Ophthalmic Surgery Practice Questions

Q: The patient underwent complete iridectomy in aphakia. Comment on the diagnosis:

Key hole pupil. ***Keyhole pupil*** - The image shows a pupil with a superior **keyhole shape** (like an inverted keyhole), which is characteristic after a **surgical iridectomy** due to **cataract surgery**. - This shape results from the removal of a portion of the iris, typically for **visual axis clearance** or **glaucoma management**. *Festooned pupil* - A festooned pupil is typically seen in cases of **posterior synechiae**, where the iris adheres to the lens capsule, leading to an **irregular, scalloped pupil margin** even when dilated. - The image does not show multiple irregular adhesions, but rather a surgical alteration of the iris. *Hammock pupil* - The term "hammock pupil" is not a standard ophthalmological descriptor for a specific pupil deformity. - It does not accurately describe the appearance of the pupil in the provided image. *D-Shaped* - A D-shaped pupil is often associated with conditions like **iridodialysis** (detachment of the iris root), where a segment of the iris pulls away from its insertion, or after some types of **iris reconstruction**. - While the pupil is irregular, it specifically presents with a superior excision, not a broad D-shape.

Q: The image shows an eye following a surgical procedure. What type of iridectomy is depicted?

Peripheral button hole iridectomy. ***Peripheral button hole iridectomy*** - The image shows a small, round opening located in the **peripheral iris**, resembling a "buttonhole." - This type of iridectomy is created to establish a communication between the anterior and posterior chambers of the eye, often in glaucoma management, and is typically **small and circular**. *Optical iridectomy* - An optical iridectomy is performed to create a new, larger pupillary opening in cases where the **natural pupil is occluded or significantly displaced**, aiming to improve vision. - It would typically be a **larger, more central opening** designed to function as an artificial pupil, which is not what is seen in the image. *Broad based iridectomy* - A broad-based iridectomy involves excising a **large sector of the iris** from the pupillary margin to the iris base. - This is a much larger tissue removal than depicted, and it often results in a **keyhole-shaped pupil**, unlike the small peripheral hole shown. *Peripheral basal iridectomy* - A peripheral basal iridectomy involves removing a portion of the iris close to its **root (base)**, typically performed in **open-angle glaucoma** or to prevent pupillary block. - While it's peripheral, it usually involves a **full-thickness excision of a small wedge**, often triangular or rectangular, which is distinct from the described buttonhole appearance.

Q: What does the given image show?

Inverse hypopyon. ***Inverse hypopyon*** - The image shows a collection of **particulate material (pigment)** in the **superior anterior chamber**, which is characteristic of an **inverse hypopyon**. - This typically occurs in eyes that have undergone **vitrectomy,** where heavy particles (like silicone oil or pigment) float upwards in the aqueous humor. *Hypopyon* - A **hypopyon** is a layering of **white blood cells** in the **inferior anterior chamber** due to gravity. - It indicates **severe inflammation** or infection within the eye, such as endophthalmitis or severe uveitis. *Pseudohypopyon* - A **pseudohypopyon** refers to a collection of **tumor cells** or **lens material** in the **inferior anterior chamber**, mimicking a hypopyon. - It is differentiated from a true hypopyon by the composition of the cellular material and its underlying cause. *Hyphema* - **Hyphema** is the presence of **red blood cells** layering in the **inferior anterior chamber**, visible as a reddish fluid level. - It is typically caused by **trauma**, surgery, or certain vascular conditions affecting the iris or ciliary body.

Q: A 60-year-old male underwent a cataract surgery. After 1 year he came with complaints of diminished vision and the finding shown in the image. Diagnosis is?

After cataract. ***After cataract*** - The image depicts a **thickening and opacification of the posterior capsule** behind an intraocular lens, which is characteristic of after cataract (also known as **posterior capsular opacification** or PCO). - PCO is a common complication following cataract surgery, leading to **diminished vision** months to years after the initial procedure, consistent with the patient's presentation. *Irvine-Gass syndrome* - Irvine-Gass syndrome refers to **pseudophakic cystoid macular edema**, which causes diminished vision after cataract surgery due to fluid accumulation in the macula. - While it can cause vision loss post-cataract surgery, it is a retinal condition and does not present with the **posterior capsule opacification** seen in the image. *UGH syndrome* - UGH (Uveitis-Glaucoma-Hyphema) syndrome is a complication typically associated with poorly designed or positioned **intraocular lenses (IOLs)** that rub against uveal tissue. - It presents with **intraocular inflammation, elevated intraocular pressure, and recurrent hyphema**, none of which are directly suggested by the provided image or clinical details. *Endophthalmitis* - Endophthalmitis is a severe **intraocular infection** that typically occurs days to weeks after cataract surgery, presenting acutely with significant **pain, redness, and severe vision loss**. - The patient's presentation of diminished vision one year after surgery and the image showing a **fibrotic posterior capsule** are not consistent with the acute, infectious nature of endophthalmitis.

