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78 Cards in this Set

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Which senile cataract is secondary to oxidation, produces a myopic shift and possibly monocular diplopia?
Nuclear Sclerotic. -Optic section
Which cataract is the most common, is caused by an imbalance of electrolytes (over-hydration), forms vaculoes and wedge shaped opacities and causes severe glare and small hyperopic shift?
Cortical Cataracts. - Retro-illuminatino
Which cataract is best seen by retroillumination, decreases vision and increases glare (but gets better with dim light) and is caused by a loss of lens fiber nuclei which are replaced by migrating epithelial cells?
Posterior Subcapsular - Least common
Do Infantile Ant/Post Polar cataracts usually affect vision?
No
Are males or females more affected by Sutural Cataracts?
Males b/c it is X-linked. -Anterior is more common
What is the most common type of Congenital cataract?
Lamellar/Zonular. -Sand-dollar appearance (circular). -Bilateral. -Usually doesn't affect vision unless dense
Which cataract is similar to a Polar cataract except it appears in a different layer?
Fetal Nuclear
List 4 systemic causes of congenital cataracts
1. Rubella (#1). 2. Mumps. 3. Hepatitis. 4. Toxoplasmosis
List 4 Secondary Cataracts
1. Oil droplet -rare. 2. Polychomatic - christmas tree. 3. Glassblower's . 4. Anterior subcapsular
Which secondary cataract is a true exfoliation cataract that causes splitting of the lens capsule caused by thermal radiation?
Glassblowers
Which secondary cataract is caused from myotonic dystrophy?
Polychomatic - christmas tree
Which secondary cataract is associated with galactosemia where galactose build up is toxic causing a myopic shift?
Oil droplet
List some common causes of a PSC
1. Chronic steroid use. 2. Uveitis. 3. RD. 4. Retinal surgery
List two Traumatic cataracts
1. Rossette - flower petal. 2. Vossius Ring - pigment from iris
Which type of cataract is an opacification of the lens capsule, cortex and nucleus?
Mature cataract
Which cataract is caused by liquification of the orbit and wrinkling of the capsule?
Hypermature cataract
Describe a Morganian Cataract - really old!
Liquification of the cortex allows the nuclear contents to sink down
What VA is considered the cutoff for cataract surgery?
20/40
List 4 pathology indications for cataract surgery
1. Phacolytic glaucoma: Lens proteins go into the anterior chamber (hypermature). 2. Lens Particle glaucoma: lens protein go into the ant. chamber (from cataract surgery, YAG, trauma). 3. Phacoanaphylaxis: (associated with uveitis) - inflammation due to lens proteins. 4. Closed angle (phacomorphic)/narrow angle
List some ocular contraindications for cataract surgery
1. Macular disease (expectation/active leaking). 2. Uveitis - free for 3-6 mos. 3. Corneal Health (decreased endo cell count/dystrophy). 4. Monocular/amblyopic - surgeon more hesitant. 5. RD
List some systemic CIs for cataract surgery
1. COPD. 2. Parkinson's. 3. Poor mental health - consent. 4. Cardio dz. 5. DM - must treat CSME before surgery. 6. Substance abuse. 7. Meds (flomax) - floppy iris. 8. Complete physical
List 3 devices that measure potential visual acuity
1. Interferometry. 2. PAM. 3. RAM
How does the interferometer measure acuity?
Projects and interference fringe pattern directly on retina (line in Maxwellian view). -Unaffected by RE, corneal irregularities, media opacities and spatial alignment of receptor cells
How do you set up the interferometer?
1. Dilate w/ no Srx. 2. Mod room illum. 3. Hi setting, 8 degree field. 4. Start at 20/80 and in the better eye 1st!
How many does the patient need correct to end test?
2/4
Does the interferometer over or under predict acuity in someone with macular disease?
Over predicts - even in amblyopic pts. -Under predicts in patients with dense catarats
How do you set-up the PAM?
1. Dilate. 2. Attach PAM to SL. 3. Dial in pts RE. 4. Focus red beam on closed eyelid. 5. Pt looks down into white opening. 6. Adjust to make bottom line clear. 7. Read numbers 1st - then letters. 8. Record smallest line of letters read
How accurate is the RAM (one we use in clinic)?
