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OPTM 737 > Test 1: Cataracts > Flashcards

Test 1: Cataracts Flashcards

(70 cards)

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1
Q

types of cataract surgery

A

couching
ICCE (intracapsular)
ECCE (extracapsular)

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2
Q

intraocular implants

A

iris fixated
anterior chamber
posterior chamber

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3
Q

iris fixated IOLs

A

can’t dilate
rare now
have to have iridectomy

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4
Q

suture techniques

A

interrupted sutures
continuous
no-stitich - clear corneal incision

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5
Q

incision techniques

A

limbal
scleral tunnel - 1-2 mm into sclera superiorly
self sealing
all done at a shallow tangential angle

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6
Q

anesthesia

A

general or local

local - retrobulbar & peribulbar

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7
Q

retrobulbar anesthesia

A

2% lidocaine short onset
0.75% marcaine long acting
epinephrine

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8
Q

general classification of cataract

A

first appear after ages 30-40 occurring in 90+% of people over age 70
generally progress at varying rates and result in decreased VA
typically classified as: location within the lens and stage of development

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9
Q

major types of cataracts include

A

nuclear
cortical
subcapsular

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10
Q

subdivisions of nuclear

A

early or advanced

brunescent, milky

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11
Q

subdivisions of cortical

A

early or incipient
immature or intumescent
mature
hypermature

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12
Q

subdivisions of sub capsular

A

early
moderate
advanced

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13
Q

nuclear cataract

A

normal lens nucleus hardens and pigments with age
known as nuclear sclerosis and only when advanced will it interfere with VA
color progresses from orange to dark brown
involves fetal nucleus which can appear darker than adult nucleus
can result in lenticular myopia or second sight
refraction become difficult in advanced stages
decreased VA from non-focused rays from above phenomenon
monocular diplopia may also be seen by patient with small nuclear change acting like prism

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14
Q

cortical cataract

A

most common opacity
early stage results in lens swelling and subsequent shallowing of anterior chamber
mature stage results from water and wast products exit the capsule

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15
Q

cortical cataract early stage reveals

A

water clefts - most common location is anterior cortex
lamellar separation - most common location is inferonasal anterior cortex
cuneiform opacity - most characteristic sign
clear vacuoles
senile punctate opacities - may be called snowflake cataract if in large numbers

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16
Q

further degeneration of cortical cataract can lead to

A

hyper mature cataract
shrunken, dry yellow lens
possible capsular folding
can appear as bag of milky fluid

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17
Q

morgagnian cataract

A

type of cortical cataract

brown nucleus which sinks to bottom of liquefied lens

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18
Q

christmas tree cataract

A

type of cortical cataract
formed by cholesterol crystals scattered throughout cortex
myotonic dystrophy

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19
Q

subcapsular cataract

A

chronic NSAIDs use
also known as cumuliform cataract because of its characteristic mature cup shape
typically occurs at earlier age than nuclear or cortical
posterior sub capsular much more common than anterior
consists of thin layer of granules beneath the capsule which may exhibit as small granular opacity
over time will enlarge to form round or irregular plaque
plaque consiste of vacuoles and crystals scattered between irregular granules
remainder of lens is clear outside of plaque
VA is affected greatly if develops in axial location, especially in glare situations

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20
Q

subcapsular cataract symptoms

A

excess glare while driving at night
trouble seeing in bright sunlight
reading difficulties with otherwise good reading lamp

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21
Q

promazine hydrochloride

A

med that can cause cataract

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22
Q

indications for surgery

A 
unhappy with VA (night glare)
phacoanaphylaxis 
phacomorphic glaucoma
phacolytic glaucoma 
dislocation of lens 
amblyopia in young patient 
to provide unobscured access for treatment of eye disease
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23
Q

indications for IOL implantation

A

IOL implantation is considered a routine procedure and si therefore performed in the majority of cases

