Purchase this article with an account.
M. J. Dieckhaus, J. Welch, R. Ahmed, K. Wise, L. M. Merin, W. B. Lauten, A. S. Chomsky; Retrospective Review: Natural Course of Asymptomatic Retinal Arteriolar Emboli in Type II Diabetic Patients. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3729.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate retinal arteriolar emboli and determine whether smoking status, cholesterol level, HDL level or type of embolus affect their transient nature.
A retrospective review of photographs and charts of patients with retinal arteriolar emboli found on diabetic retinopathy photography screening at the Veterans Administration Tennessee Valley Healthcare system during a period of May 1st, 2003 to September 30th, 2006 that had at least two follow-up photographic screenings. Age of patient, smoking status, cholesterol and HDL levels and presumed type of emboli based on appearance was collected. At least two trained retinal photography readers analyzed the images and any intra-arterial lesions were subsequently confirmed by a board-certified ophthalmologist.
Out of 7819 total patients, 67 patients were identified with emboli that had at least two follow-up screening photographs. At first follow-up visit (0.8 to 3.1 years from baseline exam), 39 patients (58.2%) no longer had identifiable retinal arteriolar emboli, 24 patients (35.8%) maintained original plaque, and 4 patients (6.0%) had developed a new plaque. At second follow-up visit (1.7 to 4.8 years from baseline and 0.87 to 3.9 years from first follow-up, n=35), 22 patients (62.8%) did not have identifiable plaques, 12 (34.2%) maintained original plaque, and 1 (2.9%) developed a new plaque. Of the 35 (52.2%) that were smokers, 13 (37.4%) had a plaque present at first follow-up while 11 (34.3%) of the non-smokers (n=32, 47.7%) had plaque present at first follow-up (p-value 0.43). Similarly, cholesterol and HDL levels of patients at initial screening that had a plaque present at first follow-up versus those that did not have a plaque present at first follow-up was not significant (p-value 0.97 and 0.47 respectively). Type of embolus was cholesterol in 35 patients (52.2%), platelet-fibrin in 19 patients (28.3%), and calcific in 13 patients (19.4%). At first follow-up, 12 of 35 (34.2%) cholesterol plaques, 8 of 19 (42.1%) platelet-fibrin plaques, and 4 of 13 (30.8%) calcific plaques were still present. There was not a statistically significant difference in type of plaque at initial examination and persistence of plaque (p-value 0.37).
Our data supports the transient nature of the majority of retinal arterial emboli. A larger percentage of persistent emboli were seen in our study, likely due to the shorter follow-up period. Smoking status, cholesterol and HDL levels and plaque type did not seem to influence the persistence of emboli.
This PDF is available to Subscribers Only