On four-field fundus photography, a diabetic patient shows retinal hemorrhages in all four quadrants, definite venous beading in two quadrants, and intraretinal microvascular abnormalities in one quadrant. There are no new vessels. What is the correct diagnosis?
- A Mild non-proliferative diabetic retinopathy
- B Severe non-proliferative diabetic retinopathy (4-2-1 rule) ✓
- C Early proliferative diabetic retinopathy
- D High-risk proliferative diabetic retinopathy
Correct answer: B. Severe non-proliferative diabetic retinopathy (4-2-1 rule)
Explanation
The 4-2-1 rule defines severe NPDR: hemorrhages in four quadrants, venous beading in two or more quadrants, or IRMA in one or more quadrant. Meeting any one criterion qualifies as severe NPDR; this patient meets all three. Proliferative disease requires new vessels or fibrovascular proliferation, which are absent here, so options C and D are excluded. Severe NPDR carries a high risk of progression to PDR within a year and warrants close follow-up or early scatter photocoagulation.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.