During pars plana vitrectomy for tractional retinal detachment secondary to diabetic PDR, the surgeon encounters a tightly adherent fibrovascular membrane over the macula. The preferred surgical technique to safely delaminate the membrane without causing iatrogenic retinal breaks is:

• A En bloc excision using scissors without segmentation
• B Bimanual dissection with delamination using horizontal scissors and simultaneous retinal tamponade
• C Segmentation alone followed by endolaser without delamination
• D Delamination using a microvitreoretinal blade with posterior vitreous cortex removal first ✓

Explanation

In dense diabetic TRD, the plane between the posterior hyaloid and the fibrovascular proliferation must be developed first. After core vitrectomy, the posterior hyaloid is engaged and peeled to create a cleavage plane. Delamination (cutting the attachments to the retina) is then performed with horizontal scissors or a vitreous cutter. En bloc excision risks traction and retinal breaks; bimanual delamination is accurate but the posterior hyaloid must be removed first to access the membrane.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.