A 30-year-old woman with poorly controlled Type 1 diabetes (HbA1c 10.2%) undergoes fundoscopy. The ophthalmologist notes microaneurysms, dot-blot haemorrhages, hard exudates in a circinate pattern around the fovea, and two areas of cotton wool spots. There are no new vessels. How should this be classified and managed?
- A Moderate NPDR with clinically significant macular oedema (CSMO); intravitreal anti-VEGF and optimise systemic control ✓
- B Mild NPDR; annual review only
- C Proliferative diabetic retinopathy; panretinal photocoagulation urgently
- D Severe NPDR; panretinal photocoagulation immediately
Correct answer: A. Moderate NPDR with clinically significant macular oedema (CSMO); intravitreal anti-VEGF and optimise systemic control
Explanation
Circinate hard exudates around the fovea represent lipid deposition from leaky microaneurysms, indicating diabetic macular oedema (DMO). Cotton wool spots and microaneurysms without neovascularisation indicate moderate to severe non-proliferative diabetic retinopathy (NPDR). The presence of macular oedema threatening or involving the centre (CSMO) is the primary reason for visual loss in NPDR and requires intravitreal anti-VEGF therapy (bevacizumab, ranibizumab, or aflibercept) along with strict glycaemic and blood pressure control.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.