A 48-year-old type 2 diabetic presents with a symptomatic tractional retinal detachment (TRD) involving the macula. He also has florid new vessels at the disc. The MOST appropriate primary surgical approach is:

• A Scleral buckling with encirclement
• B Intravitreal anti-VEGF injection alone
• C Panretinal photocoagulation (PRP) and observation for 3 months
• D Pars plana vitrectomy (PPV) with membrane peeling and endolaser ✓

Explanation

Macula-involving tractional retinal detachment in proliferative diabetic retinopathy is a surgical emergency requiring pars plana vitrectomy with removal of fibrovascular membranes and intraoperative endolaser. Scleral buckling is used for rhegmatogenous detachments, not tractional. Anti-VEGF alone cannot release fibrovascular traction and may paradoxically worsen TRD by causing rapid membrane contraction. Deferring surgery with PRP risks permanent visual loss from chronic macular detachment.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.