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1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh. These OSPE are dedicated to the postgraduate student who are decided to builds their carrier in ophthalmology. I hope that they will be benefited if they solve these OSPE
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04/07/2023 [email protected] 1
Objective Structured Practical Question (OSPE)
Topic: CataractAccording to the course curriculum of
Bangladesh College of Physician & Surgeon (BCPS)
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AUTHOR:Dr Md Anisur Rahman Anjum.MBBS (Dhaka Medical College). DO (Dhaka University) FCPS (EYE)Associate ProfessorNational Institute of OphthalmologyDhaka, Bangladesh. Chamber: Mojibunnessa Eye HospitalHouse: 18 Road: 6. Dhanmondi, Dhaka, 1205. Bangladesh.Email: [email protected]: 01711-832397
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Question
• A 56-year-old woman complains of increasing difficulty reading the newspaper in the morning, especially in bright sunlight.
1) What may be the cause?2) What will be the treatment of choice?3) Before doing the treatment proper, what
investigation you have to do? Mention one general and two ocular investigation.
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Answer
1) Posterior subcapsular cataracts• (Posterior subcapsular cataracts create more difficulty with glare
and near vision. Nuclear and cortical cataracts affect distance vision more than near vision. Progressive loss of vision from oil droplet or anterior polar cataracts is not often seen in this age group)
2) Phacoemulsification with posterior chamber intra ocular lens implantation.
3) General: Blood SugarOcular: a) Biometry, b) IOP or SPT
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Referring to the picture below
• What is the name of this device? • b. Name two conditions which may increase
the use of this device.
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ANSWER
• ANS=1. Intra capsular tension ring. It is used to expand capsule following significant zonulolysis.
• ANS=2Marfan’s syndrome.Pseudo exfoliation syndrome
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Question A l -month -old baby is diagnosed with unilateral
anterior polar cataract that is approximately 1.5 mm in diameter.
Q: 1. What is the most appropriate initial management?Q: 2. What is the another name of this cataract?Q: 3. How many bigger are they?Q: 4. Are they usually required surgery?Q: 5. Why the vision is usually affected?Q: 6 What should you do to preserve the vision?
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Answer
1) Close observation.2) Pyramidal cataract.3) They are < 3 mm.4) No5) there is an increased incidence of anisometropia in
patients with anterior polar cataracts;6) Refraction.
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Marks distribution
1) Close observation. ----------------------- 22) Pyramidal cataract. ---------------------- 23) They are < 3 mm ------------------------- 14) No ------------------------------------------ 15) there is an increased incidence of
anisometropia in patients with anterior polar cataracts; ------------------------------------ 3
6) Refraction. --------------------------------- 1
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• a. Anterior polar cataracts are typically small «3 mm) white opacities located centrally in the anterior lens capsule. They are not progressive and are not large enough to interfere with vision. However, there is an increased incidence of anisometropia in patients with anterior polar cataracts; refractions should therefore be monitored in these patients.
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• Anterior polar cataract may be flat or project as a conical opacity into the anterior chamber (pyramidal cataract) Flat anterior polar opacities are central, less than 3 mm in diameter, bilateral in one-third of cases and visually insignificant. Pyramidal opacities are frequently surrounded by an area of cortical opacity and may affect vision. Occasional associations of anterior polar cataracts include persistent pupillary membrane. Aniridia, Peters anomaly and anterior lenticonus
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• The following patients are seen in the pre-assessment clinic for cataract surgery. Which of the following patients are candidates for astigmatic keratotomy during cataract surgery with intraocular implant.
• Patient 1 44.50/48.25@90, refraction -1.75/-3.00X175 Patient 2 45.25/45.55@160 ,refraction -0.75/+2.25X170 Patient 3 42.00/45.00@5 , refraction +1.75/-2.25X100 Patient 4 44.28/44.75@30 , refraction -2.00/+1.75X35
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• Patient 1 & 3.• It is important for the surgeon to recognize
the contribution of lenticular astigmatism to the refraction. Astigmatic keratotomy should only be performed on patient with mainly corneal astigmatism.
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• The above is the A-scan of a patient's eye taken at the pre-operative assessment for cataract surgery.
• a. Which formulae is best for this eye? • b. Is peribulbar or retrobulbar anaesthesia the
anaesthesia of choice in this patient? Give your reason(s)
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• The eye has a high axial length, hence high myopia. The best formula to use is SRK/T.
• No, a large eye increases the risk of accidental globe perforation. Other technique may be preferable such as topical anesthesia, intracameral anesthesia or sub-tenon anesthesia,
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Formulae for biometry Axial length (mm) Formula
<22mm Hoffer Q
22-24.5mm Average of Hoffer Q, Holladay and SRK/T
24.6-26mm Holladay
>26mm SRK/T
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This 70 year-old woman is due to have a cataract extraction. Her A-scan taken in the pre-assessment clinic is shown above.
1 ) Which eye is this A-scan taken from? = 12) What are the three peaks (A, B & C) shown here? = 33) What is the required lens power for emmetropia
assuming the A constant is 118 and her average keratometry is 44.0D? =4
4) If the axial length were overestimated by 1mm would the resultant lens implant (which you aim for emmetropia) give rise to hypermetropia or myopia?=2
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1) OS and therefore left eye. (OD = right eye)
2) A = anterior lens echo B = posterior lens echo C = retinal echo
3) Power of the intraocular lens needed for emmetropia = 118 – {2.5x(22.3) - 0.9x(43)} = 23.55D The power needed would be 23.50D as the implant comes in step of 0.5D
4) The resultant refraction would be hypermetropic if the axial length is overestimated.
