Ophthalmic Surgery — MCQs

Ophthalmic Surgery Indian Medical PG Practice Questions and MCQs

Question 91: The image shows an eye following a surgical procedure. What type of iridectomy is depicted?

A. Optical iridectomy
B. Broad based iridectomy
C. Peripheral button hole iridectomy (Correct Answer)
D. Peripheral basal iridectomy

Explanation: ***Peripheral button hole iridectomy*** - The image shows a small, round opening located in the **peripheral iris**, resembling a "buttonhole." - This type of iridectomy is created to establish a communication between the anterior and posterior chambers of the eye, often in glaucoma management, and is typically **small and circular**. *Optical iridectomy* - An optical iridectomy is performed to create a new, larger pupillary opening in cases where the **natural pupil is occluded or significantly displaced**, aiming to improve vision. - It would typically be a **larger, more central opening** designed to function as an artificial pupil, which is not what is seen in the image. *Broad based iridectomy* - A broad-based iridectomy involves excising a **large sector of the iris** from the pupillary margin to the iris base. - This is a much larger tissue removal than depicted, and it often results in a **keyhole-shaped pupil**, unlike the small peripheral hole shown. *Peripheral basal iridectomy* - A peripheral basal iridectomy involves removing a portion of the iris close to its **root (base)**, typically performed in **open-angle glaucoma** or to prevent pupillary block. - While it's peripheral, it usually involves a **full-thickness excision of a small wedge**, often triangular or rectangular, which is distinct from the described buttonhole appearance.

Question 92: What does the given image show?

A. Hypopyon
B. Pseudohypopyon
C. Inverse hypopyon (Correct Answer)
D. Hyphema

Explanation: ***Inverse hypopyon*** - The image shows a collection of **particulate material (pigment)** in the **superior anterior chamber**, which is characteristic of an **inverse hypopyon**. - This typically occurs in eyes that have undergone **vitrectomy,** where heavy particles (like silicone oil or pigment) float upwards in the aqueous humor. *Hypopyon* - A **hypopyon** is a layering of **white blood cells** in the **inferior anterior chamber** due to gravity. - It indicates **severe inflammation** or infection within the eye, such as endophthalmitis or severe uveitis. *Pseudohypopyon* - A **pseudohypopyon** refers to a collection of **tumor cells** or **lens material** in the **inferior anterior chamber**, mimicking a hypopyon. - It is differentiated from a true hypopyon by the composition of the cellular material and its underlying cause. *Hyphema* - **Hyphema** is the presence of **red blood cells** layering in the **inferior anterior chamber**, visible as a reddish fluid level. - It is typically caused by **trauma**, surgery, or certain vascular conditions affecting the iris or ciliary body.

Question 93: Patient with eye surgery done 2 days ago presents with pain and dimness of vision. Which of the following is not useful for management?

A. Intravenous antibiotics
B. Intravitreal antibiotics
C. Pars plana vitrectomy
D. Topical antibiotics (Correct Answer)

Explanation: ***Topical antibiotics*** - This patient presents with symptoms suggestive of **post-surgical endophthalmitis** (pain and dimness of vision after eye surgery), which is a severe infection of the intraocular fluids (vitreous and/or aqueous humor). - Topical antibiotics typically do not achieve sufficient intraocular concentrations to effectively treat a deep-seated infection like endophthalmitis. *Intravenous antibiotics* - **Intravenous antibiotics** can provide systemic coverage and may reach the posterior segment of the eye, although their penetration into the vitreous can be limited. - They are often used as an adjunct to more direct routes of administration in severe endophthalmitis. *Intravitreal antibiotics* - **Intravitreal antibiotics** are injected directly into the vitreous cavity, providing high local concentrations of medication directly at the site of infection. - This is considered a cornerstone of endophthalmitis management due to its immediate and potent antimicrobial effect. *Pars plana vitrectomy* - **Pars plana vitrectomy** involves surgical removal of the infected vitreous, which reduces the bacterial load and inflammatory mediators, and allows for direct sampling for microbiology. - It is particularly indicated in cases of severe endophthalmitis or when there is poor response to antibiotics, often improving visual outcomes.

