Board Certified Ophthalmologist Glaucoma Diagnosis and Management 4 — Questions and Answers
Question 1: A young myopic man has Krukenberg spindle, mid-peripheral radial iris transillumination defects, and a concave peripheral iris. The underlying mechanism is:
- Pupillary block
- Reverse pupillary block with iris-zonule rubbing (Correct answer)
- Lens protein leakage
- Endothelial membrane proliferation
Correct answer: Reverse pupillary block with iris-zonule rubbing
In pigment dispersion syndrome, reverse pupillary block bows the iris posteriorly against zonules, releasing pigment.
Question 2: In neovascular glaucoma secondary to proliferative diabetic retinopathy, the most important step addressing the underlying cause is:
- Laser peripheral iridotomy
- Topical pilocarpine
- Panretinal photocoagulation with anti-VEGF therapy (Correct answer)
- Selective laser trabeculoplasty
Correct answer: Panretinal photocoagulation with anti-VEGF therapy
Anti-VEGF gives rapid regression and PRP reduces the ischemic VEGF drive long term.
Question 3: An elderly patient with a hypermature cataract presents with acute IOP elevation, an open angle, and iridescent particles in the anterior chamber. Definitive treatment is:
- Laser iridotomy
- Cataract extraction (Correct answer)
- Long-term topical steroids
- Trabeculectomy
Correct answer: Cataract extraction
Phacolytic glaucoma results from high-molecular-weight lens proteins obstructing the meshwork and is cured by removing the lens.
Question 4: Recurrent unilateral episodes of markedly elevated IOP with mild anterior chamber cells and fine KPs in an otherwise healthy adult have been associated with which pathogen?
- Herpes simplex virus
- Cytomegalovirus (Correct answer)
- Toxoplasma gondii
- Treponema pallidum
Correct answer: Cytomegalovirus
Posner-Schlossman syndrome (glaucomatocyclitic crisis) is frequently associated with CMV in aqueous samples.
Question 5: A middle-aged woman with unilateral corneal edema, 'beaten-metal' endothelium, high peripheral anterior synechiae, and minimal iris changes most likely has:
- Axenfeld-Rieger syndrome
- Chandler syndrome (Correct answer)
- Posterior polymorphous dystrophy
- Fuchs dystrophy
Correct answer: Chandler syndrome
Chandler syndrome is the ICE variant dominated by corneal edema with mild iris findings.
Question 6: After starting topical prednisolone acetate, steroid-induced IOP elevation typically appears within:
- 24 hours
- 2 to 6 weeks (Correct answer)
- 6 to 12 months
- Only after 2 years
Correct answer: 2 to 6 weeks
Steroid response generally manifests a few weeks after initiation, though it can occur at any time.
Question 7: After trabeculectomy, a patient has uniformly shallow central and peripheral anterior chamber, elevated IOP, and a patent iridotomy. Choroidal effusion is excluded. First-line treatment is:
- Topical miotics
- Cycloplegics plus aqueous suppressants (Correct answer)
- Repeat laser iridotomy
- Bleb needling
Correct answer: Cycloplegics plus aqueous suppressants
Aqueous misdirection (malignant glaucoma) is treated initially with cycloplegia to pull the lens-iris diaphragm back plus aqueous suppression.
