AAPC April
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- Cornelius Wilkins
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1 Common Ophthalmology Surgical Procedures AAPC April 2011 Eric J Poulsen MD Eric J. Poulsen, MD ejpoulsen@insightvisioncenter.com
2 What do these have in common?
3 Where are we headed?
4 Overview How the eye works Anatomy/Physiology What can go wrong Pathology How we fix it Surgery
5 How the eye works
6 Why do we need glasses? Nearsightedness (Myopia) Farsightedness (Hyperopia) Astigmatism Presbyopia (after age 40)
7 Farsightedness
8 Farsightedness
9 Farsightedness
10 Nearsightedness
11 Nearsightedness
12 Astigmatism
13 How are these treated? Eyeglasses Contact lenses Refractive Surgery LASIK, PRK Lens Implants
14 Refractive Surgery Laser RK Lens Implant LASIK ? PRK Phakic IOL RLE
15 Radial Keratotomy
16 What is a LASER?
17 What is a LASER? Light Amplification by Stimulated Emission i of Radiation
18 Custom Excimer Laser
19 PRK
20 LASIK
21 Femtosecond Laser
22
23 Excimer Laser
24
25
26 LASIK Candidates Nearsighted, Farsighted, Astigmatic Stable vision No chronic eye conditions No diseases that affect eyes
27 Potential Side Effects Temporary irritation Under-correction Over-correction Infection Displaced flap
28 Phakic Intraocular Lens
29 Visian
30 Visian ICL
31 Verisyse
32 Pathology, or what goes wrong? External Infections Opacity Retina Congenital
33 Corneal Opacity Corneal Dystrophy Fuchs Corneal Dystrophy Pseudophakic Bullous Keratopathy Corneal Degeneration Keratocous Ectatia Corneal Scar Injury HSV
34 Corneal Foreign Body 65222
35 Hammering Metal
36
37 Hammering a nail
38 s/p Surgery
39 Corneal lt Transplant Lamellar Full Thickness DALK DSEK Penetrating /- Keratoplasty /65755
40 Penetrating Keratoplasty
41 DSEK, DALK Transplanting only the needed layer of cornea Faster recovery Fewer long-term problems (?)
42 Cataract
43
44
45
46 Cataracts are treated with A) Laser B) Blade C) Eyedrops D) Ultrasound E) Radiation
47
48
49 Cataract are treated with
50
51 Old Extracapsular
52 Phacoemulsification
53 Phacoemulsification
54 Lens Implantation
55 Phacoemulsification (ECCE)
56
57
58
59
60
61 Cataract Surgery Complex Standard Pupil dilation Capsule dye No extra maneuvers
62 Complex Cataract
63
64
65 Cataract Extraction with Lens Implant Monofocal Multifocal
66 Lens Implantation
67 Intraocular Lenses Premium Standard Multifocal Toric Monofocal Monofocal
68 Pterygium
69 Healed Conjunctival Graft
70 Recurrent Pterygium
71 Pterygium Excision
72
73
74
75
76
77
78
79 Pterygium Excision i Graft No Graft Conjunctival Amniotic Autograft Membrane Mitomycin-C 65435?
80 Retinal Detachment
81 Age-related Macular Degeneration Dry Wet Treatments
82 ARMD
83
84
85
86 Macular Degeneration Wet (Exudative) Dry (Non- exudative) dti Intravitreal Laser Injection AREDS
87 Nonproliferative Diabetic Retinopathy Microaneurysms Intraretinal hemorrhages Dot/Blot Flame Cotton-wool spots Venous dilation/beading IRMA Exudates Macular edema
88 NPDR
89
90 Proliferative Diabetic Retinopathy Retinal neovascularization Iris neovascularization Fibrovascular proliferation Vitreous hemorrhage Traction retinal detachment
91 Argon Laser
92 Argon Laser
93 PDR
94 End-Stage Retinopathy
95 Traction Retinal Detachment
96
97 Retina Laser Treatment 67228
98 BRAO
99 BRAO
100 BRVO
101 Retinal Vein Occlusion
102 Optic Nerve Glaucoma Optic Neuritis--Multiple Sclerosis Ischemic Optic Neuropathy
103 Glaucoma Damage to optic nerve IOP Types Treatment
104
105
106
107 Glaucoma Laser Surgery Open Angle Narrow Angle ALT = SLT Cyclo- Destruction 66710/66711 Laser Iridotomy 66761
108 YAG Laser
109 Laser Iridotomy
110 Glaucoma Surgery Filter Valve Trabeculectomy Ahmed Ex-PRESS Baerveldt Molteno 66180
111 Ahmed Valve
112
113
114
115
116
117
118
119 Benign or Malignant Eyelid Lesions
120 Droopy Eyelids Brow Droop Direct Endoscopic Coronal Dermatochalasis Blepharoplasty Ptosis Levator Advancment, Frontalis Sling, 67901
