Ohp II Mt 2 Cataracts

Since COPD pts have increased chances of coughing, its important to make sure they are under the proper anesthesia to reduce this potential. Parkinson's pts have increased change of shaking.

The statement is true. Oral glaucoma medications are indeed used before surgery to help control intraocular pressure (IOP). However, it is recommended to switch the patient from using prostaglandins because they can aggravate inflammation.

Intracameral has less potential side effects

anterior lens spike > posterior lens spike

Anterior: Y
Posterior: inverted Y

Peribulbar is less risky than retrobulbar
Retrobular is the most dangerous...you inject the needle as in peribulbar, but then you tilt upward to go into the muscle cone...this is risky bc you might hit the optic nerve

--> Sunflower cataract

ICCE: increased risk of inflammation & complications (CME, RD)
- iris-fixed IOL will produce square-shaped pupil

All of the above are causes, but RUBELLA is most common cause
Rubella is assoc with ear/heart defects + salt/pepper fundus

Mneumonic: "Salt&Pepa were such (ru)bellas, they went through my ear straight to my heart"

As a person ages, the lens in their eye can grow and become thicker, potentially causing a condition known as phacomorphic lens. This condition can lead to narrow angle glaucoma, where the angle between the iris and the cornea becomes blocked or closed off. This blockage can increase the pressure inside the eye, leading to symptoms such as eye pain, blurred vision, and even vision loss if left untreated. Therefore, the statement "A phacomorphic lens can cause narrow angle glaucoma because with age the lens grows and can close off the angle" is true.

Damage by speculum or complication of retrobulbar anesthesia can cause ptosis, which is a post-operative lid complication. Ptosis refers to the drooping of the upper eyelid, which can occur due to various reasons, including trauma or nerve damage during surgery. In this case, the speculum or retrobulbar anesthesia might have caused damage to the muscles or nerves responsible for lifting the eyelid, resulting in ptosis.

The LEAST common is PSC

The surgery itself will cause inflammation and therefore a uveitis must be treated 3-6 mo prior to sx

VA same = no significant glare problem
VA reduced = glare is a problem
VA improves = pinhole effect --> recheck Rx

The absence of scleral spikes during A Scan indicates that the probe is oriented toward the optic nerve head (ONH). This is because scleral spikes are reflections from the sclera, which is the white outer layer of the eye. When the probe is properly oriented towards the ONH, the scleral spikes are not visible because the sound waves are directed towards the optic nerve head instead of reflecting off the sclera. Therefore, the statement is true.

Cataract surgery can result in a significant loss of endothelial cells, specifically 60% of them. The endothelial cells are responsible for maintaining the clarity of the cornea by regulating the fluid balance. During cataract surgery, the natural lens of the eye is removed and replaced with an artificial lens. This surgical procedure can cause damage to the endothelial cells, leading to their loss. It is important to consider this potential loss when assessing the risks and benefits of cataract surgery.

The correct answer is 3-5 weeks. After cataract surgery, it is important to wait for the eye to heal and stabilize before performing a refraction and prescribing a new spectacle prescription (SRx). This typically takes around 3-5 weeks for the patient's vision to stabilize and for any residual refractive error to become apparent. Waiting until this point ensures that the refraction is accurate and that the patient's vision is optimized with the new intraocular lens (IOL).

97% accurate

Glare testing is typically done with the patient undilated, not dilated. Dilating the eyes can affect the accuracy of the test results, as it changes the size of the pupil and can alter the perception of glare. Therefore, it is important for the patient to be undilated during glare testing to obtain accurate and reliable results.

Posterior & Anterior Subcapsular cataracts are commonly associated with being VISUALLY DEVASTATING.

