Ophthalmic Surgery — MCQs

Ophthalmic Surgery Indian Medical PG Practice Questions and MCQs

Question 111: Which of the following is not an indication for evisceration?

A. Severe globe trauma
B. Panophthalmitis
C. Expulsive hemorrhage
D. Malignancy (Correct Answer)

Explanation: ***Malignancy*** - **Malignancy** is a direct contraindication for evisceration because removing only the intraocular contents risks leaving behind **cancerous tissue** in the scleral shell. - For suspected or confirmed intraocular malignancies like **retinoblastoma** or **choroidal melanoma**, **enucleation** (removal of the entire globe) is necessary to ensure complete tumor excision and prevent metastatic spread. *Severe globe trauma* - **Severe globe trauma**, especially with ruptured globe and extensive tissue loss, is a common indication for **evisceration** to relieve pain and prepare for a prosthetic eye. - In such cases, the damaged intraocular contents are removed while preserving the scleral shell, which can provide a good cosmetic and functional outcome. *Panophthalmitis* - **Panophthalmitis** refers to a severe infection involving all layers of the eye and surrounding orbital tissues, making evisceration an appropriate treatment. - Evisceration helps to **remove infected tissue**, control the spread of infection, alleviate pain, and prevent systemic complications. *Expulsive hemorrhage* - An **expulsive hemorrhage** is a catastrophic event involving massive choroidal bleeding that extrudes intraocular contents, often requiring emergent evisceration. - Evisceration in this context aims to **control bleeding**, alleviate severe pain, and remove non-viable tissue.

Question 112: YAG laser is used in the treatment of:

A. Open-angle glaucoma
B. Retinal detachment
C. Diabetic retinopathy
D. After cataract (Correct Answer)

Explanation: ***After cataract*** - YAG laser is primarily used for **posterior capsulotomy** to treat **"after cataract"** or **posterior capsule opacification (PCO)**, a common complication following cataract surgery. - This procedure creates an opening in the opacified posterior capsule to restore clear vision without requiring a surgical incision. *Open-angle glaucoma* - YAG lasers are sometimes used in **peripheral iridotomy** for narrow-angle or **angle-closure glaucoma**, but not typically for the primary treatment of open-angle glaucoma, which is managed with medications or other laser procedures (e.g., SLT). - While YAG laser can be used for **iridotomy** in specific glaucoma types, it is generally not the go-to treatment for improving outflow in **open-angle glaucoma**. *Retinal detachment* - Retinal detachment is a surgical emergency typically treated with procedures like **vitrectomy**, **scleral buckle**, or **pneumatic retinopexy**. - Lasers used for retinal issues are often **argon lasers** for creating chorioretinal adhesions to prevent or wall off detachments, not YAG lasers for the detachment itself. *Diabetic retinopathy* - **Diabetic retinopathy** is primarily treated with **argon laser photocoagulation** (panretinal photocoagulation or focal laser) to destroy abnormal blood vessels and reduce macular edema. - YAG lasers are not used for the direct treatment of **diabetic retinopathy** or its associated neovascularization.

Question 113: The primary indication for enucleation is:

A. Malignant melanoma
B. Glaucoma
C. Retinoblastoma (Correct Answer)
D. Phthisis bulbi

Explanation: ***Retinoblastoma*** - **Retinoblastoma** is the most common intraocular malignancy in children and the **primary indication for enucleation** in ophthalmology - Enucleation is indicated in advanced cases (Group D/E) where the eye cannot be salvaged, to prevent metastasis and save life - Given its aggressive nature and potential for life-threatening spread, **enucleation** remains the definitive curative treatment for advanced retinoblastoma *Malignant melanoma* - While intraocular melanoma can require enucleation, it is not the primary indication - Smaller tumors are often managed with globe-preserving treatments like **brachytherapy** or **proton beam radiation** - Enucleation is reserved for large melanomas, treatment failures, or eyes with severe pain and no vision *Glaucoma* - **Glaucoma** is primarily managed with medications, laser therapy, or filtering surgeries to lower intraocular pressure - Enucleation for glaucoma is exceedingly rare, considered only for intractable pain in a blind eye when all other treatments have failed *Phthisis bulbi* - **Phthisis bulbi** is a shrunken, non-functional eye resulting from severe trauma, inflammation, or disease - Enucleation may be performed for cosmetic reasons or pain relief, but this is a secondary indication - It represents end-stage ocular damage, not a primary life-saving indication like retinoblastoma

