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Refractive surgery techniques and complications 1.

COURSE CODE: C-12918

The following FREE Visual Recognition and Identification of Clinical Signs (VRICS) test should be completed online by clicking on the VRICS test button at www.otcet.co.uk. Respondents should use the 12 images/photos to answer the 12 associated Multiple Choice Questions (MCQ). Please note that there is only one correct answer for each MCQ. Successful completion of the VRICS test will result in two CET points. VRICS regularly appears in Optometry Today.

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1. The complication shown here can occur following photorefractive keratectomy (PRK). What is this complication and what is the most appropriate management?

(a) This is bacterial keratitis. Treat with intensive chloramphenicol eye drops

(b) This is corneal haze. Treat with corticosteroid eye drops or phototherapeutic keratectomy

(c) This is corneal haze. Treat with chloramphenicol eye drops

(d) This is dry eye. Treat with artificial tear drops

2. Which of the following is TRUE about the intraocular lens (IOL) implant shown here? (a) This is an anterior chamber IOL which is used if there is posterior capsular rupture

(b) This is an anterior chamber IOL which is used for phakic correction of refractive error

(c) This is an 'accommodating' IOL which is used to correct presbyopia

(d) This is an Implantable Collamer Lens, used for phakic correction of refractive error

3. Which of the following is TRUE about the type of corneal implant shown here?

(a) This is an AcuFocus corneal inlay which can be used to treat presbyopia

(b) This is a MyoRing implant which can be used to treat keratoconus

(c) This is an Intacs implant which can be used to treat keratoconus

(d) This is an Intacs implant which can be used to treat low hyperopia

4. This patient had Intacs implants removed. What is the resulting corneal abnormality shown here and what might this patient experience?

(a)This is corneal neovascularisation. The patient will be asymptomatic

(b) This is corneal fibrous scar tissue. The patient will be asymptomatic

(c) This is corneal fibrous scar tissue. The patient will experience increased blurred vision as the refractive error returns to the pre operative state

(d) This is a healing track. The patient will experience increased blurred vision as the refractive error returns to the pre-operative state

5. Which of the following is NOT a common visual problem associated with bilateral implantation of the intraocular lens (IOL) shown here?

(a) Glare and haloes when driving at night

(b) Better vision in bright light compared to dim light

(c) Reduced stereoacuity

(d) Reduced contrast sensitivity

6. What is the purpose of the markings shown on this intraocular lens (IOL) implant?

(a) They indicate multifocality of the IOL for correction of presbyopia

(b) They indicate toricity of the IQL aiding alignment in the eye for correction of astigmatism

(c) They indicate the anterior surface of the IOL for correct implantation

(d) They indicate the vertical orientation of the IOL for correct implantation

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7. This complication was observed after a 30-year-old patient received a refractive surgery procedure. What is the complication shown and which procedure causes this?

(a) This is metallic debris arising from the microkeratome during LASIK surgery

(b) This is pigment dispersion arising after LASIK surgery

(c) This is anterior uveitis arising after implantation of a sulcus-supported phakic intraocular lens (IOL)

(d) This is loss of corneal endothelial cells following implantation of an angle-supported phakic intraocular lens (IOL)

8. This patient received myopic LASIK surgery five years previously. The corneal topography now is shown in this image. What is indicated to have occurred and what is the MOST appropriate management?

(a) The refractive error has regressed. Re-treat with LASIK

(b) The patient has developed keratoconus. Re treat with LASIK

(c) The patient has developed keratoconus. Fit with contact lenses

(d) The patient has developed keratectasia. Fit with contact lenses or Intacs

9. Which of the following is FALSE about the suturing technique shown here as used during corneal transplant surgery?

(a) The technique allows suture adjustment to reduce astigmatism

(b) Only 8 "bites" (sutures) ate required

(c) The technique is suitable when the risk of suture-related complications is low

(d) This type of suture should be avoided in eyes with infection or inflammation

10. This patient received intraocular lens (IOL) implantation. From what is evident in this image, which of the following is TRUE about the procedure that this patient received?

(a) A toric pseudophakic IOL was implanted to correct high astigmatism

(b) A piggyback sulcus-fixated IOL was implanted to correct high myopia

(c) An iris-supported anterior chamber IOL was implanted to correct high hyperopia

(d) A piggyback sulcus-fixated IOL was implanted to correct residual refractive error

11. Which of the following is a contraindication for the implant shown in this image?

(a) Shallow anterior chamber depth

(b) Posterior capsular bag rupture during extracapsular cataract extraction

(c) Phakic implantation for the correction of a high refractive error

(d) Correction of aphakia following primary intracapsular cataract extraction

12. Which of the following is TRUE about this particular intraocular lens (IOL) implant?

(a) It can be used asa phakic IOL

(b) It can be used during intracapsular cataract extraction procedures

(c) It can be used in patients that are aphakic

(d) It can be used in patients that have had phacoemulsification

Associated Reading:

1. "Cornea" by Krachmer, Mannis and Holland. 2nd edition. Published by Elsevier-Mosby

2. www.rayner.com

3. Journal of Cataract and Refractive Surgery. (Many articles deal with the subject matter)

4. www.ilase.co.uk

Mohammed Muhtaseb FRCOphth

Mohammed Muhtaseb is consultant ophthalmic surgeon at Singleton Hospital, Swansea. He has developed a new service in his sub-specialty area of cornea, cataract and refractive surgery since he joined the department in June 2006. His website is www.ilase.co.uk.
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Title Annotation:VRICS: VISUAL RECOGNITION AND IDENTIFICATION OF CLINICAL SIGNS
Author:Muhtaseb, Mohammed
Publication:Optometry Today
Geographic Code:4EUUK
Date:Feb 26, 2010
Words:980
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