How would you manage this patient?

Submitted by Jennfier Nadelmann MD and Kyle Kovacs MD | Weill Cornell Medicine, Department of Ophthalmology, New York, NY USA

A 37-year-old female presents with a prior history of endogenous endophthalmitis (from staphylococcus pasteuri). She had initially undergone multiple intravitreal antibiotic injections and later a 25 g PPV/vitreous biopsy.  Five months after vitrectomy she developed a rhegmatogenous retinal detachment, for which she underwent a vitrectomy, scleral buckle, lensectomy, silicone oil, and a subsequent vitrectomy, membrane peeling, relaxing retinotomy with oil for PVR. In the post operative period she developed a tractional band overlying the optic nerve that extended from the macula to the inferonasal retinotomy, which remained stable and was thus observed for over a year. She subsequently developed progressive macular subretinal fluid under a fibrotic tractional membrane with retinal thickening. What is the etiology and what would your management plan be?

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