Question 94: All the following statements regarding the image given are true except: (Recent Neet Pattem 2016-17)

A. Lichen sclerosus
B. Premalignant
C. Can involve anus
D. Most commonly seen in reproductively active females (Correct Answer)

Explanation: ***Most commonly seen in reproductively active females*** - **Lichen sclerosus** predominantly affects **prepubertal girls** and **postmenopausal women**, not reproductively active females. - The disease is associated with **hormonal changes**, explaining its bimodal age distribution. *Lichen sclerosis* - The image displays characteristic **whitish, atrophic, thin skin** with areas of **erythema and erosions** in the anogenital region, consistent with vulvar lichen sclerosus. - This chronic inflammatory skin condition primarily affects the **genital and perianal areas**. *Premalignant* - While not inherently malignant, lichen sclerosus is considered a **premalignant condition** with a small risk of transforming into **squamous cell carcinoma**. - Long-standing or inadequately treated lichen sclerosus can lead to chronic inflammation and cellular atypia, increasing the risk of malignant change. *Can involve anus* - Lichen sclerosus commonly involves the anogenital region, forming a **figure-of-eight or hourglass shape** around the vulva and anus. - Involvement of the anus can lead to **pruritus, pain**, and, in severe cases, anal fissures and scarring.

Question 95: 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 96: Evisceration is removal of which layer of eyeball?

A. Middle and inner (Correct Answer)
B. All the layers of eyeball
C. Outer and inner
D. Outer and middle

Explanation: ***Middle and inner*** - **Evisceration** involves the surgical removal of the internal contents of the eyeball, which include components derived from the **middle (uveal) and inner (retinal) layers**. - The **sclera** (outermost layer) and **extraocular muscles** are preserved, allowing for a more natural prosthetic eye fit. *All the layers of eyeball* - This describes **enucleation**, where the entire eyeball is removed including all three layers (sclera, choroid/ciliary body/iris, and retina). - Enucleation is a more extensive procedure than evisceration, typically performed for intraocular tumors or severe trauma where preservation of the sclera isn't possible. *Outer and inner* - This option is incorrect because the **outer layer (sclera)** is specifically preserved in evisceration. - Removing the outer layer would lead to a more destructive procedure, inconsistent with the definition of evisceration. *Outer and middle* - This option is incorrect because the **outer layer (sclera)** is preserved during evisceration, while the entire **inner layer (retina)** is removed. - The middle layer (uvea) is removed, but this option inaccurately states the fate of the outer and inner layers.

Question 97: For laser iridotomy which laser is used?

A. Nd YAG laser (Correct Answer)
B. Argon laser
C. CO2 laser
D. Excimer laser

Explanation: ***Nd YAG laser*** - The **Nd:YAG laser** is the **primary laser used for laser iridotomy** due to its ability to create precise perforations in the iris. - This laser operates with a **photodisruptive mechanism**, generating plasma formation that effectively creates an opening in the iris. - It is the **treatment of choice for angle-closure glaucoma** and pupillary block. *Argon laser* - The **argon laser** was historically used for iridotomy but is now less commonly the primary choice due to its thermal effect causing more inflammation and scarring. - It is sometimes used in **sequential laser iridotomy** (argon first to thin the iris, followed by Nd:YAG to perforate) in cases where the iris is very thick or heavily pigmented. - Also used for **peripheral iridoplasty** and other thermal applications. *CO2 laser* - **CO2 lasers** are primarily used for **tissue ablation** in surgical procedures, particularly on the skin, eyelid lesions, or in general surgery. - They are **not suitable** for precise intraocular procedures like iridotomy due to their infrared wavelength (10,600 nm) and poor penetration through aqueous humor. *Excimer laser* - **Excimer lasers** are primarily used in **refractive surgery** (e.g., LASIK, PRK) to reshape the cornea. - They work by **photoablation** at 193 nm wavelength, precisely removing tissue layer by layer, and are not designed for creating an opening in the iris.

Question 98: Site of bleeding after cataract surgery is:

A. Posterior choroidal vessels
B. Anterior choroidal vessels
C. Anterior ciliary vessels
D. Posterior ciliary vessels (Correct Answer)

