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Follow up report reviewing the current clinical status of diabetic patients identified with early macular lesions


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Follow up report reviewing the current clinical status of diabetic patients identified with early macular lesions
S. Osei- Amoako1, R. Lone1, H. Wharton1, J. Gibson1,2, & P. Dodson1,2

1Diabetes & Ophthalmology Departments, Birmingham Heartlands Hospital- UK

2School of Health and Life Sciences, Aston University, Birmingham- UK
Introduction

On magnification of digital diabetic eye screening retinal images, a pale yellow circular rim around a single macula microaneurysm may be observed; these we term MAYR (microaneurysm with yellow rim) (or previously lone lesions).

As the significance of these lesions is unclear, patients are re-photographed at six monthly intervals in the Birmingham, Black Country and Solihull diabetic eye Screening Programme. The purpose is to monitor the natural history of MAYR and whether they are predictors of development of macular oedema (DMO).
Method

A sample of 135 patients with MAYR in the macula at diabetic eye screening were followed up over a minimum of five years. Morphology of the lesions and clinical outcomes of the patients were recorded.


Results

Of the 135 patients, 65 (48%) were referred to the hospital eye service (HES) after an average of 13 months (4-56 months) of the lesion being identified. Forty seven (72%) of the referrals were due to a persistence of the MAYR or progression of exudation from the lesion. Of these 47, 16 (34%) developed DMO and nine required laser treatment.

Sixty one (45%) patients were placed on annual recall for screening after an average of 14 months (4- 36 months) of MAYR identification as the lesion improved, resolved or remained unchanged. However 14 (23%) of these were referred to HES at a later date, three due to the MAYR progressing.

Overall of the 135 patients identified with MAYR, 47 (35%) were discharged from six monthly photography follow up and remained on annual recall, 50 (37%) were referred to HES due to the lesion persisting or progressing, 29 (21%) were referred to HES for other reasons and the remaining nine (7%) failed to attend their last photography appointment so do not have a definite outcome.


Conclusion

A high number of patients with MAYR were referred to HES due to progression of exudation from the lesion. However, most do not require immediate referral and in some cases the MAYR improves and referral is not necessary. The data suggests monitoring MAYR in re-photography clinics is appropriate, reducing unnecessary referrals HES.


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