Q: Patient with eye surgery done 2 days ago presents with pain and dimness of vision. Which of the following is not useful for management?

Topical antibiotics. ***Topical antibiotics*** - This patient presents with symptoms suggestive of **post-surgical endophthalmitis** (pain and dimness of vision after eye surgery), which is a severe infection of the intraocular fluids (vitreous and/or aqueous humor). - Topical antibiotics typically do not achieve sufficient intraocular concentrations to effectively treat a deep-seated infection like endophthalmitis. *Intravenous antibiotics* - **Intravenous antibiotics** can provide systemic coverage and may reach the posterior segment of the eye, although their penetration into the vitreous can be limited. - They are often used as an adjunct to more direct routes of administration in severe endophthalmitis. *Intravitreal antibiotics* - **Intravitreal antibiotics** are injected directly into the vitreous cavity, providing high local concentrations of medication directly at the site of infection. - This is considered a cornerstone of endophthalmitis management due to its immediate and potent antimicrobial effect. *Pars plana vitrectomy* - **Pars plana vitrectomy** involves surgical removal of the infected vitreous, which reduces the bacterial load and inflammatory mediators, and allows for direct sampling for microbiology. - It is particularly indicated in cases of severe endophthalmitis or when there is poor response to antibiotics, often improving visual outcomes.

Q: Identify the surgical step shown in the image given below

Lens aspiration. ***Lens aspiration*** - The image shows a **phacoemulsification handpiece** (the instrument with the shining tip and central bore tube) actively fragmenting and aspirating the lens material, indicated by the cloudy material being removed. - This step is part of cataract surgery where the cataractous lens material is removed from the eye. *Capsulorrhexis* - This involves creating a **continuous curvilinear tear** in the anterior lens capsule, typically done at the beginning of cataract surgery. - The image does not show a tearing or incising action on the capsule; instead, it depicts material removal. *Hydrodissection* - This step involves injecting a **fluid wave** between the lens capsule and the lens cortex to separate them, facilitating nuclear rotation and removal. - The image depicts the removal of lens material, not the injection of fluid to separate layers. *Intraocular lens implantation* - This step involves inserting the **artificial lens** into the capsular bag after the cataractous lens has been removed. - The visual cues in the image indicate material removal and emulsification, not the insertion of a new lens.

Q: Evisceration is removal of which layer of eyeball?

Middle and inner. ***Middle and inner*** - **Evisceration** involves the surgical removal of the internal contents of the eyeball, which include components derived from the **middle (uveal) and inner (retinal) layers**. - The **sclera** (outermost layer) and **extraocular muscles** are preserved, allowing for a more natural prosthetic eye fit. *All the layers of eyeball* - This describes **enucleation**, where the entire eyeball is removed including all three layers (sclera, choroid/ciliary body/iris, and retina). - Enucleation is a more extensive procedure than evisceration, typically performed for intraocular tumors or severe trauma where preservation of the sclera isn't possible. *Outer and inner* - This option is incorrect because the **outer layer (sclera)** is specifically preserved in evisceration. - Removing the outer layer would lead to a more destructive procedure, inconsistent with the definition of evisceration. *Outer and middle* - This option is incorrect because the **outer layer (sclera)** is preserved during evisceration, while the entire **inner layer (retina)** is removed. - The middle layer (uvea) is removed, but this option inaccurately states the fate of the outer and inner layers.

