During vitrectomy for a chronic total retinal detachment with dense anterior and posterior proliferative vitreoretinopathy, the retina remains shortened and immobile despite complete membrane removal and cannot be apposed to the pigment epithelium even under perfluorocarbon liquid. Which step should the surgeon take next?

• A Perform a relaxing (relieving) retinectomy to allow the retina to settle flat ✓
• B Repeat membrane peeling with forceps until the retina flattens
• C Inject additional perfluorocarbon liquid to stretch the retina
• D Apply diffuse endolaser and accept partial attachment

Explanation

When intrinsic retinal shortening from chronic PVR prevents flattening despite complete membrane dissection, a circumferential relaxing retinectomy at the posterior edge of the shortened retina allows it to unfold and reattach under tamponade, followed by extensive endolaser around the cut edge. Injecting more PFCL only forces fluid into the subretinal space, and further peeling will not lengthen a physically shortened retina.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.