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:
Ans: (b) Retinal detachmentRef: A.K.Khurana's Comprehensive Ophthalmology, 6th edition, Page 277The question is not framed with all the information needed to answer it.Retinal detachment presents with sudden painless loss of vision but fundus picture usually shows detached retina with break or tractional bands, not with flame shaped hemorrhages alone.Proliferative Diabetic retinopathy (PDR) alone will not cause loss of vision. Patient can have 6/6 vision even in the presence of PDR.If vitreous hemorrhage was given in the option, I would go for it.Causes of Defective Vision in Diabetic Retinopathy:Diabetic maculopathy - Macular edema, ischemic maculopathy, clinically significant macular edema (CSME). The most common cause of defective vision in DR.Advanced diabetic eye diseases like:Vitreous hemorrhage.Tractional retinal detachment,Neovascular glaucoma.Classification of Diabetic Retinopathy:ETDRS (Early Treatment Diabetic Retinopathy Study) Classification:Non-proliferative diabetic retinopathy (NPDR).Proliferative diabetic retinopathy (PDR).Diabetic macular edema (DME).Non-Proliferative Diabetic Retinopathy (NPDR)MildFew microaneurysms Retinal haemorrhage Hard exudates in 1 or 2 quadrantsModerateAbove findings seen in 2 or 3 quadrantsSevere4:2:1 Rule*. Haemorrhages or Microaneurysms or both in all 4 Quadrants*. Venous Beading in 2 Quadrants*. IRMA (Intra Retinal Microvascular abnormality - A-V shunts secondary to microvascular occlusion ) in atleast 1 QuadrantVery severeAny two of the above 4:2:1 ruleProliferative diabetic retinopathy:Neovascularization of the disc (NVD).Neovascularization elsewhere (NVE).Advanced diabetic eye disease:Neovascular glaucoma.Tractional retinal detachment.Vitreous hemorrhage.Clinically Significant Macular Edema:Retinal edema within 5oop from the centre of fovea.Retinal thickening that is one disc area or larger, any part of which is within one disc diameter from the centre of fovea.Hard exudates within 500|j from the centre of fovea, if associated with adjacent retinal thickening.
CRAO
Retinal detachment
Proliferative retinopathy
Cystoid macular edema
Retina