A 35-year-old male presents with sudden-onset inferior visual field loss. Fundus exam shows a superotemporal horseshoe tear with surrounding subretinal fluid not extending to the macula. The MOST appropriate management is:
- A Observation with serial fundus photography
- B Pneumatic retinopexy
- C Laser retinopexy (demarcation laser) to the borders of the detachment ✓
- D Pars plana vitrectomy with fluid-air exchange
Explanation
A subclinical retinal detachment (not extending to within 2 disc diameters of the macula or optic disc) with a causative horseshoe tear can be managed with laser retinopexy (demarcation photocoagulation) around the detachment borders to create a chorioretinal adhesion barrier preventing further progression. Observation risks macula-involving extension. Pneumatic retinopexy requires the detachment to be in the superior 8 clock hours and achieves reattachment via gas tamponade, appropriate for a recent break but less so when fluid is already present without macula involvement. PPV is reserved for complex or macula-involving detachments.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.