Lens and Cataract (Types, Surgery, IOL, Complications) MCQs

Ophthalmology · 73 free questions with answers & explanations.

1. A 7-year-old child is diagnosed with bilateral posterior subcapsular cataracts after prolonged use of systemic corticosteroids for nephrotic syndrome. What is the primary mechanism of steroid-induced cataract formation?
2. During phacoemulsification cataract surgery, the surgeon inadvertently ruptures the posterior capsule during nucleus removal. Vitreous presents at the wound. What is the most important immediate step?
3. Which type of cataract is characteristically associated with Myotonic dystrophy (Steinert disease)?
4. A 65-year-old woman develops gradual decrease in vision 3 months after an uneventful cataract surgery with in-the-bag IOL implantation. Slit-lamp examination shows a wrinkled, thickened posterior capsule with Elschnig pearls. The most appropriate treatment is:
5. A 1-year-old child is diagnosed with bilateral cataracts secondary to galactosaemia. Which type of cataract morphology is classically seen in galactosaemia?
6. A 68-year-old patient undergoes phacoemulsification and in-the-bag IOL implantation. On day 1 postoperatively, the anterior chamber is flat, the IOP is 4 mmHg, and the wound is well apposed. Ultrasound biomicroscopy shows choroidal detachments. The most likely diagnosis is:
7. An 8-year-old child undergoes cataract surgery in the left eye for a dense unilateral congenital cataract. Primary posterior capsulotomy and anterior vitrectomy are performed. Postoperatively, the most critical management to prevent amblyopia is:
8. A 60-year-old patient with a history of zonular weakness (pseudoexfoliation) is assessed for cataract surgery. The surgeon plans to use a capsular tension ring (CTR). What is the primary function of a CTR in this context?
9. Which intraocular lens design is currently favoured to minimise posterior capsule opacification (PCO) rate after cataract surgery?
10. During phacoemulsification surgery, the surgeon notices the posterior capsule rupture with vitreous prolapse. Nucleus fragments have already been removed. The anterior chamber maintainer is in place. What is the MOST appropriate immediate next step?
11. An 18-year-old patient with Marfan syndrome has bilateral ectopia lentis with the lens subluxated inferiorly, causing significant monocular diplopia. The lens is still partially in the pupillary axis. Regarding the mechanism of lens subluxation in Marfan syndrome:
12. A patient develops posterior capsular opacification (PCO) 18 months after uncomplicated phacoemulsification with implantation of a hydrophobic acrylic IOL. The visual acuity has dropped from 6/6 to 6/18. The treatment of choice and the mechanism of improvement is:
13. A patient is planned for phacoemulsification. Axial length (AL) = 23.5 mm, keratometry = 44.0 D in both meridians. The SRK/T formula yields IOL power = 21.0 D. The surgeon uses the Haigis formula and obtains 20.5 D. For this patient's AL, which formula is considered MOST accurate?
14. During phacoemulsification, posterior capsule rupture occurs. The surgeon notices vitreous prolapse into the anterior chamber. Which is the CORRECT sequence of management steps?
15. In the context of IOL power calculation, the SRK/T formula differs from the original SRK formula (SRK I) primarily in which way?
16. Toxic anterior segment syndrome (TASS) following cataract surgery is distinguished from infectious endophthalmitis by which clinical characteristic?
17. During phacoemulsification, a posterior capsule rupture occurs before nucleus emulsification is complete. The vitreous remains intact. Which is the most appropriate immediate next step?
18. Toxic anterior segment syndrome (TASS) following cataract surgery is differentiated from infectious endophthalmitis primarily by which clinical feature?
19. A patient with a history of uveitis requires cataract surgery. Which type of intraocular lens material is preferred to minimize postoperative uveitis recurrence and posterior capsule opacification in this setting?
20. Nd:YAG laser capsulotomy is performed for posterior capsule opacification. The estimated percentage of PCO requiring capsulotomy within 5 years of modern acrylic IOL implantation with a sharp square-edge design is approximately:
21. The SRK-T formula for IOL power calculation is most appropriate for which axial length range?
22. Posterior capsule opacification (PCO) following cataract surgery occurs primarily due to:
23. Phacomorphic glaucoma is mechanically distinct from phacoantigenic uveitis. The pathophysiological mechanism of phacomorphic glaucoma is:
24. Anterior capsule contraction syndrome (capsular phimosis) after cataract surgery is most likely to occur with which IOL design?
