During routine pars plana vitrectomy, an iatrogenic retinal break is detected at the end of membrane dissection. At which location are iatrogenic breaks created during vitrectomy MOST commonly situated?

• A Posterior pole adjacent to the optic disc margin
• B At the macula following internal limiting membrane peeling
• C Along the temporal vascular arcades where epiretinal membranes were removed
• D Near the sclerotomy ports, at or posterior to the vitreous base ✓

Explanation

Most iatrogenic breaks arise near the entry scleratomies, where traction from instrument insertion and removal tugs on the unremoved peripheral vitreous base, producing horseshoe tears just posterior to the ora. This is why careful inspection of the peripheral fundus with scleral indentation at the end of every vitrectomy is mandatory, followed by endolaser retinopexy of any break found. Posterior breaks from peeling occur but are distinctly less frequent.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.