During pars plana vitrectomy for tractional retinal detachment in proliferative diabetic retinopathy, a surgeon creates a posterior vitreous detachment and finds fibrovascular membranes adherent to the retina at multiple points. The preferred technique to delaminate these membranes without causing iatrogenic retinal breaks is:

• A Bimanual dissection with chandelier illumination ✓
• B En bloc dissection
• C Segmentation alone
• D Perfluorocarbon liquid injection prior to membrane dissection

Explanation

Bimanual dissection with chandelier (or twin-light) illumination allows the surgeon to use both hands — one for retraction/tissue stabilization and one for cutting — greatly improving safety when delaminating densely adherent fibrovascular membranes in PDR. This reduces iatrogenic retinal breaks compared to single-instrument techniques. En bloc dissection removes large portions of vitreous together, suitable for less adherent membranes. Segmentation cuts membranes into islands but does not remove vitreoretinal adhesions. Perfluorocarbon liquid is used to stabilize already detached retina, not during membrane dissection.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.