Complications of Refractive Surgery — MCQs
All of the following are complications of traumatic hyphema except which of the following?
In which of the following conditions does IOL implantation after cataract surgery require the greatest caution and specialized management?
In a case of myopia, LASIK can correct up to how many diopters?
What is the most likely complication of the condition shown in the image below?
Posterior staphyloma is seen in -
Which of the following is a known complication of vernal keratoconjunctivitis?
A lady wants LASIK surgery for her daughter. All the following are indications for performing LASIK surgery, except:
A lady wants LASIK surgery for her daughter. She asks for your opinion. All the following things are suitable for performing LASIK surgery except:
Maximum correction of myopia can be done by?
1mm change in axial length of the eyeball would change the refracting power of the eye by?
Complications of Refractive Surgery Indian Medical PG Practice Questions and MCQs
Question 1: All of the following are complications of traumatic hyphema except which of the following?
- A. Pupillary Block
- B. Posterior synechiae
- C. Rebleeding
- D. Corneal Ulcer (Correct Answer)
Explanation: ***Corneal Ulcer*** - A **corneal ulcer** is typically caused by infection, trauma, or exposure keratitis and is not a direct complication of blood in the anterior chamber from a **traumatic hyphema**. - While prolonged elevation of **intraocular pressure** from hyphema could theoretically impair corneal health, a direct ulcer is not a typical or primary complication. *Rebleeding* - **Rebleeding** is a common and serious complication of hyphema, usually occurring 2-7 days after the initial injury. - It often results in a more significant bleed and carries a higher risk of complications such as **elevated intraocular pressure** and **blood staining of the cornea**. *Pupillary Block* - **Pupillary block** can occur if the amount of blood from the hyphema prevents the flow of aqueous humor from the posterior to the anterior chamber. - This blockage leads to a buildup of **aqueous humor** in the posterior chamber, causing the iris to bow forward and potentially precipitating **acute angle-closure glaucoma**. *Posterior synechiae* - **Posterior synechiae** can develop due to inflammation (uveitis) associated with the hyphema, where the iris adheres to the anterior lens capsule. - This complication can lead to **irregular pupil shape**, **pupillary block glaucoma**, or other visual disturbances.
Question 2: In which of the following conditions does IOL implantation after cataract surgery require the greatest caution and specialized management?
- A. Fuchs' heterochromic iridocyclitis
- B. Psoriatic arthritis
- C. Reiter's syndrome
- D. Juvenile rheumatoid arthritis (Correct Answer)
Explanation: ***Juvenile rheumatoid arthritis*** - Patients with **juvenile rheumatoid arthritis (JRA)**, particularly those with **pauciarticular JRA** and **ANA positivity**, are at high risk for developing chronic uveitis, which can lead to significant cataract formation and severe postoperative complications. - Due to the high risk of severe postoperative inflammation, glaucoma, and vision loss, IOL implantation in JRA patients requires extensive preoperative optimization of inflammation and careful intraoperative/postoperative management. *Fuchs' heterochromic iridocyclitis* - This condition presents with chronic, low-grade, **non-granulomatous anterior uveitis** and often leads to cataract formation. - While IOL implantation in these patients is generally well-tolerated, it does not pose the same high risk of severe postoperative inflammation and complications as seen in JRA-associated uveitis. *Psoriatic arthritis* - Psoriatic arthritis can be associated with acute anterior uveitis, but it typically presents as an acute, intermittent inflammation. - The risk of chronic, severe uveitis leading to complex cataract surgery and significant postoperative complications is not as consistently high or as severe as in JRA. *Reiter's syndrome* - Reiter's syndrome (now part of **reactive arthritis**) is another seronegative spondyloarthropathy that can cause acute anterior uveitis. - Similar to psoriatic arthritis, the uveitis is usually acute and self-limiting, and while ocular inflammation needs to be controlled, the risk profile for IOL implantation is not as challenging as in JRA.
Question 3: In a case of myopia, LASIK can correct up to how many diopters?
- A. -4D
- B. -12D (Correct Answer)
- C. -20D
- D. -6D
Explanation: ***-12D*** - LASIK can effectively correct myopia up to approximately **-12 diopters** in suitable candidates, though this can vary slightly based on individual corneal thickness and health. - The excimer laser reshapes the **cornea** to reduce its curvature, thereby decreasing the focusing power of the eye and correcting the myopic error. *-20D* - While some highly myopic individuals might desire such a correction, LASIK is generally not recommended or effective for myopia higher than **-12 to -14 diopters** due to limitations in corneal tissue removal and potential for complications. - Correcting very high myopia with LASIK would require removing too much corneal tissue, potentially leading to **corneal instability** or vision-threatening complications like **ectasia**. *-6D* - This is a common and highly successful range for LASIK correction, but it represents only a **moderate level of myopia** and not the maximum correctable range. - Patients with myopia of -6D typically achieve excellent visual outcomes with very low complication rates after LASIK. *-4D* - This is a relatively low level of myopia, and LASIK is very effective for this amount of correction, but it is far from the **upper limit** of what LASIK can achieve. - This level of correction requires minimal corneal reshaping and typically results in a very high success rate and predictable outcomes.
