March 9 review cor, glau, plast

kuleya's version from 2016-03-10 14:41

review march 9

Question Answer
how long must you be out of rgp lenses pre-lasik?a month per decade of use + 2-3 wks
how long must you be out of soft contacts pre lasik?3-12 days (>14 days soft toric)…hard lenses 2-3 weeks
Zernike polynomials express abberations as what? what is typical value?RMS value < 0.3 microns
MOA of dipivefrin?nonselective adrenergice agonists. can exacerbate CME and cause adenochrome deposits.. increases aqueous outflow, reduces production slightly
how do beta blockers reduce pressure?black Na/K pump reducing cAMP in ciliary epithelium, 20% iop reduction from decreased production
how does brimonidine work?decrease episcleral venous pressure to reduce production
how does epi and dipivefrin reduce IOP?improve aqueous outflow
how does pilocarpine work to reduce IOP?contraction of ciliary body opens TM… improves TM outflow, reduces uveoscleral outflow
NF-1 cause glaucoma houw?dysgenesis of trabecular meshwork
how do prostaglandin analogues work?inhibit PGF2a – increase uveoscleral outflow
side effects of prostaglandin analogues?flu-like symptoms, hyperemia, eyelash growth, periogcular skin and iris pigmentations, CME, reactivation of herpes
which medication reduces vitreous volume?mannitol/glycerin/isosorbide
Myotonic dystrophy does what to IOP? How?lower..ciliary body detachment
unilateral glaucoma with pedunculated iris nodules are found in what?cogan reese
Most commone iridocorneal endothelial syndrome?chandler… major feature is corneal edema
Essential iris atrophy shows whatcorectopia, glaucoma
what is cyclodialysis cleft?separation of ciliary body from scleral spur, often from trauma…direct communication to suprachoroidal space causing hypotony…if heals can cause IOP spike
treatment of cyclodialysis cleft?NOT PILO… cycloplegia or argon laser to induce
Goldmann equation IOP =F/C + EVP (F = production rate, C = outflow facility (rate/pressure), EVP = episcleral venous pressure
pathology of glaucomadropout of ganglion cells, replacement of NFL with dense gliotic tissue and gial nuclei… loss of mullers and amacrine cells…earliest changes at lamina cribrosa
most common complication of vitrectomy?glaucoma from intraocular gas, hyphema, ghost cells, silicone oil
MPS stains with colloidal iron (blue) with what disease?schnabels cavernous optic atrophy
gene for pigmentary glaucoma?GLC1F 7q35-36


Question Answer
OHTN study risks for POAG?age, IOP, CCT, increased C/D, PSD… not family Hx…. DM is protective
CIGTS showed what?we should start on drops first… don’t go straight to surgery..VF progression not significantly different
malignant ciliary block glaycoma is whataqueous misdirection from choroidal effusion shallowing chamber from pressing forward, IOP 9 (with shallow chamber → kinda high) suprachoroidal hemorrhage….in chronic ACG… findings are → shallow AC, increased IOP, patent PI, no suprachoroidal heme (it’s in differential, but it’s not malignant glaucoma)
tx malignant ciliary block glaucomaatropine, cycloplegic, aqeous suppressnats, YAG cap in pseudophakes to hyalioid face. argon laser to ciliary processes if all else fails vitrectomy
aqueous humor componentshypertonic, pH 7.2, high ascorbate, low k high na
tight junctions between apical layers of pigmen/nonpigmented epithelium (blood aqueous barrier)yay
formationaqueous by what mechanismsultrafiltration and simple diffusion
SWAP is more sensitive than?white on white… it is blue on yellow
lens rim artifact is worse starting at what degree of hyperopia?+3 doubles +6 quadruples…
which increase uveoscleral outflowpge and alphga2 agonists
parasimpathomimetcs do whatincrease tm
most effective glaucoma medPGE 33 % > BB 25-30 > alpa 20-25 > topical CAI 15%
timolol reduces HDL…OK
important side effects of CAI?sulfa allergy, renal stones, hypokalemia
don’t use what medication ins HSV keratitis?prostaglandin analogues
bad taste from what meds?topical CAI
critical angle of air-corneal interface is?46 degrees
which lense can do indentation gonioscopy to determine aposoitional vs. synechial?Zeiss…posner…sussman (not goldmann)
tear between longitudinal and ciliary muscles in what?recession
pigmentary glauc occurs in…white myopic mildly men
unilateral white person glaucoma ddx?pigmentary or traumatic >>> poag
peripheral iris concavity with large sampaolesi laine, dx?pigmentary glaucoma
distrubtion of lens issues in PXE?midperipheral clear zone, central translucent dis, peripheral granular
Japanese people get what?glaucoma
what should not be used in NVA?miotics
who gets exfoliation glaucoma?Scandinavian 60-70 year olds
what clinical sign is seen least commonly in fuchs….PS/PAS
typically unilateral fuchs…rubella…atropich hypochromic atrophic… fine vese.s not classic… onset later in lifehellllz yeah
segmental atrophy fromacute angle closure
bilateral mesodermal dysgenesis is reigers findingautosomal dominant juvenile glaucoma, high insertion into tm, iris stromal hypoplasia, corectopia, posterior embryotoxon, iris strads, dental and skeletal defects..reigers
corneal edema is a feature of what ICE?chandler
what kind of glaucoma is aniridia?JUVENILE not congenital…PAX6 gene…sporadic gets Wilms tumor.. progressive corneal pannus or leukoma in 100%, cataract in 85%, glaucoma in 60%
white patches on anterior mature cataract are what pathologically?macrophages
silicone oil blocks pupil why?less dense
need tPA for fibrinoid trabeculectomy high IOPcool!
NO NUCLEI IN RBC DUH for phacolytic vs. ghost cells in angle/Ok
pigmentarypigment granules
melanomalytic glaucoma pathmelanin in macrophages
goniotomy in CHILDREN…do trabecolotomy inCHILDREN!... trabeculectomy in adults
goniotomy and trabeculotomy are equally effective…goniotomy requires view… trabeculotomy doesn’t require a view…. cut down to schlemms canal and canalize it rotate and cut!
mean IOP was the same between tubes and trabs.gooood!
pilo 2% for phacomorphic.. avoid what?cycloplegics
paracentesis fixes pressure corneal edema how long?couple MINUTES!!

