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Lasers_Final Flashcards

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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
What is the differential diagnosis for hypotony?
Anterior Uveitis | Retinal Detachment
26
What are some signs for acute corneal edema?
Blurry Vision FBS Possible Pain
27
what are some signs for acute corneal edema?
Epithelial Microcysts or bullae Stromal edema and thickening Folds in Descemet's membrane.
28
What do you do if you notice the presence of endocapsular hematoma during a hyphema?
Nd:YAG capsulotomy is required.
29
What do you need to rule out for an anterior uveitis occurrence?
Infection. | If disproportionate inflammation; you need to suspect endophthalmitis.
30
What is an IOL decentration/pupillary capture?
IOL is not symmetrically located within the pupil yet maintains most of tissue support.
31
How do you evaluate an IOL lens decentration/pupillary capture?
Examine with and w/o dilation. Don't dilate an iris-fixated IOL.
32
What gives you an increase risk of Retinal detachment for a choroidal detachment?
Kissing choroidals | Need to immetiately consult with the operating surgeon.
33
What is another name for thermal effect?
Photocoagulation
34
Describe the characteristics of thermal effect?
Denaturation of proteins Coagulation of blood (no bleeding) Moderate inflammation --> Creates scarring and adhesion
35
What is another name for photodisruptive effect?
Wave-acoustic Shock
36
Describe the characteristics of photodisruptive effect?
Causes tissue to be reduced to plasma Majority of energy is back towards the physician Does not coag the blood thus bleeding possible.
37
Which laser is tissue dependent?
Photocoagulation or Thermal effect
38
Name the two categories for Laser Trabeculoplasty?
Argon Laser Trabeculoplasty. | Selective Laser Trabeculoplasty.
39
Which of the two Laser Trabeculoplasty methods have a better success rate?
SLT
40
Describe ALT?
Burn and contract | Scarring of the TM leads to mech contraction of TM tissue leads to opening up in adjacent tissues.
41
Describe SLT?
Biological activation of inflammatory mediators --> Cleans up the TM Selective for pigmented TM cells, no structural or photocoagulative damage to TM
42
T/F? | Both forms of laser trabeculoplasty leads to an increase of aqueous outflow
True
43
When do you utilize Argon laser peripheral iridoplasty?
To treat plateau iris syndrome. | To open up the angle for ALT/SLT
44
How do you diagnose Plateau iris syndrome?
When LPI fails. | A residual angle closure results.
45
Who's at risk for plateau iris syndrome?
20-50 y.o caucasian females.
46
What characteristics is needed for plateau iris syndrome?
Narrow angles Deep AC Flat iris
47
MOA for ALPI?
Scars peripheral iris causing it to shrink and pull away/out of the angle 20-25 burns in a circular fashion around peripheral iris
48
Which of the Nd:YAG requires pigment?
Nd:YAG 532nm (green) Nd:YAG SLT Thus it is a thermal effect
49
Which of the Nd:YAG does not require pigment?
Nd:YAG 1064 nm (infrared)
50
What is the Laser:Power density formula?
W/cm^2 | J/s divided by cm^2
51
What is energy (J)
The number of photons
52
What is Power (W)
The transfer of a number of photons per second (J/s)
53
What is power density (W/cm^2)?
Transfer of a number of photons per second to a given area
54
What happens to the power density if you have a smaller area (cm^2)
Higher power density
55
What happens to the power density if you have a shorter pulse(s)?
Higher power density
56
What happens to the power density if you have higher energy (J)
Higher power density
57
What is Q-switching?
Extremely brief pulse of the beam. | Remember that with a shorter pulse, you get higher power density.
58
What are the two different types of spot sizes?
Fixed spot size | Adjustable spot size
59
Which laser are you able to virtually adjust anything?
Most photocoagulation Systems 532 nm
60
Which laser are you fixed in?
Photodisruptive Systems 1064nm
61
T/F? | Risk of complications increases proportionately to cumulative energy?
True
62
What is the rule of thumb when dealing with lasers?
Use the lowest energy setting, the least number of shots, and lowest duration possible to accomplish desired effect
63
Where should the focus point be for YAG Capsulotomy?
Just deep to the capsule. | The laser is usually infrared
64
What is the most common complicatons for ANt Seg Laser Energy?
IOP spike | Inflammation
65
What should you treat an IOP spike with
1 drop alphagan pre-op and post-op
66
What should you treat inflammation with?
