During vitrectomy for chronic tractional retinal detachment in advanced proliferative diabetic retinopathy, the surgeon finds the posterior retina contracted and shortened, and membranes cannot be separated without excessive traction. After delamination fails to flatten the retina, which surgical manoeuvre is indicated?

• A Repeat en bloc dissection with a heavier perfluorocarbon fill
• B Relieving retinotomy or retinectomy to open the contracted retina ✓
• C Scleral buckling combined with cryotherapy to the posterior pole
• D Injection of expansile gas alone without further membrane work

Explanation

When fibrovascular proliferation contracts circumferentially and the retina becomes rigid and foreshortened, peeling or delamination would tear rather than flatten it. A relaxing retinotomy or retinectomy cuts the retina to release tangential traction and allow reattachment under perfluorocarbon, followed by endolaser and long-acting tamponade, usually silicone oil. Buckling addresses peripheral traction, not posterior contraction, and gas alone cannot overcome intrinsic retinal shortening.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.