A 35-year-old myope presents with a 2-day history of floaters and a curtain across his inferior visual field. B-scan ultrasonography confirms a bullous superior rhegmatogenous retinal detachment with a U-shaped tear at 11 o'clock. Best corrected visual acuity is 6/6. What finding on examination would indicate that immediate surgery (within 24 hours) is essential rather than semi-urgent?

• A Subretinal fluid extending beyond the equator
• B Proliferative vitreoretinopathy grade B present
• C Presence of a superior horseshoe tear at 11 o'clock
• D Macula-on status (fovea not yet detached) ✓

Explanation

The macula-on status is the single most critical prognostic indicator demanding same-day or next-morning repair: once the fovea detaches, even successful reattachment does not restore 6/6 vision. Every hour the macula remains attached is critical because foveal photoreceptors can still be saved. Inferior extension of subretinal fluid and PVR grade B indicate severity but are not the indicator for emergency timing when macula is still on. The superior horseshoe tear simply confirms the rhegmatogenous cause and guides surgical approach.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.