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24
Q

contraindications for surgery

A 
visual reduction secondary to coexisting condition 
patient satisfied with current VA
poor systemic health 
patient doesn't desire surgery 
surgery won't improve visual function
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25
complications of cataract surgery
post capsular opacification CME posterior capsular rupture endophthalmitis
26
contraindications for IOL implantation
corneal endothelial disease unilateral aphakia with spectacle correction rubeosis irides and/or neovascular glaucoma young patient
27
conditions which require additional evaluation before surgery
``` monocular patients high myopia traumatic cataract Fuch's dystrophy glaucoma history of lattice degeneration or retinal detachment chronic iritis/uveitis ```
28
eligibility for cataract surgery
snellen 20/40 or worse reduction in VA of 2 lines under glare testing 2D of anise have to have a functional complaint
29
pre-surgical care ocular evaluation
``` keratometry potential acuity assessment BAT contrast sensitivity endothelial cell cunt A scan B scan medications patient edu ```
30
pre-surgical medical evaluation
detailed history - cardiovascular, respiratory, hepatic, neuro/musculoskeletal, renal/metabolic, social, misc. physical assessment - cardiovascular, chest/lungs, abdomen, extremities, neurological, mental status
31
pre-surgical lab testing
CBC with differential ECG urinalysis electrolytes
32
post surgical care examination procedures performed at each visit
case history including amount of discomfort and quality of vision VA keratometry refraction biomicroscope - cornea, AC reaction and depth, iris and pupil, intraocular lens, capsule wound - no-stitch surgery, suture type and placement, integrity with Seidel test tonometry posterior pole evaluation, vitreous, ONH, macula, surrounding retina
33
schedule of visits
``` one day one week (evaluate fellow eye at 1 week) 3-6 weeks 2 months three months six months 12 months ```
34
medications
``` topical corticosteroids topical borad spectrum antibiotics combo steroid/antibiotic anti glaucoma meds lubricants ```
35
patient instructions
avoid activities which are associated with risk of trauma or toxic and infectious exposure check vision every day for significant change use meds as directed metal shield at bedtime for 3 days sunglasses and/or glasses for protection avoid lifting heavy objects or bending over for long periods
36
suture removal
the amount of post-op suture induced astigmatism is based upon the type of surgery performed larger incisions show higher amounts and no stitch show very little incisions of 3-4 mm show ~1-2D of refractive astigmatism, 5-8 mm usually 2-3 D this, of course is based on the surgeon and how tight the suture is tied
37
interrupted sutures
can be removed as soon as 1 week post-op remove suture in steep K meridian if refraction shows -2.00 -4.00 x 010 remove the suture at axis 100
38
continuous sutures
should not be removed for ~6 weeks post op technique consists of cutting the suture nearest the inferior insertion into the eye forceps are used to grab long free end of suture and gently pull the suture through
39
refractive cataract surgery
used in cases of preexisting or induced high corneal astigmatism can be performed as an adjunct technique at the time of surgery or post op behind the slit lamp one or two corneal incisions are made along the limbus at the steepest corneal meridian no stitch scleral incision made at the steepest corneal meridian
40
posterior capsulotomy
initial complaint of clouding or film decreasing VA posterior capsule reveals significant haze typically performed with nd YAG laser photo disruptive laser designed to disrupt or separate tissue opening usually 3-4 mm and is usually performed 6-8 weeks post-op
41
surgical eligibility for posterior capsulotomy
patient has decreased ability to carry out activities of DL including but not limited to reading, TV, etc. pt has BCVA in which glare testing decreases VA by 2 lines pt has determined that he or she is no longer able to function adequately with the current level of visual function other eye diseases have been excluded as the primary cause of visual functional disability, except for instance in which significant visual debility physician concurrence with significant pt defined improvement in visual function an be expected as a result of surgery pt has been edu on risks and benefits
42
eyelid complications
bruising ptosis edema and erythema
43
conjunctiva complications
subconjunctival hemorrhage chemosis localized GPC
44
cornea complications
astigmatism edema bulls keratopathy descemet's membrane detachment
45
anterior chamber complications
``` hypopyon hyphema shallow chamber wound leak epithelial downgrowth increased IOP ```
46
iris complications
iritis | iris prolapse into wound
47
pupil complications
pupillary distortion (peaked pupil) pupillary capture atonic pupil
48
lens, capsule, and IOL complications
``` torn posterior capsule retained cortex posterior capsule opacification anterior capsular contraction dislocated IOL ```
49
complications involving anterior chamber lenses
``` UGH syndrome partial or total erosion through angle anterior synechia dislocation pupillary capture reverse pupillary block ```
50
