The Early Treatment Diabetic Retinopathy Study (ETDRS) defined clinically significant macular edema (CSME). Which of the following findings does NOT fulfill the ETDRS criteria for CSME?

• A Retinal thickening within 500 μm of the center of the fovea
• B Microaneurysms alone within 500 μm of the foveal center without thickening ✓
• C Hard exudates within 500 μm of the center of the fovea with adjacent retinal thickening
• D Retinal thickening one disc area or more in size, any part of which is within one disc diameter of the foveal center

Explanation

ETDRS CSME criteria require retinal thickening or hard exudates with adjacent thickening — microaneurysms alone without accompanying retinal thickening do not fulfill CSME. The three ETDRS criteria are: (1) thickening within 500 μm of the foveal center; (2) hard exudates within 500 μm with associated adjacent thickening; (3) a zone of thickening ≥1 disc area in size, any portion within 1 disc diameter of the foveal center. Modern management has largely shifted to OCT-guided center-involving DME, but the ETDRS definition remains a landmark.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.