A 62-year-old woman has a full-thickness idiopathic macular hole involving more than half the foveal diameter with vitreofoveal traction on OCT, and visual acuity of 6/36. What is the definitive treatment?
- A Intravitreal anti-VEGF injection
- B Observation with serial OCT
- C Pars plana vitrectomy with internal limiting membrane peeling and gas tamponade ✓
- D Focal argon laser photocoagulation
Correct answer: C. Pars plana vitrectomy with internal limiting membrane peeling and gas tamponade
Explanation
Full-thickness macular holes of stage 2 and above are treated surgically with pars plana vitrectomy, posterior hyaloid separation, internal limiting membrane peeling to relieve tangential traction, and gas tamponade followed by postoperative face-down positioning. Anti-VEGF agents have no role in closing a full-thickness hole, and observation leads to progressive enlargement and worsening acuity. Focal laser would damage the fovea permanently and is not used for macular holes.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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