Ophthalmic Surgery

Ophthalmic Surgery Indian Medical PG Question 1: Which of the following statements are correct regarding primary survey/management of traumatic head injury patient? I. Ensure adequate oxygenation and circulation II. Exclude hypoglycaemia III. Check for mechanism of injury IV. Check pupil size and response Select the answer using the code given below :

• A. II, III and IV
• B. I, III and IV
• C. I, II and III
• D. I, II and IV (Correct Answer)

Ophthalmic Surgery Explanation: ***I, II and IV*** - **Primary survey** in trauma management, including head injury, focuses on immediately life-threatening conditions (Airway, Breathing, Circulation, Disability, Exposure). Ensuring adequate **oxygenation and circulation** (Statement I) is paramount to prevent secondary brain injury. - Exclude **hypoglycemia** (Statement II) is critical because altered mental status due to low blood sugar can mimic head injury and delay appropriate treatment, making it an essential part of the 'D' (disability) assessment. Checking **pupil size and response** (Statement IV) is also part of the 'D' assessment, providing vital information about potential brain stem compromise or intracranial pressure changes. *II, III and IV* - While excluding hypoglycemia and checking pupil response are crucial parts of the primary survey, Statement III, "Check for mechanism of injury," is typically part of the **secondary survey** or initial assessment but not immediately life-saving like ABCD. - The primary survey prioritizes immediate threats to life, and while understanding the mechanism of injury informs subsequent care, it does not directly address a patient's immediate physiologic stability. *I, III and IV* - This option includes checking the mechanism of injury (Statement III) as part of the primary survey, which is generally conducted after the **life-threatening conditions** are addressed. - It omits the critical step of excluding **hypoglycemia** (Statement II), which is an immediate reversible cause of altered mental status that must be ruled out during the primary assessment. *I, II and III* - This option correctly includes ensuring adequate **oxygenation and circulation** (Statement I) and excluding **hypoglycemia** (Statement II) as part of the primary survey. - However, it incorrectly includes checking for the **mechanism of injury** (Statement III) as a primary survey component and omits checking **pupil size and response** (Statement IV), which is an essential part of the 'Disability' assessment in the primary survey for head injury.

Ophthalmic Surgery Indian Medical PG Question 2: All of the following are complications of traumatic hyphema except which of the following?

• A. Pupillary Block
• B. Posterior synechiae
• C. Rebleeding
• D. Corneal Ulcer (Correct Answer)

Ophthalmic Surgery Explanation: ***Corneal Ulcer*** - A **corneal ulcer** is typically caused by infection, trauma, or exposure keratitis and is not a direct complication of blood in the anterior chamber from a **traumatic hyphema**. - While prolonged elevation of **intraocular pressure** from hyphema could theoretically impair corneal health, a direct ulcer is not a typical or primary complication. *Rebleeding* - **Rebleeding** is a common and serious complication of hyphema, usually occurring 2-7 days after the initial injury. - It often results in a more significant bleed and carries a higher risk of complications such as **elevated intraocular pressure** and **blood staining of the cornea**. *Pupillary Block* - **Pupillary block** can occur if the amount of blood from the hyphema prevents the flow of aqueous humor from the posterior to the anterior chamber. - This blockage leads to a buildup of **aqueous humor** in the posterior chamber, causing the iris to bow forward and potentially precipitating **acute angle-closure glaucoma**. *Posterior synechiae* - **Posterior synechiae** can develop due to inflammation (uveitis) associated with the hyphema, where the iris adheres to the anterior lens capsule. - This complication can lead to **irregular pupil shape**, **pupillary block glaucoma**, or other visual disturbances.

Ophthalmic Surgery Indian Medical PG Question 3: Which of the following is not a treatment option for glaucoma?

