Corneal Surgeries — MCQs
A patient presents with eye pain, redness, and blurred vision after sleeping in contact lenses. Fluorescein staining reveals a corneal ulcer. What is the most appropriate management?
Which of the following is not a standard treatment for myopia?
A 15-year-old girl with myopic astigmatism does not want to wear glasses. What is the best alternative for her?
Acute corneal hydrops is seen in:
Among the following organisms, which is the most common cause of postoperative endophthalmitis following corneal transplantation?
Which is an emergency therapeutic indication of keratoplasty?
All of the following are true about Keratoconus, except:
A 56-year-old patient presents after 3 days of cataract surgery with a history of increasing pain and diminished vision after an initial improvement. The most likely cause would be –
Identify the surgical step shown in the image given below
What is the preferred surgical technique for traumatic cataract in children?
Corneal Surgeries Indian Medical PG Practice Questions and MCQs
Question 1: A patient presents with eye pain, redness, and blurred vision after sleeping in contact lenses. Fluorescein staining reveals a corneal ulcer. What is the most appropriate management?
- A. Topical antibiotics (Correct Answer)
- B. Oral antibiotics
- C. Topical corticosteroids
- D. Saline irrigation
Explanation: ***Topical antibiotics*** - A **corneal ulcer**, especially in a contact lens wearer, is highly suspicious for **bacterial infection**, necessitating immediate and aggressive topical antibiotic therapy. - **Broad-spectrum antibiotics** (e.g., fluoroquinolones) are often started empirically and adjusted based on culture results. *Oral antibiotics* - **Systemic antibiotics** are generally not indicated for uncomplicated bacterial corneal ulcers, as they don't achieve sufficient concentrations in the cornea to be effective. - They may be considered for severe cases with limbal involvement or scleral extension, or if there is a concern for concurrent systemic infection. *Topical corticosteroids* - **Corticosteroids** are contraindicated in the initial management of suspected infectious corneal ulcers because they can suppress the immune response and worsen the infection. - They may be cautiously used later in treatment to reduce inflammation after the infection is well-controlled. *Saline irrigation* - While helpful for removing foreign bodies or debris, **saline irrigation alone** is insufficient to treat a bacterial corneal ulcer. - It does not eradicate the infection and delaying definitive antibiotic treatment can lead to severe complications.
Question 2: Which of the following is not a standard treatment for myopia?
- A. Phakic intraocular lens
- B. Radial Keratotomy
- C. Holmium laser thermoplasty (Correct Answer)
- D. LASIK
Explanation: ***Holmium laser thermoplasty*** - This procedure was explored for the treatment of **hyperopia**, not myopia, as it aims to steepen the cornea to increase its refractive power. - It involves using a holmium laser to apply heat to the peripheral cornea, causing **collagen shrinkage** and steepening, which is the opposite of what is needed for myopia correction. *LASIK* - **LASIK (Laser-Assisted in Situ Keratomileusis)** is a common and effective surgical procedure for correcting myopia by reshaping the cornea to reduce its refractive power. - It involves creating a **corneal flap** and using an excimer laser to remove tissue from the underlying stromal bed. *Phakic intraocular lens* - **Phakic intraocular lenses (IOLs)** are implanted into the eye without removing the natural lens and are a standard treatment for moderate to high myopia, especially in patients not suitable for LASIK. - They work by adding refractive power to the eye, allowing light to focus correctly on the retina. *Radial Keratotomy* - **Radial Keratotomy (RK)** was an early surgical procedure for myopia, involving making radial incisions in the cornea to flatten it and reduce its refractive power. - Although largely replaced by LASIK due to its unpredictable outcomes and potential for glare and night vision problems, it was historically a standard treatment for myopia.
Question 3: A 15-year-old girl with myopic astigmatism does not want to wear glasses. What is the best alternative for her?
- A. LASIK
- B. Spherical Specs
- C. Contact lenses (Toric) (Correct Answer)
- D. FEMTO Lasik
Explanation: ***Contact lenses (Toric)*** - **Toric contact lenses** are specifically designed to correct **astigmatism**, along with myopia or hyperopia, by having different refractive powers in different meridians. - They offer a non-surgical alternative to glasses, addressing the patient's desire not to wear spectacles, and are generally safe and effective for teenagers. *LASIK* - **LASIK (Laser-Assisted In Situ Keratomileusis)** is a surgical procedure to correct refractive errors, but it is not typically recommended for individuals under **18-21 years of age** due to continued eye growth and refractive changes. - The patient's age of 15 makes her an unsuitable candidate for LASIK at this time. *Spherical Specs* - **Spherical spectacles** are designed to correct myopia or hyperopia but cannot adequately correct **astigmatism**, which is a significant component of this patient's refractive error. - The patient also explicitly states she does not want to wear glasses, making this option undesirable. *FEMTO Lasik* - **FEMTO LASIK** is an advanced form of LASIK that uses a femtosecond laser to create the corneal flap, offering higher precision and safety. - However, similar to traditional LASIK, it is a **refractive surgical procedure** and typically not performed on patients younger than **18 years old** due to ongoing eye development.
