Board Certified Ophthalmologist Lens and Cataract 2

Question 1

Which organism is most frequently isolated in acute postoperative endophthalmitis after cataract surgery?

Accepted Answer

Coagulase-negative staphylococci

Answer

The Endophthalmitis Vitrectomy Study found coagulase-negative staphylococci (mainly S. epidermidis) in about 70% of culture-positive cases.

Question 2

A patient has diffuse limbus-to-limbus corneal edema and an anterior chamber reaction 18 hours after uneventful phacoemulsification, with no vitritis. What is the most likely diagnosis?

Accepted Answer

Toxic anterior segment syndrome

Answer

TASS starts within 12-48 hours with widespread corneal edema from endothelial toxicity, and the inflammation stays in the anterior segment.

Question 3

Intraoperative floppy iris syndrome is most strongly associated with which systemic medication?

Accepted Answer

Tamsulosin

Answer

Tamsulosin selectively blocks alpha-1A receptors in the iris dilator muscle, which causes billowing, prolapse and progressive miosis.

Question 4

During phacoemulsification the posterior capsule ruptures and a large nuclear fragment drops into the vitreous. What is the most appropriate next step?

Accepted Answer

Do an anterior vitrectomy, place a suitable IOL, close, and refer for pars plana vitrectomy

Answer

Trying to retrieve a posteriorly dislocated nucleus from the anterior approach risks retinal tears, so the fragment should be removed later by pars plana vitrectomy.

Question 5

Clinically significant pseudophakic cystoid macular edema (Irvine-Gass syndrome) most commonly peaks at what time after surgery?

Accepted Answer

4-6 weeks

Answer

Irvine-Gass CME usually appears 4-12 weeks after surgery and is most common around 4-6 weeks.

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist Lens and Cataract 2