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3F: Surgery Final > YAG Cap > Flashcards

YAG Cap Flashcards

(53 cards)

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1
Q

Capsule

A 
Elastic membrane 
Barrier
Permeable 
Reproducing 
-basal membrane of lens epithelium-anterior 
-basal membrane of elongating fiber cells-posteriorly 
Thickness 
-thickest near the equator 
-thinnest at post capsular poles
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2
Q

Lens

A

Surrounded by a capsule

  • anteiror
  • posterior
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3
Q

Surgery on lens

A

Anterior=capsulorhexis
Posterior=remains in tact to hold the IOL implant
-posterior capsular opacification. Growth and proliferation of lens epithelial cells from original cataract migrate on lens capsule

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4
Q

Anterior capsular opacification

A

Anterior capsular opacification

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5
Q

Posterior form of capsular opacification

A

Fibrosis
Proliferation
Linear
mixed

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6
Q

Anterior capsular opacification and anteiror capsule contracture syndrome

A
  • starts by the 1st post op month-6 months
  • occurs at the continuous capsulorhexis (CCC)
  • complications: decenter IOL-multifocal IOL, MUST maintain good centration, lens title induced astigmatism
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7
Q

Incidence of anteiror capsular opacification nand antihero capsule contracture syndrome

A

Lens materials

  • highest with silicone IOL with sharp optic edges and plate haptic silicone design
  • lowest: acrylic IOL
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8
Q

Disease and anteiror capsular opacification and anteiror capsule contracture syndrome

A

RP ad DM

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9
Q

Soemmering’s ring

A

Looks like anteiror capsular opacification but ONLY OCCURS in APHAKIA

Results of anterior capsule edges attachment to the posterior capsule

  • absence of IOL
  • congential aphakia
  • Lowe syndrome and hallerman-Streiff Francois syndrome
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10
Q

Fibrosis form of capsular opacification

A
  • anterior epithelial cells form spindle shaped fibroblasts-migrate to PC
  • appearance: white opacities, fine folds, wrinkles
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11
Q

Proliferation (pearl form) O.D. opacification

A
  • pre-equatorial zone lens epithelial cells form swollen cells called bladder (or Wedl) cells-migrate to PC
  • appearance: circular opacification, pearls (elschnig pearls)
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12
Q

Mixed form opacification

A

Combination of fibrosis and proliferation

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13
Q

Linear form of opacification

A
  • PCO along persistent striae-create a channel allowing epithelial cells to bypass the barrier created by the square edge design of the IOL
  • appearance: linear striae
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14
Q

Most common complication of cataract surgery

A

PCA

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15
Q

When doe PCA occur

A

30-50% within 3-5 years

Occurs within 20-26 months usually

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16
Q

Yougner patients and PCA

A

Highest risk

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17
Q

PCA within 3mm zone affects

A

High contrast sensitivity
Low contrast acuity
Psychophysical test resutls with differing degrees of sensitivity
-forward light scatter>contrast sensitivity>VA

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18
Q

Preventing PCO

A
  • removal of all epithelial cells and cortical remnants
  • lovage the intracapsular space with saline during surgery to denature residual epithelial cells
  • clean the anterior chamber well with an irrigation dynamic pressure-assisted hydrodiessection tool
  • pharmacological drops
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19
Q

Previous treatments for PCO

A
  • surgical cutting or peeling

- polishing posterior capsule

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20
Q

New treatments for PCA

A

Nd:YAG 1064

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21
Q

Nd:YAG 1064

A
  • pigment independent
  • 4ns. Large amount of energy delivered in small spot size for brief time

photodisruptive:
- high light energy causes tissue to reduce to plasma
- disintegrates tissue
- no thermal or coagulation effect
- hydrodynamic waves and acoustics pulses travel back toward surgeon=OFFSET

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22
Q

Nd-YAG laser capsulatomy Sadie’s

Study These Flashcards
A

Dilating drops
Use lenses
Half use steroid

23
Q

Contraindications for yag cap

Study These Flashcards
A

Absolute

  • corneal haze or pathology
  • unable to hold steady/fixate

Relative

  • glass IOL
  • active intraocular inflammation
  • known/suspect CME
  • high risk for RD
24
Q

