JCAHPO Assisting with Interventions & Procedures 5 — Questions and Answers
Question 1: When assisting with a corneal transplant (penetrating keratoplasty), the donor cornea is stored in which medium prior to surgery?
- Normal saline at room temperature
- Optisol-GS or similar corneal preservation medium at 4°C (Correct answer)
- Balanced salt solution (BSS) at 37°C
- Distilled water with antibiotic additives at room temperature
Correct answer: Optisol-GS or similar corneal preservation medium at 4°C
Donor corneas are stored in Optisol-GS or similar hypothermic preservation medium at 4°C to maintain endothelial cell viability until transplantation.
Question 2: Following a retrobulbar injection for eye surgery, the assistant should monitor the patient for which potentially serious complication?
- Elevated blood pressure from pain
- Brainstem anesthesia or retrobulbar hemorrhage with proptosis and increased IOP (Correct answer)
- Miosis and ptosis limited to the injected eye only
- Temporary reduction in the patient's visual acuity in the fellow eye
Correct answer: Brainstem anesthesia or retrobulbar hemorrhage with proptosis and increased IOP
Brainstem anesthesia (from inadvertent subarachnoid injection) and retrobulbar hemorrhage (presenting with proptosis and rising IOP) are serious, potentially vision- or life-threatening complications after retrobulbar block.
Question 3: During the setup for an anterior segment optical coherence tomography (AS-OCT) scan, the assistant should instruct the patient to:
- Keep both eyes tightly closed during the scan
- Fixate on the internal fixation target and blink normally between acquisitions (Correct answer)
- Dilate pupils with phenylephrine 10% prior to every scan
- Remove contact lenses only if they are soft; rigid lenses can remain in place
Correct answer: Fixate on the internal fixation target and blink normally between acquisitions
The patient should fixate on the internal fixation target and blink between image acquisitions to maintain tear film quality and reduce motion artifact during AS-OCT imaging.
Question 4: A surgeon requests a corneal trephine for a biopsy. The assistant should know that the trephine size selected will determine:
- The amount of viscoelastic used during the procedure
- The diameter of the tissue sample or keratoplasty button excised (Correct answer)
- The depth of the cataract incision
- The gauge of the intravitreal injection needle
Correct answer: The diameter of the tissue sample or keratoplasty button excised
A corneal trephine is a circular cutting device; its size (measured in millimeters) determines the diameter of the corneal button or biopsy specimen obtained.
Question 5: When assisting with a selective laser trabeculoplasty (SLT), compared to argon laser trabeculoplasty (ALT), the key difference the assistant should understand is:
- SLT uses a continuous-wave laser that coagulates all trabecular tissue permanently
- SLT selectively targets pigmented trabecular meshwork cells without causing coagulative damage, and can be repeated (Correct answer)
- SLT requires a larger spot size and longer pulse duration than ALT
- SLT is applied to the peripheral retina rather than the trabecular meshwork
Correct answer: SLT selectively targets pigmented trabecular meshwork cells without causing coagulative damage, and can be repeated
SLT uses a Q-switched Nd:YAG laser to selectively target melanin-containing cells in the trabecular meshwork with minimal thermal damage, allowing the procedure to be repeated if needed.
Question 6: When the physician performs a forced duction test intraoperatively, the assistant should provide:
- A Schirmer strip and timer
- Toothed or non-toothed forceps to grasp the conjunctiva or sclera near the limbus (Correct answer)
- A Goldmann applanation tonometer
- A pachymeter probe for corneal thickness measurement
Correct answer: Toothed or non-toothed forceps to grasp the conjunctiva or sclera near the limbus
A forced duction test requires forceps to grasp the conjunctival or episcleral tissue so the surgeon can mechanically rotate the globe and assess whether restriction is mechanical or paralytic.
Question 7: After a patient receives a subconjunctival injection of antibiotic at the conclusion of surgery, what immediate response should the assistant anticipate and inform the patient about?
- Permanent change in eye color at the injection site
- Temporary chemosis (conjunctival swelling) and a small bleb visible under the conjunctiva (Correct answer)
- Immediate improvement in visual acuity
- Pupil dilation lasting up to 72 hours
Correct answer: Temporary chemosis (conjunctival swelling) and a small bleb visible under the conjunctiva
A subconjunctival injection creates a visible bleb (fluid blister) under the conjunctiva and may cause temporary chemosis, which resolves as the medication is absorbed.
JCAHPO Assisting with Interventions & Procedures 5
When assisting with a corneal transplant (penetrating keratoplasty), the donor cornea is stored in which medium prior to surgery?