Cases

Question 1 of 25

1. Question
Question 1: Which of the following is not a possible cause of pigment in the anterior chamber angle?
- Pseudoexfoliation syndrome
- Trauma to the angle
- Pigment dispersion syndrome
- Uveal melanoma
- Acute macular neuroretinopathy
Question 2 of 25

2. Question
Question 2: Which of the following is not associated with pigment dispersion syndrome?
- Headaches and blurred vision
- Elevated intraocular pressure
- Family history of glaucoma
- Peripheral anterior synechiae
- Increased pigment release following vigorous exercise
Question 3 of 25

3. Question
Question 3: Which of the following is not a possible treatment for pigmentary glaucoma?
- Selective laser trabeculoplasty
- Goniotomy
- Minimally invasive glaucoma surgery (MIGS)
- Trabeculectomy with mitomycin C
- Topical prostaglandin analogues
Question 4 of 25

4. Question
Question 4: What is the relationship between pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG)?
- They are two separate diseases
- PDS is a precursor to PG
- PG is a precursor to PDS
- They are unrelated
Question 5 of 25

5. Question
Question 5: Which of the following is not a main risk factor for conversion from PDF to PG?
- Male sex
- Smoking
- Myopia
- Caucasian
- IOP >21 mmHg at initial diagnosis
Question 6 of 25

6. Question
Question 6: Which characteristic is not seen in patients with pigment dispersion syndrome?
- Glaucomatous optic neuropathy
- Krukenberg’s spindle
- Sampaolesi’s line
- Heavily pigmented trabecular meshwork
- Mid-peripheral iris transillumination defects
Question 7 of 25

7. Question
Question 7: Which glaucoma category does pigmentary glaucoma fall under?
- Primary open angle glaucoma
- Secondary open angle glaucoma
- Angle closure glaucoma
- Congenital glaucoma
- Uveitic glaucoma
Question 8 of 25

8. Question
Question 8: Which one of the following statements is NOT True
- Myopia is a risk factor for PDS
- The higher the myopia the greater the risk of PDS.
- The risk of developing glaucoma with PDS is 35-50%
- The greatest risk of conversion to glaucoma with PDS is after the age of 70.
- PDS is equally common in men and women, but PDS glaucoma is more common in men
Question 9 of 25

9. Question
Question 9: Which of the following is NOT True?
- Caucasian men are more prone to develop PDS glaucoma compared to Asian or African American men.
- The most relevant clinical finding is Krukenberg spindles that is more common on the inferior corneal endothelium
- PDS is more commonly diagnosed because patients present with symptoms rather than on routine examination.
- Transillumination is not always obvious and may be subtle.
- Pigment deposition can also occur on the anterior lens capsule
Question 10 of 25

10. Question
Question 10: What is the mechanism of reverse pupillary block in pigment dispersion syndrome?
- Posterior bowing of the iris results in irido-zonular touch
- Anterior bowing of the iris results in the formation of peripheral anterior synechiae
- Accumulation of pigment at the pupil ruff reduces the flow of aqueous
- Anterior bowing of the iris results in the formation of posterior synechiae
- Pigment dispersion syndrome results in a plateau iris configuration
Question 11 of 25

11. Question
Question 11: Which of the following is false with regard to the role of miotics in the treatment of pigment dispersion syndrome?
- They tend to be poorly tolerated by younger patients
- Miotics may increase the risk of retinal detachment in myopic patients
- Miotic agents can reduce irido-zonular contact, diminishing liberation of pigment
- Miotics, including pilocarpine cause a reduction in IOP by increasing drainage of aqueous humour via the uveoscleral route
- Patients on topical miotic therapy may have difficulty with vision in dim light
Question 12 of 25

12. Question
Question 12: Why are prostaglandin analogues used as first-line medical therapy in the treatment of pigmentary glaucoma?
- They constrict the pupil
- Due to their proinflammatory activity
- They increase uveoscleral aqueous outflow
- They reduce aqueous production
- Prostaglandin analogues reduce iridozonular contact
Question 13 of 25

13. Question
Question 13: Which of the following is false regarding the use of laser peripheral iridotomy in the treatment of pigment dispersion syndrome or pigmentary glaucoma?
- Laser peripheral iridotomy creates an alternative channel for the flow of aqueous humour
- Laser peripheral iridotomy can reduce the reverse pupillary block by flattening the iris
- Treatment with laser peripheral iridotomy may be more effective earlier in the disease process
- There is a lack of high quality evidence about the effectiveness of laser peripheral iridotomy in the treatment of pigment dispersion syndrome and pigmentary glaucoma
- Laser peripheral iridotomy cannot reduce the release of pigment in patients with pigment dispersion syndrome
Question 14 of 25

