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ODP quiz 2 with correct answers 2024
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ODP quiz 2 with correct answers
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ODP quiz 2 with correct answers- Answer -
Pigmentary Dispersion Syndrome (PDS)
characteristics - Answer -concave bowing of peripheral iris causes physical contact of
the posterior iris with the zonules
Bilateral
YOUNG MYOPIC MALES
PDS Findings - Answer -liberation of pigment from posterior iris
iris transillumination defects
Krukenberg's spindle
pigment deposition on zonules and posterior lens capsule
Uniform TM hyperpigmentation
Scheie's stripe
Focal point for 20D - Answer -2 in
Complications for PDS - Answer -RD
exercise activates dispersion
can have large diurnal variations in IOP as well as spikes in IOP due to pigment release
and exercise
PDS conversion to pigmentary glaucoma - Answer -underdiagnosed in black patients
10-20 convert to gluacoma
Pigmentary Glaucoma
characteristics - Answer -pressure elevates and causes glaucomatous changes to optic
nerve in those with PDS
,must have ONH changes
thought to be pigment granules accumulate in the TM and cause dysfunction of
trabecular endothelial cells
Older you get, the less pigmentation and krukenberg spindles due to lens pushing the
iris forward
treatment of pigmentary glaucoma - Answer -Pilocarpine
glaucoma meds
peripheral iridotomy
-laser hole to neutralize anterior and posterior pressure
-studies show no benefit
-low risk procedure
ALT (argon laser trabeculoplasty)
SLT( selective laser trabeculoplasty)
Pseudoexfoliation syndrome - Answer -made of elastic fibers (fibrillin and alpha-elastin)
and non-collagenous basement membrane material (laminin) that forms fibrils
coated with glycosaminoglycan hyaluronic acid
PES associations - Answer -hyperhomocystemia
high caffeine usage
LOXL1 (lysyl oxidase-like 1) gene
PES findings - Answer -patchy hyperpigmentation of the TM
pigment mixed with amyloid
Kurkenberg spindles
Bulls eye lens
PES Complications - Answer -don't dilate well
can have marked increase in IOP following dilation
use apraclonidine/iopidine before dilation to prevent spike
phenylephrine causes more amyloid release than other dilation drops***
, more complicated cataract surgery
lens can dislocate
slightly higher risk for Alzheimer's
PES management - Answer -RTC 6 months
Pt.education about wearing sunglasses
>21mmHg lower IOP with glaucoma medications
Exfoliative Glaucoma (XFG) - Answer -one of the most common secondary open angle
glaucomas
angle is open in terms of gonioscopy appearance
pigment does not seem to contribute to increased outflow resistance
unlike in pigmentary glaucoma
fluctuations in IOP of 15mmHg or greater in 35% of patients
harder to treat than poag
XFG mechanisms - Answer -connective tissue elastosis due to exfoliation leads to
structural and functional alteration and increased vulnerability of the lamina cribosa
toward elevated IOP
forward displacement of the lens due to zonular weakness
XFG post-cataract surgery - Answer -TM is aspirated intraoperatvely - lavaged out and
vacuumed up
taking the lens out removes some exfoliative material with it
IOP is less of an issue for a few 3-6months then exfoliative material re-accumulates -
less or no medication for this period
Treatment of XFG - Answer -ALT and SLT lower IOP
SLT has greater lowering effects in XFG than Poag
Angle Recession Glaucoma - Answer -only need 50% TM to be functional to maintain
IOP
results from a contusion to the TM and tears in the uveal meshwork and ciliary muscle
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