A 62 years old poorly controlled diabetic presents with sudden painless loss of vision. No history of floaters. He also complaints of visual field defect which is progressively worsening over past few months. History of similar complaints present in the other eye and vitrectomy was done. What is next step in management?
Refer: Kanski s Clinical Ophthalmology: A Systematic Approach 8th edition pg 602
TRACTIONAL RETINAL DETACHMENT

Due to retina being mechanically pulled away from its bed by the contraction of fibrous tissue in the vitreous (vitreoretinal tractional bands).
Clinical features
	
presence of vitreoretinal bands
Retinal breaks are usually absent and configuration of the detached area is concave.
The highest elevation of the retina occurs at sites of vitreoretinal traction.
Retinal mobility is severely reduced and shifting fluid is absent.


Treatment - It is difficult and requires pars plana vitrectomy to cut the vitreoretinal tractional bands and internal tamponade.
Pan- retinal photocoagulation
Pars plana vitrectomy
Scleral buckling
Pneumatic retinopexy