Glaucoma: drainage device surgery: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Glaucoma: drainage device surgery

Sample item

A diabetic patient has neovascular glaucoma with an intraocular pressure of 42 mmHg despite maximal medical therapy and a closed angle with extensive new vessels. Trabeculectomy is likely to fail. Which surgery is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Glaucoma drainage device implantation

In neovascular glaucoma, and after failed filtering surgery, a tube-and-plate drainage device such as an Ahmed or Molteno implant is preferred because the fibrovascular tissue makes trabeculectomy unreliable. Anti-VEGF injection or panretinal photocoagulation treats the ischaemic drive.

Option by option

  • A. Glaucoma drainage device implantation (correct)

    Correct. A drainage device bypasses the scarred, vascularised angle and controls the pressure.

  • B. Goniotomy

    Goniotomy is for congenital glaucoma with an open, clear angle.

  • C. Laser peripheral iridotomy

    Iridotomy treats pupillary block and does not help a fibrovascular angle closure.

  • D. Selective laser trabeculoplasty

    Laser trabeculoplasty needs an open angle and visible trabecular meshwork.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is A, Glaucoma drainage device implantation. In neovascular glaucoma, and after failed filtering surgery, a tube-and-plate drainage device such as an Ahmed or Molteno implant is preferred because the fibrovascular tissue makes trabeculectomy unreliable.

Why is "Goniotomy" not the answer?

Goniotomy is for congenital glaucoma with an open, clear angle.

Why is "Laser peripheral iridotomy" not the answer?

Iridotomy treats pupillary block and does not help a fibrovascular angle closure.

Why is "Selective laser trabeculoplasty" not the answer?

Laser trabeculoplasty needs an open angle and visible trabecular meshwork.

What concept does this question test?

It tests Glaucoma: drainage device surgery in Ophthalmology. Anti-VEGF injection or panretinal photocoagulation treats the ischaemic drive.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Glaucoma: drainage device surgery?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.