Treatment of advanced proliferative diabetic retinopathy with extensive vitreoretinal fibrosis and tractional retinal detachment involves all of the following except –
**Core Concept**
Proliferative diabetic retinopathy (PDR) is a complication of diabetes characterized by the growth of new, fragile blood vessels in the retina. Advanced PDR often leads to extensive vitreoretinal fibrosis and tractional retinal detachment, which can cause vision loss. Treatment of these advanced cases requires a multi-modal approach involving surgical and pharmacological interventions.
**Why the Correct Answer is Right**
Treatment of advanced proliferative diabetic retinopathy involves panretinal photocoagulation (PRP) to reduce neovascularization, intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents to inhibit angiogenesis, and surgical interventions such as scleral buckling or vitreoretinal surgery to address tractional retinal detachment. The primary goal is to reduce ischemia, decrease neovascularization, and restore retinal function.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is likely incorrect because **corticosteroids** can actually worsen diabetic retinopathy by increasing intraocular pressure and promoting neovascularization. Corticosteroids are generally contraindicated in diabetic retinopathy.
**Option B:** This option is incorrect because **cyclophotocoagulation** is a treatment for glaucoma, not diabetic retinopathy. It involves destroying part of the ciliary body to reduce intraocular pressure.
**Option C:** This option is incorrect because **laser photocoagulation** is a treatment for diabetic retinopathy, but it is typically used for non-proliferative diabetic retinopathy (NPDR) or early proliferative diabetic retinopathy (PDR). Advanced PDR often requires more aggressive treatment.
**Clinical Pearl / High-Yield Fact**
In diabetic retinopathy, the risk of retinal detachment increases with the duration of diabetes and the severity of retinopathy. Early detection and treatment of diabetic retinopathy are crucial to prevent vision loss.
**Correct Answer: A. Corticosteroids.**