In the Wills Eye classification of rhegmatogenous retinal detachment (RRD), which of the following findings most strongly indicates the need for scleral buckling rather than primary vitrectomy?

• A Proliferative vitreoretinopathy grade C2 with posterior involvement
• B Multiple peripheral tears in a pseudophakic patient > 60 years
• C Giant retinal tear involving more than 90 degrees of the circumference
• D Inferior horseshoe tear with subretinal fluid extending to the macula in a phakic young patient ✓

Explanation

Scleral buckling (SB) is particularly preferred in young phakic patients with a single inferior horseshoe tear because it avoids vitrectomy-induced cataract (a major concern in young phakic patients), provides long-term support for the break, and achieves excellent anatomical outcomes without inducing nuclear sclerosis. SB works by indenting the sclera to reduce traction on the break and support closure by RPE pump. Giant retinal tears and PVR grade C2+ are better managed with vitrectomy due to the need for direct manipulation. Pseudophakic patients tolerate vitrectomy better as cataract risk is irrelevant.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.