Pred Forte QID x 1 week. Except for SLT
67
What do you absolutely need for SLT to work?
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
When do you use dilating drops for pre-op?
Only for YAG capsulotomy
69
When do you use Pilocarpine 1%
ALPI | Optional for SLT/ALT: to help see TM. LPI: stretches the iris, making it thinner and easier to treat.
70
List some procedures you can do with Nd:YAG 1064 nm
YAG capsulotomy YAG iridotomy this is pigment independent
71
List some procedures you can do with argon or frequency doubled Nd:YAG 532nm
``` Argon Iridotomy ALT ALPI Corneal suture lysis (this is pigment dependent) ```
72
List some procedures you can do with Frequency doubled YAG 532 nm
SLT | (this is pigment dependent
73
Describe some key features for Nd: YAG 1064nm
Spot size fixed Duration of burn fixed Energy Variable.
74
What is the energy for an ALT procedure?
600 mW
75
What is the energy for SLT?
0.6 to 0.8mJ
76
What is the diff b/w SLT vs ALT?
``` 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
What is the thermal relaxation time of melanin?
1 microsec.
78
Describe ALPI
Long pulse duration: 0.5 sec Large spot size: 500 microns Low energy 200mW We do not desire to make a hole.
79
List some postoperative care of intermediate to late complications
``` Ptosis Diplopia Oc HTN/Glaucoma Chronic corneal edema/Corneal decompensation Late Hyphema Chronic ANt Uveitis Posterior Capsular Opacity Pseudophakic Cystoid Macular Edema. ```
80
What are some causes of postoperative care of intermediate to late complications: glacuoma/HTN?
Steroids IOL irritation Synechial angle closure
81
What is Uveitis-Glaucoma-Hyphema syndrome?
Classic presentation of IOL irritation. | Hyphema + AC inflammation = obstruction of TM with inflammatory and hemorrhagic debris which leads to IOP elevation.
82
Which IOL poses the greatest risk for Synechial angle closure?
AC-IOL poses the greatest risk. | If do gonio--> May reveal "Cocconing"
83
How do u trt inflammation from synechial angle closure?
topical steroids
84
How do u trt IOP elevation from synechial angle closure?
aqueous suppressants.
85
What is white out syndrome?
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
Trt for late hyphema?
Low concentration miotics may stabilize pupillary motion but may increase inflammation.
87
What do u suspect with a chornic anterior uveitis?
Endopthalmitis
88
Posterior Capsular Opacity
One of the most common sequelae of cataract sx.
89
Trt of pseudophakic CME?
NSAIDs Steroids Injections
90
What is one of the most common causes of vision loss in pts with Diabetes?
Diabetic macular edema
91
Define microangiopathy?
Damage to the retinal capillaries.
92
What does mild NPDR have only?
Microaneurysms
93
What does severe NPDR have?
Intraretinal hem Venous beading IRMA
94
How do you systemically trt DR?
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
How do you trt DR ocularly?
PRP | Pan-retinal photocoag.
96
Purpose of PRP?
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
When do you consider PRP?
Severe NPDR and | PDR
98
What is the definition of Diabetic macular edema?
Retinal thickening within 2DD of the fovea.
99
T/F? | DME can occur at any stage?
True
100
When is trt recommoned for diabetic mac edema?
When it is SCME
101
What is treatment of diabetic macular edema?
Focal/Grid photocoagulation
102
What is focal photocoagulation?
Direct ablation of microaneurysms to areas of thickening Reduces the risk of mod visual loss by 50% Benefit is indep of initial VA
103
How long must pass before considering additional trt for CSME?
3-6 months.
104
When do u consider PRP for CSME?
When concurrent PDR or severe NPDR exist.
105
What may happen if you zap to close to fovea with focal photocoag?
Initial decrease in VA Paracentral scotoma Permanent central scotoma
106
Name some adjunct therapy for Diabetic Macular edema?
Anti-VEGF therapies Intravitreal Steroids COmbo therapy: macular laser + pharmacotherapy.
107
Name the four types of RD?
Rhegmatogenous Exudative Tractional Tractional-Rhegmatogenous
108
What are the three pre-reqs for RRD?
1. Liquefaction of the vitreous 2. Tractional forces that produce a retinal break 3. RB through which fluid gains into subret space
109
What are some risk factors for RRD?
