Surgical Therapy

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Author:
angelletta
ID:
116351
Filename:
Surgical Therapy
Updated:
2011-11-13 14:41:22
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Glaucoma Ch8
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Description:
Glaucoma Ch8
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  1. Name 3 commons types of Laser Trabeculoplasty
    • SLT (Selective Laser Trabeculoplasty)
    • ALT (Argon Laser Trabeculoplasty)
    • Diode Laser
  2. What % is an LTP expected to lower IOP?
    20-25%
  3. What type of glaucoma is LTP contraindicated?
    • secondary glaucomas
    • Inflammatory
    • ICE
    • Neovascular
    • PAS
    • Developmental glaucoma
    • Angle recession- can try it..but may be ineffective
    • lack of effect in the other eye
    • advanced damage and high IOP
  4. Does lens status affect LTP?
    Yes, doesnt work as well on Aphakic and psuedophakic patients
  5. Argon Laser Trabeculoplasty
    Laser Settings
    • 50um spot size
    • 0.1 sec
    • 300-1000 mW
  6. Argon Laser Trabeculoplasty
    Location
    Endpoint
    Amount
    • junction anterior nonpigmented and posterior pigmented TM
    • blanching or tiny bubbles
    • 40-50 application over 180 degrees
  7. Diode Laser Trabeculoplasty Settings
    • 75um spot
    • 600-1000mW
    • 0.1 sec
  8. SLT Selective Laser Trabeculoplasty
    settings
    • 400um
    • 0.4-1.0 mJ
    • 0.3ns duration
  9. SLT Selective Laser Trabeculoplasty
    Location
    target intracelluar melanin
  10. What the difference between SLT and ALT?
    • SLT is repeatable
    • SLT has less coagulative damage
  11. What is the mechanism of LTP
    • shrinkage causing stretching of adjacent areas
    • Chemical modulation leading to increase in outflow through induction of matrix metallopretinases
  12. What populations is filtering surgery less sucessful?
    • young age
    • aphakic/pseudophakic
    • uvetic or neovascular
    • Blacks
    • previous surgery
  13. What are relative contraindications to filtering surgery?
    • blind eye--ciliary body ablation instead
    • dz that cause scaring
  14. What meds should be stopped prior to filtering surgery?
    Which should be stopped post -op?
    • anticholinesterase agents 3-6 wks to reduce bleeding and iridocylclitis
    • CAI
  15. What decreases the risk of expulsive chorodial hemmorrhage after filtering surgery?
    • lowering the IOP to close to normal levels
    • DC antiplatelets
    • control BP
  16. What is the most common cause of decreased vision after trab?
    Cataract
  17. What patients should caution be used in treatment with antifibrotic agents in primary trabs and why?
    Young patients with myopia due to increased risk of hypotony maculopathy
  18. What is the mechanism of 5FU?
    inhibit fibroblast proliferation through interfering with DNA synthesis through action on thymidylate synthetase
  19. Mitomycin C is derived from
    strepomyces caepitosus
  20. Mitomycin C mechanism of action?
    alkylating agent leading to DNA cross linking
  21. What has been associated with increased risk of bleb related endophthalmitis?
    5FU/MMM
  22. What are contrainditcation to LPI? What is an alternative?
    • active rubeosis iridis
    • Use Argon instead of Nd/YAG for iridectomy
  23. What are LPI laser settings?
    Argon
    • Argon
    • 50um
    • 800-1000mW
    • 0.02-0.1 sec
  24. Nd:YAG
    2-8 mJ
  25. Iridoplasty laser setting
    • 200-500 um
    • 200-500 mW
    • 0.1-.5 sec
  26. What are nonvalved devices
    • nmemonic- BM --no valve allows a BM
    • Non-valved-Baerveldt & Molteno
    • Valved- Ahmed Krupin AK
  27. What are indications for Shunts?
    • Failed trab
    • Active Uveitis
    • Neovascular Glaucoma
    • Inadequate conj
    • Aphakia
  28. Cyclophotocoagulation laser settings
    • 17-19 application 270 degrees
    • 1.5-2W
    • 2 secs

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