Secondary Glaucoma

SECONDARY GLAUCOMA

Q. 1

Iridocorneal endothelial syndrome is associated with:

 A

Progressive atrophy of iris stroma

 B

Bilateral stromal edema of iris & cornea

 C

Deposition of collagen in Descemet’s membrane

 D

Deposition of glycosaminoglycan in Descemet’s membrane

Q. 1

Iridocorneal endothelial syndrome is associated with:

 A

Progressive atrophy of iris stroma

 B

Bilateral stromal edema of iris & cornea

 C

Deposition of collagen in Descemet’s membrane

 D

Deposition of glycosaminoglycan in Descemet’s membrane

Ans. A

Explanation:

IRIDOCORNEAL ENDOTHELIAL (ICE) SYNDROME (Aka. ESSENTIAL IRIS ATROPHY, CHANDLER SYNDROME, COGAN REESE-SYNDROME & IRIS NEVUS SYNDROME)

This rare idiopathic condition of young adults is usually unilateral and manifested by corneal decompensation, glaucoma, and iris abnormalities (corectopia and polycoria).
It is unilateral, progressive, relatively uncommon and non-familial condition in young adults. It is associated with glaucoma due to the obstruction caused. The etiology of the condition is unknown.
Ref: Roy and Fraunfelder’s current ocular therapy, Frederick Hampton Roy, F. Frederick W. Fraunfelder, Frederick T. Fraunfelder, Elsevier Health Sciences, 2007.

 


Q. 2

A male patient with a history of hypermature cataract presents with a 2 day history of ciliary congestion, photophobia, blurring of vision and on examination has a deep anterior chamber in the right eye. The left eye is normal. The diagnosis is:

 A

Phacomorphic glaucoma

 B

Phacolytic glaucoma

 C

Phototoxic glaucoma

 D

Phacoanaphylactic uveitis

Q. 2

A male patient with a history of hypermature cataract presents with a 2 day history of ciliary congestion, photophobia, blurring of vision and on examination has a deep anterior chamber in the right eye. The left eye is normal. The diagnosis is:

 A

Phacomorphic glaucoma

 B

Phacolytic glaucoma

 C

Phototoxic glaucoma

 D

Phacoanaphylactic uveitis

Ans. D

Explanation:

A hypermature cataract may leak lens proteins into anterior chamber. These proteins may act as antigens and induce antigen antibody reaction leading to uveitis known as phacoanaphylactic uveitis. Due to shrinkage of lens, anterior chamber becomes deep. Clinical features include severe pain, loss of vision, marked congestion and signs of granulomatous iridocyclitis associated with presence of lens matter in the anterior chamber. Treatment consists of removal of causative lens matter, topical steroids and cycloplegics.
 
Ref: Comprehensive Ophthalmology by AK Khurana, 4th edition, Page 160.

Q. 3

Neovascular glaucoma can occur in all of the following, except:

 A

CRVO

 B

Eale’s disease

 C

Retinopathy of prematurity

 D

Hypertension

Q. 3

Neovascular glaucoma can occur in all of the following, except:

 A

CRVO

 B

Eale’s disease

 C

Retinopathy of prematurity

 D

Hypertension

Ans. C

Explanation:

Neovascular glaucoma can results due to formation of a neovascular membrane involving angle of the anterior chamber. Usually seen in diabetic retinopathy, CRVO, Eale’s disease, diabetic retinopathy.

Ref: A K Khurana, 5th Edition, Page 103

Quiz In Between


Q. 4

Rubeosis iridis is NOT COMMONLY seen in:

 A

CRVO

 B

CRAO

 C

Diabetic retinopathy

 D

Neovascularization

Q. 4

Rubeosis iridis is NOT COMMONLY seen in:

 A

CRVO

 B

CRAO

 C

Diabetic retinopathy

 D

Neovascularization

Ans. B

Explanation:

Rubeosis iridis or neovascularization of iris is a medical condition of the iris in which new blood vessels are found on the surface of the iris. It is associated with conditions which cause ischemia of the retina. Conditions commonly associated with rubeosis iridis are central retinal vein occlusion, proliferative diabetic retinopathy, ocular ischemic syndrome, ocular surgery complication and chronic retinal detachment. Rubeosis iridis may also be associated with CRAO but is less common than with CRVO.
 
Ischemic diseases of the retina causes the release of VEGF which in turn stimulate angiogenesis. They can be seen on the iris, and it can also grow into the angle of the eye resulting in an increase in intra ocular pressure.
 
Ref: Glaucoma Surgery  edited by Ashok Garg, page 350, Ocular Angiogenesis: Diseases, Mechanisms, and Therapeutics  edited by Joyce Tombrain-Tink, PAGE 128.