Question 4: What is the most likely complication of the condition shown in the image below?
- A. Exposure Keratitis (Correct Answer)
- B. Difficulty in eye movement
- C. Cataract
- D. Glaucoma
Explanation: ***Exposure Keratitis*** - The image shows **proptosis** (exophthalmos) of the right eye, where the eyeball protrudes forward. This condition often leads to incomplete eyelid closure (lagophthalmos). - **Exposure keratitis** occurs when the cornea is inadequately covered by the eyelids, leading to drying and damage due to constant exposure to air and environmental factors. *Difficulty in eye movement* - While **proptosis** can sometimes be associated with restricted eye movements (e.g., in severe Graves' ophthalmopathy due to muscle swelling), it is not the **most likely direct complication** of the exposure itself. - The image primarily depicts the physical displacement of the globe, which predisposes to corneal issues, not necessarily oculomotor dysfunction as the primary complication. *Cataract* - **Cataracts** are opacities of the lens and are typically associated with aging, trauma, or certain systemic conditions (e.g., diabetes, steroid use). - They are not a direct or common complication of **proptosis** or the resulting **exposure of the ocular surface**. *Glaucoma* - **Glaucoma** is a group of conditions characterized by damage to the optic nerve, often due to elevated intraocular pressure. - While severe **proptosis** leading to orbital congestion can theoretically increase intraocular pressure, it is not the most direct or prevalent complication compared to **exposure keratitis**, which is a direct consequence of inadequate globe protection.
Question 5: Posterior staphyloma is seen in -
- A. Degenerative high axial myopia (Correct Answer)
- B. Corneal Ulcer
- C. Chronic Uncontrolled glaucoma
- D. Complication of cataract surgery
Explanation: ***Degenerative high axial myopia*** - **Posterior staphyloma** is a hallmark feature of **pathological** or **degenerative high axial myopia**, characterized by an outpouching of the posterior sclera. - This condition arises from excessive **axial elongation** of the eyeball, leading to thinning and weakening of the sclera at the posterior pole. *Corneal Ulcer* - A **corneal ulcer** is an open sore on the cornea, often caused by infection, and primarily affects the **anterior segment** of the eye. - It does not involve changes in the scleral structure or lead to **posterior staphyloma**. *Chronic Uncontrolled glaucoma* - **Chronic uncontrolled glaucoma** is characterized by progressive optic nerve damage and visual field loss, typically due to elevated intraocular pressure. - While it can lead to cupping of the optic disc, it does not directly cause **posterior staphyloma**. *Complication of cataract surgery* - Complications of **cataract surgery** include conditions like posterior capsule opacification, cystoid macular edema, or retinal detachment. - These complications do not involve the development of a **posterior staphyloma**.
Question 6: Which of the following is a known complication of vernal keratoconjunctivitis?
- A. Keratoconus (Correct Answer)
- B. Retinal detachment
- C. Vitreous hemorrhage
- D. Cataract
Explanation: ***Keratoconus*** - **Vernal keratoconjunctivitis (VKC)** is a chronic allergic eye condition associated with persistent eye rubbing, which can lead to thinning and bulging of the cornea, a condition known as **keratoconus**. - Long-term inflammation and mechanical stress from allergic reactions and *eye rubbing* contribute to the corneal structural changes seen in keratoconus. - This is the **most common and well-recognized complication** of VKC. *Cataract* - While cataracts can occur in VKC patients (particularly from **chronic topical steroid use** or severe disease with shield ulcers), they are **less common than keratoconus** as a direct complication. - Keratoconus remains the more characteristic and frequently encountered complication specifically associated with the mechanical trauma of eye rubbing in VKC. *Retinal detachment* - **Retinal detachment** is a condition where the retina separates from its underlying support tissues and is typically associated with trauma, high myopia, or diabetic retinopathy, not VKC. - VKC primarily affects the conjunctiva and cornea, and its inflammatory processes do not directly cause retinal detachment. *Vitreous hemorrhage* - **Vitreous hemorrhage** involves bleeding into the gel-like substance that fills the eye and is commonly caused by conditions like diabetic retinopathy or retinal tears, not VKC. - VKC does not involve the posterior segment of the eye in a way that would lead to vitreous hemorrhage.
