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Refractive surgery techniques and complications 2 course code: C-13395.

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. What is the conjunctival lesion shown in this image and which procedure can be used to manage this, for which the markings shown have been made?

(a)This is a conjunctival intra-epithelial neoplasia; an excision biopsy is conducted

(b) This is a pyogenic granuoloma; it is treated by excision

(c) This is Stevens-Johnson syndrome scarring; a conjunctival flap is created

(d) This is ocular cicatricial pemphigoid; it is treated with an amniotic membrane graft

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2. Which of the following is a contraindication for surgical treatment of the conjunctival abnormality shown in this image?

(a) Encroachment on the visual axis

(b) Poor cosmetic appearance

(c) Excessive redness and irritation despite topical medication

(d) Anxiety about future growth and the possible affect on vision

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3. What is the conjunctival lesion shown in this image and what is the preferred treatment?

(a) This is a choroidal prolapse which does not require treatment

(b) This is a squamous cell carcinoma which should be treated with topical anti-neoplasm drops

(c) This is a melanoma which should be surgically excised using a no-touch technique

(d) This is a birdseed which should be surgically excised

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4. This patient suffered a blunt trauma to the eye. What is the diagnosis and appropriate treatment of the resulting problem?

(a) This is hyphaema. Treat with topical cycloplegics and corticosteroids

(b) This is iridodialysis. Treat with broad iridectomy

(c) This is iridodialysis, Treat by surgically suturing the iris root to the scleral wall

(d) This is a cataract. Treat with phacoemulsification and intraocular ocular lens (IOL) implant

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5. This image is a high-magnification depiction of a corneal endothelium problem in a 65 year-old patient who complains of "misty vision". If this patient later goes on to have cataract surgery, which complication has an increased risk of occurring?

(a) Lens zonule weakness/rupture

(b) Corneal decompensation

(c) Corneal infection

(d) Wound leakage

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6. This patient with keratoconus has received treatment that has left the yellow appearance as shown in this image. What treatment has this patient received?

(a) Riboflavin drops instilled as part of a corneal collagen cross-linking procedure

(b) Corneal graft with ruptured limbal vessels causing corneal staining

(c) Implantation of a yellow (blue-blocking) IOL

(d) Fluorescein drops instilled as part of a routine eye examination

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7. This image shows an enclavation procedure, whereby a Verisyse iris-clip IOL is being clipped to the posterior surface of the iris, in an eye that is also receiving a corneal graft. What is the advantage of placing the IOL on the posterior iris surface?

(a) Reduced risk of hyphaema

(b) Reduced risk of corneal decompensation

(c) Better optical image quality

(d) Reduced risk of glaucoma

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8. The picture shows progression of the capsulorrhexis during phacoemulsification cataract surgery. What is represented by the crescent of light at the top of the lens and what is a reasonable approach to management?

(a) This is normal and no extra action is required

(b) This is lens coloboma. Intracapsular cataract extraction is indicated

(c) This indicates zonule weakness. An iris hook in the capsulorrhexis is indicated to provide stability

(d) Vitreous is presenting around the lens. Anterior vitrectomy is indicated

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9. What operation is shown in these images and when might it be employed?

(a) Scleral tunnel removal of a traumatic cataract in globe rupture

(b) Sutured extracapsular cataract extraction of a dense cataract

(c) Phacoemulsiflcation converted to extracapsular cataract extraction due to complication

(d) Sutureless extracapsular extraction of a dense cataract with scleral tunnel

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10. What operation is shown in these images and when might it be indicated?

(a) Penetrating keratoplasty. Indicated to treat opacity of the cornea

(b) Descernet's stripping endothelial keratoplasty. Indicated for endothelial dysfunction

(c) Deep anterior lamellar keratoplasty. Indicated for opacity in the anterior corneal stroma

(d) Amniotic membrane graft. Indicated for poor epithelial defects and ulcers

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11. This image is of an eye soon after penetrating keratoplasty. What is the complication shown and what is the best treatment?

(a) This is wound leakage and requires re-suturing

(b) This is a persistent epithelial defect, which should be treated with intensive lubricants, and amniotic membrane graft

(c) This is herpes simplex keratitis and requires treatment with topical Aciclovir

(d) This is bacterial keratitis and requires treatment with topical antibiotics

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12. This eye suffered a corneal melting process and had a tectonic corneal graft. This is the appearance three months after initial surgery. What has occurred and what treatment has been applied?

(a) This is a herpetic corneal ulcer that has been treated with steroids

(b) This is crystalline keratopathy, which has been treated with antibiotics

(c) This is corneal perforation and a scleral contact lens has been fitted

(d) This is further corneal melting and a corneal glue has been applied

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 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:VISUAL RECOGNITION AND IDENTIFICATION OF CLINICAL SIGNS
Author:Muhtaseb, Mohammed
Publication:Optometry Today
Geographic Code:4EUUK
Date:Apr 23, 2010
Words:964
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