Q. 5

Secondary glaucoma associated with angle recession is seen in

 A

Concussion injury

 B

Radiation injury

 C

Penetrating injury

 D

Chemical injury

Q. 5

Secondary glaucoma associated with angle recession is seen in

 A

Concussion injury

 B

Radiation injury

 C

Penetrating injury

 D

Chemical injury

Ans. A

Explanation:

A i.e. Concussion injury 

Angle recession involves rupture of face of ciliary body, the portion that lies between the iris root and the scleral spur. It is detected gonioscopically as widening of ciliary body band. It is seen in large number of blunt trauma Q patients but glaucoma Q develops in 6-9%.


Q. 6

Secondary glaucoma in early stage of herpes zoster ephthalmicus occurs due to:

 A

Trabeculitis

 B

Iridocyclitis

 C

Haemorrhagic hypopyon

 D

Hypersecretion of aqueous humour

Q. 6

Secondary glaucoma in early stage of herpes zoster ephthalmicus occurs due to:

 A

Trabeculitis

 B

Iridocyclitis

 C

Haemorrhagic hypopyon

 D

Hypersecretion of aqueous humour

Ans. A

Explanation:

Ans. Trabeculitis

Quiz In Between


Q. 7

Neovascular glaucoma can occur in all except:

 A

Diabetes mellitus

 B

Hypertension

 C

CRAO

 D

CRVO

Q. 7

Neovascular glaucoma can occur in all except:

 A

Diabetes mellitus

 B

Hypertension

 C

CRAO

 D

CRVO

Ans. B

Explanation:

Ans. Hypertension

  • The three most common predisposing conditions for NVG are diabetic retinopathy (DR) (33%), ischemic CRVO (33%) and the ocular ischemic syndrome (13%).
  • Other forms of retinal vascular diseases resulting in significant ischemia [central retinal artery occlusion (CRAO), branch RVO, Eales’ disease and sickle cell retinopathy], intraocular neoplasms, chronic retinal detachment and severe intraocular inflammation are among the numerous disorders that cause anterior-segment NV.

Q. 8

Secondary glaucoma following corneal perforation is due to:

 A

Central anterior synechiae formation

 B

Peripheral anterior synechiae

 C

Intraocular haemorrhage

 D

Angle recession

Q. 8

Secondary glaucoma following corneal perforation is due to:

 A

Central anterior synechiae formation

 B

Peripheral anterior synechiae

 C

Intraocular haemorrhage

 D

Angle recession

Ans. B

Explanation:

Ans. Peripheral anterior synechiae


Q. 9

Intractable secondary glaucoma is seen in:

 A

Diffuse iris melanoma

 B

Nodular iris melanoma

 C

Melanocytic deposits in anterior part of iris

 D

Melanocyte proliferation in posterior oveal tissue.

Q. 9

Intractable secondary glaucoma is seen in:

 A

Diffuse iris melanoma

 B

Nodular iris melanoma

 C

Melanocytic deposits in anterior part of iris

 D

Melanocyte proliferation in posterior oveal tissue.

Ans. A

Explanation:

Ans. Diffuse iris melanoma

Quiz In Between


Q. 10

The commonest cause of rubeosis iridis is

 A

Diabetes mellitus

 B

Central retinal vein occlusion

 C

Central retinal artery occlusion

 D

Carotid stenosis

Q. 10

The commonest cause of rubeosis iridis is

 A

Diabetes mellitus

 B

Central retinal vein occlusion

 C

Central retinal artery occlusion

 D

Carotid stenosis

Ans. A

Explanation:

Ans. Diabetes mellitus


Q. 11

Neovascular glaucoma is caused by:         

 A

CRVO

 B

CRAO

 C

Diabetes mellitus

 D

All of the above

Q. 11

Neovascular glaucoma is caused by:         

 A

CRVO

 B

CRAO

 C

Diabetes mellitus

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above

Although NVG primarily effects the front part of the eye (anterior chamber), its cause usually is associated with a lack of oxygen to the retina in the posterior region (vitreous chamber).

The technical term for this lack of oxygen is retinal hypoxia.

Conditions leading to retinal hypoxia include diabetic retinopathy and central retinal vein occlusion (CRVO).

These two diseases account for about two-thirds of all NVG cases.

The predisposing condition for diabetic retinopathy obviously is diabetes.

With respect to CRVO, predisposing conditions include elevated intraocular pressure and systemic hypertension (high blood pressure).

The remaining one-third of NVG cases has less-common causes. Among these are:

  • Central retinal artery occlusion (CRAO)
  • Carotid artery obstructive disease
  • Rhegmatogenous retinal detachment (a tear in the retina with fluid accumulating underneath that can further separate the pigment layer from other layers).
  • Choroidal melanoma beneath a retinal detachment.
  • Sickle-cell retinopathy
  • Carotid-cavernous fistula

A causative condition for NVG that is not associated with retinal hypoxia, is chronic anterior uveitis (irritation of the middle layer of the eye).


