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Endgames Case Review

Unilateral retinopathy in a patient with diabetes and coronary heart disease

BMJ 2018; 361 doi: (Published 14 June 2018) Cite this as: BMJ 2018;361:k1703
  1. Maria Fernanda Abalem, retina specialist1 4,
  2. Kim A Eagle, professor of internal medicine (cardiology)5,
  3. Rajesh C Rao , assistant professor of ophthalmology (vitreoretinal diseases & surgery) 1 2 3
  1. 1Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
  2. 2Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
  3. 3Division of Ophthalmology, Surgical Service, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
  4. 4Department of Ophthalmology, Faculty of Medicine, University of São Paulo, Brazil
  5. 5Division of Cardiology, Department of Internal Medicine, Samuel and Jean Frankel Cardiovascular Center, University of Michigan Medical School, Ann Arbor, MI, USA
  1. Correspondence to R Rao rajeshcrao{at}

A 69 year old man with type 2 diabetes mellitus, obesity, hypertension, and coronary artery disease was referred for diabetic retinopathy screening. He was also undergoing evaluation for transient ischaemic attack after experiencing dizziness and intermittent weakness in the left hand over the past six months. Visual acuities and intra-ocular pressures were normal, and slit lamp examination of the anterior segment of both eyes was unremarkable. Funduscopic examination (figs 1, 2) and wide field fluorescein angiography (fig 3) revealed unilateral retinopathy in the left eye. These unilateral findings prompted concern for carotid disease. Doppler carotid ultrasonography (fig 4) and computed tomography angiography found complete occlusion of the left internal carotid artery.

Fig 1

Ultrawide field …

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