``` High myopia Cataract Sx Lattice Degen (big time) Ocular infections Glaucoma ```
110
What is the most imp periph retinal degeneration that predisposes to RRD?
Lattice Degen
111
List some peripheral retinal degenerations that are at high risk for developing an RD?
LD Retinoschisis Cystic Retinal Tuft Zonular Traction Tuft
112
When would u consider prophylactic trt for LD?
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
what do u do w/ a pt with retinoschisis?
Monitor periodically | Pt education to RTC STAT if s/sx occur
114
Do u recommend prophylact trt for a pt with cystic retinal tuft?
Nope. | The risk is low.
115
Refer to page 10 for prophlyactic trt for RRD
Yes ma'am
116
What is the one thing u must pick up when suspect RRD?
Retinal break. | May not always be detectable tho.
117
What is the trt of RRD?
Surgical Requires closure of RB Nead to close then seal hole
118
What is closing and sealing hole
Closing: apposition of Retina & underlyine RPE Sealing: Creation of permanent adhesion b/w retina and underlying tissue.
119
Trt options for RRD?
Scleral buckle Tamponade Cryotherapy laser
120
Tamponade gas
BLocks retinal hole by surface tension | Prevents fluid flow
121
What is Cryotherapy/laser
Creates tissue injury | -Chorioretinal adhesion 5-10 days later.
122
What are the signs of PVD?
Light flashes | Floaters
123
T/F | Retinal tears and detachment are always found in pts who have PVD w/o VH?
False
124
T/F? | Retinal tears and detachments are found in 2/3 of pts who have PVD w/ VH
True | Up to 50% of those patients have more than one tear.
125
What are the symptoms for PVD?
Flashes/FLoaters
126
What are the symptoms for RD?
VF loss | Decreased VA
127
Tobacca dust can be found in patients with RD?
True
128
Advantages for Scleral buckling?
SRF drainage is not necessary | Eliminates vitreous traction
129
Contraindications for Scleral Buckling?
Media opacities (diff to localize all RBs) Giant retinal tears Posterior tears Multiple tears in diff meridians
130
What is the most imp thing during scleral buckling?
Isolation of rectus muscles.
131
Post op disadvantages of scleral buckling?
``` Prolonged recoverty time Pain Increased myopia Floaters Ocular motility disorders - most common, but temporary ```
132
What is the most common cause of failurs for Sceral buckling?
Proliferative Vitreoretinopathy
133
How do you prevent proliefrative Viteroretinopathy?
5-FU | LMWH
134
Trt of PVR
1. Closure of all retinal breaks 2. Counteraction of traction 3. Minimizing the recurrence traction
135
Pars Plana Vitrectomy
1. Instruments introduced into the eye through the pars plana Removal of vitreous gel from t he eye.
136
Advantage of Pars Plana Vitrectomy
Ability to visualize all RBs | Removal of opacities and synechiae
137
Disad of Pars Plana Vitrectomy
Avoidance of flying Extended recovery time. Need for post-op positioning
138
What is the most common cause of failure for Pars Plana vitrectomy?
Missed RBs
139
What is pneumatic retinopexy?
INjection of an expansile gas into the vitreous cavity. Closes RBs. SRF is absorbed Chorioretinal adhesion.
140
When is pneumatic retinopexy most appropriate?
superior breaks in one quadrant.
141
Contraindic for Pneumatic reinopexy?
Inferior RBs PVR Lattice Media opacities
142
Advantages for Pneumatic retinopexy?
Minimally invasive procedure | Reduced Post-op Morbidity
143
Disadv for Pneumatic Retinopexy?
Post-op positioning Close follow up Avoidance of air travel.
144
T/F? | Traction is not released during Pneumatic Retinopexy
True | Thus New RBs can form and original RB can reopen
145
Post Op care for Pneumatic retinopexy?
Topical antibiotics Anti-inflammatory drops Cycloplegia
146
T/F? | Macular holes can spontaneously close on its own?
True
147
What is the main goal for vitrectomy?
Make room for a large bubble gas. | Release any tangential resistance to closure of MH
148
What is the most common intra-operative complication for Vitrectomy?
Iatrogenic RB
149
What is the most serious post op complication for vitrectomy?
RD
150
What is the most common complication for vitrectomy?
Cataracts
151
T/F? there is no trt available for dry AMD
True | Can take vitamin supplements
152
Trt for wet AMD?
Intravitreal injections
153
What is the process for intravitreal drug injection?
``` 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 ```

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