A 62-year-old diabetic has persistent center-involving macular thickening despite repeated anti-VEGF injections. OCT demonstrates focal vitreomacular traction with partial posterior hyaloid adherence to the fovea. What is the most appropriate next intervention?

• A Perform pars plana vitrectomy with removal of the adherent posterior hyaloid ✓
• B Continue anti-VEGF injections indefinitely at shortened intervals
• C Apply grid laser photocoagulation directly over the area of traction
• D Administer an intravitreal corticosteroid implant and reassess in six months

Explanation

Vitreomacular traction is a mechanical cause of edema that pharmacological agents address poorly, because the adherent hyaloid continues to distort the fovea. Vitrectomy with surgical induction or completion of posterior hyaloid separation removes the traction permanently and often permits resolution of edema with reduced dependence on injections. Grid laser is avoided over areas of traction, and steroid implants do not relieve mechanical pull, eliminating both C and D.

Reference: AAO Basic and Clinical Science Course, Section 12: Retina and Vitreous, 2023-2024 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.