IOLs
What type of IOL should be avoided in patients with silicone oil in the eye or who may have silicone oil later on?
Silicone lens
What is the minimal acceptable difference in axial length between the two eyes?
0.3mm
List three risks of retrobulbar anesthesia
retrobulbar hemorrhage, optic nerve injury, globe penetration, EOM toxicity, inadvertent IV injection, inadvertent intradural injection
In a clear corneal incision cataract surgery, what anticoagulants need to be stopped prior to surgery?
Bonus +100: What is the "time to restoration" after stopping warfarin?
None!
3-5 days
What is a potential complication of posterior polar cataract and what should you try to avoid doing during surgery?
Posterior capsule rupture. Avoid complete hydrodissection
What is an advantage of a square-edge IOL? Bonus +200: What would be an advantage of round-edge IOL?
Reduced rates of PCO
Decreased rates of dysphotopsias
If a surgeon chooses to place a 3-piece IOL in the sulcus with optic capture, how should he/she adjust the power of the IOL from the original power chosen?
No adjustment necessary, IOL is still in the bag
What is used to promote sterilization prior to starting cataract surgery?
5% povidone-iodine SOLUTION in the eye and 10% around the eye
What kind of refractive error can occur in someone with Fuchs who has CE IOL and later needs an EK?
hyperopic shift-- important to leave people more myopic if concerned for possible need for EK in future
What is the name given to a cataract with swollen cortical material that envelops a hard nucleus
Intumescent cataract
Explain monovision, including the refractive goals of each eye and which eye is set for which refractive power
Mini-monivision is -0.50 ro -1.50D, while full monovision is -1.50 to -2.50D
List the 5 spikes in an A-scan. Bonus +100: What is something that a patient could have in the eye that could cause the AL to be falsely large?
1. Cornea/probe
2. Anterior lens
3. Posteiror lens
4. Retina
5.Choroid/sclera
Silicone oil
What two intracameral antibiotics are most popular in the US?
Bonus +100: Intracameral is no longer used because of what complication?
Moxifloxacin, cefuroxime
Hemorrhagic occlusive retinal vasculitis (HORV)
What would be an advantage of doing a PK procedure first prior to CE IOL, vs combined phaco/PK?
After PK is done, can have more reliable keratometry for IOL calcs
List three ways to overcome a small pupil in cataract surgery
Malyugin ring, iris hooks, iris stretching, OVDs
What does it mean that an IOL is aspheric and why is this a good thing?
The lens is not perfectly spherical. They have negative spherical aberration, which counteracts the positive spherical aberrations (higher order aberration)
If a surgeon initially chose to use a +29.00D in-the-bag IOL, but then decided to put a lens in the sulcus, what adjustment should be made to the IOL power?
Subtract -1.50D (+27.50D)
Cohesive OVDs have (long/short) chains, (high/low) molecular weight, (high/low) viscosity, (high/low) surface tension
long, high, high, high
What postoperative refractive surprise occurs in patients with previous RK and why?
hyperopia because the incisions swell, flattening the cornea
List 4 reasons why someone could have zonular incompetence
Pseudoexfoliation, trauma, prior surgery/vitrectomy, marfan, ehlers-danlos, homocystinuria, weill-Marchesani
What is the difference in a multifocal IOL and an EDOF IOL?
MFIOL: achieve distance/intermediate/near vision by dividing light into 2 or more focal points
EDOF: Creates an elongated focal range from distance through intermediate, but no near
List the main difference between corneal topography and corneal tomography
Bonus +200: What is the other name for tomogrsphy?
Topography: Measures anterior corneal surface with palcido disk-based technology
Tomography: Anterior AND posterior cornea curvature is measured
Scheimpflug imaging
List the three components of OVDs
1. Sodium hyaluronate
2. Chondroitin sulfate
3. Hydroxylpropyl methylcellulose (HPMC)
What does LIDRS stand for, what happens, and who does it happen in?
Bonus +300: How do you stop it?
Lens-iris diaphragm retropulsion syndrome. 360 degree iridocapsular contact causing reverse pupillary block, dilation and pain
Manually separate the iris from the anterior capsule rim
Nanophthalmos predisposes patients to what particular problem after surgery? Bonus +200- how would you treat it?
Uveal effusion
Cycloplegics, steroids, aqueous suppressants