Ophthalmic Surgery Practice Questions

Q: Plication of inferior lid retractors is indicated in which of the following conditions?

Senile entropion. **Explanation:** **Senile (Involutional) entropion** is primarily caused by age-related changes in the lower eyelid. The pathophysiology involves four key factors: 1. **Horizontal lid laxity** (stretching of canthal tendons). 2. **Vertical instability** due to **attenuation or dehiscence of the lower lid retractors** (capsulopalpebral fascia). 3. **Overriding of the preseptal orbicularis oculi** over the pretarsal orbicularis. 4. Enophthalmos (atrophy of orbital fat). **Plication (shortening/tucking) of the inferior lid retractors** (e.g., Jones procedure) directly addresses the vertical instability by re-establishing the downward pull on the tarsal plate, preventing it from rotating inward. **Analysis of Incorrect Options:** * **Senile ectropion:** This involves an outward turning of the lid. While horizontal laxity is present, the surgical focus is on horizontal shortening (e.g., Lateral Tarsal Strip) rather than retractor plication. * **Cicatricial entropion:** Caused by conjunctival scarring (e.g., Trachoma, Stevens-Johnson Syndrome). The treatment requires addressing the scarred tissue, often via a mucous membrane graft or tarsal rotation (Wies procedure), not retractor repair. * **Paralytic entropion:** This is a distractor; facial nerve palsy typically causes **paralytic ectropion** due to loss of orbicularis oculi tone. Entropion is not a standard feature of paralysis. **High-Yield Clinical Pearls for NEET-PG:** * **Jones Procedure:** Specifically refers to the plication of lower lid retractors for involutional entropion. * **Quickert’s Sutures:** Temporary everting sutures used for bedside management of entropion. * **Wies Procedure:** A full-thickness eyelid transverse incision with everting sutures, used for both involutional and mild cicatricial entropion. * **Key distinction:** If the question mentions "overriding of orbicularis," think **Entropion**; if it mentions "punctal eversion," think **Ectropion**.

Q: A patient with fixed dilated pupil, iris atrophy, and secondary glaucoma after penetrating keratoplasty is suggestive of which syndrome?

Uretes Zavalia syndrome. **Explanation:** **Urrets-Zavalia Syndrome (UZS)** is the correct diagnosis. It is a rare but classic complication characterized by a **permanent fixed dilated pupil**, iris atrophy, and secondary glaucoma following ophthalmic procedures, most classically **Penetrating Keratoplasty (PKP)** for keratoconus. * **Pathophysiology:** The exact mechanism is debated but is primarily attributed to **iris ischemia**. This occurs due to a sudden rise in intraocular pressure (IOP) post-operatively (often from viscoelastic retention or surgical trauma) which compresses the iris root and its vasculature against the peripheral cornea, leading to sphincter paralysis and atrophy. * **Clinical Features:** Fixed mydriasis (non-reactive to light or pilocarpine), iris thinning/atrophy, and posterior synechiae. **Analysis of Incorrect Options:** * **Benedict’s Syndrome:** A brainstem stroke syndrome (Midbrain) involving the 3rd nerve fascicle and red nucleus, presenting with ipsilateral CN III palsy and contralateral tremors/ataxia. * **Posner-Schlossman Syndrome (Glaucomatocyclitic Crisis):** Characterized by recurrent episodes of very high IOP associated with mild anterior uveitis and fine keratic precipitates. The pupil is typically normal or slightly dilated during an attack, but it does not cause permanent iris atrophy or follow PKP. * **Kaufmann’s Syndrome:** This is not a standard ophthalmic eponym related to this presentation; Herbert Kaufman is a famous corneal surgeon, but no such syndrome exists with these features. **High-Yield Pearls for NEET-PG:** * **Classic Association:** Keratoconus patients undergoing PKP are at the highest risk. * **Trigger:** Use of strong mydriatics (like Atropine) post-operatively was historically linked to this, though IOP spikes are the primary driver. * **Management:** Prevention is key by controlling post-op IOP. Once established, the pupil changes are usually irreversible.

Q: Which of the following is NOT true regarding suprachoroidal hemorrhage?

