Risk of intraocular haemorrhage remains unknownBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6985.1009a (Published 15 April 1995) Cite this as: BMJ 1995;310:1009
- Stephen Fava,
- Joseph Azzopardi,
- Hugo Agius Muscat,
- Frederick F Fenech
- Senior registrar Consultant physician and diabetologist Director, health information systems unit Director of medicine Department of Medicine, St Luke's Hospital, Guardamangia, Malta
EDITOR,—Helen Ward and John S Yudkin conclude that thrombolysis should not be withheld in diabetic patients with retinopathy.1 We have shown that diabetic subjects are less likely to receive this treatment than non-diabetic controls.2
The authors note that there has been only one case report of intraocular bleeding in diabetic patients after thrombolysis (in a patient with treated proliferative retinopathy).3 The condition may, however, be underreported. Furthermore, intraocular bleeding may be rare only because patients with proliferative diabetic retinopathy rarely receive thrombolysis. We retrospectively analysed 507 diabetic patients who had been admitted to our coronary care unit with an acute myocardial infarction during 1 January 1991 to 30 June 1994. Of the 172 who received thrombolytic treatment, only 14 had diabetic retinopathy and none had proliferative changes. Of the 26 patients with proliferative retinopathy, none received thrombolytic treatment. Intraocular haemorrhage did not occur in patients with or without diabetic retinopathy.
This important issue can be fully addressed only by a prospective case-control study. While thrombolysis is of proved value in diabetic patients, the risk of precipitating intraocular haemorrhage remains unknown. We agree that diabetic retinopathy should not be regarded as an absolute contraindication to thrombolysis, but it may sway the balance against this treatment when the potential benefit is marginal—for example, in those presenting relatively late.
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