Final - Surgical Management

Question 1

Laser trabeculoplasty

• target
• how reduces IOP
• first 24 hours
• common complications

Answer 1

TM

Improving facility of outflow

On medications to prevent possible IOP spikes post-procedure

Iritis, periph ant synechiae

Question 2

Laser trabeculoplasty

• 2 subtypes
• which scars (cannot repeat in same area)
• target of type that can be repeated

Answer 2

ALT, SLT

ALT

Melanin (SLT)

Question 3

Laser trabeculoplasty

-best for what types of glaucoma (3)

Answer 3

POAG, exfoliation, pigmentary

Question 4

Laser iridotomy

• brief description
• procedure of choice for

Answer 4

Hole in peripheral iris with argon or Nd:YAG

Angle-closure glaucoma

Question 5

Laser iridotomy

-why/what it does/how it works (3)

Answer 5

Equalize pressure b/w AC and PC

Deepen AC

Open AC angle

Question 6

Laser iridotomy

• how to check to make sure it’s all the way thru
• complications

Answer 6

Transillumination - check for defect

Transient spike, mild ant uveitis, hyphema, K damage, ct, retinal burn, blurring, closure of sx

Question 7

Laser peripheral iridoplasty

• aka (2)
• when

Answer 7

Gonioplasty, peripheral iris retraction

When iridotomy fails

Question 8

Laser peripheral iridoplasty

• how it works
• complications

Answer 8

Argon laser makes contraction burns to periph iris -> opens angle

Tightening of periph iris -> pulls it posteriorly from TM

IOP elevation, mild transient iritis

Question 9

Laser pupilloplasty

• what
• when
• complications

Answer 9

Partially dilates pupil by applying contraction burns near pupillary portion of iris

Alternative method for pupillary block when cornea is cloudy

IOP rise, transient iritis

Question 10

Iris sphincterotomy

• what
• how

Answer 10

Pupil is enlarged, reshaped, or repositioned

Make linear cut across iris, allowing intrinsic tension to spread the cut apart

Question 11

Incisional iridectomy

• what
• when
• complications

Answer 11

Small section of periph iris is excised thru limbal incision

Acute angle closure

Hemorrhage, incomplete sx, lens injury, endopthalmitis

Question 12

Trabeculectomy

• what
• complications

Answer 12

Creates opening in TM to est. direct communication b/w AC and Schlemm’s

False passage (if mis-ID Schlemm’s) -> cyclodialysis, possible hyphema

Question 13

Trabeculectomy

-how it works

Answer 13

Probe inserted thru TM into Sclemm’s -> thermal ablation removes TM and internal wall of SC

Question 14

Canaloplasty

• what
• when

Answer 14

Microcatheter/tube in Schlemm’s to enlarge drainage canal, relieving pressure inside the eye

Open-angle glauc, those at high risk for infection/bleeding, those who had complications with other eye, pts who wear CLS

Question 15

Cyclodialysis

• what
• how it helps

Answer 15

Separate CB from SS via cyclo spatula -> creates direct communication b/w AC and suprachoroidal space

Incr uveoscleral outflow, reduces aqueous production (by changing ciliary anatomy)

Question 16

Cyclodialysis

• indications
• complications

Answer 16

Alternative to filtering sx, esp. in aphakic eye, or in combo with ct extraction

Heme, damage to Descemet’s, K damage, tear in CB/iris, lens injury, vitreous loss