A 55-year-old male presents with metamorphopsia and decreased central vision. OCT shows a hyporeflective space between the neurosensory retina and RPE with an overlying point of traction from the posterior vitreous cortex at the fovea. Visual acuity is 6/18. The MOST appropriate management at this stage is:
- A Immediate pars plana vitrectomy ✓
- B Intravitreal anti-VEGF injection
- C Intravitreal gas injection (pneumatic vitreolysis)
- D Observation for 3 months with repeat OCT
Explanation
Vitreomacular traction (VMT) with associated loss of visual acuity (6/18), metamorphopsia, and subretinal fluid indicates clinically significant VMT syndrome requiring vitreoretinal surgical intervention. PPV with careful removal of the posterior hyaloid and, if present, internal limiting membrane (ILM) peeling is the standard treatment for symptomatic VMT. Pneumatic vitreolysis (intravitreal C3F8 or SF6 gas) is an option for VMT without macular hole, but with subretinal fluid and significant VA loss, vitrectomy is more definitive. Anti-VEGF has no role in VMT. Observation is appropriate only for asymptomatic or minimally symptomatic VMT.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.