Question 114: What is the most important absolute indication for ophthalmic enucleation?

A. Absolute glaucoma
B. Intraocular retinoblastoma (Correct Answer)
C. Mutilating ocular injury
D. Endophthalmitis

Explanation: ***Intraocular retinoblastoma*** - **Intraocular malignancy**, particularly unilateral retinoblastoma, is the most important absolute indication for enucleation as it is life-threatening. - Enucleation is performed to prevent **metastasis** and save the patient's life, as retinoblastoma can be fatal if not treated aggressively. - Other intraocular malignancies like **choroidal melanoma** may also require enucleation. *Absolute glaucoma* - Absolute glaucoma (painful blind eye) is also an absolute indication for enucleation when the eye is blind, painful, and medical management has failed. - However, it is less critical than intraocular malignancy as it doesn't pose a life-threatening risk. - Enucleation relieves pain and prevents the risk of **sympathetic ophthalmia**, though other palliative procedures like **cyclodestructive procedures** may be tried first. *Mutilating ocular injury* - Severe ocular trauma is a relative indication, not an absolute one. Initial management focuses on **repair and salvage** of the globe. - Enucleation is considered only if there's no potential for vision recovery, severe pain, or significant risk of **sympathetic ophthalmia** in the fellow eye. - Primary enucleation after trauma is rarely performed immediately. *Endophthalmitis* - Endophthalmitis is a severe intraocular infection, but enucleation is typically a last resort after medical management fails. - Initial treatment involves **intravitreal antibiotics** and possibly **vitrectomy** to eradicate the infection. - Enucleation is only considered if the infection is uncontrolled, leading to a blind and painful eye, or if there's risk of **orbital extension** or panophthalmitis.

Question 115: Uncontrolled hypertension may cause which of the following complications in cataract surgery:

A. Retinal detachment
B. Glaucoma
C. Suprachoroidal hemorrhage (Correct Answer)
D. Endophthalmitis

Explanation: ***Suprachoroidal hemorrhage*** - **Uncontrolled hypertension** significantly increases the risk of **suprachoroidal hemorrhage** during cataract surgery due to fragile blood vessels and elevated intraoperative blood pressure. - This complication can lead to acute, severe pain, vision loss, and globe rupture, often requiring immediate surgical intervention. *Retinal detachment* - While a serious complication of ocular surgery, **retinal detachment** is not directly caused by uncontrolled hypertension during cataract surgery. - It is more commonly associated with posterior capsular rupture, vitreous loss, or high myopia. *Glaucoma* - **Glaucoma** is a chronic condition characterized by optic nerve damage, often due to elevated intraocular pressure, and is not an acute complication of uncontrolled hypertension during cataract surgery. - While hypertension is a risk factor for certain types of glaucoma, it does not directly cause an acute glaucomatous event during the procedure. *Endophthalmitis* - **Endophthalmitis** is a severe infection of the intraocular fluids and tissues, typically occurring post-operatively. - It is primarily caused by bacterial or fungal contamination during or after surgery and is not directly linked to uncontrolled hypertension.

