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): :
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.
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.
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.
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.
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.