Self-resolving. **Suprachoroidal Hemorrhage (SCH)** is one of the most dreaded complications of intraocular surgery (like cataract or glaucoma surgery). It occurs due to the rupture of the **long or short posterior ciliary arteries**, leading to the accumulation of blood in the potential space between the choroid and the sclera. ### Why "Self-resolving" is NOT true: Suprachoroidal hemorrhage is a **surgical emergency**, not a self-limiting condition. If it occurs intraoperatively (Expulsive Hemorrhage), it requires immediate closure of the wound to prevent permanent vision loss. Post-operatively, it often requires surgical intervention (sclerotomy) to drain the blood and manage secondary complications like intractable glaucoma or retinal detachment. ### Explanation of Incorrect Options: * **Shallowing of anterior chamber:** As blood accumulates in the suprachoroidal space, it pushes the ciliary body and iris diaphragm forward, leading to a sudden shallowing of the AC. * **Expulsion of intraocular contents:** In "Expulsive Hemorrhage," the rapid increase in intraocular pressure can force the vitreous, lens, or even the retina out through the surgical incision. * **Bleeding from short posterior ciliary artery:** This is the classic pathophysiological mechanism. Sudden hypotony (low pressure) during surgery causes these vessels to rupture into the suprachoroidal space. ### High-Yield Clinical Pearls for NEET-PG: * **Risk Factors:** Systemic hypertension (most common), advanced age, glaucoma, high myopia, and aphakia. * **Intraoperative Signs:** Sudden loss of red reflex, hardening of the globe (rock hard eye), and gaping of the wound. * **Management:** Immediate suturing of the wound is the first step. Definitive drainage of the hemorrhage is typically delayed for **7–14 days** to allow for clot liquefaction. * **Prophylaxis:** Preoperative control of BP and intraocular pressure (IOP) is crucial.

Q: Following cataract surgery, a patient comes with complaints of decreased visual acuity. On examination, posterior capsular opacification is seen. What type of laser can be used to treat this condition?

Nd YAG laser. ***Nd YAG laser*** - The **Nd YAG laser** (Neodymium-doped Yttrium Aluminum Garnet) is the gold standard for treating **Posterior Capsular Opacification (PCO)**, which causes secondary visual decline after cataract extraction. - It employs **photodisruption** (a non-thermal process creating plasma) to precisely cut an opening in the opacified posterior capsule, restoring the visual axis (YAG capsulotomy). *Femto laser* - The **Femtosecond laser** is commonly used for creating the corneal flap in **LASIK** or performing certain steps (**capsulotomy**, lens fragmentation) during primary cataract surgery. - It is not typically used for the treatment of *established* PCO as the **Nd YAG** laser procedure is faster, more efficient, and specifically designed for posterior capsule cutting. *Argon fluoride* - **Argon fluoride** is the emission medium for the **Excimer laser**, which operates in the ultraviolet spectrum. - The primary application of the Excimer laser in ophthalmology is **photoablation** of corneal tissue for refractive surgery (e.g., **PRK** and **LASIK**). *Argon* - The **Argon laser** is a thermal laser used primarily for **photocoagulation** in retinal conditions, such as treating **diabetic retinopathy** or performing peripheral iridotomy. - It is unsuitable for PCO treatment because its thermal mechanism would cause unnecessary heat damage to surrounding structures, unlike the non-thermal **photodisruption** of the Nd YAG laser.

Q: The type of iridectomy shown in the image is:

Peripheral basal iridectomy. ***Peripheral basal iridectomy*** - The image clearly depicts an iris with a small, circular opening located at its **periphery**, specifically at the base near the ciliary body. - This type of opening is characteristic of a **peripheral basal iridectomy**, which creates an alternative pathway for aqueous humor flow to relieve pupillary block, often associated with angle-closure glaucoma. *Sector iridectomy* - A **sector iridectomy** involves removing a full-thickness, wedge-shaped section of the iris that extends from the pupillary margin to the iris root, creating a keyhole-shaped pupil. - The image does not show a wedge-shaped defect extending to the pupil. *Button-hole iridectomy* - A **button-hole iridectomy** is typically a small, central opening in the iris that is completely surrounded by iris tissue, often performed for optical purposes. - The image shows a peripheral opening, not a central one. *Complete iridectomy* - A **complete iridectomy** implies the removal of the entire iris, or at least a very large portion, which would result in a highly enlarged and distorted pupil. - The image shows a small, localized opening, not extensive iris removal.

