Test 43
(Matching papers)
A. type 1 Duane's syndrome F. secondary esotropia
B. type 2 Duane's syndrome G. consecutive esotropia
C. type 3 Duane's syndrome H. accommodative esotropia
D. myasthenia gravis I. partially accommodative esotropia
E. sixth nerve palsy J. accommodative spasm
F. infantile esotropia K. myositis

1. Match the following 5 cases with the most likely diagnosis from above:
a.  A 15 year-old boy is referred because of abnormal eye movement which has been present since birth. The vision is normal in both eye at 6/6. Ocular movement reveals failure of the right eye to abduct. However, right adduction is normal with palpebral narrowing and enophthalmos. The movement of the left eye is normal.

b. A 34 year-old man complains of right esotropia. His vision is 6/36 in the right eye and 6/6 in the left eye. He developed a right exotropia from the age of 15 following a right traumatic corneal laceration. 10 months ago he underwent a right squint surgery.

c. A 6 year old boy presents with a right esotropia. The vision is 6/12 in the right and 6/18 in the left. Cycloplegic refraction reveals hypermetropia with the RE +3.75/-1.00X75 and LE +5.25 /-1.25 X45. The esotropia measures 40 prism dioptres for near and 35 for distant fixation.  A pair of glasses are prescribed and his vision with glasses improves 6/7.5 in the right and 6/9 in the left. Repeated orthoptic assessment reveals 10 prism dioptre with glasses for near and 8 prism dioptre with glasses for distant fixation.

d. A 25 year-old man complains of diplopia and the cover test reveals bilateral esotropia. Fundoscopy shows bilateral optic disc swelling without vessel pulsation.

e. A 6 year-old girl developed a right esotropia one year after sustaining a right traumatic globe perforation. The vision is 6/60 in the right eye and 6/6 in the left eye.

A.  Early Manifest Glaucoma Trial (EMGT)
B.  Ocular Hypertension Treatment Study (OHTS)
C. Collaborative Initial Glaucoma Treatment Study (CIGTS)
D. Collaborative Normal Tension Glaucoma Study (NTGS)
E. Advanced Glaucoma Intervention Study (AGIS)
2. Match the following findings with the above landmark glaucoma studies:
a. This study compared the effect on progression of early diagnosed open angle glaucoma of immediate treatment (ALT and Betaxolol) versus no treatment. The study showed a mean IOP reduction of 25% was associated with a 27.4% reduction in risk of disease progress. Each 1 mmHg lowering of IOP correlated to a 10% risk reduction.

b. This study assessed the effect on early diagnosed open angle glaucoma patients of initial therapy with either topical medications or with trabeculectomy. After 5 years of follow-up, both medical and surgical intervention were shown to be equally effective in reducing IOP and preventing vision loss.

c. This randomized study looked at the effect of  lowering IOP medically on the onset of visual field defects in ocular hypertensive patients. The study concluded that active treatment more than halved the risk of developing primary open angle glaucoma over the 5-year follow-up.

d. This long-term study looked at the relationship between IOP and visual field deterioration after surgical intervention for glaucoma. The study showed that maintenance of IOPs at less than 18mmHg resulted in stable visual fields throughout the 6-year study.

e. This randomized study looked at the effect on normal-tension glaucoma of surgically or medically lowering IOP by 30% from baseline (compared to untreated control group). The study showed that of IOP normal-tension glaucoma patients reduction significantly reduced disease progression.

More MCQs