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Glaucoma Flashcards

7 cards from real ABO practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Glaucoma flashcards as text

  1. A 45-year-old hyperopic woman has persistent appositional angle closure despite a patent laser peripheral iridotomy, and UBM shows anteriorly positioned ciliary processes. What is the most appropriate next laser procedure?

    Answer: Argon laser peripheral iridoplasty

    Plateau iris configuration persists after iridotomy and responds to argon laser peripheral iridoplasty, which contracts the peripheral iris away from the angle.

  2. In acute primary angle closure with an IOP of 62 mmHg, why is pilocarpine often ineffective as initial therapy?

    Answer: Iris sphincter ischemia prevents miosis at very high IOP

    At very high IOP the iris sphincter becomes ischemic and unresponsive, so pilocarpine works only after IOP is lowered by other agents.

  3. One day after trabeculectomy, a patient has a uniformly flat central and peripheral anterior chamber, IOP of 38 mmHg, a patent iridotomy, and no suprachoroidal fluid on B-scan. What is the best initial treatment?

    Answer: Intensive cycloplegia with atropine plus aqueous suppressants

    This is aqueous misdirection (malignant glaucoma), which is initially treated with cycloplegics to tighten the zonules and move the lens-iris diaphragm posteriorly.

  4. A patient started on topiramate for migraines 10 days ago presents with bilateral acute myopic shift, shallow anterior chambers, and IOP of 45 mmHg. Which treatment is NOT effective?

    Answer: Laser peripheral iridotomy

    Topiramate causes ciliochoroidal effusion with anterior rotation of the ciliary body, a non-pupillary-block mechanism that iridotomy does not relieve.

  5. Which gonioscopic technique best distinguishes appositional angle closure from peripheral anterior synechiae?

    Answer: Indentation (dynamic) gonioscopy with a Zeiss four-mirror lens

    Indentation with a small-diameter lens pushes aqueous into the angle, opening appositional closure but not synechial closure.

  6. On the Van Herick test, which finding suggests an angle at risk of closure?

    Answer: Peripheral AC depth less than one-quarter of corneal thickness

    A peripheral chamber depth under one-quarter of the corneal thickness (grade 1) indicates a potentially occludable angle requiring gonioscopy.

  7. Small gray-white anterior subcapsular lens opacities seen after resolution of an acute IOP spike are known as:

    Answer: Glaukomflecken

    Glaukomflecken are focal lens epithelial necroses that mark a prior episode of acute angle closure.