NEET-PG 2022 — Ophthalmology

Q: A 65-year-old male presents with blurred vision and a history of cataract surgery. Upon examination, fluffy white deposits are noted on the anterior lens capsule. What is the most likely diagnosis?

Pseudoexfoliation syndrome. ***Pseudoexfoliation syndrome*** - The description of **fluffy white deposits on the anterior lens capsule** in an older patient with blurred vision and a history of cataract surgery is highly characteristic of **pseudoexfoliation syndrome**. - This condition is caused by the abnormal production and accumulation of an **extracellular fibrillar material**, which can also affect the iris, ciliary body, and trabecular meshwork, potentially leading to **glaucoma** and lens subluxation. *Intraocular foreign body* - An intraocular foreign body would typically present with a history of **trauma** and might be visible as a distinct object, rather than diffuse fluffy deposits. - While it can cause inflammation and vision changes, its appearance is not consistent with the described findings. *Ocular trauma* - Ocular trauma would typically have an associated history of injury and could present with various signs like hyphema, iritis, or retinal detachment, but not specifically this type of **fluffy white deposit** on the lens. - While it can lead to vision issues, the specific clinical findings do not point towards acute or chronic sequelae of trauma as the primary diagnosis. *Vossius ring* - A **Vossius ring** is a deposition of iris pigment on the anterior lens capsule, forming a circular ring corresponding to the pupil margin at the time of blunt trauma. - It would appear as a **pigmented ring**, not fluffy white deposits, and is directly linked to a history of blunt trauma. [Practice more Ophthalmology PYQs on OnCourse]

Q: A diabetic patient presents to you with visual acuity of 6/9 in one eye. Further investigations revealed preretinal hemorrhages with neovascularization at the optic disc. What is the next step in management?

Pan-retinal photocoagulation. ***Pan-retinal photocoagulation*** - The presence of **preretinal hemorrhages** and **neovascularization at the optic disc (NVD)** indicates **high-risk proliferative diabetic retinopathy (PDR)**. - **NVD is a high-risk characteristic** for severe vision loss and requires urgent treatment with **pan-retinal photocoagulation (PRP)**. - PRP aims to ablate ischemic peripheral retina, which reduces the production of **VEGF** and other angiogenic factors that stimulate neovascularization. *Focal laser photocoagulation* - This treatment targets discrete leaking microaneurysms in cases of **clinically significant macular edema (CSME)**, which is not the primary issue here. - It is used for **non-proliferative diabetic retinopathy** with macular involvement, not for neovascularization. *Grid laser photocoagulation* - Grid laser is a type of focal laser used for **diffuse macular edema** where specific leaking microaneurysms cannot be identified. - It is not indicated for **neovascularization** or **preretinal hemorrhages**, which are signs of PDR. *Scleral buckling* - **Scleral buckling** is a surgical procedure primarily used to treat **retinal detachment** by indenting the sclera to relieve vitreoretinal traction. - It is not the initial or primary treatment for **proliferative diabetic retinopathy** or **neovascularization**. [Practice more Ophthalmology PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

A 65-year-old male presents with blurred vision and a history of cataract surgery. Upon examination, fluffy white deposits are noted on the anterior lens capsule. What is the most likely diagnosis?

A diabetic patient presents to you with visual acuity of 6/9 in one eye. Further investigations revealed preretinal hemorrhages with neovascularization at the optic disc. What is the next step in management?

NEET-PG 2022 - Ophthalmology NEET-PG Practice Questions and MCQs

Question 1: A 65-year-old male presents with blurred vision and a history of cataract surgery. Upon examination, fluffy white deposits are noted on the anterior lens capsule. What is the most likely diagnosis?

A. Intraocular foreign body
B. Pseudoexfoliation syndrome (Correct Answer)
C. Ocular trauma
D. Vossius ring

Explanation: ***Pseudoexfoliation syndrome*** - The description of **fluffy white deposits on the anterior lens capsule** in an older patient with blurred vision and a history of cataract surgery is highly characteristic of **pseudoexfoliation syndrome**. - This condition is caused by the abnormal production and accumulation of an **extracellular fibrillar material**, which can also affect the iris, ciliary body, and trabecular meshwork, potentially leading to **glaucoma** and lens subluxation. *Intraocular foreign body* - An intraocular foreign body would typically present with a history of **trauma** and might be visible as a distinct object, rather than diffuse fluffy deposits. - While it can cause inflammation and vision changes, its appearance is not consistent with the described findings. *Ocular trauma* - Ocular trauma would typically have an associated history of injury and could present with various signs like hyphema, iritis, or retinal detachment, but not specifically this type of **fluffy white deposit** on the lens. - While it can lead to vision issues, the specific clinical findings do not point towards acute or chronic sequelae of trauma as the primary diagnosis. *Vossius ring* - A **Vossius ring** is a deposition of iris pigment on the anterior lens capsule, forming a circular ring corresponding to the pupil margin at the time of blunt trauma. - It would appear as a **pigmented ring**, not fluffy white deposits, and is directly linked to a history of blunt trauma.

Question 2: A diabetic patient presents to you with visual acuity of 6/9 in one eye. Further investigations revealed preretinal hemorrhages with neovascularization at the optic disc. What is the next step in management?

A. Focal laser photocoagulation
B. Pan-retinal photocoagulation (Correct Answer)
C. Grid laser photocoagulation
D. Scleral buckling

Explanation: ***Pan-retinal photocoagulation*** - The presence of **preretinal hemorrhages** and **neovascularization at the optic disc (NVD)** indicates **high-risk proliferative diabetic retinopathy (PDR)**. - **NVD is a high-risk characteristic** for severe vision loss and requires urgent treatment with **pan-retinal photocoagulation (PRP)**. - PRP aims to ablate ischemic peripheral retina, which reduces the production of **VEGF** and other angiogenic factors that stimulate neovascularization. *Focal laser photocoagulation* - This treatment targets discrete leaking microaneurysms in cases of **clinically significant macular edema (CSME)**, which is not the primary issue here. - It is used for **non-proliferative diabetic retinopathy** with macular involvement, not for neovascularization. *Grid laser photocoagulation* - Grid laser is a type of focal laser used for **diffuse macular edema** where specific leaking microaneurysms cannot be identified. - It is not indicated for **neovascularization** or **preretinal hemorrhages**, which are signs of PDR. *Scleral buckling* - **Scleral buckling** is a surgical procedure primarily used to treat **retinal detachment** by indenting the sclera to relieve vitreoretinal traction. - It is not the initial or primary treatment for **proliferative diabetic retinopathy** or **neovascularization**.