Ohp2 Mt2 - Cataract Pre/post Operations

Front 1

Which senile cataract is secondary to oxidation, produces a myopic shift and possibly monocular diplopia?

Back 1

Nuclear Sclerotic. -Optic section

Front 2

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?

Back 2

Cortical Cataracts. - Retro-illuminatino

Front 3

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?

Back 3

Posterior Subcapsular - Least common

Front 4

Do Infantile Ant/Post Polar cataracts usually affect vision?

Back 4

No

Front 5

Are males or females more affected by Sutural Cataracts?

Back 5

Males b/c it is X-linked. -Anterior is more common

Front 6

What is the most common type of Congenital cataract?

Back 6

Lamellar/Zonular. -Sand-dollar appearance (circular). -Bilateral. -Usually doesn't affect vision unless dense

Front 7

Which cataract is similar to a Polar cataract except it appears in a different layer?

Back 7

Fetal Nuclear

Front 8

List 4 systemic causes of congenital cataracts

Back 8

1. Rubella (#1). 2. Mumps. 3. Hepatitis. 4. Toxoplasmosis

Front 9

List 4 Secondary Cataracts

Back 9

1. Oil droplet -rare. 2. Polychomatic - christmas tree. 3. Glassblower's . 4. Anterior subcapsular

Front 10

Which secondary cataract is a true exfoliation cataract that causes splitting of the lens capsule caused by thermal radiation?

Back 10

Glassblowers

Front 11

Which secondary cataract is caused from myotonic dystrophy?

Back 11

Polychomatic - christmas tree

Front 12

Which secondary cataract is associated with galactosemia where galactose build up is toxic causing a myopic shift?

Back 12

Oil droplet

Front 13

List some common causes of a PSC

Back 13

1. Chronic steroid use. 2. Uveitis. 3. RD. 4. Retinal surgery

Front 14

List two Traumatic cataracts

Back 14

1. Rossette - flower petal. 2. Vossius Ring - pigment from iris

Front 15

Which type of cataract is an opacification of the lens capsule, cortex and nucleus?

Back 15

Mature cataract

Front 16

Which cataract is caused by liquification of the orbit and wrinkling of the capsule?

Back 16

Hypermature cataract

Front 17

Describe a Morganian Cataract - really old!

Back 17

Liquification of the cortex allows the nuclear contents to sink down

Front 18

What VA is considered the cutoff for cataract surgery?

Back 18

20/40

Front 19

List 4 pathology indications for cataract surgery

Back 19

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

Front 20

List some ocular contraindications for cataract surgery

Back 20

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

Front 21

List some systemic CIs for cataract surgery

Back 21

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

Front 22

List 3 devices that measure potential visual acuity

Back 22

1. Interferometry. 2. PAM. 3. RAM

Front 23

How does the interferometer measure acuity?

Back 23

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

Front 24

How do you set up the interferometer?

Back 24

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!

Front 25

How many does the patient need correct to end test?

Back 25

2/4

Front 26

Does the interferometer over or under predict acuity in someone with macular disease?

Back 26

Over predicts - even in amblyopic pts. -Under predicts in patients with dense catarats

Front 27

How do you set-up the PAM?

Back 27

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

Front 28

How accurate is the RAM (one we use in clinic)?

Back 28

97%. -Goggles with one eye occluded and pinhole on the other. -Use lens if distance correction is on (near lens)

Front 29

Is the patient dilated or not during the Penlight glare test?

Back 29

Not dilated. -Recorded as 'under glare conditions'

Front 30

T or F? During the BAT (brightness acuity tester) the patient is best corrected and dilated in a dark room?

Back 30

False.. -Pt is best corrected, UNDILATED and in a dark room

Front 31

Describe the outcomes of the BAT and Penlight Glare Test

Back 31

-If VA stays the same - No significant glare problem. -If VA reduced - Glare is a problem. -If VA improves - Pinhole effect = recheck Rx

Front 32

Entopic images, Maddox rod and B-scan ultrasound are all used to assess which type of cataract?

Back 32

Mature

Front 33

Where is the transilluminator placed when performing Entopic images?

Back 33

Temporal upper lid. -Veins on a leaf is a positive result and indicator of good macular function

Front 34

What does a negative result mean on the Entopic image test?

Back 34

It is not predictive of poor macular function (20% of normals do not see it)

Front 35

If the horizontal maddox rod was placed over the eye to be tested - what does the patient see?

Back 35

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

Front 36

Why should an Endothelial cell count be performed prior to cataract surgery?

Back 36

To prevent or predict Bullous Keratopathy. -taken sup, central, inf corneal endothelium

Front 37

What endothelial cell count would make a patient a poor candidate?

Back 37

< 800 cells/mm2. - Okay if b/w 1200-1400 cells. -Ave in geriatric pts = 2000

Front 38

What does an A-scan Ultrasonagraphy assess?

Back 38

Uses sound waves to assess density of tissue and relative distance between tissues. -Determines axial length - used to calculate IOL power

Front 39

What is the most accurate A-scan technique?

Back 39

Immersion: probe is put into a scleral shell filled with fluid - reduced compression

Front 40

Which structures does an A-scan pickup?

Back 40

Cornea, ant. lens, post. lens, retina, scleral/orbital fat. -Structures should have equal spikes if set up correctly

Front 41

0.3mm error = ___D error when performing an A-scan

Back 41

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

Front 42

Why should NSAIDs be taken pre-op?

