6.1.11 Understands the treatment of a range of common ocular conditions.

LOOK OVER GLAUCOMA MEDS

SLT for glaucoma (3)

- SLT is increasingly used as a first line treatment to lower IOP.

- Laser is applied directly to the trabecular meshwork to help open the drainage.

- This method lowers IOP by 20-30% and has a duration of actions of 1-5years.

YAG laser iridotomy (2)

- Mainly used in treatment of ACG and pigment dispersion

syndrome due to inadequate aqueous drainage.

- Focused laser beam is used to create a small opening through the

iris. This allows trapped fluid behind the iris to flow into the front

of the eye, thus reducing IOP.

Trabeculectomy (7)

- Filtration surgery that reduces IOP by creating a fistula.

- A small incision in made in the conjunctiva under the upper eyelid.

- Then, a scleral flap is created under the incision and a small piece of tissue is removed

under the flap to make an opening into the eye.

- Sometimes a small piece of the iris may also be removed, this is known as iridectomy.

- The flap is sown back into place to control the

flow of the fluid.

- The fluid draining out is collected into a filtering

'bleb' and this looks like a bubble; however, this

is hidden under the upper eyelid.

- The fluid in the bleb does not leave the eye and

is reabsorbed back into the blood stream.

Phacoemulsification CAT (9)

- Standard cataract extraction method.

- Topical local anaesthetic instilled into the conjunctival sac.

- Two small corneal incisions are made, approximately 180 degrees apart.

- Fluid is inserted through the incision to support surrounding structures.

- Top of the lens capsule is removed to gain access to the cataract.

- Ultrasonic waves used to fragment and emulsify the clouded portions of the lens.

- These portions are then removed with a vacuum.

- An IOL is then inserted.

- The incisions may be sealed with corneal stromal saline injection.

Extracapsular CAT extraction (4)

- Used when there is an extremely dense nuclear opacity.

- A large limbal incision of approximately 8-10mm is created. Big enough to remove the

cataract in one piece.

- Requires stitches.

- Slower to recover compared to phacoemulsification.

§ A patch is placed to cover the eye post-surgery.

§ Outpatient procedures (same day discharge).

§ Bright light may be uncomfortable.

§ No driving.

What is PCO

- Posterior capsular opacification (PCO) is the most common complication of cataract

surgery.

- Results from the proliferation of the lens capsule that is left in when removing the

cataract

How to tx (3)

- Commonly treated with YAG laser.

- Topical local anaesthetics and mydriatics instilled.

- Laser is used to create an opening in the back of the eye's cloudy lens capsule. This allows

the light to pass through the lens and focus properly on the retina, restoring clear vision.

Scatter laser tx - PRP for DR (6)

- Commonly known as panretinal photocoagulation (PRP).

- Laser treatment for proliferative retinopathy.

- Local topical anaesthetic is instilled in the eye.

- Laser is applied to the peripheral retina which causes the blood vessels to shrink and

inhibits them from growing in the future.

- Also reduces chances of vitreous haemorrhage and retinal detachment.

- Multiple laser treatments may be required.

Focal laser photocoagulation (2)

- Laser treatment for diabetic maculopathy.

- Laser burns are applied directly to leaking microaneurysms.

Grid laser photocoagulation (3)

- Laser treatment for diabetic maculopathy.

- Laser burns are applied to leaking microaneurysms that are no closer than 500μm to the

macula or optic disc,

- So, if leakage is more on macula or optic disc, grid laser is used and directly lasering these

structures would cause oedema/further damage.

Dry AMD tx (6)

- No treatment available.

- If patient a smoker, advise them to stop and explain risk of wet ARMD.

- Advice green leafy vegetables, Omega 3 supplements, vitamin supplements, e.g., B12,

antioxidants such as leutin and zeaxanthin (AREDS 2).

- AREDS supplements contain beta-carotene which could be a health hazard for smokers.

- Advice UV protections - tints/UV blockers.

- Depending on VA, discuss low vision aids.

Wet AMD - AV

- Stops new blood vessels from leaking/growing and bleeding under the retina.

- VEGF is a protein that promotes growth of new leaky blood vessels.

- Available therapies: Macugen (Pegaptanib), Bevacizumab (Avastin) and Lucentis

(Ranibizumab)

§ Macugen involves intravitreal six weekly injections of the drug.

§ Lucentis involves intravitreal four weekly injections of the drug.

§ Injections into the eye using a fine needle. Procedure lasts 5-7mins but injections

given in

Photodynamic therapy (4)

- Uses combination of light-activated drug (Verteporfin) and low powered cool laser.

- Verteporfin is injected through intravenous infusion, which travels to abnormal vessels

behind central macula.

- Laser is focused on abnormal vessels to activate the drug causing only to destroy

unwanted blood vessels.

- Multiple treatments required.

Argon later (4)

- This is a rarely used method now

- Argon blue-green laser.

- Suitable for patients with extrafoveal lesions.

- Laser unwanted blood vessels.