Abnormal deposits

Hard exudates, These are well-defined, yellowish-white deposits in the retina, often arranged in rings. They are caused by lipoproteins leaking out of an abnormally permeable blood vessel, which may be visible in the centre of the ring. At the macula they tend to accumulate in a Star

Hard And Soft Exudates
Fig. 7.17 Retinal soft exudates, flame haemorrhages and early macular star of hard exudate in hypertensive diabetic patient.

shape because of the unique horizontal arrangement of the deep retinal layers around the fovea (Fig. 7.17). They are commonly seen in hypertension, diabetes and following retinal vascular occlusions.

Soft exudates. These look like deposits of cotton wool in the superficial retina. They occur around areas of infarcted retina and may he associated with other features of retinal ischaemia (venous dilatation, haemorrhages and new blood vessels). They are due to swelling of the nerve fibre layer axons (Fig, 7.17).

Colloid bodies. Those may be mistaken for hard exudates. They are small, round yellow deposits in the deepest retinal layer appearing most commonly in the elderly and around the macula (Fig. 7.18).

Other abnormal deposits include foci of active chorioretinal inflammation, metastatic infections (e.g. CMV. miliary tuberculosis) and carcinomas.

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