• A. Trabeculectomy
• B. Trabeculotomy
• C. Vitrectomy (Correct Answer)
• D. Viscocanalostomy

Ophthalmic Surgery Explanation: ***Vitrectomy*** - A **vitrectomy** is a surgical procedure to remove the **vitreous humor** from the eye, typically performed for conditions like **retinal detachment**, **diabetic retinopathy**, or **vitreous hemorrhage**, not glaucoma. - While glaucoma can sometimes coexist with these conditions, vitrectomy itself is not a direct treatment for addressing the **intraocular pressure** or **optic nerve damage** characteristic of glaucoma. *Trabeculectomy* - **Trabeculectomy** is a common surgical procedure for glaucoma that creates a new drainage pathway for **aqueous humor** to reduce **intraocular pressure**. - It involves removing a small piece of the **trabecular meshwork** and sclera to form a filtering bleb. *Trabeculotomy* - **Trabeculotomy** is a surgical procedure primarily used in **congenital glaucoma** or some forms of **open-angle glaucoma** to improve the outflow of aqueous humor. - It involves incising the **trabecular meshwork** to open up the natural drainage channels. *Viscoanulostomy* - **Viscocanalostomy** (not viscoanulostomy) is a non-penetrating glaucoma surgery that aims to reduce **intraocular pressure** by improving the outflow of **aqueous humor** through the **Schlemm's canal**. - It involves dissecting the outer wall of **Schlemm's canal** and injecting viscoelastic material to dilate the canal, without creating a full-thickness fistula.

Ophthalmic Surgery Indian Medical PG Question 4: Calcified canal is explored with all of the given instruments except:

• A. 10 K file (Correct Answer)
• B. 6 K file
• C. C+ file
• D. Profinder

Ophthalmic Surgery Explanation: ***10 K file*** - **#10 K-files** are typically used for initial negotiation of **larger, more accessible canals**, not for exploring highly calcified or severely constricted canals. - Their larger diameter (0.10 mm) makes them too stiff and prone to ledge formation or perforation in extremely calcified areas. *6 K file* - **#6 K-files** are extremely small and flexible (0.06 mm in diameter), making them ideal for initial penetration through tight, calcified canal orifices. - Their fine tip and flexibility help in navigating complex anatomy and overcoming initial resistance without causing iatrogenic damage. *C+ file* - **C+ files** are specifically designed for calcified or severely curved canals due to their **stiffer shaft, non-cutting tip**, and improved resistance to buckling. - They are offered in multiple diameters, including very small sizes like 06 and 08, which are suitable for initial exploration of challenging canal anatomy. *Profinder* - **ProFinder files** are specialized stainless steel hand files with a **triangular cross-section** and non-cutting tip, designed for initial negotiation of difficult and calcified canals. - Their enhanced tip design and shaft stiffness facilitate easy insertion into tight orifices and help maintain the canal pathway.

Ophthalmic Surgery Indian Medical PG Question 5: A patient sustained blunt trauma to the eye, after which he developed sudden loss of vision with deep anterior chamber. Most likely cause is:

• A. Retinal haemorrhage
• B. Lens dislocation (Correct Answer)
• C. Berlin's oedema
• D. Recession of angle of AC

Ophthalmic Surgery Explanation: ***Lens dislocation*** - **Blunt trauma** can cause **zonular rupture**, leading to **lens dislocation** into the vitreous or anterior chamber. - A dislocated lens in the vitreous space results in a **deep anterior chamber** and sudden vision loss due to loss of the refractive power of the lens. *Retinal haemorrhage* - While blunt trauma can cause **retinal haemorrhage**, it typically does not present with a **deep anterior chamber**. - Vision loss from retinal haemorrhage depends on its size and location, but it's not directly associated with changes in anterior chamber depth. *Berlin's oedema* - Also known as **commotio retinae**, this condition involves **retinal oedema** due to blunt trauma, causing sudden vision loss. - However, Berlin's oedema is a retinal condition and does not typically alter the **depth of the anterior chamber**. *Recession of angle of AC* - **Angle recession** is a common consequence of blunt trauma, where the ciliary body detaches from the scleral spur, causing a widening of the **anterior chamber angle**. - While it can lead to **secondary glaucoma** over time, it typically does not cause **sudden profound vision loss** immediately after trauma and does not necessarily result in a *deep* anterior chamber.

Ophthalmic Surgery Indian Medical PG Question 6: Which of the following is a scoring system for severity of wound infection, and is particularly useful for surveillance and research ?

