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Diabetic Retinopathy – Classification of Diabetic Retinopathy : Background Retinopathy

Background retinopathy (BGR) or non-proliferative retinopathy always predates proliferative retinopathy.

Initially BGR consists of microaneurysms only…

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progressing to microaneurysms with small haemorrhages (dot and blot haemorrhages)…

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and flame-shaped haemorrhages (labelled 1 in the image below) which are also associated with hypertension…

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The image above also shows a crescent on the temporal aspect of the optic disc (labelled 2) which is a normal variant.

Maculopathy

Hard exudates are also consistent with the designation of background retinopathy…

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However, where these changes – both haemorrhages…

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and hard exudates…

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are within the macular area, the picture is designated as ‘Diabetic Maculopathy’ so as to highlight the potential sight-threatening nature of this condition.

Diabetic maculopathy is classified into focal, diffuse and ischaemic types although for physicians this is a rather academic exercise since all patients will require a formal ophthalmic review. Visual loss is due to macular oedema (which can only be viewed by binocular stereoscopic slit lamp examination) and/or ischaemia. Differentiation of these components is usually achieved by fluorescein angiography.

Cotton Wool Spot

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An occasional cotton wool spot and/or mild venous dilatation (which is so subjective that it cannot usually be seen) is consistent with background retinopathy.

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Diabetic Retinopathy Menu

Introduction
  • Aims and Audience
  • How Images Work
Normal Features
  • General
  • Racial Pigmentation
  • Localised Pigmentation
  • Drusen
  • Myelination
Features of Diabetes
  • Microaneurysms
  • Intraretinal Haemorrhages
  • Hard Exudates
  • Cotton-wool Spots
  • Venous Abnormalities
  • IRMAs
  • Neovascularisation
  • Retinal Detachment
  • Vitreous Haemorrhage
  • Sub-hyaloid Haemorrhage
Classification
  • Background
  • Pre-proliferative
  • Proliferative
Screening
  • Screening
Treatment
  • Treatment

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