A 75-year-old patient who was a known case of diabetes mellitus for the past 25 years presented with sudden painless loss of vision. On fundus examination, flame shaped hemorrhages were seen in retina. Probable diagnosis:
**Core Concept**
Diabetic retinopathy is a complication of diabetes mellitus, characterized by damage to the blood vessels in the retina, leading to vision loss. The condition can be divided into two stages: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). In NPDR, microaneurysms and hemorrhages are observed, whereas in PDR, new blood vessels grow, which can lead to further complications.
**Why the Correct Answer is Right**
The presence of flame-shaped hemorrhages in the retina is a hallmark of diabetic retinopathy. These hemorrhages occur due to the rupture of small blood vessels in the retina, leading to bleeding into the surrounding tissue. In diabetic retinopathy, the blood vessels become weakened due to the high glucose levels, making them more susceptible to rupture. The flame-shaped hemorrhages are a result of the bleeding into the vitreous humor, which causes the hemorrhage to appear as a bright red spot on the retina.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not a probable diagnosis as it does not match the clinical presentation of diabetic retinopathy. Diabetic retinopathy typically presents with painless vision loss, whereas other conditions such as central retinal artery occlusion may present with sudden, painful vision loss.
**Option B:** This option is not correct as it does not match the fundus examination findings of diabetic retinopathy. The presence of flame-shaped hemorrhages is a specific finding in diabetic retinopathy, whereas other conditions such as hypertensive retinopathy may present with different findings.
**Option C:** This option is not a probable diagnosis as it does not match the clinical presentation of diabetic retinopathy. Diabetic retinopathy typically presents with vision loss in one or both eyes, whereas other conditions such as glaucoma may present with vision loss in one eye.
**Clinical Pearl / High-Yield Fact**
The presence of flame-shaped hemorrhages in the retina is a specific finding in diabetic retinopathy. These hemorrhages can be a sign of NPDR or PDR, and prompt referral to an ophthalmologist is essential to prevent further complications.
**Correct Answer: C. Diabetic retinopathy.**