In the proliferative stage of diabetic retinopathy, which process occurs?

• A. Neovascularization
• B. Cystoid macular edema only
• C. Retinal detachment as the first sign
• D. Cotton-wool spots without new vessels

Answer: (A)

Neovascularization is the hallmark of the proliferative stage. When the retina becomes ischemic from diabetic damage, it releases factors like VEGF that stimulate the growth of new, fragile blood vessels on the retinal surface and around the optic disc. These abnormal vessels are prone to bleed into the vitreous and can pull on the retina, leading to tractional retinal detachment. This phase contrasts with the nonproliferative stage, where changes such as microaneurysms, dot-blot hemorrhages, cotton-wool spots, and edema predominate without new vessel growth. Cystoid macular edema can occur, but it’s not the defining process of the proliferative stage.