?

A

5-FU

LMWH

134
Q

Trt of PVR

A
  1. Closure of all retinal breaks
  2. Counteraction of traction
  3. Minimizing the recurrence traction
135
Q

Pars Plana Vitrectomy

A
  1. Instruments introduced into the eye through the pars plana
    Removal of vitreous gel from t he eye.
136
Q

Advantage of Pars Plana Vitrectomy

A

Ability to visualize all RBs

Removal of opacities and synechiae

137
Q

Disad of Pars Plana Vitrectomy

A

Avoidance of flying
Extended recovery time.
Need for post-op positioning

138
Q

What is the most common cause of failure for Pars Plana vitrectomy?

A

Missed RBs

139
Q

What is pneumatic retinopexy?

A

INjection of an expansile gas into the vitreous cavity.
Closes RBs.
SRF is absorbed
Chorioretinal adhesion.

140
Q

When is pneumatic retinopexy most appropriate?

A

superior breaks in one quadrant.

141
Q

Contraindic for Pneumatic reinopexy?

A

Inferior RBs
PVR
Lattice
Media opacities

142
Q

Advantages for Pneumatic retinopexy?

A

Minimally invasive procedure

Reduced Post-op Morbidity

143
Q

Disadv for Pneumatic Retinopexy?

A

Post-op positioning
Close follow up
Avoidance of air travel.

144
Q

T/F?

Traction is not released during Pneumatic Retinopexy

A

True

Thus New RBs can form and original RB can reopen

145
Q

Post Op care for Pneumatic retinopexy?

A

Topical antibiotics
Anti-inflammatory drops
Cycloplegia

146
Q

T/F?

Macular holes can spontaneously close on its own?

A

True

147
Q

What is the main goal for vitrectomy?

A

Make room for a large bubble gas.

Release any tangential resistance to closure of MH

148
Q

What is the most common intra-operative complication for Vitrectomy?

A

Iatrogenic RB

149
Q

What is the most serious post op complication for vitrectomy?

A

RD

150
Q

What is the most common complication for vitrectomy?

A

Cataracts

151
Q

T/F? there is no trt available for dry AMD

A

True

Can take vitamin supplements

152
Q

Trt for wet AMD?

A

Intravitreal injections

153
Q

What is the process for intravitreal drug injection?

A 
Anesthesia
Antiseptic
Keep eyelashes away from injection site
Mark pars plana
Injection through the marked site into the mid vitreous cavity
Remove needle
Injection site tamponade

lasers (1 decks)

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