Vitreoretinal Surgery and Diabetic Retinopathy Management — Advanced MCQs

Ophthalmology · 58 free questions with answers & explanations.

1. A 52-year-old type 2 diabetic undergoes pars plana vitrectomy for tractional retinal detachment involving the macula. Intraoperatively, perfluorocarbon liquid (PFCL) is instilled. The PRIMARY role of PFCL during vitreoretinal surgery is:
2. According to the Early Treatment Diabetic Retinopathy Study (ETDRS), the indication for macular laser photocoagulation in diabetic macular edema (DME) is:
3. Silicone oil tamponade after vitreoretinal surgery is preferred over gas tamponade in which clinical situation?
4. The Diabetic Retinopathy Study (DRS) defined 'high-risk characteristics' for severe visual loss. Which combination MOST correctly identifies these?
5. In a patient with proliferative diabetic retinopathy (PDR) planning panretinal photocoagulation (PRP), a pre-PRP injection of anti-VEGF (bevacizumab) is most beneficial because:
6. During pars plana vitrectomy for a complex case, the surgeon notices proliferative vitreoretinopathy (PVR) with posterior membranes causing retinal star folds. The most appropriate intraoperative adjunct to relax the retina and allow flattening is:
7. A patient with proliferative diabetic retinopathy undergoes pars plana vitrectomy. During surgery, the surgeon finds that the posterior hyaloid is densely adherent to the disc and macula. The preferred maneuver to achieve posterior vitreous detachment in this situation is:
8. In the ETDRS classification of diabetic retinopathy, the criterion that distinguishes severe NPDR from moderate NPDR (the 4-2-1 rule) includes all of the following EXCEPT:
9. A patient with a rhegmatogenous retinal detachment involving the macula for 5 days undergoes successful scleral buckling. Postoperatively, the retina is flat but visual acuity remains 6/60. Which finding on OCT would best explain the persistent poor vision?
10. Following pars plana vitrectomy with SF6 gas tamponade for a macular hole, the patient is instructed to maintain face-down positioning. The primary purpose of this positioning is to:
11. Diabetic macular edema (DME) is now classified as center-involving (CI-DME) versus non-center-involving. The threshold for initiating anti-VEGF therapy according to DRCR.net Protocol T is:
12. Silicone oil is preferred over C3F8 gas as intraocular tamponade in which specific situation?
13. A 60-year-old patient with type 2 diabetes and proliferative diabetic retinopathy (PDR) undergoes pars plana vitrectomy. Intraoperatively, perfluorocarbon liquid (PFCL) is used. Which of the following best describes the primary function of PFCL during vitreoretinal surgery?
14. According to the ETDRS (Early Treatment Diabetic Retinopathy Study), the threshold for treating clinically significant macular edema (CSME) with laser photocoagulation is defined by which criterion?
15. A patient develops endophthalmitis 4 days after cataract surgery. Vitreous tap and intravitreal antibiotics are planned. The most common causative organism in acute post-cataract endophthalmitis and the first-line intravitreal antibiotic combination are:
16. Which tamponade agent is preferred in inferior retinal detachments involving the inferior vitreous base and is associated with the need for the patient to maintain a face-down posture postoperatively?
17. The Amsler grid test is most useful for detecting which type of visual disturbance in macular disease?
18. In the classification of diabetic retinopathy by the International Clinical Diabetic Retinopathy Disease Severity Scale, the finding that indicates the transition from non-proliferative to proliferative diabetic retinopathy is:
19. A 52-year-old type 2 diabetic presents with sudden painless loss of vision in the right eye. Fundus examination reveals extensive pre-retinal hemorrhage obscuring disc details with sheet-like blood anterior to the retina. IOP is normal. Ultrasound shows no retinal detachment. What is the MOST appropriate initial management?
20. During pars plana vitrectomy for tractional retinal detachment in proliferative diabetic retinopathy, a surgeon creates a posterior vitreous detachment and finds fibrovascular membranes adherent to the retina at multiple points. The preferred technique to delaminate these membranes without causing iatrogenic retinal breaks is:
21. The Early Treatment Diabetic Retinopathy Study (ETDRS) defined clinically significant macular edema (CSME). Which of the following findings does NOT fulfill the ETDRS criteria for CSME?
22. A 44-year-old woman presents with a sudden unilateral curtain of vision loss. Fundus shows a corrugated, rhegmatogenous retinal detachment involving the macula. B-scan confirms subretinal fluid. She is a −3.0 D myope. The MOST appropriate primary surgical repair is:
23. During vitreoretinal surgery, perfluorocarbon liquid (PFCL) is introduced. Which property of PFCL makes it suitable as an intraoperative tool to unfold a giant retinal tear?
24. The ETDRS (Early Treatment Diabetic Retinopathy Study) definition of clinically significant macular edema (CSME) requires which ONE of the following as a standalone criterion?
25. In proliferative diabetic retinopathy, panretinal photocoagulation (PRP) reduces neovascularisation primarily by which mechanism?
26. A 55-year-old diabetic patient undergoes pars plana vitrectomy (PPV) for tractional retinal detachment. The surgeon uses 'en bloc dissection' technique. This technique is PRIMARILY used for which type of membrane?
27. In the management of giant retinal tear (GRT ≥90°), what is the MOST important intraoperative consideration that distinguishes it from routine retinal detachment repair?
28. According to the International Classification of Retinopathy of Prematurity (ICROP), 'Plus disease' is defined by which finding?
