A patient with proliferative diabetic retinopathy undergoes pars plana vitrectomy. During surgery, the surgeon finds that the posterior hyaloid is densely adherent to the disc and macula. The preferred maneuver to achieve posterior vitreous detachment in this situation is:

• A Chandelier-assisted bimanual dissection with scissors
• B Perfluorocarbon liquid injection to hydraulically separate hyaloid
• C Enzymatic vitreolysis with ocriplasmin intravitreal injection
• D Triamcinolone-assisted vitrectomy with active suction using the vitreous cutter ✓

Explanation

In dense posterior hyaloid adhesion during PDR vitrectomy, triamcinolone acetonide (IVTA) is used to stain the vitreous cortex/posterior hyaloid, making it visible under the microscope. Active suction with the vitreous cutter at the disc surface then allows controlled induction of posterior vitreous detachment. PFCL is used later to flatten a detached retina, not to separate hyaloid. Ocriplasmin is used preoperatively in tractional conditions, not intraoperatively in advanced PDR.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.