36 Questions
What is the first line therapy for glaucoma?
Prostaglandin Analogues or Beta-blockers
What is the purpose of YAG laser iridotomy in glaucoma treatment?
To create a small opening through the iris
What is the duration of action of Selective laser trabeculoplasty (SLT) in glaucoma treatment?
1-5 years
What is the main purpose of Trabeculectomy in glaucoma treatment?
To reduce IOP by creating a fistula
What is the purpose of Phacoemulsification in cataract extraction?
To remove cataract through two small corneal incisions
What is the main indication for using Pilocarpine in glaucoma treatment?
IOP >30mmHg
What is the purpose of the scleral flap in Trabeculectomy?
To control the flow of the fluid
What happens to the fluid in the filtering 'bleb' after Trabeculectomy?
It is reabsorbed back into the blood stream
What is the purpose of using ultrasonic waves in phacoemulsification?
To fragment and emulsify the cataract
What is the primary reason for PCO occurrence?
Proliferation of the lens capsule
What is the objective of scatter laser treatment in diabetic retinopathy?
To reduce the risk of vitreous haemorrhage and retinal detachment
What is the recommended course of action for patients with dry ARMD?
Lifestyle modifications and supplements
What is the mechanism of action of anti-VEGF therapy in wet ARMD?
Stops new blood vessels from leaking and growing
What is the advantage of phacoemulsification over ECCE?
No need for stitches
What is the purpose of grid laser photocoagulation in diabetic maculopathy?
To treat diabetic maculopathy with leakage near the macula
Why is beta-carotene not recommended for smokers with dry ARMD?
It can cause health hazards in smokers
What is the purpose of the large limbal incision in ECCE?
To remove the cataract in one piece
What is the objective of focal laser photocoagulation in diabetic maculopathy?
To apply laser burns directly to leaking microaneurysms
In what scenario would you use a combination of Prostaglandin analogues and Beta-blockers as a treatment for glaucoma?
When first line therapy is not effective
What is the purpose of creating a small opening in the iris during YAG laser iridotomy?
To allow trapped fluid to flow into the front of the eye
What is the advantage of Selective laser trabeculoplasty (SLT) over other laser treatments?
It can be used as a first line treatment
What is the purpose of removing a small piece of tissue under the scleral flap during Trabeculectomy?
To make an opening into the eye
What is the role of the filtering 'bleb' in Trabeculectomy?
To collect and reabsorb fluid into the bloodstream
What is the mechanism of action of Phacoemulsification in cataract extraction?
Emulsification of the lens using ultrasonic waves
In which scenario would you use Pilocarpine in glaucoma treatment?
When IOPs are >30mmHg
What is the purpose of making two small corneal incisions in Phacoemulsification?
To allow insertion of instruments
What is the primary purpose of removing the top of the lens capsule during phacoemulsification?
To access the cataract
What is the main difference between phacoemulsification and ECCE?
The method of removing the cataract
What is the purpose of corneal stromal saline injection in phacoemulsification?
To seal the incision
Why is PCO more likely to occur after ECCE?
Because more of the lens capsule is left behind
What is the primary purpose of scatter laser treatment in diabetic retinopathy?
To reduce blood vessel growth
What is the main difference between focal and grid laser photocoagulation in diabetic maculopathy?
The location of the laser burns
What is the recommended course of action for patients with dry ARMD who are smokers?
Advise them to stop smoking and avoid AREDS supplements
What is the primary mechanism of action of anti-VEGF therapy in wet ARMD?
Stopping new blood vessel growth
What is the purpose of intravitreal injections in anti-VEGF therapy?
To deliver the medication directly to the retina
What is the primary advantage of phacoemulsification over ECCE?