25. A patient undergoes phacoemulsification and develops glistening (fluid-filled microvacuoles) in the IOL optic postoperatively. This phenomenon is predominantly associated with which IOL material?
26. Posterior capsular opacification (PCO) after cataract surgery is primarily caused by the migration and proliferation of which cell type?
27. Which type of toric IOL orientation error leads to the greatest loss of its intended astigmatism correction?
28. A patient develops pseudophakic bullous keratopathy 5 years after extracapsular cataract surgery with anterior chamber IOL implantation. The primary mechanism of corneal decompensation is:
29. The SRK/T formula for IOL power calculation performs WORST in which corneal condition?
30. A patient undergoes phacoemulsification with posterior capsule rupture (PCR) and vitreous loss. The anterior chamber IOL (ACIOL) is implanted. Two years later, the patient develops bullous keratopathy. The pathophysiological mechanism is:
31. In calculating IOL power using the SRK/T formula, which biometric variable has the highest influence on the final calculated power?
32. Posterior capsule opacification (PCO) following phacoemulsification occurs due to proliferation of residual lens epithelial cells. Which IOL design feature has most significantly reduced PCO rates?
33. A 68-year-old diabetic patient 4 days post-phacoemulsification develops severe pain, visual acuity of hand motion, corneal edema, hypopyon, and vitreous haze. Vitreous tap culture grows coagulase-negative Staphylococcus. Management should be:
34. During phacoemulsification, posterior capsule rupture (PCR) with vitreous loss occurs. The surgeon converts to manual small incision cataract surgery (MSICS) and completes cortical clean-up. Which IOL should be implanted?
35. In the Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO), the ideal cruciate pattern of shots creates the opening. Which complication is specifically more common when the YAG energy exceeds 3 mJ per pulse?
36. The A-constant in IOL power calculation formulas is specific to each IOL model. It represents:
37. Sympathetic ophthalmia is a bilateral granulomatous panuveitis. The inciting antigen responsible is most likely derived from:
38. Posterior capsule rupture during phacoemulsification is a recognized intraoperative complication. If posterior capsule rupture occurs with vitreous prolapse into the anterior chamber, the MOST appropriate immediate next step is:
39. A patient reports glare and halos after multifocal IOL implantation. This dysphotopsia is primarily caused by:
40. During phacoemulsification of a dense brunescent cataract, the posterior capsule ruptures during nucleus management. The surgeon completes cortex aspiration, performs an anterior vitrectomy to manage vitreous loss, and plans IOL implantation. In the presence of a posterior capsule tear with anterior vitreous in the anterior chamber, the SAFEST IOL option is:
41. Posterior capsular opacification (PCO) — the most common late complication of cataract surgery — is caused by which cellular mechanism?
42. During phacoemulsification, a posterior capsule rupture occurs with nuclear fragments in the anterior vitreous. The surgeon stabilizes the anterior chamber. The BEST next step is:
43. A patient develops posterior capsule opacification (PCO) 18 months after uncomplicated phacoemulsification with a PMMA IOL. Visual acuity drops to 6/36. The treatment of choice and the expected mechanism of action is:
44. A 65-year-old diabetic patient undergoes uneventful phacoemulsification and in-the-bag IOL implantation. At 3 months post-operatively, vision drops to 6/36. Slit-lamp examination reveals a thick, opaque posterior capsule with proliferating lens epithelial cells (Elschnig's pearls). The most appropriate treatment and its mechanism is:
45. During phacoemulsification, the surgeon notices posterior capsule rupture with vitreous loss. The nuclear fragment drops into the vitreous cavity. What is the correct immediate intraoperative management priority?
46. A 55-year-old patient has a toric IOL implanted to correct 3.0 D of pre-existing corneal astigmatism. At 1-month follow-up, residual astigmatism is 2.5 D and the patient sees poorly. Slit-lamp examination shows the lens axis marking at 80° but the intended axis was 110°. What is the intervention?
47. A 68-year-old patient undergoes uncomplicated phacoemulsification with posterior chamber IOL implantation. Six weeks later, he complains of halos and glare at night, especially with oncoming headlights. The IOL used was a diffractive multifocal IOL. The most appropriate counselling is:
48. During phacoemulsification, the surgeon notes that the posterior capsule has ruptured and vitreous is prolapsing. The most critical immediate step to prevent vitreous incarceration in the wound and subsequent complications is:
49. A patient requires IOL power calculation before cataract surgery. Axial length is 26.5 mm (high myopia), and keratometry is 44.0D. Using a 3rd generation formula (e.g., SRK/T), a hyperopic surprise is more likely than with 4th generation formulas. The reason is:
50. During phacoemulsification, posterior capsule rupture (PCR) occurs. The surgeon notes vitreous presentation. The most critical next step to prevent nucleus drop and manage the complication is:
51. Posterior capsular opacification (PCO) after IOL implantation results from proliferation of which cell type, and which IOL design minimizes its occurrence?
