<prompt> Earliest sign of Diabetic retinopathy isMicro-aneurysmCotton wool spotsHard exudatesFlame shaped haemorrhage  <response>: 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 glaucomaMost common cause of vitreous hemorrhage in adults is - Diabetes PDR 297-Parson 20thHARD EXUDATES - seen in -DR, Hypertensive retinopathy, coats 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 