14. Question
Question 14: Which of the following was not a primary or secondary outcome measure in the Cochrane review of laser peripheral iridotomy in pigment dispersion syndrome and pigmentary glaucoma?
- logMAR visual acuity at six months and one year
- Mean IOP reduction at six months
- Visual field progression
- Change in anterior chamber depth
- Pigment accumulation in the trabecular meshwork and iris
Question 15 of 25

15. Question
Question 15: Which feature will not help to discriminate anterior uveitis from pigment dispersion syndrome?
- The presence of pigment on the corneal endothelium
- Circumciliary injection
- A complete medical and ophthalmic history
- The presence of inflammatory cells in the anterior chamber
- Presence of posterior synechiae
Question 16 of 25

16. Question
Question 16: Which of the following is used in the management of patients with pigmentary glaucoma?
- Selective laser trabeculoplasty
- Alpha-adrenergic eye drops
- Trabeculectomy
- Beta blocker eye drops
- All of the above
Question 17 of 25

17. Question
Question 17: Why should IOP be closely monitored following the use of selective laser trabeculoplasty in the treatment of patients with pigmentary glaucoma?
- Not all patients have a reduction in IOP in response to treatment with selective laser trabeculoplasty
- Selective laser trabeculoplasty should not be performed in patients with pigmentary glaucoma
- Selective laser trabeculoplasty should be performed following argon laser trabeculoplasty as less energy is required
- There have been reports of post-selective laser trabeculoplasty pressure spikes in patients with pigmentary glaucoma
- All of the above
Question 18 of 25

18. Question
Question 18: Which of the following is true regarding the surgical management of pigmentary glaucoma?
- Laser PI is a treatment for high IOP in PDS.
- Aqueous shunts should always be performed prior to trabeculectomy
- Inadequate IOP control and evidence of visual field defect progression on maximal antiglaucoma therapy are clear indications for glaucoma surgery
- Laser iridotomy should be performed in all cases of PDS
- Trabeculectomy should only be performed once the patient has already had a laser peripheral iridotomy to alter the iris configuration
Question 19 of 25

19. Question
Question 19: Which of the following is false regarding the epidemiology of PDS?
- PDS affects 2-4% of patients during the second to fourth decades of life
- Hyperopia is a risk factor for PDS development
- Myopia has a positive correlation with PDS severity
- The risk of developing PG in patients with PDF ranges from 20% to 50%, depending on the study
- Males are affected by POHT and PG more than females
Question 20 of 25

20. Question
Question 20: Which imaging modalities may be useful in the examination of patients with pigmentary glaucoma?
- Ultrasound biomicroscopy
- Anterior segment optical coherence tomography
- Posterior segment OCT
- A and B
- A, B and C
Question 21 of 25

21. Question
Question 21: Which statement is TRUE for PDS
- The gene for PDS has been identified.
- The majority of patients have a family history of PDS
- There is a higher incidence of lattice degeneration and retinal breaks in patients with PDS compared to other myopic patients
- Eyes with PDS do not have increased irido-lenticular contact area.
- Iris concavity is not a mechanism of pigment release
Question 22 of 25

22. Question
Question 22: With regards to pigment dispersion, which statement is false.
- In those with established PG, the amount of trabecular meshwork pigmentation is related to the disease severity
- PDS is often missed especially in the early stages
- Women with PDS are more likely to have high pressures than men with PDS
- All patients with PDS should have a complete assessment for glaucoma
- The greatest risk of conversion to glaucoma is within the first 10 years.
Question 23 of 25

23. Question
Question 23: With regards to pigment dispersion, which statement is false.
- The pigment reversal sign is increased pigment density in the inferior quadrant (relative to the superior Anterior segment optical coherence tomography)
- The degree of pigment in the trabecular meshwork angle is not a risk factor for the development of glaucoma, although it is a related to the severity of glaucoma in those with PD glaucoma.
- Frequent follow-up and close monitoring of patients with PD glaucoma is necessary
- PD glaucoma is harder to control than POAG
- Eventually the phase of pigment release declines in the end stages of PD glaucoma.
Question 24 of 25

24. Question
Question 24: Regarding PDS, which statement is false:
- In the end stages, inferior angle pigment clears before superior angle pigment leading to a darker trabecular meshwork superiorly.
- Heterochromia is always present
- If heterochromia is present, the darker iris is the one that is most affected.
- Patients with PDS tend to have a deep anterior chamber
- Free pigment in the anterior chamber can be seen.
Question 25 of 25

25. Question
Question 25: Regarding the clinical signs of PDS, which of the following is TRUE.
- Blinking influences Krukenberg spindle development.
- Krukenberg spindles are always present in PDS
- Pigment is never seen on the posterior capsule
- Pigment dispersion may be seen on the iris anterior surface
- Pigment dispersion is always a unilateral condition

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Case 1 – Examinations – 2024

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