Q: The patient underwent complete iridectomy in aphakia. Comment on the diagnosis:

Key hole pupil. ***Keyhole pupil*** - The image shows a pupil with a superior **keyhole shape** (like an inverted keyhole), which is characteristic after a **surgical iridectomy** due to **cataract surgery**. - This shape results from the removal of a portion of the iris, typically for **visual axis clearance** or **glaucoma management**. *Festooned pupil* - A festooned pupil is typically seen in cases of **posterior synechiae**, where the iris adheres to the lens capsule, leading to an **irregular, scalloped pupil margin** even when dilated. - The image does not show multiple irregular adhesions, but rather a surgical alteration of the iris. *Hammock pupil* - The term "hammock pupil" is not a standard ophthalmological descriptor for a specific pupil deformity. - It does not accurately describe the appearance of the pupil in the provided image. *D-Shaped* - A D-shaped pupil is often associated with conditions like **iridodialysis** (detachment of the iris root), where a segment of the iris pulls away from its insertion, or after some types of **iris reconstruction**. - While the pupil is irregular, it specifically presents with a superior excision, not a broad D-shape.

Question 1

What is phacoanaphylactic uveitis?

Accepted Answer

Uveitis as a result of lens tissue-induced inflammation following cataract surgery

Answer

Uveitis following cataract extraction in autoimmune diseases like rheumatoid arthritis

Answer

Uveitis seen with phacoemulsification cataract surgery

Answer

Uveitis associated with fungal corneal ulcer

Question 2

Plication of inferior lid retractors is indicated in which of the following conditions?

Accepted Answer

Senile entropion

Answer

Senile ectropion

Answer

Cicatricial entropion

Answer

Paralytic entropion

Question 3

A patient with fixed dilated pupil, iris atrophy, and secondary glaucoma after penetrating keratoplasty is suggestive of which syndrome?

Accepted Answer

Uretes Zavalia syndrome

Answer

Benedict's syndrome

Answer

Posner-Schlossman syndrome

Answer

Kaufmann's syndrome

Question 4

What is the percentage of endothelial cell loss during Descemet's stripping automated endothelial keratoplasty?

Accepted Answer

30 – 40%

Answer

0 – 5%

Answer

10 – 20%

Answer

50 – 60%

Question 5

Which of the following is NOT true regarding suprachoroidal hemorrhage?

Accepted Answer

Self-resolving

Answer

Shallowing of anterior chamber

Answer

Expulsion of intraocular contents

Answer

Bleeding from short posterior ciliary artery into suprachoroidal space

Question 6

Following cataract surgery, a patient comes with complaints of decreased visual acuity. On examination, posterior capsular opacification is seen. What type of laser can be used to treat this condition?

Accepted Answer

Nd YAG laser

Answer

Argon

Answer

Argon fluoride

Answer

Femto laser

Question 7

Following a fungal corneal ulcer, a farmer underwent corneal transplant surgery. What is the preservative used for storing the donor corneal graft and the suture material used in the procedure?

Accepted Answer

McCarey-Kaufman, Nylon

Answer

Polyethylene glycol, Nylon

Answer

Moist chamber, Vicryl

Answer

Ethanol, Silk

Question 8

The type of iridectomy shown in the image is:

Accepted Answer

Peripheral basal iridectomy

Answer

Sector iridectomy

Answer

Button-hole iridectomy

Answer

Complete iridectomy

Question 9

A patient on day 2 after cataract surgery has developed the following findings which are diagnostic of:

Accepted Answer

Acute postoperative endophthalmitis

Answer

Acute postoperative glaucoma

Answer

Acute bullous keratopathy

Answer

Acute anterior uveitis

Question 10

The patient underwent complete iridectomy in aphakia. Comment on the diagnosis:

Accepted Answer

Key hole pupil

Answer

Festooned pupil

Answer

Hammock pupil

Answer

D-Shaped

Ophthalmic Surgery — MCQs

Ophthalmic Surgery — MCQs

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