Retinopathy of Prematurity — MCQs
A baby born at 34 weeks gestation weighs 3kg. Which of the following conditions is this child most likely to develop in the immediate postnatal period?
A 2-year-old child presents with unilateral leukocoria and poor vision. What is the most likely diagnosis?
In infants of diabetic mothers (IDM), when is ophthalmologic evaluation indicated?
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?
All of the following are true for retinopathy of prematurity except which of the following?
The laser procedure, most often used for treating iris neovascularization is
What does extraretinal fibrovascular proliferation at the ridge indicate?
For a neonate with threshold retinopathy of prematurity, the most appropriate treatment would be:
What is the most common cause of vitreous hemorrhage in diabetic retinopathy?
Which of the following is NOT a feature of Fuchs' Heterochromic Uveitis?
Retinopathy of Prematurity Indian Medical PG Practice Questions and MCQs
Question 1: A baby born at 34 weeks gestation weighs 3kg. Which of the following conditions is this child most likely to develop in the immediate postnatal period?
- A. APH
- B. Diabetes
- C. Anemia (Correct Answer)
- D. None of the options
Explanation: ***Anemia*** - Macrosomic babies (3kg at 34 weeks is **large for gestational age**) initially develop **polycythemia** due to chronic intrauterine hypoxia and increased erythropoiesis, but this is followed by rapid **hemolysis** and breakdown of excess red blood cells after birth, leading to anemia in the immediate postnatal period. - Among the given options, **anemia** is the most appropriate answer as it represents a recognized complication of LGA babies through the **polycythemia-hemolysis cycle**, even though **hypoglycemia** is statistically the most common immediate complication. *APH* - **Antepartum hemorrhage (APH)** is a maternal obstetric complication involving bleeding before delivery, not a condition that the baby itself develops or shows. - While APH can affect fetal growth and well-being, it is not a **neonatal condition** that the child would present with after birth. *Diabetes* - Although **maternal diabetes** is the most common cause of fetal macrosomia, the newborn does not develop diabetes itself in the immediate postnatal period. - Instead, these babies are at risk for **hypoglycemia**, **respiratory distress**, and **hyperbilirubinemia** due to fetal hyperinsulinemia, but not diabetes as a presenting condition. *None of the options* - This is incorrect because **anemia** is indeed a valid condition that macrosomic babies can develop through the described polycythemia-hemolysis mechanism. - While other complications like **hypoglycemia** and **birth trauma** are more common, anemia remains a recognized sequela among LGA babies in the immediate postnatal period.
Question 2: A 2-year-old child presents with unilateral leukocoria and poor vision. What is the most likely diagnosis?
- A. Congenital cataract
- B. Retinoblastoma (Correct Answer)
- C. Endophthalmitis
- D. Coats disease
Explanation: ***Retinoblastoma*** - **Leukocoria** (white pupillary reflex) is the **most common presenting sign** of retinoblastoma, occurring in approximately 60% of cases - The combination of **unilateral leukocoria** and **poor vision** in a **2-year-old child** (peak age 18-24 months) is highly suggestive - It is a **rapidly growing malignant intraocular tumor** arising from the neural retina, requiring urgent evaluation and treatment - Other presenting features may include **strabismus**, **red eye**, and in advanced cases, **proptosis** *Congenital cataract* - Can also present with **leukocoria** due to opacification of the lens - However, congenital cataracts are typically **bilateral** (75% of cases) and diagnosed earlier in infancy - The **static, non-progressive nature** distinguishes it from the rapidly growing retinoblastoma - Family history and associated systemic conditions (TORCH infections, metabolic disorders) are common *Endophthalmitis* - Severe **intraocular infection** affecting vitreous and aqueous humor - Typically presents with **acute pain**, **severe redness**, **hypopyon**, and **rapid vision loss** - Usually follows **penetrating trauma** or **intraocular surgery**, which would be uncommon in a 2-year-old - **Leukocoria without acute inflammatory signs** makes this diagnosis unlikely *Coats disease* - Characterized by **abnormal telangiectatic retinal vessels** with **exudative retinal detachment** and **yellow subretinal exudates** - Can present with leukocoria (yellow reflex due to lipid deposits) in young children - However, it typically affects **older children** (mean age 5-8 years), is predominantly **unilateral**, and has a **more indolent course** - More common in **males** and usually lacks the rapid progression of retinoblastoma
Question 3: In infants of diabetic mothers (IDM), when is ophthalmologic evaluation indicated?