• A. Southampton grading system (Correct Answer)
• B. Apgar score
• C. Glasgow scoring system
• D. ASA classification

Ophthalmic Surgery Explanation: ***Southampton grading system*** - The **Southampton grading system** is specifically designed for the **severity of wound infection**, offering a clear framework for classification based on clinical signs. - Its utility in **surveillance and research** stems from its structured and reproducible assessment, allowing for consistent data collection on wound healing and infection rates. *Apgar score* - The **Apgar score** is a rapid assessment of a **newborn's health** immediately after birth, evaluating heart rate, respiratory effort, muscle tone, reflex irritability, and color. - It is not used for assessing wound infection severity. *Glasgow scoring system* - The **Glasgow Coma Scale (GCS)** is used to assess the **level of consciousness** in a person following a brain injury, comprising eye opening, verbal, and motor responses. - It is not relevant to wound infection assessment. *ASA classification* - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is used to assess a patient's **overall health before surgery**, providing an indication of anesthetic risk. - It is not used for evaluating wound infection.

Ophthalmic Surgery Indian Medical PG Question 7: All are ophthalmological emergencies except -

• A. Endophthalmitis
• B. CRVO (Correct Answer)
• C. Acute congestive glaucoma
• D. CRAO

Ophthalmic Surgery Explanation: ***CRVO*** - Central Retinal Vein Occlusion (CRVO) is characterized by painless **vision loss** due to retinal hemorrhage and edema, but it is generally *not* considered an immediate, vision-threatening emergency in the same vein as the other options. - While it requires prompt evaluation and management to preserve vision, CRVO allows for a less urgent intervention compared to conditions that can lead to permanent vision loss within hours. *Endophthalmitis* - **Endophthalmitis** is a severe inflammation of the intraocular fluids and tissues, typically caused by infection, and can lead to rapid and irreversible vision loss if not treated urgently. - It presents with pain, redness, reduced vision, and hypopyon (pus in the anterior chamber), necessitating immediate antibiotic treatment and surgical intervention. *Acute congestive glaucoma* - **Acute congestive glaucoma** (acute angle-closure glaucoma) involves a sudden increase in intraocular pressure, causing severe pain, redness, corneal edema, and profound vision loss. - If left untreated, the high pressure can cause irreversible damage to the optic nerve within hours, making it a true ocular emergency. *CRAO* - **Central Retinal Artery Occlusion (CRAO)** is a sudden, painless loss of vision in one eye due to blockage of the central retinal artery, leading to retinal ischemia. - It is an ocular emergency because irreversible retinal damage and vision loss can occur within 90-120 minutes of the occlusion, requiring immediate intervention to restore blood flow.

Ophthalmic Surgery Indian Medical PG Question 8: The laser procedure, most often used for treating iris neovascularization is

• A. Panretinal photocoagulation (PRP) (Correct Answer)
• B. Laser iridoplasty
• C. Laser trabeculoplasty
• D. Goniophotocoagulation

Ophthalmic Surgery Explanation: ***Panretinal photocoagulation (PRP)*** - **PRP** is the most effective laser procedure for **iris neovascularization** and **neovascular glaucoma**, as it ablates the ischemic retina, reducing the production of **vascular endothelial growth factor (VEGF)**. - By destroying the ischemic peripheral retina, PRP reduces the **angiogenic drive** that leads to new vessel formation on the iris and in the angle. *Laser iridoplasty* - This procedure involves applying laser energy to the peripheral iris to cause contraction and widen the **anterior chamber angle**, primarily used for **angle-closure glaucoma**. - While it can open a closed angle, it does not address the underlying **ischemic drive** causing neovascularization. *Laser trabeculoplasty* - This procedure targets the **trabecular meshwork** to improve aqueous humor outflow, commonly used for **open-angle glaucoma**. - It does not directly affect **iris neovascularization** or the ischemic factors driving its development. *Goniophotocoagulation* - This involves directly lasering new vessels in the **anterior chamber angle**, often as an adjunct to PRP, but it's not the primary treatment to prevent **iris neovascularization**. - It treats existing vessels but does not address the underlying cause of **retinal ischemia** that promotes new vessel growth.

