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A potential pathway for managing diabetic patients with arterial emboli detected by retinal screening

G Hadley1, J J Earnshaw, I Stratton

  • 1English National Diabetic Retinopathy Screening Programme, UK.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|May 28, 2011
PubMed

Insights

Diabetic patients with retinal artery emboli detected via screening have a defined care pathway. This pathway identified carotid stenosis, enabling timely intervention and preventing major morbidity.

Area of Science:

  • Ophthalmology
  • Cardiology
  • Diabetology

Background:

  • Diabetic retinopathy screening identifies various ocular conditions.
  • Retinal artery emboli in diabetic patients may indicate underlying carotid artery disease.
  • A clear care pathway is essential for managing these high-risk patients.

Purpose of the Study:

  • To review an established care pathway for diabetic patients diagnosed with retinal artery emboli.
  • To assess the effectiveness of the pathway in identifying and managing associated carotid artery stenosis.

Main Methods:

  • Retrospective review of a multidisciplinary team-agreed care pathway from 2001.
  • Analysis of prospectively collected data from the Gloucestershire Diabetic Retinal Screening Programme database.
  • Review of carotid duplex imaging results and patient casenotes for those identified with retinal emboli.

Main Results:

  • Prevalence of retinal emboli in diabetic patients was 0.85% (214/25,299).
  • Of 200 diabetic patients undergoing carotid duplex imaging, 23 had ipsilateral and 2 had contralateral carotid stenosis >70%.
  • Ten patients underwent carotid endarterectomy with no major morbidity.

Conclusions:

  • A care pathway effectively manages diabetic patients with retinal emboli.
  • The pathway successfully identified significant carotid artery stenosis requiring intervention.
  • This established pathway can serve as a model for other diabetic populations.
Abstract

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