- A. At the time of diagnosis
- B. Only if visual symptoms develop (Correct Answer)
- C. After 5 years routinely
- D. After developing diabetes
Explanation: ***Only if visual symptoms develop*** - Unlike **retinopathy of prematurity**, infants of diabetic mothers (IDMs) do not have a higher incidence of **retinopathy** or other **ocular abnormalities** at birth or in early infancy. - **Ophthalmologic evaluation** is generally reserved for IDMs who develop specific **visual symptoms** or signs of ocular pathology. *At the time of diagnosis* - Routine ophthalmologic screening at the time of diagnosis of IDM is **not standard practice**, as the risk of **congenital ocular anomalies** is not substantially elevated to warrant universal screening. - Initial management focuses on metabolic stability, especially **glucose control**, and screening for other common IDM-related complications like **cardiac defects** or **respiratory distress**. *After 5 years routinely* - There is **no evidence or recommendation** for routine ophthalmologic screening of IDMs specifically at the age of 5 years. - Regular **well-child check-ups** include basic vision screening, which would identify significant refractive errors or strabismus, but not specifically for diabetes-related ocular issues. *After developing diabetes* - While it is true that individuals with **type 1 or type 2 diabetes** require regular **ophthalmologic evaluations** for **diabetic retinopathy**, this refers to the child developing diabetes later in life, not being an IDM. - Being an IDM is a **risk factor for developing diabetes** later in life, but it doesn't automatically mean they have diabetes-related ocular issues from birth.
Question 4: 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**.
Question 5: All of the following are true for retinopathy of prematurity except which of the following?
- A. Due to hypoxia there occurs neovascularization followed by fibroproliferation
- B. Occurs in premature infants due to abnormal retinal blood vessel development.
- C. End result is bilateral blindness (Correct Answer)
- D. Blindness can be prevented by early diagnosis and ablation of avascular peripheral retina with cryotherapy or photocoagulation
Explanation: ***End result is bilateral blindness*** - While retinopathy of prematurity (ROP) can lead to severe vision loss or blindness, it is not always a bilateral end result, especially with early diagnosis and treatment. The severity can vary between eyes, and some cases resolve spontaneously. - Modern screening and intervention strategies, such as laser photocoagulation or anti-VEGF injections, are often successful in preventing complete blindness in one or both eyes. *Due to hypoxia there occurs neovascularization followed by fibroproliferation* - This statement accurately describes the pathogenesis of ROP. The initial phase involves delayed normal retinal vascularization, followed by a proliferative phase characterized by **neovascularization** in response to hypoxia in the avascular retina. - These new, abnormal vessels are fragile and prone to bleeding, and their associated **fibrovascular proliferation** can lead to retinal detachment. *Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation* - This is a true statement. **Early diagnosis** through ophthalmologic screening of premature infants is crucial, and treatments like **laser photocoagulation** or **cryotherapy** are effective in ablating the avascular peripheral retina to halt the progression of abnormal vessel growth. - These interventions reduce the hypoxic drive that fuels neovascularization, thereby preventing severe retinal detachment and subsequent blindness. *Occurs in premature infants due to abnormal retinal blood vessel development.* - This statement is correct. ROP is a disease primarily affecting **premature infants** because their retinal blood vessels have not completed development by the time of birth. - Postnatal factors, including oxygen fluctuations and low birth weight, further disrupt this critical development, leading to **abnormal vascularization**.
Question 6: 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
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.
Question 7: What does extraretinal fibrovascular proliferation at the ridge indicate?
- A. Normal retina
- B. Stage II Retinopathy of Prematurity
- C. Stage III Retinopathy of Prematurity (Correct Answer)
- D. Stage I Retinopathy of Prematurity
Explanation: ***Stage III Retinopathy of Prematurity*** - Extraretinal fibrovascular proliferation at the ridge is the defining characteristic of **Stage III Retinopathy of Prematurity (ROP)**. - This stage signifies significant **neovascularization** extending into the vitreous, increasing the risk of **retinal detachment**. *Normal retina* - A normal retina does not exhibit **fibrovascular proliferation** or a distinct ridge, as its vascularization is fully developed and confined to the retinal plane. - Absence of any abnormal vascular growth or demarcation line indicates a healthy, mature retinal structure. *Stage II Retinopathy of Prematurity* - Stage II ROP is characterized by a **ridge** that is elevated and appears three-dimensional, but it **lacks extraretinal fibrovascular proliferation**. - This stage represents progression from Stage I, where the demarcation line becomes a prominent ridge, but without new vessel formation outside the retina. *Stage I Retinopathy of Prematurity* - Stage I ROP is characterized by a thin, flat **demarcation line** distinguishing vascularized from avascular retina, without any significant elevation or fibrovascular proliferation. - This initial stage indicates an arrested phase of retinal vascular development, but without the more severe signs of neovascularization.
