Saudi Board Ophthalmology Part 1 Complete Review Guide 2026–2027

4. Superotemporal lens subluxation suggests Marfan; inferonasal suggests homocystinuria, with thromboembolism risk under anesthesia.
5. Posterior capsule rupture with vitreous loss: perform anterior vitrectomy and clear vitreous from the wounds.
6. Acute post-cataract endophthalmitis: coagulase-negative staphylococci are most common; treat with vitreous tap and intravitreal antibiotics.
7. In the EVS, immediate vitrectomy benefited only eyes with light perception vision.
8. Chronic delayed inflammation with a white capsular plaque months after surgery suggests Cutibacterium acnes.
9. Pseudophakic CME (Irvine-Gass) peaks at 4-6 weeks and is treated first with topical NSAID plus steroid.
10. Tamsulosin causes intraoperative floppy iris syndrome (IFIS).
11. A 1 mm axial length error gives about 2.5-3 D of refractive error; a 1 D keratometry error gives about 1 D.
12. Each degree of toric IOL rotation loses about 3.3% of cylinder correction; 30 degrees loses almost all of it.
13. Intracameral cefuroxime at the end of surgery reduced endophthalmitis about fivefold (ESCRS study).
14. Phacolytic glaucoma has an open angle with lens protein in the chamber; phacomorphic has a closed angle from a swollen lens. Both need cataract extraction.
15. Contact lens keratitis: Pseudomonas is the classic organism; severe pain out of proportion with a ring infiltrate suggests Acanthamoeba.
16. First-line Acanthamoeba treatment: topical biguanide (PHMB or chlorhexidine), with or without a diamidine.
17. In HEDS, oral acyclovir 400 mg twice daily halved recurrences of ocular HSV.
18. Hutchinson sign (vesicles on the nose tip) means nasociliary involvement and higher ocular risk in herpes zoster ophthalmicus.
19. Lattice dystrophy has amyloid, granular has hyaline, and macular has glycosaminoglycans, is autosomal recessive and relatively common in Saudi Arabia.
20. A Khodadoust line of keratic precipitates on the graft endothelium means endothelial rejection; treat with intensive topical steroids.
21. Phenylephrine 10% blanches episcleral vessels but not the deep vessels of scleritis.
22. Prentice's rule: prism (Δ) = decentration in cm × lens power in dioptres.
23. Normal central corneal thickness is about 540 µm; corneal power is about 43 D and the lens about 20 D.
24. Post-LASIK ectasia risk rises when residual stromal bed is below 250 µm or percent tissue altered exceeds 40%.

Common mistakes in this chapter

• ✕ Topical steroids are often chosen for active HSV dendritic epithelial keratitis. They worsen it; treat with antivirals.
• ✕ Voriconazole is often picked for filamentous fungal ulcers, but MUTT I showed natamycin is better, especially for Fusarium.
• ✕ In alkali burns, testing acuity or pH before irrigating is wrong. Irrigate immediately first.
• ✕ Nuclear and posterior subcapsular cataract are confused: 'second sight' for reading means nuclear; glare and poor near vision point to PSC.
• ✕ Patching bacterial keratitis is wrong, especially in contact lens wearers. Take cultures, then start intensive drops.
• ✕ Placing a single-piece acrylic IOL in the sulcus after capsule rupture causes UGH syndrome. Use a three-piece IOL.
• ✕ Working distance is often applied the wrong way in retinoscopy. At 67 cm, subtract 1.50 D from the neutralizing lens.
• ✕ Standard keratometry formulas after myopic LASIK overestimate corneal power and cause a hyperopic surprise. Use post-refractive formulas.