Question 116: Enucleation is done for - a) Retinoblastoma b) Malignant melanoma c) Glaucoma d) Phthisis bulbi

A. abd (Correct Answer)
B. abc
C. acd
D. bcd
E. ab

Explanation: ***abd*** - **Enucleation** (surgical removal of the entire eyeball) is indicated for **retinoblastoma** and **malignant melanoma** due to the malignant nature of these conditions and the risk of metastasis. - It is also performed in cases of severe **phthisis bulbi**, where the eye is shrunken, non-functional, and often painful, to alleviate symptoms and for cosmetic reasons. *abc* - This option incorrectly includes **glaucoma** as a primary indication for enucleation. - While severe, painful, and blind glaucomatous eyes might eventually undergo enucleation, it is not the initial or typical treatment; many other medical and surgical options are explored first. *acd* - This option incorrectly includes **glaucoma** for the aforementioned reasons and omits **malignant melanoma**. - **Malignant melanoma** of the choroid is a significant indication for enucleation, especially in larger tumors, due to its metastatic potential. *bcd* - This option incorrectly includes **glaucoma** and omits **retinoblastoma**. - **Retinoblastoma** is a life-threatening pediatric malignancy, and prompt enucleation is often crucial for treatment and survival.

Question 117: What are the differences between phacoemulsification and extracapsular cataract extraction (ECCE) regarding recovery time and astigmatism risk?

A. Phacoemulsification has faster recovery and less risk of astigmatism. (Correct Answer)
B. Phacoemulsification typically results in less astigmatism.
C. ECCE has faster recovery but higher astigmatism risk.
D. Both techniques have similar recovery times and astigmatism risks.

Explanation: ***Phacoemulsification has faster recovery and less risk of astigmatism.*** - **Phacoemulsification** involves a **smaller incision (2.2-3.2 mm)**, leading to **quicker healing** and **faster visual recovery** compared to ECCE. - The smaller incision size minimizes corneal distortion, resulting in a **significantly lower risk of surgically induced astigmatism**. - Most patients achieve functional vision within **days to weeks** after phacoemulsification. *Both techniques have similar recovery times and astigmatism risks.* - This is **incorrect** - there are substantial differences between the two techniques. - Phacoemulsification's smaller incision (2.2-3.2 mm) versus ECCE's larger incision (10-12 mm) leads to **significantly different outcomes** in both recovery time and astigmatism induction. *Phacoemulsification typically results in less astigmatism.* - This statement is **true but incomplete** - it only addresses astigmatism risk. - The question specifically asks about **both recovery time and astigmatism risk**, making this a partial answer. - The reduced astigmatism is due to the **smaller self-sealing incision** that preserves corneal architecture. *ECCE has faster recovery but higher astigmatism risk.* - This is **incorrect** - ECCE does **not** have faster recovery. - The **larger incision (10-12 mm)** in ECCE requires sutures and takes **several weeks to months** to heal completely, resulting in **slower visual rehabilitation**. - While it correctly identifies higher astigmatism risk, the recovery time component is factually wrong.

Question 118: A 70-year-old patient with cataracts presents for surgery. Which type of intraocular lens (IOL) is most commonly used to restore vision after cataract extraction?

A. Posterior chamber IOL (Correct Answer)
B. Anterior chamber IOL
C. Scleral-fixated IOL
D. Iris-claw IOL

Explanation: ***Posterior chamber IOL*** - This is the **most commonly used** type of IOL due to its placement closer to the natural lens position, offering excellent optical quality and stability. - It provides the best visual outcomes by mimicking the natural lens's location and minimizing optical aberrations. *Anterior chamber IOL* - These IOLs are placed in front of the iris and are typically reserved for cases where there is **insufficient capsular support** for a posterior chamber IOL. - They are associated with a **higher risk of complications**, such as corneal endothelial damage and chronic inflammation. *Scleral-fixated IOL* - This type of IOL is used in cases of **absent capsular support** or when other IOL fixation methods are not possible, requiring sutures to secure the lens to the sclera. - It is a more complex surgical procedure with a **higher risk of complications**, such as scleral erosion or suture-related issues. *Iris-claw IOL* - These IOLs are clipped onto the iris and are typically used in cases where there is **no capsular support** and the anterior chamber is too shallow for an anterior chamber IOL. - While providing good visual results, it carries risks such as **iris damage**, pigment dispersion, and Uveitis-Glaucoma-Hyphema (UGH) syndrome.

