Ophthalmology (Prometric)

During deep anterior lamellar keratoplasty for advanced keratoconus, a large central Descemet membrane perforation occurs with loss of anterior chamber stability and inability to maintain a safe lamellar dissection plane. Which intraoperative strategy is most appropriate?

A 72-year-old patient with new headache and jaw claudication has sudden severe monocular visual loss. The optic disc is pale and swollen, and erythrocyte sedimentation rate and C-reactive protein are markedly elevated. Which immediate management is most appropriate?

A 51-year-old patient has disabling foreign-body sensation and tearing. Slit-lamp examination shows redundant inferior bulbar conjunctiva overriding the lower eyelid margin and disrupting the inferior tear meniscus. Lubricants have failed. Which intervention is most appropriate?

A 61-year-old patient underwent endothelial keratoplasty six months ago and remains on prednisolone acetate. Intraocular pressure has increased from 16 to 34 mmHg, gonioscopy is open, the graft is clear, and there are no inflammatory cells. Which management is most appropriate?

A patient with a spectacle prescription of +10.00 D is being converted to a contact lens worn at the corneal plane. The spectacles are positioned approximately 12 mm in front of the cornea. Which optical consequence should be expected when converting the high-plus correction?

A 67-year-old hypertensive woman reports a painless superior visual-field disturbance that began several months ago. Visual acuity is 20/30. The fundus photograph is shown, and OCT demonstrates no current center-involving macular edema. Which management is most appropriate for the retinal condition at this visit?

B-scan ultrasonography is being used through a dense vitreous hemorrhage to search for a subtle retinal membrane. Increasing the receiver gain makes weak echoes more visible but also introduces additional background signals. Which trade-off best describes this adjustment?

A 73-year-old patient develops sudden painless inferior altitudinal visual-field loss on awakening. Visual acuity is 20/40, there is a relative afferent pupillary defect, and the optic disc is diffusely swollen. The fellow disc has a very small physiologic cup. ESR and CRP are normal, and there are no systemic inflammatory symptoms. Which diagnosis is most likely?

A 69-year-old highly myopic patient has an axial length of 32 mm, posterior staphyloma, and a retinal detachment centered on a full-thickness macular hole. Peripheral examination reveals no causative retinal break. Which surgical approach is most appropriate?

During phacoemulsification, a limited zonular dialysis occurs. A capsular tension ring is inserted, the posterior chamber intraocular lens is stable, and no further surgery is required. The patient is unaware of the event. Before postoperative review, the surgeon considers saying nothing because acuity may still be excellent. What should the ophthalmologist do?