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A. El-Sanhouri, J. Law, J. Gasperini, A. G. Sharma, D. Eliott; Cerebrovascular Disease in Patients Undergoing Diabetic Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):166.
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To determine the presence of cerebrovascular disease in patients undergoing diabetic vitrectomy.
Hospital records of 350 patients that underwent diabetic vitrectomy by one vitreoretinal surgeon (DE) were reviewed for evidence of cerebrovascular disease using the computer database of the Detroit Medical Center (affiliated hospital system of the Kresge Eye Institute). Cerebrovascular disease in the form of a stroke was documented based on neuroimaging and medical records of visits to the Detroit Medical Center. The time interval between the strokes and the diabetic vitrectomies were studied.
During hospital visits to the Detroit Medical Center for medical reasons unrelated to their ocular disease, 79 patients underwent neuroimaging for reasons such as syncope, loss of consciousness, trauma, stroke, or transient ischemic attack. Of these, 47 patients had evidence of stroke on neuroimaging. In addition, 12 patients had a well documented history of stoke on medical records (history and physicals, discharge summaries, and emergency room reports). A total of 59/350 (17%) patients who underwent diabetic vitrectomy had evidence of stroke. During these hospital visits, most patients had evidence of chronic strokes, however, fifteen patients (15/59; 25%) had an acute stroke. Of patients with acute strokes, 2 patients had it greater than one year prior to vitrectomy, 2 patients had it within 1 year of vitrectomy, 5 patients had it within 2 years after vitrectomy, and 6 patients had it greater than 2 years after vitrectomy.
Patients requiring vitrectomy for complications of their proliferative diabetic retinopathy have severe systemic manifestations of diabetes including stroke. The limitation of this study is that medical records were reviewed at one hospital center. It is possible that some patients who underwent diabetic vitrectomy may have presented with cerebrovascular disease at outside community hospitals. Therefore, this study underestimates the prevalence of cerebrovascular disease in patients who underwent diabetic vitrectomy. However, a significant number of patients undergoing diabetic vitrectomy did have cerebrovascular disease leading to increased morbidity and mortality in this subgroup of patients.
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