Most common complications of yag cap

Study These Flashcards
A

IOP spike

Floaters

25
IOP spike in yag cap
-reduced faciltiy for aqueous humor outflow —capsular debris —acute inflammation cells —liquefaction of the vitreous —shock wave damage to TBM ->10mmHg in 15-67% of patients. Peaks at 3-4 hours but decreases after 24 hours -associated with: glaucoma, capsuolotomy size, lack of IOL, sulcus fixation, energy, myopia, vitreoretinal Disease
26
Stromal haze/edema/decreased endothelial cell count in yag cap
- occurs in 2.3-7% of patients | - this can lead to Fuchs dystrophy depending on extend of damage
27
CSME and yag cap
- occurs in 0.55-2.5% of patients - within 3 weeks-11 months - decrease risk by increasing time between ECCE and capsulotomy
28
IOL damage/pitting and yag cap
Significant glare and image degradation | Minimal VA impact
29
Material complications and yag cap
Glass=fractures PMMA=sustain cracks and central defects with radiating fractures Silicone=blistered lesions and localized pits Acrylic=white haze (highest risk of pitting)
30
RD and yag cap
- lifetime risk of RD after cat sx=1% - lifetime risk of RD after capsuolotomy=additional 0.8-1.9% - incidence: immediately to 1+ years
31
Retinal breaks and yag cap
Asymptatomic breaks found in 2.1% of patients within 1 month
32
Endophthlamitis and yag cap
- propionibacterium acnes endophthalmits reported following capsuolotomy - presumed opportunity for organisms within capsule=vitreous
33
Nd:YAG energy levels for PCO 2015
474 consecutive eyes studied on several factors VERSUS total energy used - complication rates - type of PCA - IOL material - fixation of IOL Analyzed for factors that led to complication
34
Incidence of IOP spike
12.9%
35
Uveitis incidence
9.9%
36
IOL pitting incidence
7.8%
37
CME incidence
2.9%
38
RD incidence
2.3%
39
Energy going in to the eye and complications
Less energy into the eye equal less complications - the more energy and higher myopia=RD more likely - pearl vs fibrosis: pearl were easier to clean off and fibrosis required more energy to get completely off. Using a lens will help concentrate the energy and decrease energy needed - IOL material and fixation had no influence on issues with total energy use
40
Candidate for YAG cap
- Vision 20/30 or worse - Symptomatic: glare, blur, vision, contrast - >3 months post op cataract surgery
41
Pre op yag cap
Psychophysical - VA - glare testing - PAM ``` SLE IOP DFE/posterior segment evaluation (or B scan if unable to visualize fundus) Signed inform consent Vitals (BP, pulse) ```
42
posterior capsulotomy setting
- 1.3-1.8mJ - spot size: fixed (8-11 microns) - duration: fixed (4ns) - pulses-1 - amount of burns: 10-40 - pattern: cruciate/horseshoe/Christmas tress/Can-opener (circular) - Offset: +150 to +500 microns posteriorly
43
Cruciate
Top to bottom
44
Horseshoe
An upside down U from 7 clockwise to 5 o clock
45
Christmas tree
12 o’clock-4:30 and 12 o’clock to 7:30 without shots in central optical zone
46
Can opening )circular)
- creates large fragments that dont necessarily sink | - large floater within vision
47
Procedure for posterior capsuolotomy
- comfortable placement - optional marker shot - 1 drop tropicamide - 1 drop alphagan 15-30m before - 1 drop proparacaine OU - focus on post cap (post offset) - adjust energy PRN. Little/no tissue interaction=increase - treat about 4mm in cruciate pattern (larger than undulated pupil). 10-40 total shots
48
Anterior capsulotomy setting
- 1.3-1.8mJ - spot size fixed (8-11) - duration: fixed (4ns) - pulses: 1 - amount of burns: 10-40 - pattern: radial burns @ the clock hours - offset: -150 to -500 microns ANTERIORLY
49
When would you make the treatemtn size smaller than the pupil in post yag cap
If they have a thick membrane. Creates a pinhole for them
50
Procedure for anteiror capsuolotomy
- comfortable placement - 1 drop tropicamide - 1 drop alphagan 15-30m prior - 1 drop proparacaine OU - focus on anterior phimosis (anterior offset) - adult energy PRN - treat in radial pattern @ clock hours to release phimosis. 10-40 total shots
51
Post op yag cap
- 1 drop alphagan - recheck IOP 15-30m in office - Rx PF QID x 7 days
52
FU for yag cap
1 day -high risk patient 1-2 weeks - check IOP - check AC reaction - dilation (r/o holes/tears/RD)
53
RTC 2m decreased vision and yag cap
Assess for - refractive error shifty - CME - RD - glaucoma - vitreous hemorrhage

3F: Surgery Final (5 decks)

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