Back 42

Maintains Mydriasis and prevents post op CME. - 1 gtt q 30 min 2 hours before surgery

Front 43

What medication might be used to help control IOP for 1st 24 hours?

Back 43

CAI - Diamox

Front 44

Which glaucoma med should be switched because of its CI for inflammation?

Back 44

Prostaglandin

Front 45

Where is a local Anesthetic injection (most common) performed?

Back 45

Subconjunctival/ Sub-Tenon's

Front 46

List some complications of a Peribulbar/Retrobulbar block? (to control ocular movement)

Back 46

1. Retrobulbar heme (most common). 2. Perforation. 3. Damage to ON. 4. CRAO and CNS toxicity

Front 47

Which site of injection is the most painful?

Back 47

Retrobulbar > Peribulbar > local. -But Retrobulbar injection is least likely to feel pain

Front 48

Which injection is the most dangerous?

Back 48

Retrobulbar - enters the muscle cone

Front 49

Is a needle used in a Sub-Tenon's injection?

Back 49

No. -Conj is opened up with scissors. -Cannuli is filled with anesthetic is pushed behind eye

Front 50

What are the two types of cataract extractions?

Back 50

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)

Front 51

What is the biggest risk with Clear Corneal incision to remove cataract?

Back 51

Endoophthalmitis. -Less painful, fast, eliminates bleeding, less induced astig, eliminates iris prolapse

Front 52

List 5 possibilities of optical correction of Aphakia

Back 52

1. Spectacles - 20-30% image difference. 2. CLs. 3. Intraocular lenses. 4. Multifocal IOLs. 5. Accommodating IOLs

Front 53

What was the 1st commercially available Multifocal PCIOL in the US?

Back 53

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

Front 54

Which lens has 5 optic zones of different sizes providing distance, intermediate and near vision and is a 2nd gen Multifocal IOL?

Back 54

ReZoom by AMO

Front 55

What does Apodization mean?

Back 55

Gradual decrease in step height and width

Front 56

At what week is the final Srx usually given post-op?

Back 56

6-8 weeks. -1 day. -1 week. -2-4 weeks. -6-8 weeks. -6 months. -1 year

Front 57

What drops are given post op?

Back 57

1. Ab for 1 week (TID-QID). 2. Steroid for 2 weeks (QID). 3. NSAID for 2 weeks (QID). 4. ZAP

Front 58

Is GAT okay to perform 1 day post op?

Back 58

Yes along with VA, SLE, DO, VAs at distance

Front 59

Is lid edema okay post op?

Back 59

No- sign of endopthalmitis. -So is chemosis of the conjunctiva

Front 60

What positive test requires immediate referral post op?

Back 60

+ Seidel Test

Front 61

List 4 complications of wound leakage

Back 61

1. Uveal incarceration. 2. FB sensation. 3. Choroidal detachment. 4. Extremely low IOPs

Front 62

List 6 corneal complications that occur early after surgery

Back 62

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

Front 63

Viscoelastic agent used to protect the endo, maintain AC depth and maintain capsule shape causes what?

Back 63

Transient IOP rise (6 hours post-op)

Front 64

What two meds are used to help reduce Post-op inflammation?

Back 64

Steroids and B-blockers (avoid prostaglandins)

Front 65

Which lens is more likely to cause a pupillary block, ACIOL or PCIOL?

Back 65

ACIOL. -Dilate pt to pull iris off IOL

Front 66

T or F? You will see lots of Cells and Flare in the AC for the first 1-2 weeks?

Back 66

Yes. -Also vitreal prolapse - if vitreous touches endo causing corneal decompinsation and will need a vitrectomy

Front 67

What should you do if a hyphema is present?

Back 67

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

Front 68

When does endopthalmitis occur post of?

Back 68

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

Front 69

List 3 post-op complications of the Iris

Back 69

1. Iris Atrophy. 2. Traumatic Mydriasis. 3. Pupillary distortion (Haptics vs. Fibrosis)

Front 70

What is Vitreous Wick Syndrome?

Back 70

Vitreous or Iris incarceration into the wound - risk of CME and RD

Front 71

List some causes of IOL decentration (weak zonules)

Back 71

1. PXE syndrome. 2. Trauma. 3. Marfans. 4. Homocystenuria

Front 72

Is Bullous Keratopathy considered a Late or Early post op complication?

Back 72

Late phase. -Due to compromised endo function. -Striae, stromal folds, microcysts and bullae. TX: Hypertonics, PKP

Front 73

How is Uveitis-Glaucoma Hyphema (UGH) syndrome caused?

Back 73

PCIOL chafing against posterior iris --> chronic iritis, recurrent hyphema and 2nd glaucoma. Tx: Prolonged steroids

Front 74

What late post-op condition is common and also known as a second cataract?

Back 74

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

Front 75

What happens when fibrosis occurs during PCO?

Back 75

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

Front 76

What are Elschnig's Pearls?

Back 76

Grape clusters: Equatorial lens epithelial cells proliferate and form pearls on posterior capsule

Front 77

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

Back 77

True. -Usually 6th week post-op after uneventful cataract surgery

Front 78

What percentage of CME will recover to normal vision within 6 months?

Back 78

50%. TX: Topical NSAIDs (Voltaren) or subtenon's steroids