Question 4: Acute corneal hydrops is seen in:
- A. Keratoconus (Correct Answer)
- B. Corneal dystrophy
- C. Anterior staphyloma
- D. Interstitial keratitis
Explanation: ***Keratoconus*** - **Acute corneal hydrops** is a classic complication of advanced **keratoconus**, occurring when a break in **Descemet's membrane** allows aqueous humor to enter the corneal stroma. - This leads to sudden onset of **corneal edema**, pain, and significant vision loss, often presenting with a milky white cornea due to stromal clouding. *Corneal dystrophy* - **Corneal dystrophies** are a group of genetic disorders that affect the clarity and structure of the cornea, typically causing progressive vision loss or recurrent epithelial erosions. - While some dystrophies can lead to corneal edema, **acute hydrops** specifically due to a Descemet's membrane rupture is not a characteristic feature. *Anterior staphyloma* - An **anterior staphyloma** is a bulging scar of the cornea and sclera, usually resulting from severe thinning or perforation, often associated with elevated intraocular pressure. - It is a structural deformation involving the entire globe's anterior segment, distinct from the sudden stromal edema of **corneal hydrops** caused by Descemet's rupture. *Interstitial keratitis* - **Interstitial keratitis** is characterized by non-ulcerative inflammation of the corneal stroma without primary involvement of the epithelium or endothelium, often associated with systemic infections like syphilis or Lyme disease. - It typically results in stromal opacification and vascularization ("salmon patch") but does not involve the acute rupture of Descemet's membrane seen in **hydrops**.
Question 5: Among the following organisms, which is the most common cause of postoperative endophthalmitis following corneal transplantation?
- A. Streptococcus
- B. Pseudomonas
- C. Propionibacterium acnes
- D. Staph epidermidis (Correct Answer)
Explanation: ***Staph epidermidis*** - **Coagulase-negative Staphylococcus** (CoNS), including *S. epidermidis*, is the most frequent cause of **postoperative endophthalmitis** after both cataract surgery and corneal transplantation due to its presence on the normal ocular flora. - These organisms can form **biofilms on intraocular lenses** or transplanted corneal tissue, making eradication difficult. *Streptococcus* - While *Streptococcus* species can cause endophthalmitis, they are associated with a **more virulent and rapid onset** of severe inflammation and are not the most common causative agents of postoperative endophthalmitis compared to *S. epidermidis*. - They tend to cause more aggressive infections with often **poorer visual outcomes**. *Propionibacterium acnes* - *Propionibacterium acnes* can cause a **late-onset, indolent form of endophthalmitis**, typically months or even years after surgery. - While it is a recognized cause, it is far **less common** than *Staphylococcus epidermidis* in immediate or early postoperative cases. *Pseudomonas* - **Pseudomonas aeruginosa** is an aggressive and rapid-onset pathogen often associated with **severe keratitis** or **post-traumatic endophthalmitis**. - Although it can cause postoperative endophthalmitis, it is **much less common** than coagulase-negative staphylococci due to its infrequency on normal conjunctival flora.
Question 6: Which is an emergency therapeutic indication of keratoplasty?
- A. Keratoconus
- B. Perforated corneal ulcer (Correct Answer)
- C. Myopia
- D. Hypermetropia
Explanation: ***Perforated corneal ulcer*** - A **perforated corneal ulcer** is an ocular emergency requiring urgent intervention to restore the integrity of the globe and prevent severe vision loss or endophthalmitis. Keratoplasty, in this context, acts as a tectonic graft to seal the perforation. - The emergent nature stems from the high risk of **intraocular infection** and **collapse of the anterior chamber**, which can lead to permanent damage and vision impairment. *Keratoconus* - While severe **keratoconus** can eventually lead to keratoplasty, it is typically an elective procedure performed to improve vision after other treatments like contact lenses are no longer effective. - It is a **slowly progressive condition** that does not usually pose an immediate threat to ocular integrity unless acute hydrops occurs, which itself may require different acute management. *Myopia* - **Myopia**, or nearsightedness, is a refractive error typically corrected with glasses, contact lenses, or elective refractive surgery (e.g., LASIK). - It is not a condition that warrants a **therapeutic or emergency keratoplasty**, as it does not involve structural compromise or disease of the cornea that would necessitate transplantation. *Hypermetropia* - **Hypermetropia**, or farsightedness, is also a refractive error, managed with corrective lenses or elective refractive surgery. - Similar to myopia, it does not involve a corneal disease process that would necessitate a **keratoplasty**, especially not on an emergency basis.