Question 119: Evaluate the best surgical technique for a 40-year-old patient with a traumatic cataract and weak zonules.

A. Intracapsular cataract extraction
B. Phacoemulsification with capsular tension ring (Correct Answer)
C. Manual small incision cataract surgery
D. Laser-assisted cataract surgery

Explanation: ***Phacoemulsification with capsular tension ring*** - This technique allows for the removal of the cataract while the **capsular tension ring (CTR)** stabilizes the capsular bag, which is crucial with **weak zonules**. - **Phacoemulsification** minimizes incision size, reducing the risk of complications associated with weak zonules during surgery. *Intracapsular cataract extraction* - This method involves removing the entire lens and capsule, which is an outdated technique with **high complication rates**, especially in younger patients. - It would necessitate **scleral fixation** of an intraocular lens, or an aphakic outcome, leading to complex visual rehabilitation. *Manual small incision cataract surgery* - While an improvement over ECCE, **MSICS** still involves a larger incision compared to phacoemulsification, leading to a higher risk of complications with **weak zonules**. - It does not specifically address the issue of **zonular weakness** as effectively as a capsular tension ring used in phacoemulsification. *Laser-assisted cataract surgery* - While beneficial for precise capsulorhexis and lens fragmentation, **LASER-assisted cataract surgery** itself does not address the underlying problem of **weak zonules**. - It would still require adjunctive measures like a **CTR** during the phacoemulsification step to manage zonular instability.

Question 120: What are the advantages of phacoemulsification compared to traditional extracapsular cataract extraction (ECCE) in cataract surgery?

A. Lower risk of astigmatism and faster recovery compared to ECCE. (Correct Answer)
B. Requires less specialized equipment and is easier to perform.
C. Results in similar visual outcomes as ECCE.
D. Has higher complication rates compared to ECCE.

Explanation: ***Lower risk of astigmatism and faster recovery compared to ECCE.*** - Phacoemulsification uses a **smaller incision (2.8-3.2mm)** compared to ECCE (10-12mm), leading to significantly less surgically induced astigmatism - The smaller incision and less tissue manipulation result in **faster visual rehabilitation** with most patients achieving functional vision within 24-48 hours - **Better wound integrity** with self-sealing incisions reduces risk of wound-related complications - Enables **same-day surgery** with faster return to normal activities *Requires less specialized equipment and is easier to perform.* - Phacoemulsification actually requires **highly specialized and expensive equipment** (phacoemulsifier machine with ultrasonic handpiece) - **More technically demanding** procedure requiring advanced surgical skills and a steeper learning curve - Requires sophisticated training in ultrasound physics, fluidics, and nuclear fragmentation techniques - ECCE is actually simpler and can be performed with basic instruments *Results in similar visual outcomes as ECCE.* - Phacoemulsification provides **superior uncorrected visual acuity** due to minimal surgically induced astigmatism - **Better refractive predictability** allowing for more accurate IOL power calculations - Reduced optical aberrations from smaller, more stable incisions - More precise IOL positioning in the capsular bag *Has higher complication rates compared to ECCE.* - Phacoemulsification has **lower overall complication rates** when performed by experienced surgeons - **Reduced risk of wound dehiscence**, expulsive hemorrhage, and vitreous prolapse due to smaller incision - Lower incidence of endophthalmitis (better wound seal) - However, posterior capsular rupture may occur during the learning phase with phacoemulsification

Practice by Chapter

Surgical Anatomy of Eye

Practice Questions

Asepsis and Sterilization in Eye Surgery

Practice Questions

Anesthesia in Ophthalmic Surgery

Practice Questions

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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