29. After pars plana vitrectomy, a patient is kept prone for 1 week. The tamponade agent used was most likely:
30. During pars plana vitrectomy (PPV) for tractional retinal detachment secondary to proliferative diabetic retinopathy, the tamponade agent of choice when inferior breaks are involved is:
31. A 52-year-old diabetic patient with vitreous hemorrhage undergoes B-scan and is found to have associated traction retinal detachment (TRD) not involving the fovea. The most appropriate next step is:
32. According to the Early Treatment Diabetic Retinopathy Study (ETDRS), clinically significant macular edema (CSME) is defined as macular thickening or hard exudates within ____ of the center of the fovea:
33. Pre-operative intravitreal anti-VEGF injection before vitrectomy for severe PDR is administered approximately 3–7 days before surgery primarily to:
34. In diabetic macular edema (DME), center-involving macular edema with best corrected visual acuity of 6/18 or worse is currently best treated with:
35. A 45-year-old type 2 diabetic patient with a 20-year history of poorly controlled diabetes presents for screening fundus examination. Ophthalmoscopy reveals dot haemorrhages, microaneurysms, and hard exudates in the posterior pole — but no neovascularisation, no vitreous haemorrhage, and no traction. However, hard exudates are found within 500 µm of the foveal centre with visual acuity of 6/18. What is the immediate treatment priority?
36. A diabetic patient with proliferative diabetic retinopathy develops a dense vitreous haemorrhage that fails to clear over 3 months. B-scan ultrasonography reveals vitreous haemorrhage with posterior hyaloid detachment and no retinal detachment. What is the appropriate management?
37. Which of the following criteria defines 'high-risk' proliferative diabetic retinopathy (PDR) that mandates immediate PRP according to the Diabetic Retinopathy Study (DRS)?
38. A 52-year-old with proliferative diabetic retinopathy undergoes pars plana vitrectomy (PPV). After core vitrectomy and removal of fibrovascular membranes, a 'relieving retinotomy' is performed. What is the primary indication for a relieving retinotomy during PPV for tractional retinal detachment?
39. According to the ETDRS (Early Treatment Diabetic Retinopathy Study) classification, which of the following constitutes 'clinically significant macular oedema' (CSME) requiring laser treatment?
40. During vitrectomy for dense vitreous haemorrhage, an 'en-bloc' technique is used. Which tamponade agent is preferred when a giant retinal tear (≥90°) is found during vitrectomy?
41. A patient with proliferative diabetic retinopathy (PDR) has high-risk characteristics (HRC). According to the Diabetic Retinopathy Study (DRS), which ONE of the following is a high-risk characteristic?
42. A patient with bilateral proliferative diabetic retinopathy is planned for panretinal photocoagulation (PRP). Which of the following best explains why 'focal/grid laser' is preferred over PRP for centre-involving DME?
43. A 52-year-old man with type 2 diabetes for 18 years presents with bilateral high-risk proliferative diabetic retinopathy (PDR) as per Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. He is planned for bilateral pan-retinal photocoagulation (PRP). Which of the following is classified as high-risk PDR by ETDRS?
44. During pars plana vitrectomy for tractional retinal detachment secondary to diabetic PDR, the surgeon encounters a tightly adherent fibrovascular membrane over the macula. The preferred surgical technique to safely delaminate the membrane without causing iatrogenic retinal breaks is:
45. A patient develops vitreous haemorrhage one month after intravitreal bevacizumab injection for PDR. OCT shows no tractional detachment. The appropriate next management step is:
46. Perfluorocarbon liquids (PFCL) are used intraoperatively during vitreoretinal surgery. The primary intraoperative purpose of PFCL in the management of giant retinal tears is:
47. A 68-year-old pseudophakic patient with a macula-off rhegmatogenous retinal detachment of 5 days duration undergoes successful 23-gauge PPV with SF6 gas tamponade. Post-operatively on day 3, she develops sudden pain and IOP of 42 mmHg. The most likely cause is:
48. A 48-year-old type 2 diabetic presents with a symptomatic tractional retinal detachment (TRD) involving the macula. He also has florid new vessels at the disc. The MOST appropriate primary surgical approach is:
49. According to the Diabetic Retinopathy Study (DRS) High-Risk Characteristics, which of the following alone carries the HIGHEST risk of severe visual loss necessitating urgent PRP?
50. In vitreoretinal surgery, the MOST important principle behind using perfluorocarbon liquids (PFCL) intraoperatively is:
51. The ETDRS definition of clinically significant macular oedema (CSME) includes which of the following as a criterion?
52. During pars plana vitrectomy for rhegmatogenous retinal detachment repair, SF6 gas is used as a tamponade agent. At what percentage concentration (in air) should SF6 be injected to achieve iso-expansile concentration (no net expansion or contraction)?
53. A 38-year-old type 1 diabetic presents with 23-gauge pars plana vitrectomy planned for non-clearing vitreous haemorrhage. The MOST appropriate pars plana incision site from the limbus in a phakic adult is:
54. According to the ETDRS classification, which of the following features MOST reliably predicts progression to high-risk proliferative diabetic retinopathy and mandates prompt pan-retinal photocoagulation?
55. In a patient with tractional retinal detachment involving the macula from proliferative diabetic retinopathy, the PREFERRED tamponade agent at the conclusion of vitrectomy in a non-giant retinal break scenario is:
56. Anti-VEGF injections are given as an adjunct before diabetic vitrectomy primarily to:
57. The Diabetic Retinopathy Study (DRS) defined 'high-risk characteristics' (HRC) for proliferative diabetic retinopathy. Which combination CORRECTLY represents HRC?
58. A 50-year-old diabetic woman has a macula-off tractional retinal detachment of 5 days duration. She undergoes successful vitrectomy and retinal reattachment. What is the MOST realistic prognosis for visual recovery?