Q. 12

Intumescent cataract is associated with which type of glaucoma:   

September 2009

 A

Phacolytic glaucoma

 B

Phacomorphinc glaucoma

 C

Phacotopic glaucoma

 D

Pseudophakic glaucoma

Q. 12

Intumescent cataract is associated with which type of glaucoma:   

September 2009

 A

Phacolytic glaucoma

 B

Phacomorphinc glaucoma

 C

Phacotopic glaucoma

 D

Pseudophakic glaucoma

Ans. B

Explanation:

Ans. B: Phacomorphinc glaucoma

Increase in the water content and alteration in the protein structure causes lens opacification.

People with cortical cataracts experience glare from oncoming car headlights which can incapacitate them leading on to what is known as “nonocular diplopia” – seeing a single object double with the affected eye, the other eye being closed.

As the lens continues to take up water it may swell and become an intumescent cataract, still later it forms a total white opacity called mature cataract and finally become Hypermature cataract.

The proteins leak out leaving behind a shrunken -Posterior subcapsular cataract – Patients develop a greater decrease in near vision than distant vision.

  • Phacolytic glaucoma is associated with a damaged lens/if lens protein from a hypermature cataract escape into the aqueous.
  • Phacomorphinc glaucoma occurs when the swollen lens (intumescent stage) obliterates the drainage angle by forcing the root of the iris against the cornea.
  • Phacotopic glaucoma is seen when a partial subluxation/ complete dislocation of lens blocks the angle of drainage.

Quiz In Between


Q. 13

Rubeosis iridis is not seen in:       

September 2008

 A

CRVO

 B

Diabetic retinopathy

 C

Hypertensive retinopathy

 D

Ocular ischemic syndrome

Q. 13

Rubeosis iridis is not seen in:       

September 2008

 A

CRVO

 B

Diabetic retinopathy

 C

Hypertensive retinopathy

 D

Ocular ischemic syndrome

Ans. C

Explanation:

Ans. C: Hypertensive retinopathy

Neovascularization of the iris (NVI) or rubeosis iridis is a condition characterized by the development of new, branching and enlarged vessels in the iris.

Rubeosis iridis is often associated with diabetes in advanced proliferative diabetic retinopathy.

Other conditions causing rubeosis iridis include central retinal vein occlusion, ocular ischemic syndrome, and chronic retinal detachment

The visual prognosis is poor


Q. 14

40 years male with spherophakia is at risk for developing ‑

 A

Phacolytic glaucoma

 B

Phacoanaphylactic glaucoma

 C

Phacomorphic glaucoma

 D

None of the above

Q. 14

40 years male with spherophakia is at risk for developing ‑

 A

Phacolytic glaucoma

 B

Phacoanaphylactic glaucoma

 C

Phacomorphic glaucoma

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Phacomorphic glaucoma

Phacomorphric glaucoma is an acute secondary angle-closure glaucoma caused by :

  1. Intumescent lens i.e., swollen cataractous lens due to rapid maturation of cataract or sometimes following traumatic rupture of capsule is the main cause of phacomorphic glaucoma.
  2. Anterior subluxation or dislocation of the lens
  3. Spherophakia (congenital small spherical lens)

Q. 15

Most common cause of neovascular glaucoma ‑

 A

Diabetes

 B

CRAO

 C

CRVO

 D

Eale’s disease

Q. 15

Most common cause of neovascular glaucoma ‑

 A

Diabetes

 B

CRAO

 C

CRVO

 D

Eale’s disease

Ans. A

Explanation:

Ans. is ‘a’ i.e., Diabetes

Neovascular glaucoma (Rubeosis iridis)

  • It is a secondary angle closure glaucoma which results due to formation of neovascular membrane over the iris i.e., neovascularization of iris (rubeosis iridis). Causes of rubeosis iridis are :-
  1. Common :- Diabetic retinopathy (most common cause), central retinal vein occlusion, Eale’s disease, sickle- cell retinopathy
  2. Rare causes : – Long standing retinal detachment, central retinal artery occlusion, intraocular inflammation (uveitis), intraocular tumors (choroidal melanoma, retinoblastoma), radiation retinopathy, ocular ischemic syndrome (carotid artery disease, carotid – cavernous fistula), Fusch’s heterochromic iridocyclitis.
  • In central retinal vein occlusion (CRVO), glaucoma manifests about 100 days after thrombosis of central vein, therefore, it is also called 100 days glaucoma.
  • The most widely accepted theory for neovascularization is that the hypoxic retina produces diffusible angiogenic factor (VEGF) that stimulates new vessel proliferation.
  • Treatment of choice is panretinal photocoagulation as it terminates the angiogenic stimulus for neovascularization of retina.

Quiz In Between



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