A 60 yr old man has both HTN and DM for 10 yrs. There is reduced vision in one eye. On fundus examination there is a central bleed and the fellow eye is normal. The diagnosis is –
Correct Answer: Diabetic retinopathy
Description: Diabetic maculopathy Changes in macular region need special mention, due to their effect on vision. These changes may be associated with non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR). The diabetic macular edema occurs due to increased permeability of the retinal capillaries. It is termed as clinically significant macular edema (CSME) if one of the following three criteria are present on slit-lamp examination with 90D lens: Thickening of the retina at or within 500 micron of the centre of the fovea. Hard exudate at or within 500 micron of the centre of fovea associated with adjacent retinal thickening. Development of a zone of retinal thickening one disc diameter or larger in size, at least a pa of which is within one disc diameter of the foveal centre. Clinico-angiographically diabetic maculopathy can be classified into four types: 1. Focal exudative maculopathy . It is characterised by microaneurysms, haemorrhages,macular oedema and hard exudates which are usually arranged in a circinate pattern. Fluorescein angiography reveals focal leakage with adequate macular perfusion. 2. Diffuse exudative maculopathy. It is characterised by diffuse retinal oedema and thickening throughout the posterior pole, with relatively few hard exudates. Fluorescein angiography reveals diffuse leakage at the posterior pole. 3. Ischaemic maculopathy. It occurs due to microvascular blockage. Clinically it is characterised by marked visual loss with microaneurysms,haemorrhages, mild or no macular oedema and a few hard exudates. Fluorescein angiography shows areas of non-perfusion which in early cases are in the form of enlargement of foveal avascular zone (FAZ), later on areas of capillary dropouts are seen and in advanced cases precapillary aerioles are blocked. 4. Mixed maculopathy. In it combined features of ischaemic and exudative maculopathy are present. Ref:comprehensive ophthalamology A k khurana 4/E pageno:261.
Category:
Ophthalmology
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