Vossius Ring: pigment ring on anterior capsule from iris

INR will tell us how much blood clots and how thin blood is
Normal INR = 2-4
If blood too thin --> inc'd risk of bleeding out/orbital hemorrhage

1200-1400 = OK candiate (minimally acceptable range for sx)

Interferometry: UNDERPREDICTS VA w/ dense cataracts & OVERPREDICTS VA w/ macular issues

Galactosemia: no galactose metabolizing enzymes --> galactose b/u to toxic levels and damages tissue --> inc'd intracellular osmotic pressure + fluid influx --> oil-droplet apperance from zonular/nuclear opacity

Diabetic cataracts = osmotic cataract --> cause LARGE MYOPIC SHIFT

Topical NSAIDs are used pre-sx (pre-surgery) to maintain mydriasis (dilation of the pupil) and prevent post-op (post-operative) CME (cystoid macular edema). The appropriate regimen is to administer 1 drop of Acular every 30 minutes, starting 2 hours before surgery. This ensures that the medication is present in the eye at the time of surgery to maintain mydriasis and minimize the risk of post-operative complications.

Sutural cataracts can occur in both the anterior and posterior of the lens, but anterior cataracts are more common. This means that while cataracts can form in both parts of the lens, they are more likely to occur in the anterior portion.

Begin tapering steroids 1 week post-op ONLY if no inflammation/cells remain

Nuclear contents can break through capsule in Morganian cataract.

Or significant impairment with glare...most other insurance policies will cover once 20/40

Coronary: radial, club-shaped opacities in cortex (similar to cortical cataracts)

Lamellar has a SAND DOLLAR apperance (ring of opacity around nucleus)

Fetal Nuclear Cataracts are limited to the embryonic nucleus. This means that the cataracts only affect the nucleus of the lens during the fetal stage of development. It suggests that the condition does not extend to the adult nucleus, which is the central part of the lens in the eye that develops after birth. The answer implies that the occurrence of cataracts is specific to a particular stage of fetal development and does not persist into adulthood.

Mature: complete opacification of lens capsule, cortex and nucleus
Hypermature: liquefaction of lens contents and wrinkling of capsule

Infantile (congenital) cataracts typically do not affect vision because they are present from birth and the brain adapts to the cloudy lens, allowing the child to develop normal vision. In some cases, if the cataracts are severe or left untreated, they can cause visual impairment. However, in general, infantile cataracts do not have a significant impact on vision.

Visible whole line = good macular fxn
Broken/wavy line = leakage/hole in macula
No visible line = need more testing (not a good indicator of poor macular fxn'ing)

Both of these occurs in the CORTEX

Grooving: groves weaken lens --> lens slowly breaks apart
Phaco-Chop: chopper breaks lens apart with force --> less time = less heat/energy = less stress on zonules = less risk of damage to endothelium (requires more skill however)

Most common = LOCAL
However, topical is recently popular bc it reduces risk of complications, however pain control is not as good.

ECCE: posterior capsule left in place so you are concerned that it may rupture
ECCE uses a PC-IOL, but if the capsule ruptures, forced to use AC-IOL

Glassblower's: TRUE exfoliation cataract (capsule splits/chips off and flakes stick to lens)
Glaucoma: psuedo-exfoliation cataract

Retinal spike sloping: falsely long axial length = weaker IOL = hyperopia = + SRx needed
AC depth inconsistency = corneal compression: falsely short axial length = stronger IOL = myopia = -Srx needed

The early post-op signs of lid edema and chemosis are indicative of endophthalmitis. Lid edema refers to swelling of the eyelids, which can occur as a result of inflammation or infection in the eye. Chemosis, on the other hand, refers to swelling of the conjunctiva, the clear membrane that covers the white part of the eye. These signs suggest an inflammatory response in the eye, which can be a sign of endophthalmitis, an infection that can occur after eye surgery.

endpoint = 2/4 presentations

Capsulorrhexis capsulometry:
- safer for the endothelium
- LESS debris floating in AC (easier to remove debris bc it's kept in capsule) = LESS inflammation

Pain Control:
retrobulbar = peribulbar > local > topical

thermal radiation: Glassblower's
Wilson's disease: Sunflower

Diabetic lens is MORE DIFFICULT to break up

Nylon sutures can be used, however, sutures are usually not necessary since the incision is so small. Because there are no sutures, and the cornea is allowed to heal on its own, there is a small hole left open and it's a bacterial entry point