Pre-proliferative diabetic retinopathy

Multiple cotton wool spots in preproliferative diabetic 

Vascular loop in preproliferative diabetic 

In addition to background diabetic retinopathy (dot and blot haemorrhages, microaneurysms and hard exudates).
The retina shows signs of ischaemia which may be:
  • venous abnormalities with venous loop, tortuosity and beading
  • multiple cotton wool spots
  • intra-retinal microvascular abnormalities (IRMA, which is caused by dilated retinal capillaries). 

  • Note: this may be confused with neovascularization but appear flat and tend to be between the artery 
    and the vein.

Look for:

  • associated maculopathy
  • neovascularization of the disc and the periphery
  • hypertensive retinal changes


1. What are the risk factors for a diabetic patient to develop diabetic retinopathy?

2. What are the mechanisms of retinopathy in diabetes mellitus?

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