Organised macular plaques in exudative diabetic maculopathy.

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Abstract
Plaques of hard exudate measuring 0.5-1.0 disc diameters showed complete organization in 8-18 mo. with the formation of scars measuring 0.2-0.5 disc diameters. The visual acuity was related to the size and situation of the scar within the fovea, and when the foveola was involved by plaque formation, visual reduction did not progress with subsequent formation of scar tissue. Fluorescein angiograms showed absence of ingrowing choroidal neovascularization and a discrete residual hyperfluorescence beneath the resolving plaques and within the scar tissue, which resembled a serous detachment of pigment epithelium but may result from a combination of pigment atrophy and leakage from retinal capillaries. This late clinical appearance may be the only ophthalmoscopic evidence that a severe exudative maculopathy was primarily responsible for severe visual loss. In older patients it requires differentiation from cicatricial disciform lesions. The absence of ingrowing choroidal neovascularization, subretinal hemorrhage and pronounced serous retinal detachment implies the origin of the fibrous replacement was not choroidal but was derived partly from the pigment epithelium and partly from the retinal vasculature. Juxtaposition of a deeply situated hard exudate plaque and the retinal pigment epithelium may initiate focal metaplasia and subsequent organization with scar formation.