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aniridia associated with what systemic condition? What test would you get
"wilms tumor, need to get abdominal ultrasound"
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brimonidine and iopidine are both what class
alpha-agonists
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brimonidine should not be given to who and why
"brimonidine should not be given to kids <10 yo since it can cause CNS depression, lethargy"
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what is possner schlossman and what you should you avoid in treatment
"possner-schlossman is low grade uveitis with spikes of IOP for a few days, can treat acute with steroids but dont use long term steroids"
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how does aniridia lead to angle closure glaucoma
"aniridia can lead to chronic angle closure glaucoma because iris stump progressively rotates forward (which takes time, pts get glaucoma in their 20s)"
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what is fuch's heterochromic iridocyclitis
"fuch's heterochromic iridocyclitis = eye pain, high IOP, stellate KPs, PSC, NVA with spontaneous hyphema (but doesn't lead to PAS, fibrous membrane in the angle, or angle closure)"
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"what mutations associated with joag, NTG, congenital glaucoma, axenfeld-reiger"
JOAG = TIGR/MYOC gene; NTG = OPTN gene; congenital glaucoma = CYP1B1 gene; Axenfeld-Reiger = PITX2 and FOXC1 mutation
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what increases and decreases uveoscleral outflow
"cycloplegics increase uveoscleral outflow, pilocarpine decreases uveoscleral outflow"
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what cells are associated iwht frequency doubling VF? SWAP?
Frequency doubling VF = M (magnocellular) cells; SWAP = koniocellular neurons
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describe axenfeld-reiger
"Axenfeld-Reiger = prominent schwabe's line, iris strand, corectopia, autosomal dominant, b/l , associated with systemic signs (hypodontia, maxillary hypoplasia, redundant periumbilical skin)"
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how is ice different from axenfeld reiger
"ICE syndrome = middle age, corneal endothelial changes/edema, corectopia"
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latatonprost contraindications?
"CME, uveitis, history of herpetic keratitis"
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chronic epinephrine drops can lead to what deposits
adenochrome deposits from oxidized metabolites
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what does aqueous humor not have that plasma has?
"bicarbs and protein (which explains its optical clarity), excess of H, Cl, ascorbate"
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what can cause high IOP in a patient with flat AC and patent LPI
"malignant glaucoma, choroidal effusion, suprachoroidal hemorrhage"
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most common side effect of brimonidine? systemic side effect?
allergic conjunctivitis; dry mouth
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"for congenital glaucoma, when do you do goniotomy vs trabeculotomy"
"goniotomy if angle can be clearly seen (clear cornea), if not then trabeculotomy"
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what are prodrugs
"latanoprost, travatan, dipivefrin, valacyclovir, famciclovir = become biologically active after being hydrolyzed by corneal esterase"
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what is the most common systemic side effect of miotics (pilo)?
increased salivation
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most common systemic SE of CAI (dorz)
abnormal taste
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field of vision last affected by end stage glaucoma
inferotemporal
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beta blockers good or bad for cholesterol
bad
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CTNG results
NTG study found 30% reduction in IOP = reduce VF progression from 35 to 12%
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what are criteria for NF1
"2 of the following: 1st degree relative, 6 or more café au late spots, 2 or more neurofibromas or 1 plexiform neurofibroma (eyelid mass), axillary/inguinal/intertriginous freckling, 2 or more lisch nodules, osseous lesion, optic nerve glioma/pilocytic astrocytoma"
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what is glaukomflecken and what causes it
anterior subcapsular opacities from lens epitheilial cell necrosis due to ischemia from high IOP
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what systemic med do you give angle closure glaucoma with kidney stones and why
methazolamide because it's metabolized by liver
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what drug causes heart block
beta blockers : levobunolol > carteolol
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what is OHTS
ocular hypertension treatment study
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"in ohts, what were risk factors for development of glaucoma in ocular hypertension patients"
"increased age, large vertical or horizontal c:d, thin CCT, african american, male, increased pattern standard deviation, heart disease, IOP"
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what are the 3 ice syndromes
"cogan reese, chandler, essential iris atrophy"
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what is the common finding for these ice syndromes
"""hammered silver"" or ""beaten metal"" appearance of corneal endothelium"
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what is the prominent feature of cogan reese syndrome
presence of iris nodules which are histologically distinct from melanoma
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prominent feature of chandler's syndrome
corneal edema
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prominent feature of essential iris atrophy
corectropia and iris atrophy
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"is ice syndrome uni or bilateral, axenfeld reiger?"
unilateral; bilateral
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what is schartz syndrome
rise in IOP after rhegmatogenous RD from retinal photoreceptors clogging the TM
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what is the chance of cataract after trab?
