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Asymmetric diabetic retinopathy and carotid ‎insufficiency- a correlative study

Session Details

Session Title: Quick Fire Free Paper 3

Session Date/Time: Thursday 11/09/2014 | 14:30-16:00

Paper Time: 15:20

Venue: Boulevard D

First Author: : M.El Rashedy EGYPT

Co Author(s): :                  

Abstract Details

Purpose:

Correlation between the degree of carotid system insufficiency ‎the severity of diabetic retinopathy in patients with asymmetric diabetic ‎retinopathy, and to what extent does the carotid stenosis affect the degree of diabetic retinopathy.

Setting:

Study carried on 20 diabetic subjects ‎with asymmetric diabetic retinopathy; ‎Patients were recruited from the outpatient ‎clinic of El Kasr-EL-Aini Hospital, Cairo ‎University. Patients with type 1 or 2 DM and ‎asymmetric diabetic retinopathy were ‎included, patients with unilateral glaucoma, ‎high myopia, optic atrophy and cataract ‎surgery were excluded. ‎

Methods:

Ophthalmological examination: BCVA, Slit ‎lamp examination, IOP measurement, ‎fundus examination using Indirect ‎ophthalmoscopy after pupillary dilatation .Fundus fluorescein angiography: using the ‎fundus camera Topcon TRC-50IA, the ‎photos were acquiesced using digital camera ‎back Sony Power HAD connected to special ‎Pc and processed under special software: ‎Image Net for Windows-C Multi-Format ‎Database .Color coded Extracranial Duplex ‎Ultrasonography: using Phillips HDI 5000 ‎ultrasound equipment; extracranial vessles ‎were evaluated by real-time imaging by a ‎liner 10 MHz transducer, real-time, sagittal, ‎coronal and axial views. B-mode transverse ‎scanning of vessles to examine the arterial ‎wall morphology, detect intima-medial ‎changes and presence of atheromatous ‎plaques. Longitudinal scanning then follows ‎and quantification of the intima media ‎thickness (IMT) at the distal far wall of the ‎CCA was done, pulsed Duplex, recordings of ‎peak systolic (PSV) blood flow velocities ‎were obtained in each examined artery.‎

Results:

Carotid plaques were defined as a ‎thickness >2 mm as measured from the ‎media-adventitia interface to the intima-‎lumen interface. We found that 50% of our ‎patients had CCA and/or ICA plaques, all ‎were ipislateral to the eye with more ‎advanced diabetic retinopathy, leading to ‎stenosis in all of them with a degree of ‎stenosis ranged 15%-50% and mean 30.5% ‎stenosis. It was noticed that in all the patients with ‎carotid stenosis they had PDR ipsilateral to ‎the side of stenosis except for one patient ‎who had NPDR, but no specific relation was ‎detected between the severity of the PDR ‎and the degree of stenosis. ‎‎

Conclusions:

Conclusion:‎ ‎ Diabetes mellitus is a systemic disease in which retinopathy usually ‎develops in a symmetric pattern over a long period of time. With respect to ‎the ocular complications of diabetes, asymmetric diabetic retinopathy is ‎considered the exception rather than the rule. Previous investigators have ‎suggested several local and systemic factors to account for the development ‎of asymmetric diabetic retinopathy. Carotid stenosis was undoubtedly a ‎predominant factor in producing such marked asymmetric retinopathy. In ‎which its identification may be of importance in early detection of carotid ‎system plaques, prevention of future strokes and planning for appropriate ‎treatment strategies.‎

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