Nader Moinfar, MD (Orlando, FL)

PURPOSE:

To determine: (1) if diabetic patients presenting with rubeosis may have significant concomitant ipsilateral cerebrovascular insufficiency, (2) the yield in assuming and investigating a nondiabetic cause of these patients’ rubeosis and (3) the ocular response to surgery of their cerebrovascular disease, when indicated.

METHODS:

This is a nonrandomized, prospective observational cohort of diabetic patients presenting with unilateral rubeosis. Enrolled patients had various stages of diabetic retinopathy in their better eye, and rubeosis in their study eye. Patients underwent either magnetic resonance angiography (MRA) of the head and neck, and/or high resolution real-time B-mode imaging
with Doppler flow velocity and spectral flow analysis. All studied eyes also underwent prompt panretinal laser photocoagulation. Outstanding imaging results were correlated with their respective laterality, and the ocular response to neurovascular intervention.

RESULTS:

Twelve eyes of 12 patients were enrolled (n=12). There were seven men, and five women. Ten patients received B-mode imaging, and two underwent an MRA. Eight of the study eyes (66%) revealed clinically significant ipsilateral abnormalities, as follows: high-grade carotid stenosis (n=7), high-grade vertebral artery stenosis and carotid artery stenosis (n=1), and internal jugular thrombosis (n=1). Seven eyes underwent carotid endarterectomy, with complete resolution of their rubeosis. One case of combined ipsilateral vertebral and carotid stenosis was deemed inoperable. The case of internal jugular thrombosis was treated medically with anticoagulation.

CONCLUSION:

A majority of diabetic patients in this study presenting with asymmetric retinopathy and rubeosis had also clinically significant cerebrovascular disease. The yield, with regards to quality of life (QAL) years of noninvasive imaging in this setting is high, particularly in light of the high moridity associated with cerebrovascular insults.