Question 7: All of the following are true about Keratoconus, except:
- A. Astigmatism
- B. Increased curvature of cornea and Astigmatism
- C. Thick cornea (Correct Answer)
- D. Fleischer's ring
Explanation: ***Thick cornea*** - Keratoconus is characterized by **progressive corneal thinning** and weakening, not thickening. - This corneal thinning leads to a conical protrusion, causing significant visual distortion and irregular astigmatism. *Increased curvature of cornea and Astigmatism* - Keratoconus features **increased corneal curvature** with progressive steepening into a cone-shaped configuration. - This results in **irregular astigmatism**, a hallmark feature causing distorted vision at all distances. *Astigmatism* - **Irregular astigmatism** is a cardinal feature of keratoconus due to the asymmetric corneal shape. - Causes blurred and distorted vision that is difficult to correct with spectacles alone. *Fleischer's ring* - **Fleischer's ring** is an iron deposit ring at the base of the cone in keratoconus, visible on slit-lamp examination. - It represents hemosiderin deposition in the basal epithelial cells and is a characteristic clinical sign of keratoconus.
Question 8: A 56-year-old patient presents after 3 days of cataract surgery with a history of increasing pain and diminished vision after an initial improvement. The most likely cause would be –
- A. Posterior capsular opacification
- B. Endophthalmitis (Correct Answer)
- C. Central retinal vein occlusion
- D. Retinal detachment
Explanation: ***Endophthalmitis*** - The presentation of **increasing pain** and **diminished vision** within days of cataract surgery, following an initial improvement, is highly suggestive of acute **postoperative endophthalmitis**. - This severe **intraocular inflammation** is often caused by bacterial infection introduced during surgery, leading to rapid vision loss if not treated promptly. *Posterior capsular opacification* - This condition typically presents weeks to months or even years after cataract surgery, not within 3 days. - It usually causes **gradual blurring of vision** without pain, unlike the acute symptoms described. *Central retinal vein occlusion* - This condition presents with **sudden, painless vision loss** and a characteristic appearance on fundoscopy (e.g., "blood and thunder" retina). - It is not directly related to cataract surgery and would not typically cause increasing pain. *Retinal detachment* - Symptoms usually include **new floaters**, **flashes of light**, and a **"curtain" or "shadow"** over the field of vision, often developing suddenly and progressing. - While it causes vision loss, it is typically painless and not a direct complication presenting with pain within 3 days post-surgery, especially after initial improvement.
Question 9: Identify the surgical step shown in the image given below
- A. Capsulorrhexis
- B. Hydrodissection
- C. Intraocular lens implantation
- D. Lens aspiration (Correct Answer)
Explanation: ***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.
Question 10: What is the preferred surgical technique for traumatic cataract in children?
- A. Lensectomy (Correct Answer)
- B. Contact lenses
- C. Extracapsular Cataract Extraction (ECCE) + Intraocular Lens (IOL)
- D. Glasses
Explanation: ***Lensectomy (Lensectomy-Vitrectomy)*** - **Lensectomy with anterior vitrectomy** is the preferred surgical approach for traumatic cataracts in children - Traumatic cataracts often have **compromised capsular integrity** and zonular weakness, making ECCE unsuitable - The procedure removes lens material and posterior capsule, significantly reducing the **high risk of posterior capsule opacification (PCO)** in children - **Primary IOL implantation** may be performed if the child is >2 years old and capsular support is adequate; otherwise, aphakic correction with contact lenses or secondary IOL is planned - Modern technique provides better long-term visual outcomes in pediatric trauma cases *Extracapsular Cataract Extraction (ECCE) + IOL* - **ECCE is largely outdated** for pediatric traumatic cataracts due to several limitations - Traumatic cataracts frequently have **capsular damage and zonular dehiscence**, making ECCE technically difficult and risky - Children have very high rates of **posterior capsule opacification (PCO)** with retained posterior capsule, requiring multiple YAG procedures - Cannot adequately address **vitreous complications** often associated with traumatic cataracts *Contact lenses for vision correction post-surgery* - Contact lenses are a **rehabilitation option**, not a surgical technique - Used for aphakic correction when primary IOL is not implanted (very young children or inadequate capsular support) - This addresses optical correction after surgery, not the surgical approach itself *Glasses for vision correction post-surgery* - Glasses are a **rehabilitation option**, not a surgical technique - Can provide aphakic correction but result in significant magnification and poor cosmesis - Less preferred than contact lenses for aphakic children due to optical limitations
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free