Ophthalmic Surgery Practice Questions

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

Malignancy. ***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.

Q: YAG laser is used in the treatment of:

After cataract. ***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.

Q: The primary indication for enucleation is:

Retinoblastoma. ***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

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

Intraocular retinoblastoma. ***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.

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

Suprachoroidal hemorrhage. ***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.

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

abd. ***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.

Q: 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?

Posterior chamber IOL. ***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.

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

Phacoemulsification with capsular tension ring. ***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 1

Which of the following is not an indication for evisceration?

Accepted Answer

Malignancy

Answer

Severe globe trauma

Answer

Panophthalmitis

Answer

Expulsive hemorrhage

Question 2

YAG laser is used in the treatment of:

Accepted Answer

After cataract

Answer

Open-angle glaucoma

Answer

Retinal detachment

Answer

Diabetic retinopathy

Question 3

The primary indication for enucleation is:

Accepted Answer

Retinoblastoma

Answer

Malignant melanoma

Answer

Glaucoma

Answer

Phthisis bulbi

Question 4

What is the most important absolute indication for ophthalmic enucleation?

Accepted Answer

Intraocular retinoblastoma

Answer

Absolute glaucoma

Answer

Mutilating ocular injury

Answer

Endophthalmitis

Question 5

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

Accepted Answer

Suprachoroidal hemorrhage

Answer

Retinal detachment

Answer

Glaucoma

Answer

Endophthalmitis

Question 6

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

Accepted Answer

abd

Answer

abc

Answer

acd

Answer

bcd

Answer

ab

Question 7

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

Accepted Answer

Phacoemulsification has faster recovery and less risk of astigmatism.

Answer

Phacoemulsification typically results in less astigmatism.

Answer

ECCE has faster recovery but higher astigmatism risk.

Answer

Both techniques have similar recovery times and astigmatism risks.

Question 8

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?

Accepted Answer

Posterior chamber IOL

Answer

Anterior chamber IOL

Answer

Scleral-fixated IOL

Answer

Iris-claw IOL

Question 9

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

Accepted Answer

Phacoemulsification with capsular tension ring

Answer

Intracapsular cataract extraction

Answer

Manual small incision cataract surgery

Answer

Laser-assisted cataract surgery

Question 10

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

Accepted Answer

Lower risk of astigmatism and faster recovery compared to ECCE.

Answer

Requires less specialized equipment and is easier to perform.

Answer

Results in similar visual outcomes as ECCE.

Answer

Has higher complication rates compared to ECCE.

Ophthalmic Surgery — MCQs

Ophthalmic Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?