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50 Cards in this Set
- Front
- Back
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Indications (4)
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-Generally >65 years old
Unless Pseudoexfoliative glaucoma -Adequate TM pigment -Adequate angle construction -POAG, Normal tension GLC, pseudoexfoliative GLC, pigment dispersion GLC, etc. |
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T/F ALT is used for mod-advanced GLC
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TRUE
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When should you use ALT for early GLC?
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Poorly compliant patient
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3 ALT Contraindications
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1)Uveitic GLC
2)Angle Closure GLC 3)Angle Recession GLC |
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2 Meds for ALT Pre-Op
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1)Alphagan (30min)
2)Steroid |
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T/F In ALT, target TM and pigmented Schwalbe's line
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FALSE
Target TM not pigmented Schwalbe's line |
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How big are the spot sizes for ALT?
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50um and 2spot space
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ALT- tx anterior half of what?
Too anterior may lead to____ Too posterior may lead to ____ |
pigmented TM
no effect inflammation (PAS) |
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What is the f/u schedule for ALT Post-op?
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1 hr
1 week- gonio, look for PAS 1 month (not global) |
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IOP effect stabilizes in __weeks
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4-6weeks
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ALT Effectivity:
__ % controlled for 1 yr __ % controlled for 5 yrs __ % controlled for 10 years __ % per year attrition rate |
80
50 30 10 |
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ALT complications
1) 2) 3) |
1)Inc. IOP (3% have 5mmHG in long term)
2)Corneal Burns 3)Heme in angles (less common) |
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OD files what CPT modifier for ALT post op
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65855-55
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What laser does SLT use?
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Selecta 7000 Laser with Q-switched Frequency doubled ND: Yag
532nm |
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What differentiates SLT and ALT?
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No coagulative damage to TM like ALT
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Indications for SLT?
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Similar to ALT
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SLT Preop Meds
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Alphagan 30min
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T/F Previous ALT is NOT a contraindication
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TRUE
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How many ___um spots over 180 deg of TM does SLT do?
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45-55 (400um spots)
larger spot size but same # of spots |
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SLT- increase power until blanches then decrease by ____ until no Rxn is seen
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0.1mJ
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SLT Post Op meds
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Topical NSAID for 1 week (ALT is on steroid for 1 week or until inflammation is gone)
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SLT post-op F/U schedule
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1hr/1day
1week 1month (not global) 3month (not global) |
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4 SLT Complications
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1)Mild discomfort (5%)
2)AC reaction (90%) 3)IOP spike (<10mmHg) 4)No PAS formation |
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SLT Effectivity
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90% response rate!
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SLT make take ___weeks to respond
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8-14weeks
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How does SLT work?
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activates macrophages by cytokine release then clean out TM by phagocytizing debris.
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T/F SLT cannot be repeated.
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FALSE. CAN REPEAT BECAUSE IT DOES NOT CAUSE SCARRING
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End Stage Glaucoma is AKA _____
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Residual Stage Glc
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Glaucoma Laser Trial:
2 yr followup 7 yr followup |
ALT eyes had lower IOP than med treated eyes
ALT treated eyes had lower IOP, better visual field, and optic disc status than eyes in the med group |
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What is MLT?
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micropulse laser trabeculoplasty
-lower energy than ALT/SLT with less TM damage, less likely to cause IOP spoke in post-trab |
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What are 2 indications for Peripheral Iridotomy?
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1)Angle Closure
2)Narrow Angle |
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T/F IOPs may be near normal during eye exam for chronic narrow angles
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TRUE
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How do you manage acute angle closure (60mmHg)?
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1)250mg of Diamox 45min onset
2)Oral glycerin 30min 3)Alphagan 20min 4)Give one of each family GLC drops except PA (inflammatorY) 5)Add Pilo at 40-45mmHg q6hr |
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CPT code for PI
___ global days |
66761 with -55 modifier attached to Dx of Narrow or Closed Angle Glaucoma
90days |
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3 PI Contraindications
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1)unable to sit at slit lamp
2)Cloudy Cornea 3)Flat AC |
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PI Pre-Op meds
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1)Pilo 1% x 2
2)Alphagan x1 30min preop |
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PI intra-op ___ and ___
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YAG (photodisruptive)
ARGON (thermal) less heme risk |
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What kind of lens for PI?
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Abraham or less popular Wise Lens
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Where is PI usually performed?
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superior nasal
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PI post f/u
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pt is on steroid for 1 week
F/U: 1 hr 1 week: gonio 1 month |
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How can you tell if a PI is a patent functionally at one week or one year?
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Transillumination
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PI Complications (6)
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1)Inc. IOP
2)Inflammation 3)Hyphema 4)Lens opacities 5)Ghost Images 6)PI Failure |
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CPT Code for Iridoplasty (less common)
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CPT: 66762
90 day global period* |
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Iridoplasty Indications
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-NAG (ALPI first then PI)
-Plateau Iris |
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Two Types of Plateau Iris
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1)Complete- RARE, IOP rises w/ DFE
2)Incomplete- IOP stable w/ DFE |
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T/F Suspect Plateau Iris if no dec. in IOP and angle doesn't open with PI
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TRUE
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Iridoplasty CI
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Must have clear cornea
-glycerin |
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T/F You don't have to have a clear cornea for Iridoplasty
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FALSE
clear cornea is a MUST |
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How does Iridoplasty work?
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Ring of burns is placed encircling entire iris
Coagulation retracts the iris and opens the angle |
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Iridoplasty complications (4)
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1.inc. IOP
2.Inflammation 3.Hyphema 4.Lens/corneal opacities |
