A 52-year-old man presents with sudden onset floaters and flashes of light in his right eye for 2 days. On examination, visual acuity is 6/9, and fundoscopy reveals a superior temporal retinal detachment involving the macula with a single break identified. The fellow eye is normal. What is the most appropriate immediate next step in management?

Explanation

## Clinical Assessment This patient presents with a **macula-on retinal detachment** (vision still 6/9, indicating macula is not yet detached) with a clear break identified on clinical examination. This is a surgical emergency requiring urgent intervention. ## Management Algorithm ```mermaid flowchart TD A[Retinal Detachment Diagnosed]:::outcome --> B{Macula Involved?}:::decision B -->|Macula-on| C[Urgent surgery within 24 hrs]:::action B -->|Macula-off| D[Emergency surgery ASAP]:::urgent C --> E[Referral to retinal surgeon]:::action D --> F[Same-day surgical intervention]:::urgent E --> G[Surgical repair: Scleral buckle or Vitrectomy]:::action ``` ## Key Management Principles **Key Point:** Macula-on retinal detachment is a **surgical emergency** requiring intervention within 24 hours to prevent macular involvement and preserve central vision. **High-Yield:** The urgency of RD surgery is determined by macular status: - **Macula-on (vision ≥6/12):** Urgent surgery within 24 hours - **Macula-off (vision <6/60):** Emergency surgery same day or next morning **Clinical Pearl:** Even though this patient has relatively preserved vision (6/9), the superior temporal location and involvement of the superior half of the macula means the macula is at imminent risk of detachment. Delay increases the risk of permanent visual loss. ## Why This Option Is Correct Urgent referral to a retinal surgeon is the appropriate next step because: 1. The patient requires **surgical intervention** (scleral buckle or vitrectomy) 2. The 24-hour window for macula-on RD is a well-established guideline 3. Vitrectomy should not be performed without proper retinal surgical setup and expertise 4. B-scan is unnecessary when the retina is clearly visualized on clinical examination **Tip:** In NEET PG exams, when a retinal detachment is already diagnosed clinically with a clear break identified, the next step is always **surgical referral**, not further investigation.