Ophthalmic Surgery Indian Medical PG Question 9: The type of iridectomy shown in the image is:

• A. Peripheral basal iridectomy (Correct Answer)
• B. Sector iridectomy
• C. Button-hole iridectomy
• D. Complete iridectomy

Ophthalmic Surgery Explanation: ***Peripheral basal iridectomy*** - The image clearly depicts an iris with a small, circular opening located at its **periphery**, specifically at the base near the ciliary body. - This type of opening is characteristic of a **peripheral basal iridectomy**, which creates an alternative pathway for aqueous humor flow to relieve pupillary block, often associated with angle-closure glaucoma. *Sector iridectomy* - A **sector iridectomy** involves removing a full-thickness, wedge-shaped section of the iris that extends from the pupillary margin to the iris root, creating a keyhole-shaped pupil. - The image does not show a wedge-shaped defect extending to the pupil. *Button-hole iridectomy* - A **button-hole iridectomy** is typically a small, central opening in the iris that is completely surrounded by iris tissue, often performed for optical purposes. - The image shows a peripheral opening, not a central one. *Complete iridectomy* - A **complete iridectomy** implies the removal of the entire iris, or at least a very large portion, which would result in a highly enlarged and distorted pupil. - The image shows a small, localized opening, not extensive iris removal.

Ophthalmic Surgery Indian Medical PG Question 10: In a patient with acute anterior uveitis presenting with raised intraocular pressure, the PRIMARY treatment should be:

• A. Topical steroids (Correct Answer)
• B. Topical beta-blockers
• C. Cycloplegics
• D. Miotics

Ophthalmic Surgery Explanation: ***Topical steroids*** - **Topical corticosteroids** are the primary treatment for **anterior uveitis** to reduce inflammation, which is the underlying cause of both the uveitis and often the raised IOP. - While IOP is elevated, managing the inflammation with steroids is crucial, as the inflammation itself can lead to secondary **IOP elevation** due to trabecular meshwork dysfunction or synechiae formation. *Topical beta-blockers* - **Topical beta-blockers** are used to lower intraocular pressure, but they do not address the underlying **inflammation** in acute anterior uveitis. - Using them alone without treating the inflammation can lead to progression of the uveitis and further ocular damage. *Cycloplegics* - **Cycloplegics** (e.g., atropine, cyclopentolate) are important adjuncts in acute anterior uveitis to relieve pain from ciliary spasm and prevent posterior synechiae formation by dilating the pupil. - They do not, however, treat the **inflammation** directly or primarily address the elevated intraocular pressure. *Miotics* - **Miotics** (e.g., pilocarpine) **constrict the pupil**, which can worsen symptoms in acute anterior uveitis by increasing ciliary body spasm and potentially increasing the risk of posterior synechiae formation. - They are contraindicated in acute anterior uveitis as they exacerbate pain and inflammation, and do not treat the underlying cause.

Ophthalmic Surgery Flashcard 1 of 10

Question: PERFECT stands for _____

Answer: Pterygium Extended Removal Followed by Extended Conjunctival Transplant

Ophthalmic Surgery Flashcard 2 of 10

Question: _____ forceps can be used as a method of lens delivery in forceps extraction

Answer: Arruga

Ophthalmic Surgery Flashcard 3 of 10

Question: Phacoprobe is based on the principle of _____

Answer: phacoemulsification

Ophthalmic Surgery Flashcard 4 of 10

Question: The surgery of choice for panophthalmitis is _____

Answer: evisceration

Ophthalmic Surgery Flashcard 5 of 10

Question: _____ refers to the phacoemulsification techniques that can be performed through a microincision (.

Answer: Microincision cataract surgery (MICS)

Ophthalmic Surgery Flashcard 6 of 10

Question: _____ forceps can be used as a method of lens delivery in forceps extraction

Answer: Arruga

Ophthalmic Surgery Flashcard 7 of 10

Question: Cyclocryotherapy in pars planitis and end-stage glaucoma can be managed using a _____

Answer: cryoprobe

Ophthalmic Surgery Flashcard 8 of 10

Question: The following lens is called as _____ lens

Answer: Singh and Worst’s iris claw

Ophthalmic Surgery Flashcard 9 of 10

Question: Modified C-loop type is a kind of _____

Answer: PCIOL

Ophthalmic Surgery Flashcard 10 of 10

Question: What is the most commonly used ACIOL? _____

Answer: Kelman multiflex