"Hole-y Macula Batman"
Surgery for Diabetic Retinopathy
Who ya gonna call? Retina!
Detached Drama
Give it a shot
200

Approximately (this) percentage of stage 1 macular holes will resolve spontaneously.

What is 50%?

200

In patients with a dense diabetic vitreous hemorrhage, this test should be performed regularly, in the clinic, if surgery is deferred.

What is serial B scan ultrasonography?

200

These are the indications for vitrectomy in the setting of Retained Lens Fragments (will accept 2 out of 3).  

What is secondary glaucoma, lens-induced uveitis, and presence of nuclear fragments.  

200

Pneumatic retinopexy is not for every patient.  These are the characteristics that define a good candidate for this procedure.  (Name 4 out of 6).

What is: 1)Confidence that all breaks have been identified. 2)Breaks confined to the superior 8 clock hours. 3)A single break, OR multiple breaks within 1-2 clock hours.  4)Absence of PVR grade CP or CA. 5)Cooperative patient who can maintain proper positioning. 6)Clear media.

200

This should be obtained and confirmed prior to any injection, laser, or surgery.  

What is informed consent?  

400

This step in MH surgery has been shown to improve the rate of hole closure in various studies.  

What is ILM peeling?

400

In the absence of a retinal detachment, Gas or air may still be indicated for a simple diabetic VH to prevent this.  

What is postoperative bleeding? 

400

These are two main reasons to delay or defer vitrectomy for retained lens fragments.

What is opacified cornea, cortical remnants only (especially if small, which usually resolve without surgery).

400

Complications of this procedure include induced myopic shift.  

What is Scleral buckling?

Additional complications include anterior ocular ischemia, diplopia, ptosis, orbital cellulitis, subretinal hemorrhage (from drainage), and retinal incarceration at drainage site.  

400
The number of intravitreal injections in the United States increased from fewer than 3000 in 1999, to this amount by 2016.  (Multiple choice: 2 million, 3.4 million, 6.5 million, 9 million).  

What is 6.5 million?  

600

It has been suggested in various studies that this newer surgical manoever may further increase closure rates, particularly in larger holes.

What is inverted ILM flap technique?

600

This pre-operative treatment may minimize intraoperative bleeding.  

What is intravitreal antiVEGF treatment?

600

If a PCIOL becomes posteriorly dislocated with the capsule, and needs to be removed, these are the three main options for IOL replacement.

What is: ACIOL, sutured IOL (to sclera or iris), or intrascleral fixated IOL.  

600

For extensive PVR, if peeling fails to relieve all the traction, this surgical procedure may become necessary. 

What is a relaxing retinotomy or retinectomy? 

600

Application of Povidone Iodine at this concentration, for this minimum amount of time, is the most universally accepted step in the injection procedure.  

What is 5%, for at least 90 seconds? 

800

This aspect of MH surgical repair may last from several hours to up to 2 weeks.

What is face down positioning?  

800

DME is largely treated with injections, but vitrectomy surgery may be considered in recalcitrant cases, especially when either of these 2 things are present on exam.  (Will accept either answer).  

What is a taut posterior hyaloid or an ERM?  
800

Risk factors for suprachoroidal hemorrhage (name 5 out of a possible 9).  

What are: 1)advanced age, 2)aphakia, 3)arteriosclerosis, 4)glaucoma, 5)Hypertension, 6)intraoperative tachycardia, 7)myopia, 8)Sturge-Weber choroidal hemangiomas, 9)anticoagulant drugs.

800

In the Silicone Oil Study, this tamponade was found to be inferior.  

What is SF6?  (Was found to be inferior to either C3F8 or Silicone oil).  

Also, patients with S.O. experienced a lower rate of hypotony compared with C3F8, though differences in outcomes were statistically insignificant.  

800

Multiple studies have suggested that restricting talking and/or using masks during injection, reduces endophthalmitis related to this organism.

What is Streptococcus viridans?

1000

This pair of pioneers first performed, and reported results of macular hole surgery at the Academy of Ophthalmology in New Orleans, in 1989.  (Half Credit if you can name just one of these).  

Who are Robert Wendel and Neil Kelly?

1000

Surgical manoever in TRD surgery in which bands of fibrovascular tissue causing traction are cut, but the epiretinal proliferations are not completely removed.

What is segmentation?  

1000

Surgical drainage of suprachoroidal hemorrhage is most successful when liquefaction of the hemorrhage occurs, usually in this time range.  

What is 7-14 days?  Can monitor level of liquefaction with serial B scans.  

1000

In addition to tamponade of the breaks (with gas) and creating a chorioretinal adhesion (with laser), an additional goal of vitrectomy for retinal detachment is this. (Will accept 1 of 2 answers). 

What is Removal of cortical vitreous adherent to the break and direct drainage of Subretinal fluid.  

1000

This injection related complication is unique to the Dexamethasone sustained release implant. 

What is severe corneal endothelial toxicity after migration of implant to the a/c?