Scleral Surgeries — MCQs
Most common cause of posterior staphyloma?
Which of the following is the most devastating complication of cataract surgery?
All of the following are complications of traumatic hyphema except which of the following?
Which of the following treatments is not suitable for advanced proliferative diabetic retinopathy with extensive vitreoretinal fibrosis and tractional retinal detachment?
'S-A-F-E program' was initiated for the control of which of the following conditions?
Which of the following is not true regarding the surgical treatment of varicose veins?
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?
Which of the following conditions is associated with posterior staphyloma?
All are causes of proptosis except:
Consider the following causes of visual loss : 1. Obstruction of the central retinal artery 2. Vitreous and retinal haemorrhage 3. Cataract 4. Retinal detachment Which of the above causes are associated with acute visual loss in a patient?
Scleral Surgeries Indian Medical PG Practice Questions and MCQs
Question 1: Most common cause of posterior staphyloma?
- A. Hypermetropia
- B. Conjunctivitis
- C. Myopia (Correct Answer)
- D. Glaucoma
Explanation: ***Myopia*** - **Posterior staphyloma** is a characteristic degenerative change in **high myopia**, where the sclera thins and bulges posteriorly. - The rapid and excessive axial elongation of the eyeball in myopia leads to stretching and weakening of the posterior sclera. *Hypermetropia* - **Hypermetropia** (farsightedness) is characterized by an eyeball that is too short, leading to light focusing behind the retina. - It is not associated with the pathological thinning and bulging of the posterior sclera seen in staphyloma. *conjunctivitis* - **Conjunctivitis** is an inflammation of the conjunctiva, the membrane lining the inside of the eyelids and covering the sclera. - It does not involve structural changes to the sclera or retina that would lead to posterior staphyloma. *Glaucoma* - **Glaucoma** is a group of diseases that damage the optic nerve, often due to high intraocular pressure, leading to vision loss. - While it can cause optic disc cupping, it is not directly associated with the development of posterior staphyloma.
Question 2: Which of the following is the most devastating complication of cataract surgery?
- A. Endophthalmitis (Correct Answer)
- B. Optic neuropathy
- C. Retinal detachment
- D. Vitreous loss
Explanation: ***Endophthalmitis*** - **Endophthalmitis** is a severe intraocular infection following cataract surgery that can rapidly lead to irreversible vision loss or even loss of the eye if not promptly treated. - It is considered the most devastating complication due to its acute onset and high potential for **permanent vision impairment**. *Optic neuropathy* - While optic neuropathy can cause visual loss, it is a less common direct complication of cataract surgery compared to endophthalmitis. - It typically results from processes like **ischemia** or severe orbital inflammation, which are rare occurrences immediately post-cataract surgery. *Retinal detachment* - **Retinal detachment** is a serious complication, but generally occurs at a lower rate than endophthalmitis and often has a better visual prognosis with timely surgical repair. - It is a known risk, particularly in patients with pre-existing **myopia** or prior posterior capsular rupture, but not necessarily the *most* devastating. *Vitreous loss* - **Vitreous loss** is an intraoperative complication that increases the risk of other issues like retinal detachment, cystoid macular edema, and endophthalmitis but is not, in itself, the most devastating. - Proper surgical technique and management during the procedure can mitigate many of its long-term sequelae.
Question 3: 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)
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.
Question 4: Which of the following treatments is not suitable for advanced proliferative diabetic retinopathy with extensive vitreoretinal fibrosis and tractional retinal detachment?