97%. -Goggles with one eye occluded and pinhole on the other. -Use lens if distance correction is on (near lens)
Is the patient dilated or not during the Penlight glare test?
Not dilated. -Recorded as 'under glare conditions'
T or F? During the BAT (brightness acuity tester) the patient is best corrected and dilated in a dark room?
False.. -Pt is best corrected, UNDILATED and in a dark room
Describe the outcomes of the BAT and Penlight Glare Test
-If VA stays the same - No significant glare problem. -If VA reduced - Glare is a problem. -If VA improves - Pinhole effect = recheck Rx
Entopic images, Maddox rod and B-scan ultrasound are all used to assess which type of cataract?
Mature
Where is the transilluminator placed when performing Entopic images?
Temporal upper lid. -Veins on a leaf is a positive result and indicator of good macular function
What does a negative result mean on the Entopic image test?
It is not predictive of poor macular function (20% of normals do not see it)
If the horizontal maddox rod was placed over the eye to be tested - what does the patient see?
a Vertical red line. . -A patient will report a visible, whole line = functioning macular. -A broken or wavy line = leaking or hole in macula. -No visible line = not a good indicator for poor macular function
Why should an Endothelial cell count be performed prior to cataract surgery?
To prevent or predict Bullous Keratopathy. -taken sup, central, inf corneal endothelium
What endothelial cell count would make a patient a poor candidate?
< 800 cells/mm2. - Okay if b/w 1200-1400 cells. -Ave in geriatric pts = 2000
What does an A-scan Ultrasonagraphy assess?
Uses sound waves to assess density of tissue and relative distance between tissues. -Determines axial length - used to calculate IOL power
What is the most accurate A-scan technique?
Immersion: probe is put into a scleral shell filled with fluid - reduced compression
Which structures does an A-scan pickup?
Cornea, ant. lens, post. lens, retina, scleral/orbital fat. -Structures should have equal spikes if set up correctly
0.3mm error = ___D error when performing an A-scan
1 D. -Ave of 3 readings all w/in 0.15mm. -Retake if:. 1. Axial length <22mm or > 25. 2. Greater than 0.3 mm difference b/w eyes. 3. Patient uncooperative
Why should NSAIDs be taken pre-op?
Maintains Mydriasis and prevents post op CME. - 1 gtt q 30 min 2 hours before surgery
What medication might be used to help control IOP for 1st 24 hours?
CAI - Diamox
Which glaucoma med should be switched because of its CI for inflammation?
Prostaglandin
Where is a local Anesthetic injection (most common) performed?
Subconjunctival/ Sub-Tenon's
List some complications of a Peribulbar/Retrobulbar block? (to control ocular movement)
1. Retrobulbar heme (most common). 2. Perforation. 3. Damage to ON. 4. CRAO and CNS toxicity
Which site of injection is the most painful?
Retrobulbar > Peribulbar > local. -But Retrobulbar injection is least likely to feel pain
Which injection is the most dangerous?
Retrobulbar - enters the muscle cone
Is a needle used in a Sub-Tenon's injection?
No. -Conj is opened up with scissors. -Cannuli is filled with anesthetic is pushed behind eye
What are the two types of cataract extractions?
1. Intracapsular (ICCE): whole lens is taken out (Aphakia) - ACIOL. -Increased risk of: CME, RD, Uveitis. 2. Extracapsular (ECCE): Posterior capsule left in place - PCIOL. -Planned (Take out whole lens) vs. Phacoemulsification (Most common - ultrasound breaks contents)
What is the biggest risk with Clear Corneal incision to remove cataract?
Endoophthalmitis. -Less painful, fast, eliminates bleeding, less induced astig, eliminates iris prolapse
List 5 possibilities of optical correction of Aphakia
1. Spectacles - 20-30% image difference. 2. CLs. 3. Intraocular lenses. 4. Multifocal IOLs. 5. Accommodating IOLs
What was the 1st commercially available Multifocal PCIOL in the US?
Array by AMO. -for pts > 60. -less than 1.00D of astig. -5 alternating zones of distance/near power. -Central = distance. -Decrease CS and Increase glare at night. -Pupil size > 3.0 mm
Which lens has 5 optic zones of different sizes providing distance, intermediate and near vision and is a 2nd gen Multifocal IOL?