cornea review

Question Answer
superior limbic keratoconjunctivitis staining?rose Bengal fine punctate of superior bulbar conj, can be associated with superior filamentary keratopathy
important tissue parameters for cornea transplant?2 – 70 yoa…. death to preservation time 12-18 hrs, tissue storage time < 4 days, endothelial cell count > 2000
CIN excision strategy (margins)4 mm
fusarium in humid climatesok!
wave-like fluorescein in LCSDalong with loss of palisades of vogt, peripheral pannus
path of LCSDpresence of conjunctival goblet cells in corneal epithelium
basic secretion with anesthetic for 5 minutes, schirmer 1?without anesthetic for 5 minutes = basic + reflex
schirmer 2schirmer I + cotton tipped applicated nasal mucosa for reflex secretion
association of keratoglobus (present at birth with perforation)ehlers danlos type VI, blue sclera, deafness, flexibility
peeing on standing is ?alkaptponuria, treat with vitamin C
most common reasons for PK?fuchs, keratoconus, PBK, repeat graft
L > G > M ma PKrecurs after PK
radius of curvature of cornea7.8 mm
causes of whorl keratopathy?
fabry is X linked deficiency in what?sulfatase causing verticillata
shield ulcer in what?vernal keratoconjunctivitis
minimal conj injection with thygeson as opposed to EKCok
type IV collagen in basement membraneshuzzah… descemet and lens capsule
Herbert pits + sup palpebral conj scarring + pannus superiorly =trachoma

111 Dystrophies

Question Answer
Lattice gene? Locus?TGFB1
Lattice inheritance?AD
Lattice location?stroma
Lattice treatment? Recurrence?BCL > superficial k > PTK > PRK/DALK most likely to recur
Reis bucklers locationbowman sheetlike
Reis bucklers gene and locusTGFB1 Locus 5q31
Reis bucker pathologysheetlike connective tissue placement, saw toothed on electron microscopy
Lisch Dystrophy locationepithelium
Findings in Lisch?feathery microcysts band shaped
Symptoms of Lisch?usually none
Inheritnce of Lisch?X dominant, locus Xp22, unkown gene
Schnyder inheritance and geneAD, UBIAD1
Schnyder pathologyoil red O cholesterol and phospholipids
age at dx of schnyder 20-40
findings in schnyderstarts centrally with subepi crystals and dens arcus, stromal, loss of photopic vision because of central opacity check HDL/LDL
caution in phaco if endothelial count is less than1000 risks pseudophakic bullous keratopathy
preop pachy that risks symptomatic edema post op?650
what pachy is there epithelial edema?>700
Patient gets edema when endo count is< 500
normal endothelial cell count1500 -300
endothelial cell count at birth4000
endothelial cell count at young adult3000
age 60 endothelial cell count2500
donor cornea needs to have how many endothelial cells2000
percent increase needed to get descemets folds10%
topical acetylcystein treatsfilamentary keratitis
common findings in congenital rubelladeafness, cardiac ductus patent, salt and pepper retinopathy > cataract and microphthalmos OR glaucoma

plastics review

Question Answer
epicanthus inversus + ptosis is autosomal ___? disease?dominant blepharophimosis
Everyone gets Embryonal, alveolar is awful, please get pleomorphicwoww

general review

Question Answer
cloquets canal isa remnant of hyaloid vasculature between lens and nerve head
axenfeld loops areciliary nerves visible in sclera near limbus
long ciliary nerve comes off what ?nasociliary V1…supplies iris, cornea, ciliary muscle…tip of nose Hutchinson sign
de morsier syndrome is?pituiutary hypolasia
standing room onlyV1 Superior orbital fissure, V2 rotundum, V3 ovale