- A. Removal of epiretinal membrane
- B. Photocoagulation (Correct Answer)
- C. Vitrectomy
- D. Reattachment of detached or torn retina
Explanation: ***Photocoagulation*** - The question asks for a treatment **not suitable** for **advanced proliferative diabetic retinopathy** with **extensive vitreoretinal fibrosis** and **tractional retinal detachment (TRD)**. - **Panretinal photocoagulation (PRP)** is a laser treatment used to ablate ischemic peripheral retina and prevent neovascularization in proliferative diabetic retinopathy. However, it is a **preventive measure** used in **earlier stages of PDR** before the development of extensive fibrosis and tractional detachment. - Once **tractional retinal detachment** has developed with **extensive vitreoretinal fibrosis**, photocoagulation alone **cannot relieve the mechanical traction** on the retina or **reattach the detached retina**. At this advanced stage, **surgical intervention is required**. - While endolaser photocoagulation can be performed **during vitrectomy** as an adjunctive measure, standalone photocoagulation is not suitable as a primary treatment for established TRD with extensive fibrosis. *Vitrectomy* - **Pars plana vitrectomy** is the **definitive surgical treatment** for advanced PDR with tractional retinal detachment and extensive vitreoretinal fibrosis. - The procedure involves removal of the vitreous gel, fibrovascular membranes, and blood, which relieves traction on the retina and allows for retinal reattachment. - This is the **gold standard treatment** for this condition. *Removal of epiretinal membrane* - **Membrane peeling** (removal of epiretinal and fibrovascular membranes) is an **essential component** of vitrectomy for tractional retinal detachment. - Removing these membranes relieves the mechanical traction causing the retinal detachment, making this a **suitable and necessary** treatment step. - This is performed as part of the comprehensive vitrectomy procedure. *Reattachment of detached or torn retina* - **Retinal reattachment** is the primary **therapeutic goal** for tractional retinal detachment in advanced PDR. - This is achieved through vitrectomy with membrane peeling, often combined with endolaser, fluid-gas exchange, or silicone oil tamponade. - This is clearly a **suitable treatment objective** for this condition.
Question 5: 'S-A-F-E program' was initiated for the control of which of the following conditions?
- A. Ocular trauma
- B. Onchocerciasis
- C. Refractive error
- D. Trachoma (Correct Answer)
Explanation: ***Trachoma*** - The **S-A-F-E program** is a comprehensive strategy developed by the World Health Organization (WHO) for the elimination of blinding **trachoma**. - **S-A-F-E** stands for **Surgery** for trichiasis, **Antibiotics** for infection, **Facial cleanliness**, and **Environmental improvement**. *Ocular trauma* - While ocular trauma is a significant cause of vision impairment, its control and prevention strategies are distinct from the specific interventions of the SAFE program. - Management of ocular trauma focuses on immediate medical attention, surgical repair, and preventive measures like protective eyewear. *Onchocerciasis* - **Onchocerciasis**, also known as river blindness, is controlled primarily through mass drug administration of **ivermectin**, alongside vector control. - This condition is caused by a parasitic worm (**Onchocerca volvulus**) and is not targeted by the SAFE program. *Refractive error* - **Refractive errors** (e.g., myopia, hyperopia, astigmatism) are corrected with spectacles, contact lenses, or refractive surgery. - They are not infectious diseases and do not require the public health interventions outlined in the SAFE program.
Question 6: Which of the following is not true regarding the surgical treatment of varicose veins?
- A. High ligation is commonly performed
- B. Compression stockings are recommended after surgery
- C. Phlebectomy is used
- D. Sclerotherapy is curative (Correct Answer)
Explanation: ***Sclerotherapy is curative*** - **Sclerotherapy** is a procedure where a solution is injected into varicose veins to cause them to scar and collapse, but it is typically not considered **curative** on its own, especially for larger or recurrent veins. - While effective for smaller veins and spider veins, its role is often **palliative** or adjunctive, and it may require multiple sessions or be combined with other treatments to achieve long-term success. - Modern guidelines prefer endovenous ablation techniques (radiofrequency or laser) for definitive treatment of great saphenous vein incompetence. *High ligation is commonly performed* - **High ligation**, involving the surgical tie-off of the sapheno-femoral junction (SFJ), is a common component of surgical treatment for **varicose veins** to prevent reflux from the deep venous system into the superficial system. - It aims to eliminate a primary source of **venous hypertension** in the superficial veins and is often combined with stripping of the great saphenous vein. *Compression stockings are recommended after surgery* - **Compression stockings** are routinely recommended after surgical treatment of varicose veins to minimize **postoperative swelling**, reduce pain, and improve venous return. - They also play a role in preventing complications such as **thrombosis** and promoting better long-term outcomes by maintaining vein compression during healing. *Phlebectomy is used* - **Ambulatory phlebectomy** is a surgical technique used to remove varicose veins through small incisions, particularly for superficial, tortuous veins that are not easily treated by other methods. - It is often performed in conjunction with **high ligation** and stripping or as a standalone procedure for localized varicose segments.