ReZoom by AMO
What does Apodization mean?
Gradual decrease in step height and width
At what week is the final Srx usually given post-op?
6-8 weeks. -1 day. -1 week. -2-4 weeks. -6-8 weeks. -6 months. -1 year
What drops are given post op?
1. Ab for 1 week (TID-QID). 2. Steroid for 2 weeks (QID). 3. NSAID for 2 weeks (QID). 4. ZAP
Is GAT okay to perform 1 day post op?
Yes along with VA, SLE, DO, VAs at distance
Is lid edema okay post op?
No- sign of endopthalmitis. -So is chemosis of the conjunctiva
What positive test requires immediate referral post op?
+ Seidel Test
List 4 complications of wound leakage
1. Uveal incarceration. 2. FB sensation. 3. Choroidal detachment. 4. Extremely low IOPs
List 6 corneal complications that occur early after surgery
1. Abrasion. 2. SPK. 3. Edema/folds (use steroids/hyperosmotic). 4. Descemet's detachment. 5. Endo deposits. 6. Thermal burn for phacoemulsification b/c not enough irrigation
Viscoelastic agent used to protect the endo, maintain AC depth and maintain capsule shape causes what?
Transient IOP rise (6 hours post-op)
What two meds are used to help reduce Post-op inflammation?
Steroids and B-blockers (avoid prostaglandins)
Which lens is more likely to cause a pupillary block, ACIOL or PCIOL?
ACIOL. -Dilate pt to pull iris off IOL
T or F? You will see lots of Cells and Flare in the AC for the first 1-2 weeks?
Yes. -Also vitreal prolapse - if vitreous touches endo causing corneal decompinsation and will need a vitrectomy
What should you do if a hyphema is present?
1. Bedrest at 45deg. 2. Stool softener, D/C anticoagulants. -If IOP > 20mmHg and large % of hypema, Topical HYPOTENSIVES to avoid blood staining of cornea. -Steroids and antifibrinolytics
When does endopthalmitis occur post of?
1-4 days usually. -painful w/ decreased vision. -Lid/corneal edema, chemosis, severe AC rx w/ or w/o hypopyon and vitritis. -Staph usually if infected. -If sterile: retained lens material, IOL, iris or vitreous incarceration in wound. -Prognosis depends on virulence of organism and speed of tx
List 3 post-op complications of the Iris
1. Iris Atrophy. 2. Traumatic Mydriasis. 3. Pupillary distortion (Haptics vs. Fibrosis)
What is Vitreous Wick Syndrome?
Vitreous or Iris incarceration into the wound - risk of CME and RD
List some causes of IOL decentration (weak zonules)
1. PXE syndrome. 2. Trauma. 3. Marfans. 4. Homocystenuria
Is Bullous Keratopathy considered a Late or Early post op complication?
Late phase. -Due to compromised endo function. -Striae, stromal folds, microcysts and bullae. TX: Hypertonics, PKP
How is Uveitis-Glaucoma Hyphema (UGH) syndrome caused?
PCIOL chafing against posterior iris --> chronic iritis, recurrent hyphema and 2nd glaucoma. Tx: Prolonged steroids
What late post-op condition is common and also known as a second cataract?
Posterior capsular opacification. -Proliferation of equatorial lens epithelium along posterior capsule. -Occurs 50% of ECCE w/in 6 months - 5 yrs. -Gradual vision loss and increase in glare and ghosting. -TX: Surgical capsulotomy. or Neodymium: YAG Laser
What happens when fibrosis occurs during PCO?
Ant. Epithelium cells change to fibroblasts and migrate to posterior capsule. -Wrinkles progress to white opacities. -If opacification of ant. capsule, contraction centripetally causes shrinking of capsular opening = Capsule Contraction Syndrome
What are Elschnig's Pearls?
Grape clusters: Equatorial lens epithelial cells proliferate and form pearls on posterior capsule
T or F? CME is a late complication characterized by painless decrease in vision, more common with ICCE or when there is a torn posterior capsule
True. -Usually 6th week post-op after uneventful cataract surgery
What percentage of CME will recover to normal vision within 6 months?
50%. TX: Topical NSAIDs (Voltaren) or subtenon's steroids