Free Board Certified Ophthalmologist Retina and Vitreous Diseases Questions and Answers

Question 1

A 68-year-old patient with non-exudative age-related macular degeneration (AMD) asks about nutritional supplements. According to the AREDS2 study, which formulation is most appropriate to recommend for reducing the risk of progression to advanced AMD?

Accepted Answer

Vitamin C, Vitamin E, lutein, zeaxanthin, zinc, and copper.

Answer

The AREDS2 study found that a formulation containing Vitamin C (500 mg), Vitamin E (400 IU), lutein (10 mg), zeaxanthin (2 mg), zinc (80 mg), and copper (2 mg) reduced the risk of progression to advanced AMD. The study recommended replacing beta-carotene with lutein and zeaxanthin because beta-carotene was linked to an increased risk of lung cancer in smokers and the new combination provided an additional reduction in risk. Omega-3 fatty acids were studied but did not show a significant additional benefit.

Question 2

A 55-year-old male presents with a one-week history of painless, progressive central vision loss in his right eye. Fundus examination reveals a localized serous detachment of the neurosensory retina in the macula. Optical coherence tomography (OCT) confirms subretinal fluid. Fluorescein angiography shows a focal point of leakage. What is the most appropriate initial management for this patient with acute central serous chorioretinopathy (CSC)?

Accepted Answer

Observation for 3-4 months with lifestyle modification advice.

Answer

For most cases of acute central serous chorioretinopathy, the standard initial management is observation, as many cases resolve spontaneously within 3 to 4 months. Patients are often counseled on modifying risk factors such as stress. Active interventions like laser photocoagulation or PDT are typically reserved for chronic or persistent cases, or in specific situations where a patient has occupational needs for rapid vision recovery.

Question 3

Which of the following is the primary mechanism of action for intravitreal anti-VEGF agents in the treatment of macular edema secondary to a central retinal vein occlusion (CRVO)?

Accepted Answer

Decreasing vascular permeability and leakage.

Answer

In retinal vein occlusion, ischemia leads to the upregulation of Vascular Endothelial Growth Factor (VEGF), which increases vascular permeability, causing macular edema. Anti-VEGF agents work by binding to and inhibiting VEGF, thereby reducing the leakage from retinal capillaries and decreasing the macular edema, which is the primary cause of vision loss.

Question 4

A 62-year-old phakic patient presents with an uncomplicated rhegmatogenous retinal detachment involving a single horseshoe tear at the 11 o'clock position with subretinal fluid extending just posterior to the equator but not involving the macula. Which of the following surgical options is generally considered the LEAST invasive procedure with a reasonable success rate for this specific presentation?

Accepted Answer

Pneumatic retinopexy.

Answer

Pneumatic retinopexy is a minimally invasive procedure best suited for uncomplicated retinal detachments with retinal breaks located in the superior portion of the retina (typically between 8 and 4 o'clock). It involves injecting a gas bubble into the vitreous cavity to tamponade the retinal break, followed by cryotherapy or laser to create a permanent adhesion. While vitrectomy and scleral buckling are also effective, they are more invasive procedures. Laser alone is insufficient to reattach the retina.

Question 5

A patient undergoes successful surgery for a rhegmatogenous retinal detachment but develops recurrent detachment 6 weeks later. The examination reveals fixed retinal folds and subretinal strands, characteristic of proliferative vitreoretinopathy (PVR). Which cell type is considered the primary driver of membrane formation in PVR?

Accepted Answer

Retinal pigment epithelial (RPE) cells

Answer

The pathogenesis of proliferative vitreoretinopathy (PVR) involves the dispersion of retinal pigment epithelial (RPE) cells into the vitreous cavity through the retinal break. These RPE cells undergo an epithelial-to-mesenchymal transition (EMT), transforming into fibroblast-like cells that proliferate and form contractile membranes on the retinal surfaces, leading to retinal traction and redetachment.

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist Practice Test

Free Board Certified Ophthalmologist Retina and Vitreous Diseases Questions and Answers