Question 7: 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 8: Which of the following conditions is associated with posterior staphyloma?
- A. Simple myopia
- B. Pathological myopia (Correct Answer)
- C. Hypermetropia
- D. Congenital myopia
Explanation: ***Pathological myopia*** - **Posterior staphyloma** is a characteristic feature of **pathological myopia**, also known as high or degenerative myopia. - It involves an **outpouching of the posterior sclera**, which can lead to significant vision loss due to associated retinal and choroidal degeneration. *Congenital myopia* - While present from birth, **congenital myopia** does not inherently imply the development of a posterior staphyloma. - It often refers to a myopia present at birth, which may or may not progress to the severe, degenerative form seen in pathological myopia. *Simple myopia* - **Simple myopia** is a common refractive error that typically does not involve degenerative changes such as posterior staphyloma. - It is characterized by an eyeball that is slightly too long, causing light to focus in front of the retina, but without structural abnormalities of the posterior pole. *Hypermetropia* - **Hypermetropia** (farsightedness) is the opposite of myopia, where the eye is too short or has insufficient focusing power. - It is not associated with posterior staphyloma; rather, the globe is typically smaller than average, and the risk of staphyloma is negligible.
Question 9: All are causes of proptosis except:
- A. Orbital cellulitis
- B. Orbital tumor
- C. Retinal detachment (Correct Answer)
- D. Graves' disease
Explanation: ***Retinal detachment*** - **Retinal detachment** is a condition where the retina separates from the underlying supportive tissue and does not cause proptosis. - Its primary symptoms include **flashes of light**, **floaters**, and a **curtain-like shadow** in the visual field. *Orbital cellulitis* - **Orbital cellulitis** is an infection of the fat and muscles around the eye, leading to inflammation and swelling. - This swelling can push the eye forward, causing **proptosis**. *Orbital tumor* - An **orbital tumor** is a mass growing within the orbit (eye socket), which occupies space and displaces the eyeball. - This displacement typically results in **proptosis**, often unilateral and progressive. *Graves' disease* - **Graves' disease** (or Graves' ophthalmopathy) involves inflammation and swelling of the extraocular muscles and orbital fat due to autoimmune processes. - This increased volume within the orbit directly causes **proptosis** and is often bilateral.
Question 10: Consider the following causes of visual loss : 1. Obstruction of the central retinal artery 2. Vitreous and retinal haemorrhage 3. Cataract 4. Retinal detachment Which of the above causes are associated with acute visual loss in a patient?
- A. 1, 3 and 4
- B. 1, 2 and 3
- C. 2, 3 and 4
- D. 1, 2 and 4 (Correct Answer)
Explanation: ***1, 2 and 4*** - **Obstruction of the central retinal artery**, **vitreous and retinal haemorrhage**, and **retinal detachment** all present as sudden, acute vision loss. - **Central retinal artery occlusion** causes complete, sudden, painless monocular vision loss. **Vitreous hemorrhage** is acute, painless, and can present with floaters or red haze. **Retinal detachment** is acute, painless vision loss, often preceded by flashes and floaters, and can present as a "curtain" coming across the vision. *1, 3 and 4* - While **central retinal artery obstruction** and **retinal detachment** cause acute vision loss, **cataracts** typically cause gradual, progressive vision loss over months to years. - Cataracts primarily affect lens clarity, leading to blurry vision, glare, and dull colors rather than an abrupt onset of blindness. *1, 2 and 3* - **Central retinal artery obstruction** and **vitreous/retinal hemorrhage** lead to acute vision loss, but **cataracts** are a cause of *chronic* and *gradual* vision impairment. - The onset and progression of a **cataract** are distinctly different from the sudden nature of acute vision loss conditions. *2, 3 and 4* - **Vitreous and retinal haemorrhage** and **retinal detachment** are causes of acute vision loss, but a **cataract** is not. - The defining characteristic of acute vision loss is its rapid onset, which does not align with the slow development of a cataract.
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