Abstract: Objective To evaluate systemic cerebrovascular risk factors in patients with proliferative diabetic retinopathy (PDR) and emphasize the importance of perioperative stroke risk assessment. Design Retrospective comparative case series. Methods This study included 33 hospitalized patients who underwent vitreoretinal surgery for PDR at Beijing Tongren Hospital, Capital Medical University, between November 2021 and October 2022. A control group of 35 non-diabetic patients undergoing vitreoretinal surgery for other retinal diseases was also included. General demographics, cerebrovascular comorbidities, body mass index (BMI), estimated creatinine clearance rate (Ccr), and preoperative Essen stroke risk score were compared between the two groups. PDR patients underwent additional assessments, including carotid/vertebral/subclavian artery ultrasound, MRI, and MRA/CTA, to thoroughly evaluate perioperative stroke risk. Main Outcome Measures Assessing the risk of perioperative stroke through stroke risk factors. Results PDR patients had significantly higher rates of prior stroke history (P=0.045) and prior coronary stenting (P=0.016), as well as a significantly higher Essen Stroke Risk Score (P<0.001), but significantly lower Ccr (P=0.023). No significant differences were observed in hypertension (P=0.481), hyperlipidemia (P=0.179), or BMI (P=0.292). Preoperative cerebrovascular imaging revealed that 48.5% (16/33) of PDR patients had moderate (≥50%) intracranial arterial stenosis, including 5 without prior stroke. Additionally, 57.6% (19/33) exhibited carotid atherosclerosis with plaque, and 33.3% (11/33) had subclavian artery atherosclerosis with plaque. Conclusion PDR patients have a significantly elevated perioperative stroke risk compared to non-diabetic patients. The Essen stroke risk score provides a simple tool for initial risk assessment. For high-risk individuals, a comprehensive evaluation of cerebrovascular status is recommended. It is crucial to inform patients of these risks and implement proactive preventive and therapeutic measures to enhance perioperative safety.

Key words: Proliferative diabetic retinopathy, Perioperative, Stroke, Essen stroke risk score