Question 7: A lady wants LASIK surgery for her daughter. All the following are indications for performing LASIK surgery, except:
- A. Stable refraction for 1 year
- B. Corneal thickness of 600 microns
- C. Age of 15 years (Correct Answer)
- D. Myopia of 4 Diopters
Explanation: ***Age of 15 years*** - LASIK surgery is generally not recommended for individuals under the age of 18, as their eyes and **refractive error** are still developing and stabilizing. - Performing LASIK on a 15-year-old could lead to **regression** of the refractive correction as the eye continues to grow. *Myopia of 4 Diopters* - A **myopia** of 4 Diopters (D) falls within the treatable range for LASIK, which can effectively correct moderate degrees of nearsightedness. - This is a common indication for individuals seeking freedom from glasses or contact lenses. *Stable refraction for 1 year* - **Stable refraction** for at least one year is a crucial criterion for LASIK, ensuring that the patient's prescription is unlikely to change significantly post-surgery. - Unstable refraction could result in suboptimal visual outcomes and the need for further correction. *Corneal thickness of 600 microns* - A **corneal thickness** of 600 microns is considered well within the safe range for LASIK surgery, allowing sufficient residual stromal bed after flap creation and ablation. - Adequate corneal thickness is essential to prevent complications such as **corneal ectasia**.
Question 8: A lady wants LASIK surgery for her daughter. She asks for your opinion. All the following things are suitable for performing LASIK surgery except:
- A. Myopia of 4 Diopters
- B. Age of 15 years (Correct Answer)
- C. Stable refraction for 1 year
- D. Corneal thickness of 600 microns
Explanation: ***Age of 15 years*** - LASIK surgery is generally not recommended for individuals under the age of 18 because their **refractive error** may still be changing. - Ensuring **refractive stability** is crucial for long-term success of the procedure. *Myopia of 4 Diopters* - This level of **myopia** (nearsightedness) is well within the treatable range for LASIK surgery. - LASIK can effectively correct moderate myopia for improved vision. *Stable refraction for 1 year* - **Refractive stability** for at least one year is a critical prerequisite for LASIK, indicating that the patient's prescription is no longer changing significantly. - This stability ensures that the surgical correction will be lasting and accurate. *Corneal thickness of 600 microns* - A corneal thickness of 600 microns is considered **more than adequate** for LASIK surgery, as it allows for the creation of a corneal flap and subsequent ablation without compromising corneal integrity. - The minimum required corneal thickness typically falls around 500 microns, with values above this being favorable.
Question 9: Maximum correction of myopia can be done by?
- A. Radial keratotomy
- B. LASIK (Correct Answer)
- C. Photorefractive keratectomy
- D. Orthokeratology
Explanation: ***LASIK*** - **LASIK (Laser-Assisted In Situ Keratomileusis)** allows for significant correction of high myopia by reshaping the cornea with an excimer laser. - It involves creating a **corneal flap** and then ablating tissue underneath, offering precise and stable vision correction for a wide range of refractive errors. - Among the given corneal refractive procedures, LASIK can correct myopia up to **-10 to -12 D**. *Radial keratotomy* - **Radial keratotomy (RK)** involves making radial incisions in the cornea to flatten it, primarily used for low to moderate myopia (up to -3 to -4 D). - It has a higher risk of **unpredictable outcomes**, induced astigmatism, and glare compared to modern laser procedures. *Photorefractive keratectomy* - **Photorefractive keratectomy (PRK)** involves direct ablation of the corneal surface without creating a flap, which is suitable for moderate myopia (up to -8 to -10 D). - While effective, PRK typically has a **longer recovery period** and more post-operative pain than LASIK. *Orthokeratology* - **Orthokeratology (Ortho-K)** uses specially designed rigid contact lenses worn overnight to temporarily reshape the cornea and correct myopia. - The effect is **temporary**, requiring continuous lens wear to maintain vision correction, and is generally limited to low to moderate myopia (up to -4 to -6 D).
Question 10: 1mm change in axial length of the eyeball would change the refracting power of the eye by?
- A. 1D
- B. 2D
- C. 3D (Correct Answer)
- D. 4D
Explanation: ***3D*** - A 1mm change in the **axial length** of the eyeball leads to an approximate **3 diopter (D) change** in the refractive power of the eye. - This relationship is crucial for understanding **refractive errors** like myopia (if the eyeball is too long) or hyperopia (if it's too short). *1D* - A 1D change in refractive power corresponds to a much larger change in the **focal length** of the eye, not typically 1mm in axial length. - This value is too small to reflect the significant impact of a 1mm axial length alteration on the eye's focusing ability. *2D* - While a direct relationship exists, 2D is an **underestimation** of the actual refractive change caused by a 1mm alteration in axial length. - This value would imply a less sensitive optical system than the human eye. *4D* - A 4D change would represent an **overestimation** of the refractive power change for a 1mm alteration in axial length. - Such a high value is generally seen with more substantial anatomical variations or surgical interventions.
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