Explanation: ***Posterior ciliary vessels*** - Bleeding after cataract surgery most commonly originates from the **posterior ciliary vessels**, particularly during or after an intraocular procedure due to their deep location and proximity to the surgical field. - This can lead to a **suprachoroidal hemorrhage**, a serious complication characterized by the accumulation of blood between the choroid and the sclera. *Posterior choroidal vessels* - While choroidal vessels are a source of ocular bleeding, the **posterior choroidal vessels** are less frequently the primary site of hemorrhage immediately following cataract surgery compared to the ciliary vessels. - These vessels are part of the main choroidal circulation but are generally deeper and not as directly exposed to the immediate surgical trauma unless there's extensive posterior segment involvement. *Anterior choroidal vessels* - The **anterior choroidal vessels** supply the anterior part of the choroid but are not typically the main source of significant post-cataract surgery bleeding. - Hemorrhage from these vessels would likely be more localized to the anterior choroid, less commonly causing the widespread suprachoroidal hemorrhage seen with posterior ciliary vessel rupture. *Anterior ciliary vessels* - The **anterior ciliary vessels** supply the anterior segment, including the ciliary body and iris, and can be injured during anterior segment surgery. - However, bleeding from these vessels is usually more superficial and tends to present as **hyphema** (blood in the anterior chamber) rather than the deeper, more severe suprachoroidal hemorrhage associated with posterior ciliary vessels.

Question 99: Which laser is used for posterior capsular opacification (PCO)?

A. Krypton
B. Argon
C. Nd:YAG (Correct Answer)
D. Diode laser

Explanation: ***ND-YAG*** - The **Nd:YAG laser** is specifically used for **posterior capsulotomy**, a procedure to treat **posterior capsular opacification (PCO)**, also known as secondary cataract. - It creates a small opening in the opacified posterior capsule using **photodisruption**, which vaporizes the tissue. *Krypton* - **Krypton lasers** are typically used in **photocoagulation** for retinal conditions, such as **diabetic retinopathy** or **retinal tears**. - They are not used for incising ocular tissues like the posterior capsule due to their wavelength and photocoagulative nature. *Argon* - **Argon lasers** are primarily used in **retinal photocoagulation** for conditions like **diabetic retinopathy**, **retinal vein occlusions**, and also for **trabeculoplasty** in glaucoma. - Like krypton lasers, their mechanism of action involves thermal coagulation of tissue, not photodisruption of the posterior capsule. *Diode laser* - **Diode lasers** have various applications in ophthalmology, including **transscleral cyclophotocoagulation** for glaucoma and **retinal photocoagulation**. - They are not used for posterior capsulotomy as their wavelength and energy delivery are unsuitable for this specific procedure.

Question 100: Gold standard procedure to reduce recurrence of pterygium after surgical excision is

A. Thiotepa
B. Amniotic membrane grafting
C. Conjunctival autograft (Correct Answer)
D. Beta-radiation

Explanation: ***Conjunctival autograft*** - **Conjunctival autografting** involves transplanting a piece of healthy conjunctiva from the superior bulbar conjunctiva to the bare scleral bed after pterygium excision, acting as a barrier to fibrovascular proliferation. - This technique has consistently shown the **lowest recurrence rates** in comparative studies, making it the **gold standard** for preventing pterygium recurrence due to its high success rate and safety profile. *Thiotepa* - **Thiotepa** is an **antimetabolite** that inhibits DNA synthesis and cell proliferation, used topically post-excision to reduce recurrence by suppressing fibroblast activity. - While it can lower recurrence rates compared to simple excision, its efficacy is generally **less than conjunctival autografting**, and it carries risks of corneal toxicity and limbal stem cell deficiency. *Amniotic membrane grafting* - **Amniotic membrane grafting** involves placing processed amniotic membrane over the scleral bed, which has anti-inflammatory, anti-scarring, and pro-epithelialization properties. - It is an effective option, especially for **large pterygia** or for patients at high risk of recurrence, but its recurrence rates are generally **not as low as those achieved with conjunctival autografting**, and the graft can sometimes detach. *B- radiation* - **Beta-radiation** (strontium-90) is a form of adjuvant therapy applied to the scleral bed immediately after pterygium excision to inhibit fibroblast proliferation and reduce recurrence. - It is effective but associated with potential complications such as **scleral melt**, corneal scarring, and cataract formation, making it a less preferred option than conjunctival autografting, especially in primary cases.

Practice by Chapter

Surgical Anatomy of Eye

Practice Questions

Asepsis and Sterilization in Eye Surgery

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Anesthesia in Ophthalmic Surgery

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Cataract Surgery Techniques

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Corneal Surgeries

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Glaucoma Surgeries

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Oculoplastic Surgeries

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Vitreoretinal Surgeries

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Strabismus Surgery

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Refractive Surgery

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Ocular Oncology Surgeries

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Management of Surgical Complications

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