Lens and cataract: pseudophakic bullous keratopathy: 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 · Lens and cataract: pseudophakic bullous keratopathy

Sample item

A 72-year-old who had cataract surgery with an anterior chamber IOL two years ago has painful blurred vision, a hazy oedematous cornea and epithelial bullae that rupture. What is the underlying mechanism?

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

The answer and the reasoning

B. Loss of endothelial cells with failure of the endothelial pump

Surgical trauma and chronic contact from an anterior chamber lens reduce endothelial cell density until the pump fails, so the stroma swells and subepithelial bullae form. Endothelial keratoplasty restores the pump function when symptoms are significant.

Option by option

  • A. Abnormal anterior basement membrane adhesion

    Anterior basement membrane dystrophy causes recurrent erosions with maps, dots and fingerprints.

  • B. Loss of endothelial cells with failure of the endothelial pump (correct)

    Correct. Endothelial decompensation allows corneal oedema and bullae.

  • C. Protease-mediated melting of stromal collagen

    Stromal melting follows infection or autoimmune ulceration and presents with thinning and a sterile ulcer.

  • D. Deficiency of limbal epithelial stem cells

    Limbal stem cell deficiency produces conjunctivalisation and vascularisation, not diffuse oedema.

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 B, Loss of endothelial cells with failure of the endothelial pump. Surgical trauma and chronic contact from an anterior chamber lens reduce endothelial cell density until the pump fails, so the stroma swells and subepithelial bullae form.

Why is "Abnormal anterior basement membrane adhesion" not the answer?

Anterior basement membrane dystrophy causes recurrent erosions with maps, dots and fingerprints.

Why is "Protease-mediated melting of stromal collagen" not the answer?

Stromal melting follows infection or autoimmune ulceration and presents with thinning and a sterile ulcer.

Why is "Deficiency of limbal epithelial stem cells" not the answer?

Limbal stem cell deficiency produces conjunctivalisation and vascularisation, not diffuse oedema.

What concept does this question test?

It tests Lens and cataract: pseudophakic bullous keratopathy in Ophthalmology. Endothelial keratoplasty restores the pump function when symptoms are significant.

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 Lens and cataract: pseudophakic bullous keratopathy?

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.