Faster recovery time
Study Notes
Glaucoma
- First line therapy: Prostaglandin Analogues or Beta-blockers
- Second line of treatment: combination of Prostaglandin analogues and Beta-blockers (e.g., Xalacom)
- Third line therapy: Alpha-2-agonists or Carbonic Anhydrase Inhibitors (CAI)
- If IOP >30mmHg, use Pilocarpine to increase outflow of aqueous humour by ciliary contraction
Laser Treatment for Glaucoma
- Selective laser trabeculoplasty (SLT): lowers IOP by 20-30%, duration of action: 1-5 years
- YAG laser iridotomy: used for ACG and pigment dispersion syndrome, creates a small opening through the iris to allow trapped fluid to flow into the front of the eye
Surgical Treatment for Glaucoma
- Trabeculectomy: filtration surgery that reduces IOP by creating a fistula, involves a small incision in the conjunctiva and removal of a small piece of tissue under the scleral flap
Cataract
- Phacoemulsification: standard cataract extraction method, involves topical local anaesthetic, two small corneal incisions, and ultrasonic waves to fragment and emulsify the clouded lens
- Extracapsular cataract extraction (ECCE): used for extremely dense nuclear opacity, involves a large limbal incision and requires stitches
Posterior Capsular Opacification (PCO)
- Most common complication of cataract surgery, results from proliferation of the lens capsule
- Treated with YAG laser, which creates an opening in the back of the eye's cloudy lens capsule
Diabetic Retinopathy (DR)
- Treatment only available for proliferative retinopathy (R3) and maculopathy (M1)
- Scatter laser treatment (panretinal photocoagulation, PRP): laser treatment for proliferative retinopathy, causes blood vessels to shrink and inhibits them from growing
- Focal laser photocoagulation: laser treatment for diabetic maculopathy, applied directly to leaking microaneurysms
- Grid laser photocoagulation: laser treatment for diabetic maculopathy, applied to leaking microaneurysms no closer than 500μm to the macula or optic disc
Age-Related Macular Degeneration (ARMD)
- Dry ARMD: no treatment available, advice on lifestyle changes (e.g., stop smoking, green leafy vegetables, Omega 3 supplements)
- Wet ARMD: medical treatments available, including Anti-VEGF, photodynamic therapy (PDT), and argon laser
- Anti-VEGF: stops new blood vessels from leaking/growing and bleeding under the retina, available therapies include Macugen (Pegaptanib), Bevacizumab (Avastin), and Lucentis (Ranibizumab)
Glaucoma
- First line therapy: Prostaglandin Analogues or Beta-blockers
- Second line of treatment: combination of Prostaglandin analogues and Beta-blockers (e.g., Xalacom)
- Third line therapy: Alpha-2-agonists or Carbonic Anhydrase Inhibitors (CAI)
- If IOP >30mmHg, use Pilocarpine to increase outflow of aqueous humour by ciliary contraction
Laser Treatment for Glaucoma
- Selective laser trabeculoplasty (SLT): lowers IOP by 20-30%, duration of action: 1-5 years
- YAG laser iridotomy: used for ACG and pigment dispersion syndrome, creates a small opening through the iris to allow trapped fluid to flow into the front of the eye
Surgical Treatment for Glaucoma
- Trabeculectomy: filtration surgery that reduces IOP by creating a fistula, involves a small incision in the conjunctiva and removal of a small piece of tissue under the scleral flap
Cataract
- Phacoemulsification: standard cataract extraction method, involves topical local anaesthetic, two small corneal incisions, and ultrasonic waves to fragment and emulsify the clouded lens
- Extracapsular cataract extraction (ECCE): used for extremely dense nuclear opacity, involves a large limbal incision and requires stitches
Posterior Capsular Opacification (PCO)
- Most common complication of cataract surgery, results from proliferation of the lens capsule
- Treated with YAG laser, which creates an opening in the back of the eye's cloudy lens capsule
Diabetic Retinopathy (DR)
- Treatment only available for proliferative retinopathy (R3) and maculopathy (M1)
- Scatter laser treatment (panretinal photocoagulation, PRP): laser treatment for proliferative retinopathy, causes blood vessels to shrink and inhibits them from growing
- Focal laser photocoagulation: laser treatment for diabetic maculopathy, applied directly to leaking microaneurysms
- Grid laser photocoagulation: laser treatment for diabetic maculopathy, applied to leaking microaneurysms no closer than 500μm to the macula or optic disc
Age-Related Macular Degeneration (ARMD)
- Dry ARMD: no treatment available, advice on lifestyle changes (e.g., stop smoking, green leafy vegetables, Omega 3 supplements)
- Wet ARMD: medical treatments available, including Anti-VEGF, photodynamic therapy (PDT), and argon laser
- Anti-VEGF: stops new blood vessels from leaking/growing and bleeding under the retina, available therapies include Macugen (Pegaptanib), Bevacizumab (Avastin), and Lucentis (Ranibizumab)
This quiz covers the different treatment options for glaucoma, including first, second, and third line therapies, as well as laser treatment. Learn about the medications and procedures used to manage glaucoma.
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