contraindications of anterior chamber IOL's include
chronic open angle glaucoma extensive peripheral anterior synechia recurrent uveitis low endothelial cell count
51
complications involving posterior chamber lenses
``` malposition of IOL - sunset syndrome, sunrise syndrome, horizontal decantation, windshield wiper syndrome pupil capture posterior synechiae posterior chafing syndrome erosion of ciliary body loop perforation through peripheral iridectomy posterior capsular opacification vitreous retina and choroid ```
52
sunset syndrome
optic displaced toward 6:00 can be caused by inferior haptic in sulcus and superior haptic in capsular bag disturbs patient from aphakic/pseudophakic correction minor displacements corrected with pilo surgical intervention may be necessary
53
sunrise syndrome
optic displaced toward 12:00 can be caused by superior haptic in sulcus and inferior haptic in capsular bag disturbs patient from aphakic/pseudophakic correction minor displacements corrected with pilo surgical intervention may be necessary
54
horizontal decentration
optic displaced horizontally can be caused by one haptic in sulcus and another haptic in capsular bag disturbs patient from aphakic/pseudophakic correction minor displacements corrected with pilo surgical intervention may be necessary
55
windshield wiper syndrome
implant too small and not placed within capsular bag most common in myopic eyes found out common with sulcus-fixated lenses placed in a vertical position superior loop rotates to the left and right head movement
56
pupil capture
lens falls forward and iris closes around lens creates irregular pupil may cause inflammation may have to be repaired by dilating pupil and pushing lens posteriors long standing pupillary capture does not require treatment all sulcus lenses
57
posterior synechiae
results from chronic inflammation | related to the following: IOL equator with pigment epithelium of iris, IOL with pigment epithelium of iris
58
posterior chafing syndrome
can occur in two forms first form reveals iris transillumination defects and microhyphemas and is characterized by the following: associated with intermittent blurring known as white out attacks, typically occurs in sulcus-fixated lenses which liberates WBCs second form caused by pigment dispersion resulting in glaucoma
59
erosion of ciliary body
seen in ciliary sulcus supported IOLs erosion and perforation can be seen through the ciliary body haptic can also erode through pars plicata, muscular
60
loop perforation through peripheral iridectomy
seen in sulcus-fixated lenses | may need surgical repair
61
posterior capsular opacification
misnomer since opacification occurs secondary to lens epithelial cells that cover capsule collagen production of lens epithelial cells results in white fibrotic opacification lens epi cells migrate from anterior capsule to posterior capsule lens epi cells can form dense clusters known as Elschnig's pearls opacification and Elschnig's pearls best seen through retro illumination opacification advancement occurs more rapidly in younger patients treatment consists of a YAG laser capsulotomy which opens the capsule
62
vitreous
vitreal hemorrhage vitreal attachment to wound vitreal touch
63
retina and choroid
choroidal detachment retinal detachment cystoid macular edema
64
medications that causes anterior capsule cataracts
amiodarone mercury, gold, silver phenothiazines
65
medications that cause anterior sub capsular cataracts
allopurinol | miotics
66
medications that cause cortical cataracts
hydrocarbons
67
medications that cause posterior subcapsular cataracts
corticosteroids systemic antimetabolites or chemotherapy hydroxychloroquine
68
conditions associated with nuclear sclerotic cataracts
acquired: drugs, radiation, trauma age related: yes congenital/genetic: down's syndrome, norris disease, X-linked ichthyosis inflammatory or vascular: ocular ischemia intraocular diseases: angle closure glaucoma, chronic uveitis, high myopia, pseudoexfoliation, stickler syndrome metabolic: chronic malnutrition or dehydration, diabetes mellitus
69
conditions associated with cortical cataracts
acquired: chemical injury, siderosis, trauma age related: yes congenital/genetic: alport syndrome, down's syndrome, lowe syndrome, myotonic dystrophy, osteogenesis imperfecta inflammatory or vascular: eczema or atopic dermatitis intraocular diseases: angle closure glaucoma, chronic uveitis, fuch's heterochromic iridocyclitis, high myopia, stickler syndrome metabolic: diabetes mellitus, galactosemia, hypocalcemia, pseudohypoparathyroidism, wilson's disease or chalcosis radiation: infrared or thermal, ionizing
70
conditions associated with subcapsular cataracts
acquired: electric shock, trauma, vitreoretinal surgery age related: yes congenital/genetic: fabry's disease, hyperornithinermia or gyrate atrophy, myotonic dystrophy, refsum's disease, RP or Usher's disease, werner's syndrome inflammatory or vascular: ocular ischemia intraocular diseases: aniridia, chronic uveitis, high myopia, iridocorneal endothelial syndromes, persistent hyperplastic primary vitreous, peter's anomaly metabolic: diabetes mellitus, mannosidosis, neonatal hypoglycemia radiation: ionizing, ultraviolet neoplastic: neurofibromatosis type II, retinoblastoma, uveal melanoma

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