Question 8: For a neonate with threshold retinopathy of prematurity, the most appropriate treatment would be:
- A. Photocoagulation (Correct Answer)
- B. Antioxidants
- C. Oxygen therapy adjustment
- D. Cryotherapy
Explanation: ***Photocoagulation*** - **Laser photocoagulation** is the most effective treatment for **threshold ROP**, as it ablates the avascular retina, preventing the growth of abnormal vessels. - This procedure aims to halt the progression of **retinal neovascularization** and reduce the risk of retinal detachment and vision loss. *Oxygen therapy adjustment* - While careful **oxygen management** is crucial in preventing and managing ROP, simply adjusting oxygen therapy is not a definitive treatment for established **threshold ROP**. - **Oxygen therapy** primarily influences the initial development of the disease rather than treating advanced stages. *Cryotherapy* - **Cryotherapy**, involving freezing of the peripheral avascular retina, was historically used but has largely been replaced by **laser photocoagulation** due to better precision and reduced collateral damage. - While effective, it is less commonly used today for **threshold ROP** compared to laser treatment. *Antioxidants* - **Antioxidants** have been investigated for their potential role in preventing ROP, but there is insufficient evidence to support their use as a primary treatment for **established threshold ROP**. - Their role is more in **prophylaxis** rather than active treatment of advanced disease.
Question 9: What is the most common cause of vitreous hemorrhage in diabetic retinopathy?
- A. Non-proliferative diabetic retinopathy
- B. Proliferative diabetic retinopathy (Correct Answer)
- C. Severe non-proliferative diabetic retinopathy
- D. Diabetic macular edema
Explanation: ***Proliferative diabetic retinopathy*** - **Neovascularization** is the hallmark of proliferative diabetic retinopathy (PDR), where new, fragile blood vessels grow on the surface of the retina and optic disc. - These delicate vessels can easily rupture and bleed into the vitreous humor, leading to a **vitreous hemorrhage**. *Non-proliferative diabetic retinopathy* - This stage is characterized by **microaneurysms**, hemorrhages, and cotton wool spots, but typically lacks significant neovascularization. - While it involves retinal vascular damage, the absence of **newly formed, fragile vessels** makes vitreous hemorrhage less common. *Severe non-proliferative diabetic retinopathy* - This stage shows extensive microvascular abnormalities, including numerous hemorrhages and venular beading, but generally **still no new vessel formation**. - Without the presence of **fragile neovascular membranes**, the risk of significant vitreous hemorrhage is lower compared to PDR. *Diabetic macular edema* - This condition involves **fluid leakage** from damaged retinal vessels into the macula, causing vision loss. - While it's a common complication of diabetes, it primarily causes **macular swelling** and does not directly lead to vitreous hemorrhage.
Question 10: Which of the following is NOT a feature of Fuchs' Heterochromic Uveitis?
- A. Heterochromia
- B. Rubeosis iridis
- C. Stellate Keratic precipitate
- D. Posterior Synechiae (Correct Answer)
Explanation: ***Posterior Synechiae*** - Posterior synechiae, which are **adhesions between the iris and the lens**, are notably absent in Fuchs' heterochromic uveitis. - This is because Fuchs' uveitis is characterized by a **mild, non-granulomatous inflammation** that does not typically lead to the formation of such adhesions. - The **absence of posterior synechiae** is a key distinguishing feature from other forms of chronic anterior uveitis. *Heterochromia* - **Heterochromia** (difference in iris color between the two eyes) is the **defining clinical feature** of this condition and gives it its name. - The affected eye typically shows a **lighter iris color** due to stromal atrophy and loss of pigment. - This feature is present in the majority of cases, though it may be subtle and sometimes only detected on careful examination. *Rubeosis iridis* - **Rubeosis iridis**, or the **formation of fine new blood vessels on the iris surface**, is a characteristic feature of Fuchs' heterochromic uveitis. - These fragile new vessels can lead to **spontaneous hyphema** (blood in the anterior chamber), particularly during intraocular surgery or paracentesis. *Stellate Keratic precipitate* - **Stellate keratic precipitates** (KPs), which are **small, star-shaped deposits** on the corneal endothelium, are a characteristic feature. - These KPs are **fine, diffuse, and scattered** over the entire corneal endothelium, unlike the larger, greasy KPs seen in granulomatous uveitis.
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