A 52-year-old diabetic patient with vitreous hemorrhage undergoes B-scan and is found to have associated traction retinal detachment (TRD) not involving the fovea. The most appropriate next step is:

• A Close observation every 2–4 weeks and laser photocoagulation when VH clears
• B Anti-VEGF injection followed by elective PPV after 3–5 days if TRD progresses
• C Pan-retinal photocoagulation laser at the current visit
• D Immediate pars plana vitrectomy to prevent foveal involvement ✓

Explanation

TRD secondary to PDR that is approaching or threatening the fovea or causes significant vision loss warrants prompt PPV. Even when not yet involving the fovea, TRD with VH that prevents monitoring or shows progression requires surgery. Anti-VEGF may be used preoperatively (3–5 days before surgery) to reduce intraoperative bleeding but is not an alternative to surgery in TRD. Laser cannot be applied through vitreous hemorrhage.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.