A 35-year-old myope presents with sudden onset of flashes and floaters followed by a dark curtain from below. OCT shows subretinal fluid with retinal pigment epithelium displacement. B-scan shows bullous inferior retinal detachment without visible breaks on indirect ophthalmoscopy. The most appropriate next diagnostic step is:

• A Fluorescein angiography to identify occult retinal break
• B ERG to assess retinal function before surgery
• C Scleral indentation under indirect ophthalmoscopy in all quadrants ✓
• D MRI orbit to rule out choroidal tumor

Explanation

In rhegmatogenous retinal detachment, the break must be identified before surgical planning. When no break is visible with standard indirect ophthalmoscopy, scleral indentation allows visualization of the peripheral retina (particularly the vitreous base) where most breaks occur. This technique brings peripheral retinal folds into view within the field of the indirect ophthalmoscope. FFA is not useful for locating retinal breaks; ERG would not change immediate management; MRI is reserved when choroidal melanoma is suspected.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.