<s>[INST] context: (Microaneurysm) (295-Person 20th) (260-62-Khurana 4th)* Earliest detactable lesion is microaneurysm in the macular area in NPDRDIABETIC RETINOPATHYOphthalmoscopic features of Non-proliferativediabetic retinopathy (NPDR)* Microaneurysm at the macular area (the earliest detectable lesion)*** Retinal haemorrhage both deep (dot and blot haemorrhage) and superficial haemorrhages (flame shaped)* Hard exudates** - yellowish- white- waxy looking patches are arranged in clumps or in the circinate pattern - seen in macular area* Retinal oedema characterized by retinal thickening* Cotton -wool spots** (if >8, there is high risk of PDR)* Venous abnormalities - beading, looping and dilatation* Intraretinal microvascular abnormalities (IRMA)* Dark-blot haemorrhages representing haemorrhagic retinal infarctsThe hall mark of proliferative diabetic retinopathy (PDR) is the occurrence of neovascularization over changes of very severe NPDRComments cause of moderate (diminuation) of vision is Macular oedema*** Advanced diabetic eve disease - It is marked by complication such as- Persistent vitreous haemorrhage**- Tractional retinal detachment**- Neovascular glaucoma**Most common cause of vitreous hemorrhage in adults is - Diabetes (PDR) (297-Parson 20th)HARD EXUDATES - seen in -DR, Hypertensive retinopathy, coat's disease, circinate retinopathySoft exudates seen in - Hypertensive retinopathy DR, Toxemic retinopathy of pregnancy, Anemia, collagen vascular disease like- SLE, PAN, SclerodermaManagement of diabetic retinopathyType of retinopathyTherapy* Background* MaculopathyCSME* Difuse leak around macula- Circinate* Preproliferative retinopathy* Proliferative retinopathy* Advanced diabetic eye diseaseControl of diabetic, regular reviewFocal photocoagulation- Grid laserFocal photocoagulation**- Frequent reviewPan retinal photocoagulation**- Vitreo, retinal surgery** with photocoagulation* Gentamicin - can cause macular or retinal toxicity even at therapeutic and low doses when given intravitreally* NIDDM with history of DM for years should have an ophthalmic examination - As early as feasible in IDDM- 5 years after the onset of diabetes [/INST] question: Earliest sign of Diabetic retinopathy is | options: A: Micro-aneurysm B: Cotton wool spots C: Hard exudates D: Flame shaped haemorrhage | answer: A </s>