52. A 70-year-old undergoes uneventful phacoemulsification; 3 weeks postoperatively he presents with pain, photophobia, and hypopyon. Slit-lamp shows a diffuse anterior chamber reaction with white fluffy material on the posterior capsule and IOL. Cultures are pending. The MOST likely diagnosis is:
53. During phacoemulsification, posterior capsule rupture (PCR) with vitreous loss occurs. The surgeon should perform all EXCEPT:
54. Posterior capsule opacification (PCO) after phacoemulsification is caused by residual lens epithelial cells (LECs) of which type primarily?
55. Posterior capsule opacification (PCO) following cataract surgery is primarily caused by which cell type and process?
56. Posterior capsule opacification (PCO) following extracapsular cataract extraction is caused primarily by:
57. A patient who underwent cataract surgery 1 month ago presents with sudden painless monocular vision loss. Fundoscopy shows pale disc, diffuse retinal whitening with cherry-red spot and retinal artery pulsations on gentle pressure. The most likely intraoperative complication that directly preceded this is:
58. Using the SRK/T formula for IOL power calculation, a patient has AL = 23.5 mm, K = 43.00 D (average), and target refraction = 0 D. The A-constant for the selected IOL is 118.0. Estimate the approximate IOL power using the SRK-II formula: P = A − 2.5L − 0.9K.
59. A posterior capsule rupture occurs during phacoemulsification. The nucleus has been removed but cortical material remains. The vitreous face is intact. What is the MOST APPROPRIATE immediate step?
60. A 70-year-old presents 2 years after uncomplicated PCIOL surgery with gradual visual decline. Retroillumination shows a posterior capsule opacity with 'bladder cells' (Elschnig pearls) centrally. What is the posterior capsule opacity (PCO) caused by, and what is the treatment?
61. What is the key optical principle distinguishing diffractive multifocal IOLs from refractive multifocal IOLs?
62. A patient has undergone uncomplicated phacoemulsification with IOL implantation 4 weeks ago. He now presents with gradually decreasing vision. Slit-lamp examination shows Elschnig's pearl-like opacification of the posterior capsule. This complication results from:
63. In phacoemulsification surgery, which IOL material has the LOWEST rate of posterior capsule opacification?
64. A myope whose spectacle prescription is -8.0 D at a vertex distance of 14 mm undergoes cataract surgery. What contact lens power would provide equivalent correction post-operatively?
65. A 65-year-old diabetic man develops a rapidly progressive cataract with white flaky opacities in the anterior subcapsular region, associated with a sudden hyperopic shift. Which type of cataract is this?
66. During phacoemulsification, a posterior capsular rent is noted. The surgeon decides to implant an IOL in the sulcus. The power of the IOL to be implanted in the sulcus compared with the originally planned capsular bag IOL should be:
67. A 6-month-old infant is found to have a dense unilateral congenital cataract. The most important reason to operate early (before 6–8 weeks of age, or as soon as detected) is:
68. A 70-year-old woman complains of difficulty reading in bright light and glare from oncoming headlights at night. Visual acuity is 6/12. Slit-lamp shows a dense plaque-like opacity immediately beneath the posterior capsule. Which type of cataract explains these symptoms?
69. A 45-year-old man with Marfan syndrome is found to have bilateral superotemporal subluxation of the crystalline lens. The most appropriate term for this condition is:
70. Accommodation-related presbyopia occurs primarily because of which age-related change?
71. Intraoperative floppy iris syndrome (IFIS) during phacoemulsification is most commonly caused by prior use of which systemic drug class, and what is the preferred intraoperative management?
72. A patient undergoes uneventful phacoemulsification with in-the-bag IOL. Six months postoperatively, the eye develops raised IOP, corneal edema, anterior uveitis, and trabecular meshwork pigmentation. The condition most likely responsible is:
73. In the endophthalmitis vitrectomy study (EVS), which management recommendation was established for post-cataract endophthalmitis presenting with vision worse than hand movements?