20-40%
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what are contraindications for nonselective adrenergic agonists like dipivefrin and epinephrine
"CME, eyes without intact post capsule"
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what are side effects of adrenergic agonists
"adenochrome deposits, stainging of soft contact lens, angle closure, blepharoconjunctivitis (allergic), HTN, ha, tachycardia"
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what happens when you put too much fluorescein with measuring IOP
IOP reading is higher than real IOP
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by what factor does the stimulus size in area change in goldman
factor of 4
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what illegal drugs increase IOP
"LSD, ketamines"
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below what pupil diameter do you get generalized depression on HVF
2.5
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what are characteristics of plateau iris
"deep AC centrally, sine wave configuration of iris on compression during gonio, peripheral angle narrowing in setting of patent LPI"
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how do you treat plateaue iris
"PI to relieve any pupillary block, then laser iridoplasty to help pull the iris from TM"
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how do you diagnose plateaue iris
there has to be a lack of change in angle configuration after LI
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what is spaeth notation for angle classification
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what is the only beta blocker you can give for asthma and why
betaxolol; only gtt to selectively block beta1 receptors; lungs contain only beta2 receptors
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what time period is the greatest risk of high IOP after traumatic hyphema and why?
3-7 days; rebleeds occur in that time period since original clot breaks down
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what conditions is laser trabeculoplasty most effective
"pds, pxg, POAG;"
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what is an indirect parasympathomimetic drug
echothiophate iodide
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what was the important finding of AGIS (advanced glaucoma intervention study)
"treat blacks and whites differently; blacks did better with A-T-T (ALT then trab then 2nd trab) while whites did better with T-A-T (trab, then alt, then 2nd trab)"
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what are advantages/disadvantages of fornix based approach to trabs
"technically easier (incision actually made at limbus while limbal incision is made 8-10 mm posterior to the limbus), more wound leaks since incision is at the limbus; lower more diffuse blebs since the subconjunctival scar is anterior to the scleral flap promoting fluid flow posterior to the flap"
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"in OHTS, what percent reduction in IOP reduced poag from 9.5 to 4.5%"
22.50%
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who has increased risk of hypotony maculopathy after trab?
"young, myopic, 1st trab, pigment dispersion glaucoma"
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what glaucoma drop can prolong paralyzing effects of succinylcholine
phospholine iodide
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what is the rate of aqueous humor formation in the eye
2.0 ug/min (1.5-4.5)
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is uveoscleral outflow pressure dependent or independent
independent
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can systemic beta blockers reduce topical beta blocker effectiveness?
yes
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what are contraindications for dCPC
"active inflammation (process causes a lot of inflammation), eyes prone to CME especially if good VA"
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what are indicaitnos for dCPC
"poor vision, poor candidates for incisional surgery"
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what should you NOT do to ICE patients
laser trabeculoplasty
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what enzyme is responsbile for active secretion of aqueous humor from the ciliary body
carbonic anhydrase II
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what was the main conclusion of CIGTS (collaborative initial glaucoma treatment study)
initial medical and surgical therapy resulted in similar VF changes after 5 years
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what was the main conclusion of EMGT (early manifest gluacoma trial)
62% of untreated patients vs 45% of treated patients showed progerssion in their fields
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what medication causes choroidal effusions
topomax
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what are side effects of beta blocker gtts
"masking of hypoglycemia, bronchospasm, bradycardia, impotence, depression, reduced glucose tolerance"
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what GDI is valved?
ahmed
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what is the only glaucoma drop that is class b and can be given to pregnant woman?
brimonidine
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what eye drop can increase uterine contractility
prostaglandin analogs
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what eye drops should be avoided in nursing mothers
beta blockers and brimonidine
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what is the main ocular findings of NF2
"PSC (no plexiform neurofibroma, no risk of gluaoma)"
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what is the main site of aqeous humor outflow
juxtacanalicular TM
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"other than betaxolol, what can you give asthmatics and why"
"carteolol; although it nonselectively blocks beta receptors, it also activates other receptors which can reduce negative side effects in lungs and heart"
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what conditiosn would cause mannitol to be less effective and why?
uveitic glaucoma; uveitis causes disruption of blood-aqeuous barrier which decreases osmotic force
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how long can you not treat someone with hypotony maculopathy before trying to bring up IOP surgically
"not really known, but most say 3 months"
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goldmann applanator measures force necessary to flatten an area of cornea of what diameter
3.06mm
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what are advantages/disadvantages of 5FU for trabs
"inexpensive, no dilution required, stable at room temp, better safety margin; less effective, high incidence of K toxicity"
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what are advtnages/disadvnatges of MMC
"results in lower pressure, need to apply for shorter time; need to reconstitute from powder, expensive, unstable at room temp, high risk of bleb leaks/ischemic blebs/infections"
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what are classic findings of suprachoroidal hemorrhage
"pain, high IOP, LP vision, shallow AC, ""seeing red glow behind the fundus"""
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what are risk factors for suprachoiroidal hemorrahge
"incisional glaucoma operations, open sky surgeries (pk), old age, myopia, CAD, aphakic, glaucoma, htn, tachycardia"
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