Q: Site of bleeding after cataract surgery is:

Posterior ciliary vessels. ***Posterior ciliary vessels*** - Bleeding after cataract surgery most commonly originates from the **posterior ciliary vessels**, particularly during or after an intraocular procedure due to their deep location and proximity to the surgical field. - This can lead to a **suprachoroidal hemorrhage**, a serious complication characterized by the accumulation of blood between the choroid and the sclera. *Posterior choroidal vessels* - While choroidal vessels are a source of ocular bleeding, the **posterior choroidal vessels** are less frequently the primary site of hemorrhage immediately following cataract surgery compared to the ciliary vessels. - These vessels are part of the main choroidal circulation but are generally deeper and not as directly exposed to the immediate surgical trauma unless there's extensive posterior segment involvement. *Anterior choroidal vessels* - The **anterior choroidal vessels** supply the anterior part of the choroid but are not typically the main source of significant post-cataract surgery bleeding. - Hemorrhage from these vessels would likely be more localized to the anterior choroid, less commonly causing the widespread suprachoroidal hemorrhage seen with posterior ciliary vessel rupture. *Anterior ciliary vessels* - The **anterior ciliary vessels** supply the anterior segment, including the ciliary body and iris, and can be injured during anterior segment surgery. - However, bleeding from these vessels is usually more superficial and tends to present as **hyphema** (blood in the anterior chamber) rather than the deeper, more severe suprachoroidal hemorrhage associated with posterior ciliary vessels.

Q: Which laser is used for posterior capsular opacification (PCO)?

Nd:YAG. ***ND-YAG*** - The **Nd:YAG laser** is specifically used for **posterior capsulotomy**, a procedure to treat **posterior capsular opacification (PCO)**, also known as secondary cataract. - It creates a small opening in the opacified posterior capsule using **photodisruption**, which vaporizes the tissue. *Krypton* - **Krypton lasers** are typically used in **photocoagulation** for retinal conditions, such as **diabetic retinopathy** or **retinal tears**. - They are not used for incising ocular tissues like the posterior capsule due to their wavelength and photocoagulative nature. *Argon* - **Argon lasers** are primarily used in **retinal photocoagulation** for conditions like **diabetic retinopathy**, **retinal vein occlusions**, and also for **trabeculoplasty** in glaucoma. - Like krypton lasers, their mechanism of action involves thermal coagulation of tissue, not photodisruption of the posterior capsule. *Diode laser* - **Diode lasers** have various applications in ophthalmology, including **transscleral cyclophotocoagulation** for glaucoma and **retinal photocoagulation**. - They are not used for posterior capsulotomy as their wavelength and energy delivery are unsuitable for this specific procedure.

Question 1

A patient on day 2 after cataract surgery has developed the following findings which are diagnostic of:

Accepted Answer

Acute postoperative endophthalmitis

Answer

Acute postoperative glaucoma

Answer

Acute bullous keratopathy

Answer

Acute anterior uveitis

Question 2

The patient underwent complete iridectomy in aphakia. Comment on the diagnosis:

Accepted Answer

Key hole pupil

Answer

Festooned pupil

Answer

Hammock pupil

Answer

D-Shaped

Question 3

The image shows an eye following a surgical procedure. What type of iridectomy is depicted?

Accepted Answer

Peripheral button hole iridectomy

Answer

Optical iridectomy

Answer

Broad based iridectomy

Answer

Peripheral basal iridectomy

Question 4

What does the given image show?

Accepted Answer

Inverse hypopyon

Answer

Hypopyon

Answer

Pseudohypopyon

Answer

Hyphema

Question 5

A 60-year-old male underwent a cataract surgery. After 1 year he came with complaints of diminished vision and the finding shown in the image. Diagnosis is?

Accepted Answer

After cataract

Answer

Irvine-Gass syndrome

Answer

UGH syndrome

Answer

Endophthalmitis

Question 6

Patient with eye surgery done 2 days ago presents with pain and dimness of vision. Which of the following is not useful for management?

Accepted Answer

Topical antibiotics

Answer

Intravenous antibiotics

Answer

Intravitreal antibiotics

Answer

Pars plana vitrectomy

Question 7

Identify the surgical step shown in the image given below

Accepted Answer

Lens aspiration

Answer

Capsulorrhexis

Answer

Hydrodissection

Answer

Intraocular lens implantation

Question 8

Evisceration is removal of which layer of eyeball?

Accepted Answer

Middle and inner

Answer

All the layers of eyeball

Answer

Outer and inner

Answer

Outer and middle

Question 9

Site of bleeding after cataract surgery is:

Accepted Answer

Posterior ciliary vessels

Answer

Posterior choroidal vessels

Answer

Anterior choroidal vessels

Answer

Anterior ciliary vessels

Question 10

Which laser is used for posterior capsular opacification (PCO)?

Accepted Answer

Nd:YAG

Answer

Krypton

Answer

Argon

Answer

Diode laser

Ophthalmic Surgery — MCQs

Ophthalmic Surgery — MCQs

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