Editorials

Aspirin for diabetic retinopathy

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7423.1060 (Published 06 November 2003) Cite this as: BMJ 2003;327:1060
  1. Eva M Kohner, honorary consultant
  1. Department of Medicine, St Thomas's Hospital, London SE1 7EH

    The evidence of a beneficial effect is from basic science, not clinical trials

    The earliest clinically recognisable lesions in diabetic retinopathy are capillary occlusions, which can be shown on fluorescein angiograms, a standard investigation in patients with retinopathy. The response to capillary blockage is dilation of neighbouring ones, leading to breakdown of the blood-retina barrier and leakage. Later large vessels become affected, and the result is retinal ischaemia, which is responsible for the secretion of vasoactive cytokines, leading to formation of the sight threatening proliferative lesions.

    Since capillary occlusion is a pivotal lesion, causes and cures for it have been sought for a long time. Aggregation of platelets is increased in diabetes, and this has been proposed as the underlying abnormality.1 An early paper by Pope et al showed platelet thrombi in retinal capillaries of diabetic patients.2 Furthermore, observational evidence showed that patients treated with acetyl salicylic acid had …

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