PART 2 WRITTEN > CATARACT - CLINICAL > Flashcards

CATARACT - CLINICAL Flashcards

(39 cards)

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1
Q

What is type of inheritence of posterior polar cataracts?

A

Autosomal dominant –> at chromosome 16

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1
Q

What is the pathogenesis of a posterior polar cataract?

A

Thought to arise from remnant of foetal hyaloid artery, and can progress throughout life. Lens fibres are attached to posterior capsule

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2
Q

What techniques should be using during cataract surgery for posterior polar cataract?

A

AVOID hydrodissection
ENCOURAGE hydrodelineation
Inside-out/reverse flower bloom techniques

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3
Q

Osmotically driven lens opacification is most directly linked to accumulation of which substance?

A

Galactitol

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4
Q

What is the difference between Wilson’s Disease cataract and hypocalcaemia ?

A

Wilsons: Sunflower cataract with subcapsular central disc with radial spokes of yellow/brown pigment

Hypocalcaemia: Flocculent cortical opacities

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5
Q

What condition is associated with christmas tree cataract?

A

Myotonic dystrophy (type 1 and type 2) - Glistening polychromatic, stellate (star-shaped) opacities in cortex

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6
Q

What type of cataract does rubella cause?

A

Dense white pearly nuclear cataract –> usually bilateral

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7
Q

What are the systemic associations with rubella?

A

Microphthalmia, glaucoma, heart defects (PDA) and sensorineural hearing loss

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8
Q

What are the consideration regarding surgical timing for paediatric cataract (unilateral vs bilateral)

A

Unilateral: Greatest urgency - ideally performed between 4-6 weeks of age –> prognosis worsens after 6 weeks

Bilateral: Surgery performed sequentially between 6-10 weeks of age. Second eye done within 1-2 weeks of the first.

Post operative management: Optical correction and occlusion therapy is crucial and long-term

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9
Q

What are the key differentiators to use in operating techniques in paeds vs adult?

A

Capsulorexis: Highly elastic capsule –> difficult to initiate and tends to tear out (Argentinian Flag) –> requires utrata forceps of vitrectohexis

Lens removal: Infantile nucleus is soft (aspiratable) - phaco is not needle. Use IA.

Suturing: Need to give suturing

Long-term steroid use with frequent post op visits

<1yo - can leave them aphakic - preferred due to rapid axiel length growth and high refractive suprise –> correcting with contafct lens

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10
Q

What are the intraoperative cataract considerations for patient with PXF?

A

Pupil expansion : Malyugin Ring
Gentle hydrodissection: Avoid argentinian flag
Capsular Tension Ring: stabilise bag post-phaco
Low power settings

In the bag lens: Haptics lying at level of defect
If sulcus lens: Haptics lying 90 degrees to defect.

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11
Q

What is the high risk threshold for patients with fuch’s when considering cataract surgery? (CCT and endothelial cell number)

A

CCT: 640 microns
Endothelial cell number: < 1000

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12
Q

How long do you have to wait for a quiet eye in uveitis before planning surgery?

A

3 months of quiet activity

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13
Q

What are the pathological challenges for patients with high myopia?

A
  1. Long axial length (AL > 26 mm)
  2. Deep anterior chamber
  3. Scleral thinning/staphyloma
  4. Weak zonules
  5. Floppy posterior capsule

Counsel patient for increased risk of post op RD.

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14
Q

Which biometry calculation is used for myopic patients who have had LASIK who want cataract surgery?

A

Haigis L

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15
Q

Which IOL formula uses regression analysis?

16
Q

What are the dosages for intravitreal Abx for post-op endophthalmitis?

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A

Vancomycin - Gram+ve - 1mg/0.1ml
Ceftazidime - Gram -ve - 2.25mg/0.1ml
Amikacin - 0.4mg/0.1ml (If ceftazidime not available as it can induce retinal toxicity profile)

17
Q

Cataract and their causes

18
Q

What refractive shift occurs when pressing too hard with biometry probe on A scan?

Study These Flashcards
A

Myopic shift (over-estimation of IOL power)

19
Q

What happens in silicone filled eyes in A scan measurement?

Study These Flashcards
A

ultrasound speed is slowered –> axial measurement is incorrectly long

20
Q

What are the risk factors postoperatively for myopic shift?

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A

Anterior movement of IOL lens due to
1. Anterior capsular fibrosis
2. Short eyes

21
Q

How can you distinguish TASS vs endophthalmitis? (5)

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A
  1. Earlier onset (12-24 hours vs 3-7 days)
  2. Limbus-to-limbus corneal oedema
  3. Raised IOP
  4. Absence of vitritis
  5. Highly sensitive to topical steroids
22
Q

What biometry formula should be used for LASIK patients?

23
Q

When should biometry be repeated? (6)

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A
  1. Axial length <21.2 or >26.6
  2. Delta K is >2.5D
  3. Mean corneal power <41 or >47
  4. Difference in axial length >0.7mm between fellow eyes
  5. Difference in mean corneal power of >0.9D
  6. 4 year old biometries
24
Difference between enhanced monofocal IOLs, EDOF IOLs and multifocal IOLs
25
What is the typical patient with galactosaemia?
2 month old with oil droplet cataract Systemic: Vomiting, jaundice, failure to thrive, intellectual disability
26
What is the genetics of galactosaemia, what is the enzyme?
Genetics: Autosomal recessive Enzyme: G1PD (galactose-1-phosphate uridylyltransferase)
27
What is the effect of corneal sutures on the meridian?
Causes steeping in meridian of insertion Removal causes flattening in meridian of removal.
28
What are the causes of congenital lens subluxation? (6)
29
What manouvre should be done when reverse pupillary block occurs during cataract surgery?
Sudden deepening of the anteiror chamber Iris pushes against anterior lens capsule --> use iris hook to tent up iris --> equalisation of pressure gradient
30
What are the features of blue dot cataract?
BLUE DOT B - benign L - Lens development abnormality U - Usually congenital E - embryonic disruption of lens fibre formation D - Dominant O - Other cerulean cataract may co-exist T - Trauma
31
What are the common causes of myopic refractive surprise? (3)
1. Previous hypermetropic refractive surgery - underestimation of power of cornea --> over-estimation of power of IOL 2. Retained healon/capsular distention syndrome 3. Erraneous Higher A constant
32
What are the most common causes of hypermetropic refractive surprise? (3)
1. Myopic refractive surgery - overestimates power of cornea --> underestimation of poer of IOL 2. Unrecognised Posterior staphyloma at most posterior portion of globe 3. Erraneously low A constant
33
What formula should be used in these situations? Previous refractive surgery?
Previous refractive surgery 1. Barrett True-K 2. Haigis-L
34
Types of PCIOL
35
What is the cause of lenticular astigmatism? WTR or ATR astigmatism?
Asymmetry or tilt of the lens --> typically against-the-rule astigmatism
36
Whats the difference between Marfan's syndrome and Homocysteinuria?
Homocysteinuria --> CBS deficiency (recessive) Marfan's --> FB1 gene on Chr15 Marfans: superotemporal lens subluxation Homocystinuria: inferonasal lens subluxation
37
Driving standards table
38
X-linked recessive disorders
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