A patient with phacodonesis and cataract as shown in the photo desires surgery. Which option is the safest method in this situation?

Wednesday, May 21, 2008

Pars plana lensectomy by retinal surgeon and insertion of AC IOL
Intracapsular cataract exctraction and insertion of AC IOL
Phacoemulsification and insertion of a capsular tension ring (CTR) and PC IOL
Phacoemulsification and iris sutured PC IOL

Correct Answer: Pars plana lensectomy by retinal surgeon and insertion of AC IOL

This patient has a subluxed cataract with greater than 180 degrees of zonular dehiscence. Although a CTR can be placed and even sewn into the sulcus to refixate the capsule and allow an IOL to be placed in the bag, phacoemulsification in this situation has a significant risk of dropping nucleus and losing vitreous, furthermore, depending on the underlying cause of the ectopia lentis, future zonular loss may occur with dislocation of the IOL-bag complex. ICCE is quite traumatic requiring a very large wound and associated with a high incidence of vitreous loss. The safest method of cataract removal in this situation is a pars plana approach by a retinal surgeon.

The photograph below depicts:
1. A punctum occluded by an intracanalicular collagen plug
2. A punctum occluded by a silicone punctal plug
3. A punctum occluded by punctal cautery
4. A punctum occluded by an extruding Jones tube
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The patient depicted in the photograph below would be best treated with:
1. Acetylcysteine 10% drops
2. Prednisolone drops
3. Sodium cromolyn drops
4. Olopatadine drops
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A 40 y.o. female pictured below comes to the office with swelling of both upper lids, mild shortness of breath and symptoms of dry eyes. One would expect to see as part of her work up:
1. A monocytic B cell infiltrate of her lacrimal glands
2. Pain on palpation of her lacrimal glands.
3. An elevated ACE.
4. A history of breast cancer.
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The following is true of the photograph below:
1. This particular stain stains only devitalized and dead cells and mucus.
2. This eye has been stained with 2% rose Bengal.
3. This stain pools in epithelial erosions and stains exposed basement membrane.
4. This stain may be a more sensitive indicator of early or mild cases of keratoconjuncitivitis sicca.
... check the answer
After permanent punctal occlusion with cautery:
1. 5-10% rate of recanalization is expected.
2. 10-20% rate of recanalization is expected.
3. 20-30% rate of recanalization is expected.
4. 30-40% rate of recanalization is expected.
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A patient with phacodonesis and cataract as shown in the photo desires surgery. Which option is the safest method in this situation?

Correct Answer: Pars plana lensectomy by retinal surgeon and insertion of AC IOL

Recent Quick Quizzes

The photograph below depicts:

The patient depicted in the photograph below would be best treated with:

A 40 y.o. female pictured below comes to the office with swelling of both upper lids, mild shortness of breath and symptoms of dry eyes. One would expect to see as part of her work up:

The following is true of the photograph below:

After permanent punctal occlusion with cautery:

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