121 Dermatochalasis Blepharoplasty p
122 Cosmetic Blepharoplasty
123 Ptosis Levator Advancement
124 Botox--Cosmetic
125 Skin Laser Resurfacing
126 Erbium-YAG Laser
127
128 12 mo. old
129 Esotropia
130 Strabismus Esotropia Exotropia Bilateral Unilateral?
131 LB1151
132 The Red Eye Infection Inflammation Injury Intraocular pressure elevation
133 Four Eyes
134 Infection Eyelid Conjunctiva Cornea
135 Cellulitis
136
137 Molluscum Contagiosum
138 Blepharitis
139 Hordeolum
140 Chalazion
141 HSV
142 HSV
143 HSV or HZV Epitheliitis
144 HSV
145 Viral conjunctivitis
146 Membranous conjunctivitis
147 Bacterial Conjunctivitis
148 Ulcer
149 Inflammation Allergy Pingueculum Pterygium Episcleritis i i Scleritis Uveitis
150 Pterygium
151 Pingueculum
152 Chemosis
153 Seasonal / Perennial Allergic Conjunctivitis
154 Vernal Keratoconjunctivitis (VKC)
155 GPC
156 Episcleritis
157 Squamous Cell Carcinoma
158 Uveitis
159 Hypopyon
160 Subconjunctival Hemorrhage
161 Corneal Abrasion
162 LASIK Flap Displacement
163 Contact Lens Overwear
164 IOFB
165 Alkali Burn
166
167 BRAO
168 BRVO
169 AION
170 Nonproliferative Diabetic Retinopathy Microaneurysms Intraretinal hemorrhages Dot/Blot Flame Cotton-wool spots Venous dilation/beading IRMA Exudates Macular edema
171 NPDR
172 Proliferative Diabetic Retinopathy Retinal neovascularization Iris neovascularization Fibrovascular proliferation Vitreous hemorrhage Traction retinal detachment
173 End-Stage Retinopathy
174 Traction Retinal Detachment
175 The Goofy Eye Strabismus congenital, CN palsy, CNS lesion Ptosis involutional involutional, CN III palsy, myasthenia Proptosis cellulitis, Grave s disease, tumor Blepharospasm and hemifacial i spasm
176 Esotropia
177 Exotropia
178 Pseudostrabismus
179 CN VI Palsy
180 CN VI Palsy
181 CN III Palsy
182 CN III Palsy
183 Internuclear Ophthalmoplegia
184 Ptosis
185 Cellulitis
186 Proptosis
187 Hemifacial Spasm
188 Treat and Triage Therapeutic patching Topical medications Diagnostic testing Rf Referral
189 Eye Injuries
190 Playing with brothers
191 History Mechanism Blunt Superficial Penetrating Mechanism mismatch Prior ocular surgery
192 Examine and Classify Ocular vs peri-ocular Blunt Superficial Penetrating
193 Vital Signs Visual Acuity Pupil exam Intraocular Pressure
194 Visual Acuity
195 APD
196 Mechanisms Blunt Trauma
197 Fist Bottle Handlebar Knee Nightstand Baseball Non-accident
198 Fist
199 Vague Trauma
200 Finger Poke
201 Golf Ball
202 Doorknob and Surgical History
203 Remote
204 Paintball Gun Retinal Tear or Detachment Flashes Floaters Shade
205 Paintball Gun
206 Head Trauma
207 Mechanisms Superficial Trauma
208 Finger
209 Paper Scrape
210 Chicken Coop
211 Sago Palm
212 Contact Lens Wearer
213 Thumb and Surgical History
214 Vague
215 Propane BBQ
216 Curling Iron vs Eye Epithelial Epithelial coagulation
217 In Garage
218 Drilling Metal
219
220 Thank You
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