Question

An elderly woman presented with gradual painless diminution of vision. The fundus picture is shown below (yellowish-white deposits around the macula). What is the diagnosis?

• A. Hard Exudates in Diabetic Retinopathy
• B. Flame shaped haemorrhages in Hypertensive Retinopathy
• C. Soft Exudates in Hypertensive Retinopathy
• D. CRVO (Central Retinal Vein Occlusion)

Hint:

Yellowish waxy deposits with well-defined edges around the macula in a diabetic patient represent lipid-laden hard exudates.

Answer 1

The Correct Option is A

Step 1: Analyse the presenting features.
Gradual, painless diminution of vision in an elderly patient with yellowish-white deposits (exudates) seen around the macula on fundoscopy points strongly toward diabetic maculopathy.

Step 2: Characteristics of hard exudates.
Hard exudates are composed of lipid and lipoprotein deposits from leaking retinal capillaries. They appear as bright yellow or waxy lesions with well-defined edges, situated mainly in the outer plexiform layer of the retina. They often form a circinate (ring-shaped) pattern around areas of leaking microaneurysms or neovascularisation near the macula. They are one of the most common and earliest clinical signs of diabetic retinopathy and indicate significant macular oedema that threatens central vision.

Step 3: Eliminate other options.
Flame-shaped haemorrhages are typical of hypertensive retinopathy and are red streaks in the nerve fibre layer, not yellow deposits. Soft exudates (cotton-wool spots) are fluffy white lesions caused by microinfarcts of the nerve fibre layer -- they are white, not yellow, and have poorly defined edges. CRVO causes massive flame-shaped haemorrhages in all four quadrants ("blood and thunder" fundus), not discrete yellow exudates.

Conclusion: The correct answer is Hard Exudates in Diabetic Retinopathy.